Biomedical subjects

Joseph M Bernstein

Publications and source records attributed to Joseph M Bernstein.

4 recordsLinked to original sources

PubMed2006

Pediatric meningoencephaloceles and nasal obstruction: a case for endoscopic repair.

OBJECTIVES: Congenital anterior skull base defects with meningoencephaloceles causing nasal obstruction are rare clinical entities. Nasal obstruction in children may also be a symptom of multiple benign nasal and allergic disorders, making the initial diagnosis of meningoencephalocele difficult. Traditionally, skull base defects have been repaired via a bifrontal craniotomy approach. With the advent of pediatric endoscopic instrumentation, more of these lesions are accessible via an intranasal endoscopic approach, even in the infant population. However, owing to the rarity of these lesions, there is a paucity of data demonstrating successful adaptation of endoscopic skull base techniques to the pediatric population. METHODS: Retrospective review of two cases of endoscopic repair of anterior skull base defects with meningoencephaloceles at a tertiary care medical center. RESULTS: Two children, ages 15 months and 6 years, underwent successful endoscopic closure of their anterior skull base defects and resection of their intranasal meningoencephalocele with resolution of their nasal obstruction and cerebrospinal fluid rhinorrhea. CONCLUSIONS: Pediatric nasal meningoencephaloceles with anterior skull base defects can be successfully repaired via a transnasal endoscopic technique, thus minimizing the complications associated with craniotomy and frontal lobe retraction. Triplanar computed tomographic and magnetic resonance imaging is paramount to evaluate the caliber of the skull base defect, consistency of the herniated intracranial contents, as well as the presence of cerebral vasculature.

Cerebrospinal Fluid Rhinorrhea↗

PubMed2004

Randomized, controlled, multisite study of intracapsular tonsillectomy using low-temperature plasma excision.

OBJECTIVE: To determine the efficacy of intracapsular tonsillectomy using low-temperature plasma excision for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively. DESIGN: Prospective, randomized, controlled, single-blind study. SETTING: Multiple private or institutional otolaryngology clinics. PATIENTS: Fifty-five children (aged 3-12 years) with obstructive tonsillar hypertrophy. INTERVENTION: Patients were randomly assigned and blinded to undergo either intracapsular tonsillectomy using low-temperature plasma excision (n = 27) or total tonsillectomy using conventional electrosurgery (n = 28). MAIN OUTCOME MEASURES: Operative data, 14-day recovery variables, and obstructive symptoms were prospectively collected through 12 months. RESULTS: During the first 14 days, significantly fewer children in the intracapsular group reported nausea (P = .01) or lost weight (P = .003). The intracapsular group had a significantly faster resolution of pain (P = .01), had an earlier return to a normal diet (P = .004), ceased taking pain medication sooner (P = .002), and returned to normal activity sooner (P = .04). Postoperatively, the intracapsular group had more residual tonsil tissue than the total tonsillectomy group (P = .002 for the 3- and 12-month visits). However, the incidence of recurring obstructive symptoms, pharyngitis, and antibiotic use was similar in both treatment groups during the 12 months. CONCLUSIONS: Postoperative morbidity normally associated with traditional (total) tonsillectomy was significantly reduced after intracapsular tonsillectomy using low-temperature plasma excision. The residual tonsillar tissue associated with this technique was of no clinical consequence.

Child↗

PubMed2004

Predicting decannulation outcomes after distraction osteogenesis for syndromic micrognathia.

OBJECTIVES: To characterize the airway anatomy by upper endoscopy in children with syndromal mandibular hypoplasia and to determine whether predistraction endoscopy is predictive of the likelihood of successful outcomes after mandibular distraction. STUDY DESIGN: Retrospective chart review. METHODS: Assessment of the upper airway by subsites was qualitatively extrapolated into a devised 4-point scale. Upper airways were characterized and evaluated in patients on the basis of decannulation outcomes after distraction. RESULTS: Of the 20 patients, 12 were decannulated, and 6 remain tracheostomy dependent. The average compiled preoperative airway obstruction scores in decannulated patients (2.25) compared with those who failed decannulation (2.36) was not statistically significant (P =.291). A significant change after distraction was noted only at the levels of the oropharynx and supraglottis (P <.001). The average airway scores at these subsites in decannulated patients improved from a mean of 3.46 to 2.17 (P =.002). In patients who failed decannulation, the pre- and postdistraction scores also improved from 3.92 to 2.50 (P =.026). Analysis of the average postdistraction airway scores in decannulated patients (2.17) compared with failures (2.5) failed to reveal a significant difference (P =.375), suggesting that some patients remain tracheostomy dependent despite adequate mandibular expansion. Preoperative airway scores in the two groups were statistically equivocal and, therefore, not predictive of the likelihood of decannulation. CONCLUSIONS: Preoperative airway endoscopy alone is not predictive of the likelihood of successful decannulation after distraction osteogenesis. Comparison of the airway patency after distraction revealed statistically equivocal airway caliber, suggesting that some children fail to advance to decannulation despite adequate mandibular distraction.

Bronchoscopy↗

PubMed2002

Incidence of complications for subtotal ionized field ablation of the tonsils.

OBJECTIVE: Ionized field ablation, or coblation-assisted subtotal tonsillectomy, has been described as a new alternative technique for the management of tonsillar disease. This study was designed to review the incidence of complications in patients undergoing this procedure. STUDY DESIGN: A 10-surgeon retrospective chart review of the intraoperative and postoperative complications of patients undergoing ionized field ablation subtotal removal of tonsils was performed. Postoperative pain, dietary restrictions, and activity level were not reviewed. RESULTS: Of the 528 patients who underwent ionized field ablation of their tonsils, the incidence of intraoperative and postoperative complications compared favorably with those reported in retrospective studies in the literature for traditional subcapsular tonsillectomy. Significant postoperative bleeding occurred in less than 1%, and only 1 patient required surgical control of bleeding in the operating room. No patients required transfusions of any blood products. CONCLUSIONS: Ionized field ablation subtotal tonsillectomy may offer an alternative to traditional subcapsular tonsillar surgery with a decreased incidence of postoperative complications. Further study is necessary to establish the complication rate of this technique.

Adolescent↗