Sinusitis and gastroesophageal reflux disease.
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Biomedical subjects
Publications and source records attributed to J V Huerter.
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The principles of functional endoscopic surgery require adequate sinus ventilation and drainage to avoid chronic disease states. The techniques employed by Messerklinger, Stammberger, and Kennedy have been demonstrated to be safe and effective. Careful evaluation of patients preoperatively with a careful allergy history and at least screening allergy tests, either intradermal or radioallergosorbent, is essential. Once the diagnosis of allergic rhinitis is established, the onset of therapy should precede surgical intervention to aid in appropriate surgical patient selection and to obtain the maximal symptomatic and functional relief postoperatively.
Obstructive sleep apnea syndrome patients usually present with multiple areas of anatomic disproportions. The site or sites of obstruction must be accurately diagnosed preoperatively by a systematic means of examining the patient. This includes nasopharyngoscopy with Muller maneuver and sometimes cephalometrics. The surgical treatment is individualized to the site or sites of obstruction and can include tracheostomy, septoplasty, UPPP, geniohyoid advancement and suspension of the hyoid. For extreme cases advancement of the maxilla, mandible and hyoid bone are sometimes necessary.
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Transient salivary gland hypertrophy is a reported clinical finding in patients with bulimia. A retrospective chart review of 49 patients enrolled in the University of Nebraska Medical Center Eating Disorders Program with a diagnosis of bulimia showed 29% (14/49) had at some time either parotid and/or submandibular gland hypertrophy noted on physical exam. Resolution of the salivary gland enlargement occurred in all of our patients after treatment of their bulimia. Bulimia must, therefore, be considered in the differential diagnosis of salivary gland hypertrophy, and treatment should be directed at the underlying behavioral disorder.
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