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September 29, 2009

USC Stafon Johnson Crushes His Voicebox & Undergoes Emergency Surgery

News organizations including ABC News reported on Sept 28, 2009 that USC tailback, Stafon Johnson, was bench-pressing a 275 pound bar when it slipped and landed on his neck crushing his voicebox resulting in emergency surgery at California Hospital Medical Center. Read the story here.

An endoscopic exam of his voicebox at time of injury may have looked something like this picture shown here, but more severe.

Most likely a trach was performed for a secure airway after reconstruction. After recovery, he is at risk for vocal cord paralysis, stenosis, etc.

Click here to read the full story.

September 24, 2009

Bifid Uvula

I recently saw a patient with a most impressive bifid uvula. For those who don't know, the uvula is the midline dangling thing in the back of the mouth. Normally, there's only one, but in this patient, there are 2.

If the clefting extended not only through the uvula, but also the palate, than that would be called a cleft palate. In other words, a bifid uvula is a birth defect that almost became a cleft palate.

A bifid uvula has no impact on swallowing or talking and no further intervention is required.

September 21, 2009

"Smoking Kills" Doctor Warned in 1606!!!

On Sept 19, 2009, the BBC published a story "Tobacco Warning from 17th Century" in which a physician, Dr. Eleazar Duncan, wrote a letter published in 1606 stating that tobacco "is so hurtful and dangerous to youth that it might have the pernicious nature expressed in the name, and that it were as well known by the name of Youths-bane as by the name of tobacco."

It goes to show you that physicians have been trying and still trying to get people to stop smoking for over 4 centuries given its ill effects.

Read the BBC story here.

September 17, 2009

How Does A Deviated Septum Cause A Nosebleed?

Over the years, I have been asked by a number of patients with deviated septums why that would make them more prone to nosebleeds.

Well, this blog article is to answer that very question. First off, a little anatomy...

A nasal septum is a wall that separates the right nasal cavity from the left side. Normally, this septum should be perfectly straight.

However, in some people, the septum may be deviated causing not only nasal obstruction, but increases the risk of nosebleeds.

When the septum is straight, nasal breathing proceeds such that the air smoothly enters the nose without creation of any turbulence.

However, if the septum is deviated, turbulence is created when the air hits the "curve" of the septum. When this happens, the lining of the septum becomes dried out resulting in cracking and increased vascularity which increases the risk of a nosebleed.

The lining of the nose in this situation is much like when a person's lips become so dried out to the point that it cracks and bleeds.

Surgical correction of the deviated septum would result in a more long-lasting "cure" of nosebleeds as it would eliminate this curve decreasing turbulence.

For more conservative management of nosebleeds, click here.

September 15, 2009

Webpage on Epistaxis (Nosebleeds) Updated!

Our practice website has updated our nosebleed (otherwise known as epistaxis) webpage to include more information on procedural treatment of nosebleeds including silver nitrate cauterization, electrocautery, nasal packing, and surgery. The webpage still includes information on conservative treatment as well as causes.

Click here to read more!

September 14, 2009

Oral Appliance Can Help With Obstructive Sleep Apnea

In the September 2009 edition of Archives of Otolaryngology Head & Neck Surgery, there was a research paper entitled "An Investigation of Upper Airway Changes Associated with Mandibular Advancement Device Using Sleep Video Fluoroscopy in Patients with Obstructive Sleep Apnea" where use of an oral appliance was found to significantly improve obstructive sleep apnea. The oral appliance increased retropalatal and retrolingual spaces as well as decreased the length of the soft palate and the angle of mouth opening.

Increased retropalatal space and decreased length of the soft palate is similar to what is accomplished by the surgical procedure uvulopalatopharyngoplasty (UPPP).

Increased retrolingual space is similar to what is accomplished by the base of tongue reduction surgery.

Click here to read more about this research.

Click here to read more about OSA and its treatment.

September 10, 2009

Washington Post Medical Mystery: Kawasaki Disease

The Washington Post on Sept 8, 2009 published a story called "A Frightful Week for a Little Girl" in its Medical Mystery section on Kawasaki Disease. This disease is rare and difficult to diagnose given its multitude of symptoms that can be due to something more benign including:

• red eyes
• fever
• rash
neck mass
• red lips/mouth

However, it is the constellation of symptoms according to guidelines that Kawasaki in children should be considered when there has been an unexplained fever lasting five days, when accompanied by other symptoms including red eyes without discharge, red lips or mouth, a rash and a swollen lymph node in the neck. The red eyes and lips/mouth is the hallmark symptom of something more sinister.

To miss this diagnosis and be without proper treatment within 10 days of symptom onset may result in heart attack, coronary artery aneurysm, and even death.

Read the article here.

September 07, 2009

Most People Prefer Right Ear for Listening

A well-known asymmetry in humans is the right ear dominance for listening to verbal stimuli, which is thought to reflect the brain's left hemisphere superiority for processing verbal information. This preference for hearing with the right ear is also found in rats, Japanese macaques, harpy eagles, sea lions and dogs.

However, the left ear (and right brain) excels at picking up emotional cues. When it comes to music, pitch, timbre and loudness are discriminated better with left ear (right hemisphere), but duration is better discriminated with the right ear (left hemisphere).

These findings may explain why people are not entirely satisfied when using hearing aids for only one ear. Ideally, BOTH ears should be aided. BUT, if one had to choose between two equally deaf ears, the right ear would be the preferred side.

Side biases in humans (Homo sapiens): three ecological studies on hemispheric asymmetries. Naturwissenschaften September 2009, Volume 96, Issue 9, pp 1099-1106

September 02, 2009

NYT: Plastic Surgery May Cure Migraine Headaches???

The New York Times on Sept 2, 2009 published a story "Plastic Surgery May Also Ease Migraine Headaches," in which a modification of the facelift may improve and in some patients, even cure migraine headaches. The research abstract describing this surgical treatment for migraine headaches upon which the NYT story is based on can be read here.

So far, the only patients who are candidates for this type of surgery are those who respond positively to Botox injections and where the trigger points are on the face (not the neck or head region... yet).

Though our office does not offer this type of surgery, we have been successfully performing Botox injections since 2005 to those patients who suffer from migraine headaches.

Click here to read the NYT article.

Read here to read more about Botox injections for migraine headaches.

How to Get Insurance to Pay for Rhinoplasty Nosejob!

Well... at least part of the cost. I learned of this from a patient who came to see me in order to obtain an "independent ENT evaluation" regarding her deviated septum.

In essence, in order for insurance to pay part of the cost of one's rhinoplasty, a few things need to happen.

Step 1:
See a plastic surgeon who will perform your nosejob rhinoplasty. If the plastic surgeon notes a deviated septum or if you also have a significant nasal obstruction, see an ENT. If the plastic surgeon is also ENT board-certified, you still need to see a DIFFERENT ENT in order to obtain an "independent evaluation."

Step 2:
See the ENT who will hopefully agree that there is a significant deviated septum contributing to one's nasal obstruction. Septoplasty IS an insurance covered procedure in order to address the medical condition of nasal obstruction. In the medical note, I've typically phrased the report as follows:

"The patient does have a significant deviated septum to the right (or left as the case may be) resulting in nasal obstruction. In order to correct this problem, it is recommended that the patient undergo a septoplasty procedure. However, given that the patient is to undergo a rhinoplasty by a plastic surgeon and instead of putting the patient under anesthesia twice, it is reasonable to have the septoplasty performed at the same time."

Please understand that if you do not have a significant deviated septum, that is exactly what will be reported!

Step 3:
Give the plastic surgeon the ENT report. Here, a little effort will be needed on both the patient and plastic surgeon's part. More than likely, insurance will deny payment for the surgery. As such, the plastic surgeon will need to write a letter of medical necessity including supporting documentation from the independent ENT evaluation. The insurance may still refuse payment and that's when the plastic surgeon may need to perform a peer-to-peer review.

Generally speaking, the insurance in the end may cover some of the anesthesia and rarely the septoplasty component of the rhinoplasty. As such, a few thousand dollars may at least be saved.

Hope this information helps!

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