Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.

In-office placement of steroid-eluting bioabsorbable implants after achieving hemostasis was well tolerated and might improve local drug diffusion and surgical outcomes.

Patients who selected sinus surgery in which BSD instruments were used on the peripheral sinuses demonstrated significantly greater improvements in quality of life compared with those who elected ongoing MM. These results were achieved through office-based procedures with the patient under local anesthesia in the majority of patients.

No abstract

Epidermoid cysts are unusual benign cysts that occur in the oral cavity less than 2% of the time. Epidermoid cysts isolated to the uvula are rare. A review of the literature has revealed only three confirmed cases of isolated uvular epidermoid cysts. We present a series of three such cases, two of which presented with significant symptomatology. The diagnosis and management of these unusual lesions will be discussed, as well as the differential diagnosis.

Background Chronic rhinosinusitis (CRS) is a devastating disease affecting nearly 30 million people in the United States. An interim analysis of data from the present study suggested that, in patients who had previously failed medical therapy, balloon sinus dilation (BSD) plus medical management (MM) provides a significant improvement in the quality of life (QOL) at 24 weeks postprocedure compared to MM alone. Objective The primary objective of this final analysis was to evaluate the durability of treatment effects through the 52-week follow-up. Methods Adults aged 19 and older with CRS who had failed MM elected either BSD plus MM or continued MM. Patients were evaluated at 2 (BSD arm only), 12, 24, and 52 weeks posttreatment. Balloon dilations were performed either as an office-based procedure under local anesthesia or in the operating room per physicians' and patients' discretion. The primary end point was change in patient-reported QOL as measured by Chronic Sinusitis Survey (CSS) total score from baseline to the 24-week follow-up. Secondary outcomes including changes in CSS, Rhinosinusitis Disability Index (RSDI), and Sino-Nasal Outcome Test (SNOT) total and subscores, sinus medication usage, missed days of work/school, number of medical care visits, and sinus infections from baseline to the 52-week follow-up are reported here within. Results BSD led to sustained greater improvements in self-reported QOL using the CSS and RSDI total scores with a trend toward improvement in the SNOT-20 total score from baseline to the 52-week follow-up compared to continued MM. There were no changes in medication usage apart from nasal steroid usage for which the MM cohort had an increase in usage. There were no device-related serious adverse events. Conclusion The current analysis highlights the safety, effectiveness, and durability of BSD in CRS patients aged 19 and older who had previously failed MM.

Self-cross-linked HA hydrogel provides superior wound healing to CMC after ethmoidectomy.

Oral Presentations P127Objectives: (1) Assess secondary nasoseptal flaps (NSF) as a viable reconstructive option. (2) Evaluate postoperative vascularity of secondary NSFs. (3) Compare cerebrospinal fluid (CSF) leaks and complication rates of secondary NSFs to primary NSFs.Methods: This is a retrospective review of patients from 2009 to 2013 undergoing transsellar approaches for skull base tumors at the University of Pittsburgh Medical Center. In cases where the necessity of a vascularized reconstructive flap was made evident only after tumor resection, the NSF was raised after the tumor had been resected and/or CSF leak had developed (secondary NSF). Outcome measures include postoperative magnetic resonance imaging (MRI) findings, CSF leak rates, and complication rates.Results: Transsellar approaches were performed in 436 patients during this timeframe. Primary NSFs were used to reconstruct 178 patients while 32 patients had secondary NSFs. Postoperative MRI scans were available in 29 of 32 secondary NSF patients; all maintained vascularity on examination of T1 post-contrast images (mean time to MRI 4.9 months). There was no significant difference in CSF leak rate between primary NSFs (3.4%) and secondary NSFs (3.1%) (P = .95). Primary NSFs had a higher overall complication rate (11.7%) compared to secondary NSFs (3.1%), but this was not statistically significant (P = .142). Logistic regression analysis demonstrated no significant effect of flap type, age, or sex on CSF leak rates.Conclusions: Secondary NSFs are a viable reconstructive option for sellar skull base defects. They maintain vascularity as evidenced on postoperative MRI imaging and compare favorably to primary NSFs in regard to CSF leak rates and complication rates.