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Cummings Otolaryngology: Head and Neck Surgery [3 Volume Set] (TRUE PDF)
دسته بندی: گوش و حلق و بینی ویرایش: 7 نویسندگان: Paul W. Flint, Bruce H. Haughey, Valerie J. Lund, K. Thomas Robbins, J. Regan Thomas, Marci M. Lesperance, Howard W. Francis سری: ISBN (شابک) : 9780323612173, 2019942176 ناشر: Elsevier سال نشر: 2020 تعداد صفحات: 4019 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 934 مگابایت
قیمت کتاب (تومان) : 37,000
کلمات کلیدی مربوط به کتاب گوش و حلق و بینی کامینگ: جراحی سر و گردن [مجموعه 3 جلدی] (PDF صحیح): گوش و حلق و بینی، راینولوژی، جراحی سر و گردن
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جامع ترین متن چند رشته ای در زمینه کامینگز Otolaryngology: Head and Neck Surgery، ویرایش هفتم، پاسخ های عملی مفصل و محتوای بالینی به راحتی قابل دسترسی را در مورد مسائل پیچیده ای که برای متخصصان گوش و حلق و بینی در همه سطوح در همه رشته های فوق تخصصی مطرح می شود، ارائه می دهد. این متن برنده جایزه یک مرجع یک مرحله ای برای تمام مراحل شغلی شما است - از رزیدنتی و گواهی هیئت مدیره تا چالش هایی که در عمل بالینی روزانه با آن مواجه می شوید. محتوای به روز شده ویرایشگر گوش شناسی جدید دکتر هوارد دبلیو فرانسیس و فصل ها و ویدیوهای جدید تضمین می کند که این نسخه هفتم مرجع قطعی در گوش و حلق و بینی امروزی باقی می ماند. ویژگی های کلیدی شما را با جدیدترین روش‌های کم تهاجمی، تغییرات اخیر در راینولوژی و تکنیک‌ها و فناوری‌های جدیدی که نتایج بیمار را شکل می‌دهند، به‌روز می‌کند. شامل 12 فصل جدید، از جمله رینوسینوزیت مزمن، درد صورت، اتولوژی سالمندان، جراحی آندوسکوپی گوش میانی، اختلالات گفتاری کودکان، کاشت حلزون در کودکان، گره های زبان و لب، شکاف حنجره تراشه، و غیره. پیشرفت‌های اخیر و رویکردهای جدید مانند روش Draf III برای CRS که بر فرورفتگی فرونتال تأثیر می‌گذارد، ویدین آندوسکوپی و نورکتومی خلفی بینی برای رینیت غیر آلرژیک، و رویکردهای آندوسکوپی برای تومورهای سینوازال و اربیتال، هم خارج و هم داخل کانولال را پوشش می‌دهد. دسترسی به 70 شاخص کلیدی (شورای اعتباربخشی برای روش‌های شاخص کلیدی آموزش پزشکی فارغ‌التحصیل) و ویدئوهای جراحی را فراهم می‌کند - افزایش 43 درصدی نسبت به نسخه قبلی. با 4000 تصویر با کیفیت بالا و صدها جدول و جعبه مرجع سریع، پشتیبانی بصری فوق العاده ای را ارائه می دهد. نسخه کتاب الکترونیکی پیشرفته همراه با خرید. کتاب الکترونیکی پیشرفته شما به شما امکان می دهد به تمام متن ها، شکل ها و مراجع کتاب در دستگاه های مختلف دسترسی داشته باشید. اطلاعات نویسنده توسط Paul W. Flint، MD، استاد و رئیس بخش گوش و حلق و بینی-جراحی سر و گردن، دانشگاه علوم و بهداشت اورگان، پورتلند، اورگان. Bruce H. Haughey، MD، FACS، پروفسور و مدیر بخش انکولوژی جراحی سر و گردن، گروه گوش و حلق و بینی-جراحی سر و گردن، دانشکده پزشکی دانشگاه واشنگتن، سنت لوئیس، MO. Valerie J. Lund، CBE، MS، FRCS، FRCSEd، استاد راینولوژی، کالج دانشگاه، لندن. مشاور افتخاری جراح گوش و حلق و بینی، مرکز رویال ملی گلو، بینی و گوش بیمارستان، کالج دانشگاه و بیمارستان های چشم مورفیلد، لندن، انگلستان؛ K. Thomas Robbins، MD، FACS، مدیر موسسه سرطان SimmonsCooper در SIU. استاد، بخش جراحی سر و گردن گوش و حلق و بینی، دانشکده پزشکی دانشگاه ایلینوی جنوبی، اسپرینگفیلد، IL. J. Regan Thomas، MD، FACS، فرانسیس L. Lederer پروفسور، رئیس بخش، بخش گوش و حلق و بینی-جراحی سر و گردن، دانشگاه ایلینویز در مرکز پزشکی شیکاگو، شیکاگو، IL. Marci M. Lesperance، MD، پروفسور، بخش گوش و حلق و بینی - جراحی سر و گردن، رئیس بخش گوش و حلق و بینی کودکان، دانشگاه میشیگان سیستم بهداشتی، Ann Arbor، میشیگان و Howard W. Francis
توضیحاتی درمورد کتاب به خارجی
The most comprehensive multi-disciplinary text in the field Cummings Otolaryngology: Head and Neck Surgery 7th Edition provides detailed practical answers and easily accessible clinical content on the complex issues that arise for otolaryngologists at all levels across all subspecialties. This award-winning text is a one-stop reference for all stages of your career—from residency and board certification through the challenges faced in daily clinical practice. Updated content new otology editor Dr. Howard W. Francis and new chapters and videos ensure that this 7th Edition remains the definitive reference in today’s otolaryngology. Key Features Brings you up to date with the latest minimally invasive procedures, recent changes in rhinology, and new techniques and technologies that are shaping patient outcomes. Contains 12 new chapters, including Chronic Rhinosinusitis, Facial Pain, Geriatric Otology, Middle Ear Endoscopic Surgery, Pediatric Speech Disorders, Pediatric Cochlear Implantation, Tongue-Ties and Lip Ties, Laryngotracheal Clefts, and more. Covers recent advances and new approaches such as the Draf III procedure for CRS affecting the frontal recess, endoscopic vidian and posterior nasal neurectomy for non-allergic rhinitis, and endoscopic approaches for sinonasal and orbital tumors, both extra- and intraconal. Provides access to 70 key indicator (Accreditation Council for Graduate Medical Education Key Indicator Procedures), and surgical videos – an increase of 43% over the previous edition. Offers outstanding visual support with 4,000 high-quality images and hundreds of quick-reference tables and boxes. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. Author Information By Paul W. Flint, MD, Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon ; Bruce H. Haughey, MD, FACS, Professor and Director, Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO; Valerie J. Lund, CBE, MS, FRCS, FRCSEd, Professor of Rhinology, University College, London; Honorary Consultant ENT Surgeon, Royal National Throat, Nose and Ear Hospital Trust, University College and Moorfields Eye Hospitals, London, UK ; K. Thomas Robbins, MD, FACS , Director, SimmonsCooper Cancer Institute at SIU; Professor, Division of Otolaryngology Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL; J. Regan Thomas, MD, FACS, Francis L. Lederer Professor, Department Head, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago Medical Center, Chicago, IL; Marci M. Lesperance, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, Chief, Division of Pediatric Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan and Howard W. Francis
فهرست مطالب
Cummings Otolaryngology Copyright Page Contributors Preface Acknowledgments Table Of Contents Video Contents I Measuring Outcomes and Performance 1 Outcomes Research Abstract Keywords Key Points Introduction History Key Terms and Concepts Bias and Confounding Assessment of Baseline Definition of Disease. Disease Severity. Comorbidity. Assessment of Treatment Control Groups. Assessment of Outcomes Efficacy. Effectiveness. Fundamentals of Study Design Randomized Trial Cohort Study Case-Control Study Case Series and Expert Opinion Other Study Designs Grading of Evidence-Based Medicine Recommendations Measurement of Clinical Outcomes Psychometric Validation Categories of Outcomes Examples of Outcomes Measures Generic Scales Disease Specific Scales Head and Neck Cancer. Otologic Disease. Rhinologic Disease. Pediatric Diseases. Voice. Swallow and Other Throat Symptom Scales. Sleep. Facial Plastic Surgery. Summary and Future Directions References 2 Interpreting Medical Data Abstract Keywords Key Points Seven Habits of Highly Effective Data Users Habit 1: Check Quality Before Quantity Habit 2: Describe Before You Analyze Habit 3: Accept the Uncertainty of All Data Habit 4: Measure Error With the Right Statistical Test Habit 5: Put Clinical Importance Before Statistical Significance Habit 6: Seek the Sample Source Habit 7: View Science as a Cumulative Process Popular Statistical Tests Used by Otolaryngologists t Test Description Interpretation Precautions Analysis of Variance Description Interpretation Precautions Contingency Tables Description Interpretation Precautions Survival Analysis Description Interpretation Precautions Multivariate (Regression) Procedures Description Interpretation Precautions Nonparametric Tests Description Interpretation Precautions Common Statistical Deceptions Surgical Satisfaction Swindle Standard Error Switcheroo Small Sample Whitewash Post Hoc P Values Multiple P Value Phenomenon Selective Analysis of Results Powerless Equalities Paired Data Proliferation Understanding Sample Size Importance of Principles References 3 Evidence-Based Performance Measurement Abstract Keywords Key Points Motivation for Physician Performance Measurement What Is Quality and Who Defines It? The Process of Building a Coherent System of Performance Measurement Engaging in the Development of Performance Measures Aggregating Demand for Performance Measurement Unifying the Response to the Demand for Performance Measurement Quality-Based or Value-Based Purchasing Medical Professionalism: the Physician-Patient Relationship Stakeholder Roles in Defining and Implementing Quality Improvement and Measurement Activity Anatomy of Performance Measures Other Stakeholder Perspectives Standardization and Implementation of Measures Barriers to Implementation of Performance Measurement The Surgeon’s Role in Performance Measurement References II General Otolaryngology 4 History, Physical Examination, and the Preoperative Evaluation Abstract Keywords Key Points Obtaining the History Physical Examination General Appearance Head and Facies Eyes Ears Auricles. External Auditory Canal. Tympanic Membrane. Hearing Assessment. Nose Nasopharynx Oral Cavity Oropharynx Larynx and Hypopharynx Neck Triangles of the Neck. Lymph Node Regions Adenopathy and Masses. Thyroid Gland Skin Neurologic Examination Special Populations Trauma Patients Children Older Patients Preoperative Evaluation Informed Consent Allergy Routine Perioperative Antibiotics Chronic Anticoagulation Considerations by Organ System Cardiovascular Respiratory Renal Hepatic Endocrine Thyroid Disorders Parathyroid Disorders Adrenal Problems Pancreatic Disorders Diabetes Mellitus. Hematologic Congenital Deficiencies of Hemostasis Liver Failure Thrombocytopenia Hemoglobinopathies Neurologic Conclusion References 5 General Considerations of Anesthesia and Management of the Difficult Airway Abstract Keywords Key Points Basic Anesthetic Care of the Patient With a NonDifficult Airway Standard Induction Versus Rapid-Sequence Induction Standards of Monitoring Standard Anesthetic Pharmacology Intravenous Medications for Induction of General Anesthesia Other Intravenous Medications: Benzodiazepines, Opioids, Lidocaine, and Dexmedetomidine Inhaled Anesthetic Agents Maintenance of General Anesthesia Depolarizing and Nondepolarizing Paralytic Agents Topical, Local, and Regional Anesthetic Agents Antihypertensive Agents Difficult Airway/Intubation: a Multispecialty Problem Definition and Incidence of Occurrence Consequences of a Difficult Airway Patient Identification Difficult Airway/Intubation Advances in Airway Techniques and Devices Johns Hopkins Hospital Difficult Airway Response Team Program and a Decade of Lessons Learned (2008–18) Conceptual Framework Prelude to the Johns Hopkins Hospital Difficult Airway Response Team Program Johns Hopkins Hospital Difficult Airway Response Team Program Initiative Documentation and Dissemination of Critical Difficult Airway/Intubation Information to Patients and Future Health Care Providers Issues With Conveying Information Verbally or in a Letter to Difficult Airway/Intubation Patients Issues With Obtaining Information from Previous Medical Records Electronic Health Record Conclusion Case-Based Learning: Case Presentations of Difficult Airway/Intubation Patients Pre-Difficult Airway Response Team Cases Difficult Airway Response Team Cases Catastrophic Cases Pre-DART Cases: OLHN and ACCM Teams Case 1: Consultation With the Airway Team for Future Airway Management Discussion and Major Teaching Points Case 2: Anticipated Difficulty After Physical Examination: Awake Nasal Intubation Discussion and Major Teaching Points Case 3: Anticipated Difficulty Because of the Surgical Procedure: Three Staged Surgeries for Temporomandibular Joint Dysfunction, Three Airway Management Algorithms Discussion and Major Teaching Points Case 4: Anticipated Difficult Intubation and Extubation: Trismus Versus Fused Temporomandibular Joint Discussion and Major Teaching Points Case 5: Unanticipated Difficult Intubation, Difficult Mask Ventilation With Laryngeal Mask Airway, Can Wake Up Discussion and Major Teaching Points Case 6: Unanticipated Difficult Intubation, Maskable, Cannot Wake Up Because of a Long-Acting Paralytic Agent Discussion and Major Teaching Points Case 7: Loss of the Ability to Perform Bag-Mask Ventilation Discussion and Major Teaching Points Case 8: Unanticipated Difficult Intubation, Failed Rapid-Sequence Induction, and Respiratory Compromise Discussion and Major Teaching Points Difficult Airway Response Team Cases: Case 9: Securing the Airway in a Patient With Penetrating Laryngeal Trauma Discussion and Major Teaching Points Case 10: Angioedema in the Emergency Department Discussion and Major Teaching Points Case 11: Morbid Obesity, Obstructive Sleep Apnea, and Respiratory Failure in the ED Discussion and Major Teaching Points Catastrophic Cases Case 12: Fire in the Airway Discussion and Major Teaching Points Case 13: Postobstructive Pulmonary Edema Discussion and Major Teaching Points Case 14: Rule Out Tension Pneumothorax Versus Anaphylactic Reaction Discussion and Major Teaching Points Case 15: Rule Out Malignant Hyperthermia Discussion and Major Teaching Points Case 16: Rule Out Pheochromocytoma Discussion and Major Teaching Points Case-Based Learning Summary Acknowledgment References 6 Surgical Management of the Difficult Adult Airway Abstract Keywords Key Points Overview Awake Fiberoptic Intubation Historical Perspective Indications Bronchoscopy Cart Preparing the Patient Psychologic Preparation Pharmacologic Preparation Conscious Sedation Topical and Local Anesthesia Technique Pearls Ensuring Successful Awake Fiberoptic Intubation Operative Surgical Airway Historical Perspectives Cricothyrotomy Anatomic Considerations Surgical Cricothyrotomy Indications Surgical Procedure Percutaneous Cricothyrotomy Transtracheal Needle Ventilation Conclusion References 7 Tracheotomy Abstract Keywords Key Points History of Tracheotomy Timing of Tracheotomy Critical Care/Intensive Care Unit Patients Trauma Patients Stroke Patients Cardiothoracic Patients Operative Technique Open Tracheotomy (Box 7.2) Percutaneous Tracheotomy Alternative Percutaneous Techniques Tracheostomy Tubes Complications Intraprocedural Complications Airway Fire Bleeding Pneumothorax/Pneumomediastinum Early Complications Infection Tube Obstruction Pressure Ulcers Accidental Decannulation Late Complications Tracheal Stenosis Tracheoinnominate Fistula Tracheoesophageal Fistula Tracheocutaneous Fistula Tracheostomy Care Decannulation References 8 Overview of Diagnostic Imaging of the Head and Neck Abstract Keywords Key Points Available Imaging Modalities Conventional Radiography Computed Tomography Computed Tomography Image Display Patient Cooperation Radiation Exposure Magnetic Resonance Imaging Magnetic Resonance Imaging Artifacts Magnetic Resonance Imaging Pulse Sequences T1-Weighted Images. T2-Weighted Images. Gadolinium Contrast Enhancement. Fat-Suppression Methods. Gradient-Echo Techniques. Diffusion Weighted Imaging. Magnetic Resonance Angiography Magnetic Resonance Imaging Disadvantages Ultrasound Nuclear Medicine Positron Emission Tomography Radionuclide Imaging Three-Dimensional Reconstruction Techniques Applications of Computed Tomography, Magnetic Resonance Imaging, and Ultrasound in the Head and Neck Application of Computed Tomography in the Head and Neck Region Suprahyoid Neck Cervical Lymphadenopathy. Salivary Glands Sialography and Computed Tomography–Sialography. Larynx and Infrahyoid Neck Thyroid and Parathyroid Glands Paranasal Sinuses Computed Tomography in Facial Trauma Temporal Bone and Skull Base Application of Magnetic Resonance Imaging in the Head and Neck Region Suprahyoid Neck Lymphadenopathy. Salivary Glands Larynx and Infrahyoid Neck Thyroid and Parathyroid Glands Paranasal Sinuses Temporal Bone Skull Base Application of Ultrasound in the Head and Neck Metastatic Lymphadenopathy Salivary Glands Infrahyoid Neck Application of 18F-Fluorodeoxyglucose Positron Emission Tomography in Head and Neck Cancer Staging T-Staging. N-Staging. M-Staging. Therapy Planning and Monitoring Detection of Residual and Recurrent Disease Principles of Image Interpretation Strategy for Image Interpretation and Differential Diagnosis Imaging Anatomy, Site-Specific Lesions, and Pseudotumors of the Head and Neck Spaces of Suprahyoid Neck Parapharyngeal Space Pharyngeal Mucosal Space Parotid Space Carotid Space Masticator Space Retropharyngeal Space Prevertebral Space Oral Cavity Sublingual Space Submandibular Space Spaces of Infrahyoid Neck Infrahyoid Retropharyngeal Space Infrahyoid Prevertebral Space Anterior and Posterior Cervical (Lateral Cervical) Spaces Hypopharyngeal Mucosal Space Visceral Space and Larynx Larynx Thyroid Gland Parathyroid Glands Lymphadenopathy Lymph Node Anatomy and Classification Lymph Nodes: Normal and Pathologic Sinuses and Skull Base Nose and Paranasal Sinuses Paranasal Sinuses Ostiomeatal Complex Nasal Cavity Facial Trauma Skull Base Temporal Bone Postoperative Neck and Face References 9 Deep Neck and Odontogenic Infections Abstract Keywords Key Points Etiology Microbiology Anatomy Maxillary Spaces Mandibular Spaces Neck Spaces Clinical Evaluation History Physical Examination Laboratory Evaluation Blood Tests Imaging Studies Plain Film Radiography Computed Tomography Magnetic Resonance Imaging Ultrasonography Treatment Medical Management Airway Management Fluid Resuscitation Antibiotic Therapy Surgical Management Principles of Surgical Management Needle Aspiration Transoral Incision and Drainage Transcervical Incision and Drainage Selected Complications of Deep Neck Infections Vascular Complications Lemierre Syndrome Cavernous Sinus Thrombosis Carotid Artery Pseudoaneurysm/Rupture Mediastinitis Necrotizing Fasciitis References 10 Head and Neck Manifestations in the Immunocompromised Host Abstract Keywords Key Points Spectrum of Immunodeficiency Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome Biology and Immunology Diagnosis and Classification Highly Active Antiretroviral Therapy Recent Advances Broadly Neutralizing Monoclonal Antibodies (bNAbs) Immune Reconstitution Inflammatory Syndrome Occupational Exposure to Human Immunodeficiency Virus Infection Manifestations of Immunodeficiency in the Head and Neck Immunodeficiency and Malignancy Kaposi Sarcoma Epidemiology and Pathogenesis Presentation and Diagnosis Treatment Cutaneous Neoplasms Noncutaneous Squamous Cell Carcinoma Lymphoma AIDS-Related Non-Hodgkin Lymphoma Epidemiology and Presentation. Diagnosis. Prognosis and Treatment. Posttransplantation Lymphoproliferative Disorder Hodgkin Lymphoma Hodgkin Lymphoma in Human Immunodeficiency Virus. Other Neoplasms Salivary Gland Disease Xerostomia in Human Immunodeficiency Virus and Transplantation Salivary Gland Lesions in Human Immunodeficiency Virus Diffuse Infiltrative Lymphocytosis Syndrome Diagnostic Approach to Neck Masses in Immunodeficient Patients History and Physical Examination Differential Diagnosis Diagnostic Workup Sinonasal Infection Presentation and Pathogenesis Diagnosis Treatment Otologic and Neurologic Manifestations of Immunodeficiency Skull Base Osteomyelitis Middle Ear Neuropathies in Human Immunodeficiency Virus Hearing Loss Cryptococcal Meningitis Otosyphilis Approach to Sensorineural Hearing Loss in HIV-Positive Patients Hearing Loss in Transplant Recipients Oral Cavity Fungal Infections Oral Candidiasis Oral Histoplasmosis Invasive Fungal Infection Viral Infections Oral Hairy Leukoplakia Herpes Simplex Virus Human Papillomavirus Aphthous Ulcers Gingivitis and Periodontal Disease Graft-Versus-Host Disease HIV-Associated Facial Lipoatrophy Summary References 11 Laryngeal and Tracheal Manifestations of Systemic Disease Abstract Keywords Key Points Granulomatosis With Polyangiitis Relapsing Polychondritis Sarcoidosis Amyloidosis Rheumatoid Arthritis Pemphigus Whooping Cough Tuberculosis Histoplasmosis Blastomycosis Cryptococcosis Coccidioidomycosis Actinomycosis Candidiasis References 12 Oral Manifestations of Systemic Diseases Abstract Keywords Key Points Diseases of the Heart Malignant Neoplasms Bisphosphonates Cerebrovascular Diseases Pulmonary Diseases Endocrine and Exocrine Disorders Diabetes Mellitus Adrenal Diseases Pituitary Diseases Thyroid Diseases Parathyroid Diseases Collagen-Vascular and Granulomatous Disorders Sjögren Syndrome Systemic Lupus Erythematosus Scleroderma Sarcoidosis Wegener Granulomatosis Infectious Diseases Viral Diseases Fungal Diseases Bacterial Diseases Arthritides and Bone Disorders Rheumatoid Arthritis Osteoarthritis Reiter Syndrome Paget Disease Ewing Sarcoma Total Joint Replacement Dermatologic Conditions Lichen Planus Pemphigus Vulgaris Mucous Membrane Pemphigoid Erythema Multiforme Gastrointestinal Disorders Crohn Disease and Ulcerative Colitis Behçet Syndrome Gastroesophageal Reflux Disease Malabsorption Diseases Neurologic Diseases Dementia Parkinson Disease Myasthenia Gravis Bell Palsy Multiple Sclerosis Myotonic Muscular Dystrophy Diseases of Organs and Glands Renal Diseases Chronic Liver Diseases and Cirrhosis Hematologic Disorders Bleeding Disorders White Blood Cell Disorders Hemoglobin Problems Women’s Oral Health and Disease Puberty Pregnancy Menopause and Postmenopause Inherited and Congenital Disorders References 13 Otolaryngology in the Elderly Abstract Keywords Key Points The Aging Ear External Ear Presbycusis Proposed Etiologies Risk Factors Increasing Age Noise Genetic Predisposition Health Comorbidities Hearing Loss and Dementia Treatment Presbystasis Vestibular Pathology Diagnostic Methods Treatment The Aging Nose Common Symptoms Olfactory Changes Changes in Nasal Appearance and Intranasal Examination Treatment The Aging Voice and Upper Aerodigestive Tract Histologic Changes Laryngoscopic Appearance Acoustic Changes Mucosal Changes Glandular Changes Sense of Taste Dental/Mandibular Changes Respiratory Changes Treatment Presbyphagia Diagnostic Testing Treatment Facial Trauma Head and Neck Oncology Etiology Treatment Conclusion References 14 Pain Management in the Head and Neck Patient Abstract Keywords Key Points Measurement of Pain Acute Pain Management Epidemiology Patient Satisfaction Preemptive Versus Preventive Analgesia Perioperative Opioids and Their Role in the Opioid Epidemic Multimodal Analgesia Enhanced Recovery After Surgery Patient Controlled Analgesia Acetaminophen Nonsteroidal Antiinflammatory Drugs Gabapentinoid Drugs N-Methyl-d-Aspartate–Receptor Antagonists Perioperative Regional Anesthesia Perioperative Considerations for Older Adults Perioperative Considerations for Patients Receiving Long-Term Opioid Therapy Cancer and Chronic Noncancer Pain Types of Pain and Pain Definitions Treatment Medication Management Nonopioid Analgesics Acetaminophen and Nonsteroidal Antiinflammatory Drugs Neuropathic Pain Medications Antiepileptics Tricyclic Antidepressants Selective Serotonin-Norepinephrine Reuptake Inhibitors Opioid Analgesics Weak Opioids Strong Opioids Multidisciplinary Pain Therapies Psychosocial Supportive Therapy Physical Rehabilitative Therapy Interventional Techniques References 15 Sleep Apnea and Sleep Disorders Abstract Keywords Key Points Historic Perspectives Classification of Obstructive Sleep-Related Breathing Disorders Snoring Upper Airway Resistance Syndrome Obstructive Sleep Apnea Pathophysiology Consequences of Untreated Obstructive Sleep Apnea Diagnosis Treatment Medical Treatment Surgical Treatment Nasal Surgery Palatal Surgery Oropharyngeal Surgery Hypoglossal Nerve Stimulation Tongue-Base Procedures Hypopharyngeal Procedures Maxillomandibular Advancement Tracheotomy Postoperative Management Sleep Disorders Classification of Sleep Disorders Normal Sleep Insomnia Sleep-Related Breathing Disorders Central Disorders of Hypersomnolence Circadian Rhythm Sleep-Wake Disorders Parasomnias Sleep-Related Movement Disorders Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues Conclusion References III Facial Plastic and Reconstructive Surgery 1 Facial Surgery 16 Aesthetic Facial Analysis Abstract Keywords Key Points Anatomic Landmarks and Reference Points Facial Proportions Subunit Analysis Forehead Eyes Nose Nasofacial Relationships Nasal Rotation and Projection Alar-Columellar Complex Lips Chin Neck Ears Skin and Rhytids Computer Imaging and Digital Photography References 17 Recognition and Treatment of Skin Lesions Abstract Keywords Key Points Introduction Benign Skin Lesions Epidermal Lesions Seborrheic Keratosis Dermatosis Papulosa Nigra Epidermal Nevus Verruca Vulgaris Cysts and Subcutaneous Lesions Epidermal Inclusion Cyst Pilar Cyst Milia Favre-Racouchot Dermoid Cyst Melanocytic Lesions Benign Nevus Lentigo Ephelis Fibroadnexal Lesions Nevus Sebaceous (of Jadassohn) Acrochordon Keloid and Hypertrophic Scar Neurofibroma Angiofibroma Sebaceous Hyperplasia Xanthelasma Other Dermatologic Manifestations Chondrodermatitis Nodularis Helicis Vitiligo Seborrheic Dermatitis Bullous Disorders of the Head/Neck: Inherited and Autoimmune Bullous Disorders Stevens-Johnson Syndrome Morphea (Including En Coup de Sabre) Malignant Skin Lesions Melanoma Nonmelanoma Skin Cancer Basal Cell Carcinoma Squamous Cell Carcinoma Bowen Disease Actinic Keratosis Keratoacanthoma Merkel Cell Carcinoma Dermatofibrosarcoma Protuberans Treatment Biopsy Electrosurgery Cryosurgery Photodynamic Therapy Mohs Micrographic Surgery Resurfacing Laser Surgery References 18 Scar Revision, Keloids, and Camouflage Abstract Keywords Key Points Indications for Revision Excision Expansion With Excision Serial Excision Tissue Expansion Irregularization, Elongation, and Reorientation: Z-plasty, W-plasty, and Geometric Broken Line Closure Z-plasty W-Plasty and Geometric Broken Line Closure Topical Therapy for “Routine” Scars Topical Steroids Silicone Sheeting Onion Extract Steroids Dermabrasion Hypertrophic Scars and Keloids Topical Therapy for Hypertrophic Scars and Keloids Pressure Therapy Mitomycin C Imiquimod Excision and Injectables 5-Fluorouracil Injections Bleomycin Interferons Laser Therapy Cryotherapy Radiotherapy Adjunctive Procedures Conclusion References 19 Facial Trauma Abstract Keywords Key Points Etiology Approach to Traumatic Injuries History Physical Examination Anesthesia Cleaning Infection Control Repair Types of Injuries Abrasions Lacerations Soft Tissue Avulsions Special Considerations in Repair of Specific Structures Lacrimal Apparatus and Eyelids Facial Nerve Lips Ears Nose Salivary Gland Trauma Parotid Duct Sialocele and Salivary Fistula Burns Classification Assessment and Treatment Special Considerations Eyelids Nasal and Auricular Cartilage Lips and Oral Commissure Frostbite Conclusion References 20 Maxillofacial Trauma Abstract Keywords Key Points Anatomy, Physiology, and Pathophysiology General Upper Third Middle Third Lower Third Evaluation and Diagnosis Physical Examination Upper Third Middle Third Lower Third Radiographic Evaluation Upper Third Middle Third Lower Third Classification Schema Upper Face Middle Third Lower Third Management General Surgical Access Upper Third Middle Third Lower Third (Mandible) Bone Healing Biomechanics of the Facial Skeleton Upper Third Middle Third Lower Third Fracture Repair Occlusion Upper Third Cerebrospinal Fluid Rhinorrhea Skull Base Disruption Middle Third Lower Third Edentulous Mandible Panfacial Fractures Complications Future Directions and New Horizons References 21 Reconstruction of Facial Defects Abstract Keywords Key Points Classification of Local Flaps Pivotal Flaps Rotation Flaps Transposition Flaps Interpolated Flaps Advancement Flaps Unipedicle Advancement Flap V-Y Advancement Flap Y-V Advancement Flaps Hinge Flaps Defects of the Nose Defects of the Lip Reconstruction of Cheek Defects Forehead Defects References 22 Hair Restoration Abstract Keywords Key Points Pathophysiology Etiology Nonscarring Alopecias Scarring Alopecias Classification Medical Treatment of Androgenetic Alopecia Minoxidil Finasteride Low-Level Light and Laser Therapy Platelet-Rich Plasma Injections Patient Consultation Candidacy Surgical Treatment of Alopecia Hairline Design Anesthesia Autograft Hair Transplantation Donor Hair Removal: Elliptical Strip Method Planning Technique Donor Hair Removal: Follicular Unit Extraction Method Technique Recipient Site Sequelae and Complications Scalp Reduction Tissue Expansion Temporoparietal-Occipital Flap Reconstructive Procedures Future Treatment Options Summary References 23 Management of Aging Skin Abstract Keywords Key Points Chemical Peels Histologic Changes of Aging Skin Patient Evaluation, Classification, and Selection Therapeutic Indications Contraindications Chemical Peel Procedure Patient Selection and Education Prepeel Preparations Chemical Peel Agents Superficial Peels Medium-Depth Chemical Peels Technique: Medium-Depth Chemical Peels. Deep Chemical Peels Hetter Peel Formulas. Patient Selection. Technique: Deep Chemical Peel. Phenol Toxicity. Postoperative Care Routine. Chemical Peel Complications Dermabrasion Patient Selection and Consultation Equipment Technique Postoperative Care Complications Laser Resurfacing Carbon Dioxide Laser Erbium:Yttrium-Aluminum-Garnet Laser Fractionated Devices Comparison of Carbon Dioxide and Erbium:Yttrium-Aluminum-Garnet Lasers Postoperative Laser Care Combined Modality Treatment Aesthetician’s Role in the Management of Aging Skin Ablative Laser Resurfacing Nonablative Facial Resurfacing Microdermabrasion Superficial Chemical Peels Medical Skin Care Regimens Summary References 24 Rhytidectomy and Facial Liposuction Abstract Keywords Key Points Historic Perspective Anatomic Considerations Surgical Technique Planning and Marking the Incisions Injection of Local Anesthesia Submentoplasty and Submental Liposuction Submental Liposuction Technique Submentoplasty (Platysmaplasty) Technique Skin Flap Elevation Superficial Musculoaponeurotic System Rhytidectomy and Deep-Plane Rhytidectomy Skin Flap Trimming and Closure Postoperative Care Complications Hematoma Infection Skin Flap Necrosis Nerve Injury Scarring Hairline Distortion and Alopecia Pigmentary Changes Contour Irregularities Depression Revision Surgery References 25 The Aesthetic Brow and Forehead Abstract Keywords Key Points Ideal Forehead Aesthetics Female Male Anatomy Musculature Skin and Fascial Layers Sensory Innervation Motor Innervation Blood Supply Aging Brow and Forehead Patient Selection Psychological Considerations Patient Evaluation Examine Surgical Goals Surgical Techniques Coronal Forehead Lift Pretrichal Forehead Lift Midforehead Lift Midforehead Brow Lift Direct Brow Lift Browpexy Endoscopic Brow Lift Temporal Lift Endoscopic Brow Lift Technique Incisions Local Anesthesia Frontal and Parietal Bone Dissection Temporal Dissection and Release of the Periosteum and Lateral Supraorbital Orbicularis Oculi Muscle Release of the Brow Depressor Muscles Brow Elevation and Fixation Postoperative Care Complications Treatment of the Depressor Muscles With Botulinum Toxin Volume Augmentation of the Brow and Temple Conclusion References 26 Blepharoplasty Abstract Keywords Key Points Anatomy Orbital Anatomy Eyebrow Anatomy Sensory Innervation Motor Innervation Fascial Layers of the Forehead and Temporal Region Musculature Blood Supply Eyelid Anatomy Surface Anatomy of the Eyelids Anterior Lamella Orbital Septum Orbital Fat Pads Upper Eyelid Retractors Lower Eyelid Retractors Tarsus Conjunctiva Midface Anatomy Aesthetic Considerations and Ideals in the Periorbital Area Brow Position Eyelid Aesthetics Upper Eyelid Ptosis Evaluation Midface Aesthetic Ideals Preoperative Planning Surgical Techniques Blepharoplasty and Ptosis Repair Upper Eyelid Lower Eyelid Blepharoplasty Transconjunctival Approach. Subciliary Approach. Lid-Shortening Procedure Complications. Adjunctive Procedures Skin Resurfacing Injectable Filler Botox References 27 Mentoplasty Abstract Keywords Key Points Patient Evaluation Chin Deformities Procedure Selection Surgical Technique Mentoplasty With Chin Implant Fixation of Alloplast Chin Implants Osseous Genioplasty Clinical Examples Case 1. Case 2. Case 3. Case 4. Case 5. Complications Noninvasive Chin Augmentation Clinical Example Summary References 28 Otoplasty Abstract Keywords Key Points History Incidence Etiology Embryology, Anatomy, and Pathophysiology Goals and Fundamentals of Otoplasty Graduated-Approach Otoplasty Incisionless Otoplasty Nonsurgical Otoplasty Complications Summary References 2 Rhinoplasty 29 The Nasal Septum Abstract Keywords Key Points Anatomy and Embryology of the Nose Turbinates Blood Supply and Innervation Nasal Obstruction Deviated Nasal Septum Nasal Valve Angle and Nasal Valve Area Nasal Physiology: Resistance and Airflow Nasal Cycle and Paradoxic Nasal Obstruction Septal Versus Turbinate Obstruction Measurement of Obstruction Septoplasty Technique and Evolution Technique Evolution Septoplasty Today Correction of Cartilaginous and Bony Septal Obstruction Anesthesia and Analgesia Incisions and Plane of Dissection for Septoplasty Addressing the Deflected Cartilaginous and Bony Septum Proper: Basic Technique Septoplasty and the Caudal Septum Septoplasty With Caudal Absence and Tip Collapse: Septal Reconstruction Septoplasty Combinations: the Rule and Not the Exception Septoplasty With Correction of the Nasal Valve Septoplasty With Septal Perforation Repair Septoplasty and the Crooked Nose Treatment of the Inferior Turbinates Postoperative Care Complications of Septoplasty Conclusion References 30 Nasal Fractures Abstract Keywords Key Points Anatomy Pathophysiology Associated Injuries Classification Diagnostic Assessment History Physical Examination Radiography Management Acute Intervention Timing of Reduction Open Versus Closed Reduction Anesthesia for Closed Reduction Technique Closed Reduction Care After Reduction Open Reduction Alternative Reduction Methods Pediatric Nasal Fractures Complications References 31 Rhinoplasty Abstract Keywords Key Points Surgical Philosophy Preoperative Patient Assessment Anatomic Evaluation Photography and Imaging Laboratory Evaluation Anesthesia and Analgesia Surgical Planes Preoperative Medication and Intravenous Analgesia Infiltration Anesthesia Surgical Landmarks Surgical Refinement of the Nasal Tip Nondelivery Approaches Delivery Approaches Open Approach Tip Projection Surgery of the Cartilaginous Vault Surgery of the Bony Vault Bony Profile Reduction Narrowing the Nose: Osteotomies Postsurgical Considerations 32 Special Rhinoplasty Techniques Abstract Keywords Key Points Analysis Incisions and Soft Tissue Elevation Septal and Columellar Modifications Caudal Repositioning Making the Final Septal Assessment Columellar Alar Relationship Nasofrontal Angle Modifications Tip and Alar Asymmetries Tip Grafts Alar Batten Grafts Transposition Techniques Osteotomies Spreader Grafts (Middle Nasal Vault) Saddle Nose Deformity Augmentation Indications Dynamic Adjustable Rotational Tip Graft Non-Caucasian Nose Dorsal Augmentation Nasal-Base Sculpting Alar Soft Tissue Sculpturing Cleft-Lip Nose Summary References 33 Non-Caucasian Rhinoplasty Abstract Keywords Key Points Anatomic Considerations Aesthetic Considerations Augmentation Rhinoplasty Concept Choice of Augmentation Material Technical Considerations With Dorsal Augmentation Hump Reduction Concept Technique Correction of a Deviated Nose Concept Technique Tip Surgery Concept Technique Alar Base Modification Postoperative Care Complications Conclusion References 34 Revision Rhinoplasty Abstract Keywords Key Points Introduction Patient Interview Physical Examination Surgical Approach Grafting Material Septal Cartilage Grafts Costal Cartilage Grafts Auricular Cartilage Grafts Calvarial Bone Grafts Alloplastic Implants Nonsurgical “Filler” Rhinoplasty Targeted Approach to Revision Rhinoplasty Bony Vault Dorsal Irregularities Deep Radix Middle Vault Internal Nasal Valve Collapse Inverted-V Deformity Open Roof Deformity Low Dorsum or Saddle-Nose Deformity Pollybeak Deformity Lower Third External Nasal Valve and Supra-Alar Collapse Alar Collapse and Retraction Tip Irregularities and Bossae Wide or Bulbous Tip Pinched Tip Short, Overrotated Nose Tip Ptosis Nasal Septum Caudal Septal Deviation and Septal Perforation Alar Base Alar Base Scarring References IV Sinus, Rhinology, and Allergy/Immunology 35 Allergy and Immunology of the Upper Airway Abstract Keywords Key Points Innate Versus Adaptive Immunity Components of the Innate Immune System Toll-Like Receptors Antimicrobial Peptides Natural Killer Cells Complement Adaptive Immunity: Cells of the Immune System and Their Responses T Cells B Cells Innate Lymphoid Cells Monocytes and Macrophages Neutrophils Eosinophils Basophils and Mast Cells Platelets and Erythrocytes Antigen Presentation Adaptive Immunity: Humoral Immune Response T-Cell–Dependent Versus T-Cell–Independent B Cell Responses Antibody-Dependent Cellular Cytotoxicity Immunoglobulins Immunoglobulin G Immunoglobulin M Immunoglobulin A Immunoglobulin E Immunoglobulin D Glycoimmunology and Siglecs Cytokines Chemokines Immunopathology Factors Related to the Development of Atopic Disease Genetics Hygiene, or Biodiversity, Hypothesis Geography Socioeconomic Factors Allergic Rhinitis Burden of Disease Pathophysiology of Allergic Rhinitis Sensitization and Immunoglobulin E Production Early Response to Antigen Neuronal Contribution Late Response to Antigen Cytokine Production During Late Response Cellular Events Adhesion Molecules and Cellular Recruitment Hyperresponsiveness Specific Hyperresponsiveness Nonspecific Hyperresponsiveness Local Allergic Rhinitis Evaluation and Diagnosis History Physical Examination Nasal Endoscopy Diagnostic Tests Skin Prick Testing Intradermal Testing Blended Skin Testing Techniques In Vitro Testing Serum Total IgE Serum Antigen-Specific IgE Nasal Specific IgE Basophil Activation Test Component Resolved Diagnosis Allergen Challenge Testing Nasal Biopsy and Cytology Therapeutic Options Avoidance Antihistamines Decongestants Anticholinergics Cromolyn Sodium Leukotriene Modifiers Intranasal Corticosteroids Systemic Glucocorticosteroids Omalizumab Combination Treatments Immunotherapy Immunologic Changes After Allergen-Specific Immunotherapy Subcutaneous Immunotherapy Sublingual Immunotherapy SCIT Versus SLIT Novel Approaches Omalizumab + Allergen-Specific Immunotherapy. Synthetic Allergens Peptide Constructs Allergoids/Polymerized Antigens Adjuvant Constructs Intralymphatic Immunotherapy Epicutaneous Allergen-Specific Immunotherapy Treatment of Eye Symptoms in Allergic Rhinoconjunctivitis Assessment of Symptom Control in Rhinitis Important Associated Conditions Rhinosinusitis Conjunctivitis Asthma Other Related Conditions General Treatment Planning References 36 Olfactory Function and Dysfunction Abstract Keywords Key Points Anatomy Olfactory Neuroepithelium Olfactory Bulb and Higher Olfactory Structures Physiology Nasal Cycle and Aerodynamics Olfactory Mucous Layer Olfactory Receptors and Transduction Cascades Olfactory Genetics and Odor Encoding Trigeminal Function Olfactory Dysfunction Definitions Epidemiology Impact of Olfactory Dysfunction Quality of Life and Association With Other Pathology Occupational Impairment and Safety Classification of Olfactory Dysfunction Common Causes of Olfactory Dysfunction Sinonasal Olfactory Dysfunction Postinfectious Olfactory Dysfunction Posttraumatic Olfactory Dysfunction Neurological/Neurodegenerative Olfactory Dysfunction Congenital Olfactory Dysfunction Olfactory Dysfunction in Endocrine Disorders Drug/Toxin-Associated Olfactory Dysfunction Age-Related Olfactory Dysfunction Other Causes of Olfactory Dysfunction Neoplasms: Intracranial Neoplasms: Intranasal Iatrogenic Dysfunction Psychiatric Conditions Autoimmune Conditions Smoking and Alcohol Idiopathic Olfactory Dysfunction Clinical Assessment History Clinical Examination Olfactory Assessment Subjective Assessment Psychophysical Assessment Orthonasal Psychophysical Tools Retronasal Olfaction and Gustatory Screening Imaging Electrophysiology and Functional Imaging Treatment General Safety Counseling Appropriate Referrals Reducing Exposure to Causative Agents Olfactory Training Medication Corticosteroids Intranasal Calcium Buffers Phosphodiesterase Inhibitors Other Surgery Conclusions Acknowledgments References 37 Objective Assessment of Nasal Function Abstract Keywords Key Points Objective Assessment of Nasal Function Mucociliary Transport and Function Measurement of Mucociliary Transport Testing of Transport in Vivo Saccharine Test. Nuclear Testing. Testing of Transport in Vitro Testing of Ciliary Activity Ex Vivo/In Vitro. Cell Culture. Additional Testing Nasal Nitric Oxide Genetic Analysis Measurement of the Upper Airway Objective Assessment of Nasal Airway Nasal Airflow Measurements Peak Nasal Flow Measurements Peak Nasal Inspiratory Flow Simultaneous Measurement of Transnasal Pressure and Airflow: Rhinomanometry Computed Tomography, Magnetic Resonance Imaging, Computational Fluid Dynamics, and Acoustic Rhinometry Acoustic Rhinometry. Nasal Spirometry and Other Methods of Objective Assessment of the Nose Nasal Spirometry. Rhinostereometry. Optical Rhinometry. Nasometry. Odiosoft-Rhino. Correlation Between Nasal Symptoms and the Objective Measurement of Nasal Airway Correlation Between Objective Tests for the Measurement of Nasal Airway (PNIF, RM, AR) The Role of Objective Tests for the Measurement of Nasal Airway in Patients Affected by Sleep-Related Breathing Disorders Objective Methods for the Measurement of the Nasal Airway Before and After Nasal Surgery: Brief Considerations Conclusions References 38 Imaging of Nose and Sinuses Abstract Keywords Key Points Imaging Techniques Radiographs Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography–Computed Tomography Image-Guided Surgery Anatomy Normal Anatomy and Physiology Cribriform Plate Olfactory Fossa Anatomic Variations Concha Bullosa Interlamellar Cell (Lamellar Bulla) Nasal Septal Deviation Paradoxical Middle Turbinate Variations in the Uncinate Process Haller Cells (Infraorbital or Infrabullar Recess Cells) Onodi Cells (Sphenoethmoidal Cells) Giant Ethmoid Bulla Extensive Pneumatization of the Sphenoid Sinus Medial Deviation or Dehiscence of the Lamina Papyracea Aerated Crista Galli Asymmetry in Ethmoid Roof Height Sinus Aplasia and Hypoplasia Pathology Infectious/Inflammatory Acute Rhinosinusitis Chronic Rhinosinusitis Fungal Rhinosinusitis Allergic Rhinosinusitis Granulomatous Rhinosinusitis Neoplasms Malignant Neoplastic Benign Tumors Neoplastic Mimics Cephalocele References 39 Nonallergic Rhinitis Abstract Keywords Key Points Introduction Pathophysiology Localized Inflammation Nociceptive Dysfunction Dysregulation of Autonomic Responses Types of Nonallergic Rhinitis (Box 39.1) Idiopathic Nonallergic Rhinitis Nonallergic Rhinitis With Eosinophilic Syndrome Hormonal Rhinitis Medication-Induced Rhinitis Atrophic Rhinitis Gustatory Rhinitis Irritant-Induced Rhinitis Occupational Rhinitis Senile Rhinitis History and Physical Examination Diagnostic Testing Screening Questionnaires and Quality of Life Tools Skin Prick and Allergen-Specific IgE Antibody Testing Response to Nasal Provocation Other Testing Medical Treatment of Nonallergic Rhinitis Avoidance Intranasal Corticosteroids Antihistamines Anticholinergics Nasal Saline Capsaicin Surgical Treatment of Nonallergic Rhinitis Inferior Turbinate Reduction Botulinum Toxin Vidian Neurectomy Posterior Nasal Neurectomy and Cryoablation of the Posterior Nasal Nerve Experimental Techniques References 40 Acute Rhinosinusitis Abstract Keywords Key Points Definitions of Acute and Chronic Rhinosinusitis Acute Rhinosinusitis Diagnosis Treatment Complications Acute Invasive Fungal Rhinosinusitis Summary References 41 Pathogenesis of Chronic Rhinosinusitis Abstract Keywords Key Points Introduction Environmental Factors Fungi Bacteria Viruses Toxins and Allergens Host Factors Mechanical Barrier Epithelial Cells Innate Lymphocytes. Eosinophils. Macrophages. Neutrophils. Basophils and Mast Cells. Dendritic Cells. Platelets Adaptive Immunity: T Cells, B Cells, and Immunoglobulins Theories of Etiology and Pathogenesis From Phenotypes to Endotypes and Relevant Biomarkers From Endotypes Toward Precision Medicine References 42 Chronic Rhinosinusitis Abstract Keywords Key Points Introduction Medical Therapies Saline Irrigations Corticosteroids Intranasal Corticosteroids—Standard Delivery Intranasal Corticosteroids—Nonstandard Delivery Oral Corticosteroids Antibiotics Oral Non-Macrolides Oral Macrolides Intravenous Antibiotics Topical Antibiotics Antifungals Oral Antifungals Topical Antifungals Alternative Therapies Topical Surfactants Manuka Honey Xylitol Colloidal Silver Photodynamic Therapy Leukotriene Inhibitors Aspirin Desensitization Immunotherapy Biologic Therapies Conclusion References 43 Chronic Rhinosinusitis Abstract Keywords Key Points Outcomes Research for Chronic Rhinosinusitis Outcomes Following Medical Treatment Quality of Life Following Initial Medical Treatment Quality of Life Following Medical Treatment for Refractory Disease Productivity Loss and Changes Following Medical Treatment Factors Prompting Crossover to Surgical Intervention Outcomes Following Endoscopic Sinus Surgery Quality of Life After Endoscopic Sinus Surgery Factors Influencing Quality-of-Life Improvement After Surgery Pulmonary, Olfactory, and Other Outcomes Following Endoscopic Sinus Surgery Improvements in Productivity Loss Following Endoscopic Sinus Surgery Patient Selection for Endoscopic Sinus Surgery Outcomes Following Balloon Catheter Dilation Comparisons of Surgical and Medical Outcomes Limitations With Existing Randomized Controlled Trials Comparing Medical and Surgical Outcomes Future Outcomes Research in Chronic Rhinosinusitis References 44 Primary Sinus Surgery Abstract Keywords Key Points Background Anatomy Ostiomeatal Complex Middle Turbinate Ethmoidal Complex Maxillary Sinus Sphenoid Sinus Frontal Sinus Importance of Frontoethmoidal Cells Anterior Skull Base Anatomic Variations Indications for Primary Sinus Surgery Chronic Rhinosinusitis Antrochoanal Polyps Recurrent Acute Rhinosinusitis Acute Complications of Rhinosinusitis Mucoceles Intractable Epistaxis Cerebrospinal Fluid Rhinorrhea and Anterior Meningoencephaloceles Noninvasive Fungal Rhinosinusitis Allergic Fungal Rhinosinusitis Invasive Fungal Rhinosinusitis Removal of Foreign Bodies Choanal Atresia Repair Headache and Facial Pain Silent Sinus Syndrome Tumors and Expanded Utilization of Transnasal Endoscopic Sinus Approaches Endoscopic Sinus Surgery for Rhinosinusitis Principles of Functional Endoscopic Sinus Surgery Extent of Surgery: Limited versus Extended Approaches Preoperative Assessment History Examination Radiographic Assessment Intraoperative and Perioperative Considerations Preoperative Medical Therapy Intraoperative Considerations Image-Guided Navigation Systems Choice of Anesthesia Local Anesthesia. General Anesthesia. Patient Preparation in the Preoperative Holding Area Intraoperative Patient Positioning and Preparation Topical Anesthesia. Basic Techniques: Messerklinger and Wigand Endoscopic Sinus Surgery Special Situations Nasal Septal Deviation Concha Bullosa Chronic Rhinosinusitis With Nasal Polyposis Allergic Fungal Rhinosinusitis Balloon Sinusotomy and Balloon-Assisted Sinus Surgery Postoperative Care for Endoscopic Sinus Surgery Complications Hemorrhage Ophthalmic Complications Intracranial Complications Results Causes of Failure of Primary Endoscopic Sinus Surgery External Procedures Caldwell-Luc Procedure and Canine Fossa Trephination Intranasal Ethmoidectomy External Ethmoidectomy External Approaches to the Frontal Sinus Approaches to the Sphenoid Sinus Conclusions Acknowledgments References 45 Causes of Failure, Revision Surgery for Rhinosinusitis, and Management of Complications in Endoscopic Sinus Surgery Abstract Keywords Key Points Introduction Causes of Failure Unrecognized Nonsinogenic Pathology Medical Factors Associated With Primary Surgical Failure Persistent Microbial Disease Persistent Inflammatory Disease Systemic Comorbidities Environmental Factors Iatrogenic Factors Associated With Primary Surgical Failure Persistent Obstruction Following Incomplete Surgery Recurrence of Obstruction Despite Complete Surgery Early Revision Surgery for Complications or Neoplasia Clinical Approach to the Revision Surgical Patient Conclusion References 46 Management of the Frontal Sinuses Abstract Keywords Key Points Surgical Anatomy of the Frontal Sinus Acute Frontal Sinusitis Complications of Acute Frontal Sinusitis Pott Puffy Tumor Chronic Frontal Sinus Disease Indications for Surgery in Chronic Frontal Sinusitis Procedures in Chronic Frontal Sinusitis Balloon Catheter Dilation Endoscopic Frontal Sinus Approach Endoscopic Frontal Sinusotomy: Draf IIa. Draf IIb Procedure. Draf III Procedure. Revision Frontal Sinus Surgery Frontal Sinus Cerebrospinal Fluid Leaks Specific Pathologic Conditions Frontoorbital Mucoceles Benign Tumors of the Frontal Sinus Osteoma Inverted Papilloma Fractures of the Frontal Sinus Pneumosinus Dilatans Complications of Frontal Sinus Surgery External Approaches to the Frontal Sinus Lynch-Howarth External Ethmoidectomy Osteoplastic Flap With or Without Obliteration of the Frontal Sinuses References 47 Epistaxis Abstract Keywords Key Points Anatomy Management Initial Considerations Preventive Measures Conservative Measures Greater Palatine Canal Injection Examination With Source Identification Address Coagulopathy Directed Treatment—Cautery or Topical Hemostatic Agents Nasal Packing Endoscopic Sphenopalatine Artery Ligation Endoscopic Maxillary Artery Ligation Ligation of the External Carotid Artery Anterior Ethmoidal Artery Ligation Embolization Pediatric Epistaxis Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu) Summary References 48 Cerebrospinal Fluid Rhinorrhea Abstract Keywords Key Points Introduction Historical Perspective Classification Pathophysiology Diagnosis Differential Diagnosis History Physical Examination Diagnostic Testing Chemical Markers Cerebrospinal Fluid Tracers Localization Studies Diagnostic Algorithm Management Conservative Treatment Transcranial Techniques Extracranial Techniques Cerebrospinal Fluid Rhinorrhea Precautions Comprehensive Management Strategy Traumatic (Nonsurgical) Etiology Intraoperative Injury With Immediate Recognition/Onset Operative Injury With Delayed Recognition/Onset Nontraumatic Leaks Conclusions References 49 Sino-Orbital Interface Abstract Keywords Key Points Endoscopic Dacryocystorhinostomy Anatomy Diagnostics Procedure Preparatory Maneuvers Flap Elevation Bone Removal Cannulation Marsupialization Flap Reinsertion and Lacrimal Intubation Revision Dacryocystorhinostomy Outcomes Pathology Technique Adjunctive Therapies Revision Complications Perioperative Surgical Failures Rare Conclusions Endoscopic Medial and Inferior Orbital Decompression Introduction Operative Indications Preoperative Evaluation Considerations Surgical Technique Exposure Bony Decompression Periorbital Incision Complications and Outcomes Endoscopic Optic Nerve Decompression Introduction Etiology Evaluation Controversies in Traumatic Optic Neuropathy Pertinent Anatomy Surgical Technique Complications and Outcomes Endoscopic Endonasal Management of Orbital Tumors Introduction Evaluation Differential Diagnosis Operative Indications and Candidacy for an Endonasal Approach Pertinent Anatomy and Classification Surgical Planning, Technique, and Reconstruction Surgical Planning Approach Soft-Tissue Dissection Reconstruction Complications and Outcomes Conclusion References 50 Benign Tumors of the Sinonasal Tract Abstract Keywords Key Points Sinonasal Papillomas Inverted Papilloma Exophytic Papilloma Oncocytic Papilloma Juvenile Angiofibroma Osteoma Lobular Capillary Hemangioma Ossifying Fibroma and Fibrous Dysplasia Schwannoma Acknowledgment References 51 Systemic Disease of the Nose and Sinuses Abstract Keywords Key Points Background Granulomatosis With Polyangiitis (Formerly Wegener Granulomatosis) Background Clinical Features Diagnosis Treatment Sarcoidosis Background Clinical Features Diagnosis Treatment Eosinophilic Granulomatosis With Polyangiitis (Churg-Strauss Syndrome) Background Clinical Features Diagnosis Treatment Cocaine-Induced Midline Destructive Lesion Background Clinical Features Diagnosis Treatment Relapsing Polychondritis Background Clinical Features Diagnosis Treatment Extranodal NK/T-Cell Lymphoma Background Clinical Features Diagnosis Treatment Cholesterol Granuloma Mycobacteria Rhinoscleroma Actinomycosis Rhinosporidiosis Syphilis Blastomycosis Histoplasmosis References 52 Facial Pain Abstract Keywords Key Points Introduction Workup Differential Diagnosis Anatomic Pain Neuropathic Pain Summary References V Laryngology and Bronchoesophagology 53 Laryngeal and Pharyngeal Function Abstract Keywords Key Points Laryngeal Motion Applied Anatomy Laryngeal Function in Breathing Protection Cough Control of Ventilation Sensory Receptors Circulatory Reflexes Pharyngeal Function in Breathing Function in Speech Phonation Expiratory Force Vocal Fold Positioning Vibratory Capacity of the Vocal Folds Vocal Fold Shape Pitch Control Resonance Articulation Sensory Input to Speech Control Central Control of Speech References 54 Visual Documentation of the Larynx Abstract Keywords Key Points Videoendoscopy and Stroboscopy Endoscopy: Assessment Using Continuous Light Laryngeal Structure Arytenoid and Vocal Fold Motion Mucus Vascularity Supraglottal Activity Vocal Fold Edges Protocol Limitations Assessment With Stroboscopy Regularity Glottal Closure Phase Closure Vertical Closure Level Mucosal Pliability and Stiffness Symmetry Protocol Stroboscopy Systems Endoscopes Rigid Endoscopes Technique. Flexible Endoscopes Technique. Troubleshooting Medical Records Laryngeal High-Speed Videoendoscopy Equipment Assessment of Vocal Fold Vibration Limitations Applications Narrow-Band Imaging Emerging Technologies References 55 Voice Evaluation and Therapy Abstract Keywords Key Points Patient-Reported Outcome Instruments Perceptual Assessment Auditory Perceptual Assessment Visual Perceptual Assessment Tactile Perceptual Assessment Instrumental Assessment Respiratory Measures Source Measures Electroglottography Inverse Filtered Flow Aerodynamic Measures Intraoral Air Pressure Phonation Threshold Pressure Airflow Laryngeal Airway Resistance Maximum Phonation Time Measures of Velopharyngeal Function Acoustic Voice Measures Frequency Intensity Voice Range Profile Perturbation and Noise Measures Spectral and Cepstral Assessment Diagnostic Therapy Introduction to Therapy for Voice and Laryngeal Airway Disorders Therapy for Voice Disorders General Comments Supraglottal Vocal Tract Laryngeal Muscle Balance Coordination of Respiratory-Laryngeal Valving Breath Posture and Alignment Additional Considerations Therapy for Laryngeal Airway Disorders Chronic Cough Paradoxical Vocal Fold Motion Conclusions References 56 Neurologic Evaluation of the Larynx and Pharynx Abstract Keywords Key Points Normal Function Neurologic Examination of the Mouth, Larynx, and Pharynx Oral Cavity and Oropharyngeal Examination Flexible Laryngoscopy Ancillary Tests Rating Scales Acoustic Analysis Performance Measures and Investigations Aerodynamic Assessment Glottography Electromyography Cineradiography—Modified Barium Swallow Functional Endoscopic Evaluation of Swallowing and Sensory Testing Other Summary References 57 Neurologic Disorders of the Larynx Abstract Keywords Key Points Laryngologic Manifestations of Neurologic Diseases Hyperfunctional Disorders Dystonia Botulinum Toxin Therapy Pseudobulbar Palsy Myoclonus Essential Tremor Stuttering Muscle Tension Dysphonia Hypofunctional Disorders Central Causes of Vocal Fold Paresis Neuromuscular Junction Disorders Poliomyelitis Myopathies Medullary Disorders Parkinson Disease Multiple Sclerosis Psychogenic, Malingering, and Mixed Causes Vocal Fold Paresis References 58 The Professional Voice Abstract Keywords Key Points Anatomic Considerations Voice Production Laryngeal Stroboscopy Voice Analysis Acoustic Measures Spectrometry Electroglottography Aerodynamic Measures Perceptual Analysis Voice Outcomes Evaluation Medical History History of Present Illness Physical Examination Problems in Singers Extraesophageal Reflux Laryngeal Hygiene Vocal Misuse Laryngitis Anxiety Pulmonary Disease Vocal Fold Varices Performance Cancelation Management Medical Therapy Role of the Speech-Language Pathologist and Vocal Pedagogue Surgical Therapy Superficial Vocal Fold Lesions Cysts Vocal Fold Varix Office-Based Procedures Postoperative Care Related Surgical Procedures Conclusion References 59 Laser Surgery Abstract Keywords Key Points History of Lasers What Is a Laser? Control of the Surgical Laser Power Spot Size Exposure Time Pattern Generation Tissue Effects Laser Types and Applications Argon Lasers Argon Tunable Dye Laser Neodymium:Yttrium-Aluminum-Garnet Laser Carbon Dioxide Laser Potassium-Titanyl-Phosphate Laser 585-nm Pulsed Dye Laser Thulium: Yttrium-Aluminum-Garnet Laser Other Lasers Pulse Structure Continuous Wave Lasers Flashlamp-Pumped Pulsed Dye Lasers Q-Switched Laser Cavity-Dumped Lasers Mode-Locked Lasers Lasers in Skin Resurfacing Ablative Resurfacing Nonablative Resurfacing Fractional Resurfacing Safety Considerations Education Safety Protocol Eye Protection Skin Protection Smoke Evacuation Anesthetic Considerations and Risk of Intraoperative Fire Effectiveness of a Safety Protocol References 60 Benign Vocal Fold Mucosal Disorders Abstract Keywords Key Points Anatomy and Physiology Evaluation of the Patient: General Principles History Onset Patient’s Beliefs Regarding Causes Common Symptom Complexes Talkativeness Profile: Vocal Overdoer Syndrome Vocal Commitments Other Risk Factors Patient Perception of Severity and Vocal Aspirations and Consequent Motivation for Rehabilitation Vocal Capability Battery Office Examination of the Larynx Objective Measures of Vocal Output Direct Laryngoscopy and Biopsy General Management Options Hydration Sinonasal Management Management of Acid Reflux Laryngopharyngitis Acute Mucosal Swelling of Overuse Laryngeal Instillations for Mucosal Inflammation Systemic Medicines That May Affect the Larynx Voice Therapy Surgery Specific Benign Vocal Fold Mucosal Disorders Vocal Nodules Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Medical. Behavioral. Surgical. Capillary Ectasia Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Medical. Behavioral. Surgical. Vocal Fold Hemorrhage and a Unilateral (Hemorrhagic) Vocal Fold Polyp Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Treatment Medical. Behavioral. Surgical. Intracordal Cysts Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Treatment Medical. Behavioral. Surgery. Glottic Sulcus Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Medical. Behavioral. Surgical. Bilateral Diffuse Polyposis Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Medical. Behavioral. Surgical. Postoperative Dysphonia Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Medical. Behavioral. Surgical. Contact Ulcer or Granuloma Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Laryngeal Examination. Management Intubation Granuloma Epidemiology Pathophysiology and Pathology Diagnosis History. Vocal Capability Battery. Management Summary Saccular Disorders Etiology of Saccular Disorders: Laryngocele and Saccular Cysts Clinical Scenario Classification Diagnosis Treatment Summary Benign Mesenchymal Neoplasms Epithelial Tumors Recurrent Respiratory Papillomatosis Vascular Neoplasms Polypoid Granulation Tissue Laryngeal Hemangiomas Muscle Neoplasms Rhabdomyoma Neoplasms of Adipose Origin Lipoma Benign Neoplasms of Glandular Origin Benign Mixed Neoplasm Oncocytic Neoplasms of the Larynx Cartilaginous Neoplasms Chondroma Neoplasms of Neural Origin Granular Cell Neoplasms Neurofibroma Neurilemmoma Summary References 61 Acute and Chronic Laryngopharyngitis Abstract Keywords Key Points Why Does Laryngopharyngitis Matter? Acute Laryngopharyngitis Viral Etiologies of Acute Laryngopharyngitis Rhinovirus Influenza Virus Human Immunodeficiency Virus Other Viral Etiologies of Acute Laryngopharyngitis Bacterial Causes of Acute Laryngopharyngitis Group A β Hemolytic Streptococcus pyogenes Less Common Pathogens That Can Cause Acute Pharyngitis Acute Fungal Laryngopharyngitis Noninfectious Causes of Acute Laryngitis Phonotrauma Chronic Laryngopharyngitis Chronic Bacterial Laryngitis Chronic Fungal Laryngitis Chronic Mycobacterial Laryngitis Noninfectious Chronic Laryngitis Reflux Laryngitis Laryngitis Associated With Autoimmune Disease Laryngitis Associated With Systemic Inflammatory Disease Broad Concepts: the Larynx as a Complex Immunologic Organ Immune Anatomy Immune Tolerance References 62 Medialization Thyroplasty Abstract Keywords Key Points Historic Aspects Vocal Fold Medialization Management of Glottal Insufficiency Associated With Unilateral Vocal Fold Motion Impairment and Soft Tissue Deficits Patient Evaluation and Selection Vocal Fold Medialization by Injection Percutaneous Injection Transoral Injection Laryngoscopic Injection Medialization Thyroplasty Technique References 63 Arytenoid Adduction and Abduction Abstract Keywords Key Points Operative Technique for Arytenoid Adduction Anesthesia Surgical Approach to the Arytenoid Postoperative Care Arytenoid Abduction for Airway Obstruction Future Directions References 64 Laryngeal Reinnervation Abstract Keywords Key Points Introduction Physiologic and Anatomic Issues in Laryngeal Reinnervation Nerve Characteristics Muscle Characteristics Laryngeal Muscles Infrahyoid Muscles Effects of Denervation Restoration of Function Laryngeal Reinnervation Selective Reinnervation Nonselective Reinnervation Common Reinnervation Techniques Recurrent Laryngeal Nerve Anastomosis Neuromuscular Pedicle Reinnervation With the Neuromuscular Pedicle Laboratory Investigations Indications Bilateral Paralysis Unilateral Paralysis Technique Bilateral Paralysis Unilateral Paralysis Clinical Results Complications Future of Neuromuscular Pedicle Ansa Cervicalis–Recurrent Laryngeal Nerve Transfer Advantages of Ansa–Recurrent Laryngeal Nerve Transfer Disadvantage of Ansa–Recurrent Laryngeal Nerve Transfer Surgical Indications and Contraindications Surgical Technique of Ansa–Recurrent Laryngeal Nerve Transfer Clinical Results Complications Direct Nerve Implant References 65 Chronic Aspiration Abstract Keywords Key Points Etiology Symptoms Evaluation Nonsurgical Management Tracheotomy Vocal Cord Medialization Salivary Duct Ligation and Botulinum Toxin Surgery Ideal Surgical Procedure for Chronic Aspiration Laryngectomy Subperichondrial Cricoidectomy Partial Cricoidectomy Endolaryngeal Stents Epiglottic Flap Closure of the Larynx Vertical Laryngoplasty Glottic Closure Tracheoesophageal Diversion and Laryngotracheal Separation Summary References 66 Laryngeal and Esophageal Trauma Abstract Keywords Key Points Introduction Mechanisms of Injury Laryngeal Trauma External Laryngeal Trauma Incidence Etiology Diagnosis Pertinent Features in the Mechanism of Injury. Symptoms of Laryngeal Trauma. Examination and Initial Management. Use of Computed Tomography. Classification of Laryngeal Trauma. Managing Laryngeal Trauma Airway Management. Surgical Versus Nonsurgical Treatment Approaches. Conservative Management. Surgical Management. Diagnostic/Therapeutic Endoscopy. Open Laryngeal Repair. Endolaryngeal Stenting. Treatment of Vocal Cord Immobility. Arytenoid Dislocation. Management of Hyoid Bone Fracture. Management of Cricotracheal Separation. Partial/Total Laryngectomy. Postoperative Care. Sequelae of Laryngeal Trauma. Outcome of External Laryngeal Trauma. Special Considerations in Pediatric External Laryngeal Trauma. Iatrogenic Laryngeal Trauma Incidence Etiology Management Caustic/Thermal Laryngeal Trauma Incidence Etiology Management Sequelae of Caustic/Thermal Laryngeal Injuries Esophageal Trauma Traumatic Injuries Caustic Injuries References 67 Surgical Management of Upper Airway Stenosis Abstract Keywords Key Points Pathophysiology Classification of Stenosis Surgical Principles Goals and Assessment Timing of Intervention Endoscopic Repair Laser Microsurgical Debridement Local Application of Mitomycin C Surgical Planning for Open Repair Skeletal Framework Epithelium of the Lumen Patency of the Lumen Surgical Management of Chronic Stenosis Supraglottic Stenosis Anterior Glottic Stenosis Posterior Glottic Stenosis Complete Glottic Stenosis Subglottic Stenosis Cervical Tracheal Stenosis Cicatricial Membranous Stenosis Anterior Wall Collapse Complete Tracheal Stenosis Laryngeal Release Procedures Tracheal and Laryngotracheal Allotransplantation Procedures Conclusion References 68 Diseases of the Esophagus Abstract Keywords Key Points Esophageal Symptom Assessment Esophageal Testing Endoscopy Esophageal Manometry Ambulatory 24-Hour Esophageal pH Monitoring Ambulatory Wireless pH Testing Multichannel Intraluminal Impedance–pH Testing Ambulatory 24-Hour Bile Monitoring New Technologies Provocative Testing Esophageal Disease States Causing Dysphagia Esophageal Motility Abnormalities Achalasia Nonachalasia Motility Disorders Strictures Rings and Webs Eosinophilic Esophagitis Other Esophageal Disease States Gastroesophageal Reflux Disease Symptoms Diagnosis Treatment Extraesophageal Gastroesophageal Reflux Disease Laryngitis Asthma Chest Pain Chronic Cough Dental Erosion Barrett Esophagus Neoplasia Esophageal Diverticula Foreign Body Pill-Induced Injury Infectious Esophagitis Caustic Injury Esophageal Manifestations of Systemic Disease Cutaneous Diseases and the Esophagus References 69 Transnasal Esophagoscopy Abstract Keywords Key Points Comparison With Conventional Endoscopy Indications and Clinical Applications Patient Preparation Technique Common Findings Monitoring and Postprocedure Care Complications Conclusion References 70 Zenker Diverticulum Abstract Keywords Key Points Introduction Presentation Pathophysiology Management External Techniques History Procedure Endoscopic Techniques History Endoscopic Staple Diverticulotomy Recurrence Summary References 71 Tracheobronchial Endoscopy Abstract Keywords Key Points Indications Diagnostic Therapeutic Diagnostic Bronchoscopy General Approaches and Visual Examination Evaluation of Infiltrates/Consolidations Bronchial Wash/Bronchoalveolar Lavage. Endobronchial and Transbronchial Biopsy. Evaluation of Lung Nodules/Masses Radial Endobronchial Ultrasound. Navigational Bronchoscopy. Evaluation of Mediastinal Adenopathy Convex Endobronchial Ultrasound. Therapeutic Bronchoscopy Introduction and Historical Background Evaluation and Management of Central Airway Obstruction Therapeutic Modalities Foreign Body Removal. Dilation and Mechanical Debulking Balloon Dilation. Microdebridement. Stent Placement. Ablation Therapies Laser Therapy. Electrocautery. Argon Plasma Coagulation. Cryotherapy. Summary References VI Head and Neck Surgery and Oncology 1 General Considerations 72 Fundamentals of Molecular Biology and Gene Therapy Abstract Keywords Key Points Fundamentals of Molecular Biology Gene Expression Cell Division Gene Therapy Replacing Defective Genes Enhancing Gene Expression Suppressing Gene Expression Genome Editing Somatic Versus Germ Cell Gene Therapy Methods of Delivering Gene Therapy Direct Injection of Genetic Material DNA-Mediated Transfer of Therapeutic Genes Direct Delivery of RNA Viral-Mediated Gene Transfer Retroviruses Adenoviruses Adeno-Associated Virus Nanoparticle-Based Delivery Systems Strategies for Administering Gene Therapy Ex Vivo Gene Therapy In Vivo Gene Therapy Why Gene Therapy? New Therapeutic Approach Site-Specific Gene Expression Improved Efficacy and Safety Improved Routes of Administration and Compliance Preventive Medicine and a Reduction in Health Care Costs Applications of Somatic Gene Therapy in Otolaryngology Inherited Disease Head and Neck Oncology Immune Modulation Approaches Genetic Modification of Tumor-infiltrating Lymphocytes Direct In Vivo Stimulation of an Antitumor Immune Response Suicide Gene Therapy Gene Augmentation Strategies Modifying Oncogenes and Tumor Suppressor Genes Inhibiting Angiogenesis Gene Suppression Strategies Gene Silencing Oncolytic Viruses Conditionally Replicating Adenovirus Therapy Plastic and Reconstructive Surgery Reconstructive Tissue Flaps and Wound Healing Repair and Regeneration of Irradiated Tissue Applications in Laryngology Applications in Otology and Neurotology Conclusion References 73 Biology of Head and Neck Cancers Abstract Keywords Key Points Introduction Dysregulated Signaling Pathways Genomic Patterns Cell Cycle Pathway TP53 CDKN2A Mitogenic Pathway Epidermal Growth Factor Receptor Ras Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Phosphatase and Tensin Homolog Differentiation Cell Death Epigenetics DNA Methylation Histone Modification MicroRNAs Oncogenic microRNAs Tumor Suppressor microRNAs Tumor Microenvironment Cancer-Associated Fibroblast Extracellular Matrix Immune System Cells Interactions With the Immune System Conclusion References 74 Human Papillomavirus and the Epidemiology of Head and Neck Cancer Abstract Keywords Key Points Epidemiology of Oral Human Papillomavirus Infection Epidemiology of Human Papillomavirus-Positive Oropharyngeal Squamous Cell Cancers Incidence Site Clinical Characteristics Demographics Risk Factor Profile Treatment Considerations High-Risk Subgroups Epidermal Growth Factor Receptor Deintensification Strategies Surgery Immunotherapy Prevention of HPV-OPSCC Future Directions References 75 Radiotherapy for Head and Neck Cancer Abstract Keywords Key Points Basic Physics Characteristics of Radiation Radiation Production by Radioactive Decay Radiation Production From Linear Accelerators Interaction of X-Rays With Matter Coherent Scattering. Photoelectric Effect. Compton Effect. Pair Production. Photodisintegration. Deposition of Dose Deposition of Energy Radiation in Conventional Medicine Linear Accelerators Particle Beams Aspects of External Beam Radiation Treatment Planning Radiobiology Cell-Cycle Arrest Mitotic Death Radiosensitivity Cell Survival Tissue-Radiation Characterizations Clinical Applications Radiation Fractionation Altered Fractionation Schedules. Radiosensitizers Reducing Hypoxia. Concomitant Chemotherapy. Unresectable Tumors. Induction Chemotherapy. Organ Preservation. Postoperative Treatment. Targeted Therapy. Advanced Radiation Technologies Intensity-Modulated Radiotherapy Intensity-Modulated Radiotherapy in Head and Neck Cancer Defining the Target: Imaging Selection and Outlining of the Targets Target Definitions in the Head and Neck. Selection and Delineation of the Lymphatic Clinical Target Volumes. Planning Target Volumes. Optimization Process: Number and Directions of the Beams. Clinical Results Nasopharynx. Paranasal Sinuses. Oropharynx. Larynx and Hypopharynx. Proton Therapy Neutron and Carbon Ion Therapy Imaging-Guided Radiotherapy Tracking Anatomic Changes During Therapy Brachytherapy Radiation Side Effects Acute Side Effects Dermatitis Xerostomia Mucositis Late Toxicities Xerostomia Osteoradionecrosis Fibrosis Thyroid Dysfunction Vascular Complications Neurologic Complications References 76 Chemotherapy and Targeted Biologic Agents for Head and Neck Cancer Abstract Keywords Key Points Introduction Overview of Treatment Strategies in Squamous Cell Carcinoma of the Head and Neck Combined-Modality Therapy Laryngeal Trials and Concomitant Chemoradiation Concomitant Chemoradiation as Adjuvant Therapy Induction Chemotherapy Systemic Chemotherapy for Recurrent or Metastatic Disease Prognostic Factors Single Agents Combination Chemotherapy Targeted Therapy Advanced Nonmelanoma Skin Cancers (NMSC) and Use of Systemic Chemotherapy Summary Acknowledgement References 77 Skin Flap Physiology and Wound Healing Abstract Keywords Key Points Skin Flap Physiology Physics of Flow Critical Closing Pressure Flap Biomechanics Flap Anatomy and Physiology Zones of Perfusion Zone I Macrovascular System. Zone II Capillary System. Zone III Interstitial System. Zone IV Cellular System. Anatomy and Physiology of Skin Vascular Anatomy by Zone Zone I: Macrocirculatory System. Zone II: Capillary System. Zone III: Interstitial System. Zone IV: Cellular System. Factors Adversely Affecting Flap Physiology Impairment of Vascular Supply. Microcirculatory Changes. Reperfusion Injury. Recovery From Flap Elevation. Clinical Flap Design and Execution Vascular Anatomy Classification of Flaps Random Cutaneous Flaps. Arterial Cutaneous (Axial) Flaps. Fasciocutaneous Flaps. Musculocutaneous and Myocutaneous Flaps. Free Microvascular Flaps. Clinical Risk Factors That Affect Flap Viability Efforts to Optimize Flap Viability Delay Phenomenon Choice of Anesthetic Anesthesia Duration and Other Perioperative Factors Drug Treatment Tissue Expansion Hyperbaric Oxygen Flap Failure Monitoring Flaps Tissue Oxygenation. Temperature Monitoring. Near-Infrared Spectroscopy. Tissue Pressure. Laser Doppler Flowmeters. Biomarkers. Laser-Assisted Indocyanine Green Angiography Flap Salvage Vacuum-Assisted Closure. Wound Healing Phases of Wound Healing Inflammatory Phase Proliferation Phase Reepithelialization. Formation of Granulation Tissue. Angiogenesis. Wound Contraction. Remodeling Phase Failure of Wound Healing Advances and Future Direction in Wound Healing References 78 Free Tissue Transfer Abstract Keywords Key Points Introduction Historical Perspectives Indications for Free Tissue Transfer Donor Site Options Soft Tissue Flaps Muscle and Myocutaneous Flaps Vascularized Bone Flaps Osteocutaneous Fibula Flap Osteocutaneous Radial Forearm Flap Osteocutaneous Scapula Free Flap Iliac Crest Flap Dental Rehabilitation Other Flaps Patient Evaluation and Preparation History of Present Illness Physical Examination Medical History Laboratory and Radiologic Studies Surgical Treatment Planning Intraoperative Management Surgical Techniques Surgical Incisions Primary Recipient Site Surgery Neck Recipient Site Surgery Free Flap Harvest Free Flap Inset and Microvascular Anastomosis Drain Placement and Wound Closure Postoperative Management Pharmacology Aspirin Heparin Dextran Free Flap Monitoring Complications and Salvage Costs and Outcomes Future Directions in Free Tissue Transfer References 79 Integrating Palliative and Curative Care Strategies in the Practice of Otolaryngology Abstract Keywords Key Points Palliative Surgery Palliative Chemotherapy Palliative Radiation Therapy Acupuncture Medical Marijuana Palliation of Common Symptoms in Head and Neck Cancer Patients References 80 Management of Cutaneous Head and Neck Melanoma Abstract Keywords Key Points Introduction Epidemiology Etiology and Risk Factors Risk Factors Genetics Congenital Nevi Classification of Melanoma Desmoplastic Melanoma Unknown Primary Diagnostic Workup History Physical Examination Biopsy Metastatic Workup Prognostic Factors and Tumor Staging Summary of Revisions Classification/Localized Disease Nodal Classification/Regional Disease M Stage/Distant Metastasis Surgical Management of the Primary Tumor Wide Local Excision and Surgical Margins Closure and Reconstruction Surgical Management of Regional Lymph Nodes Therapeutic Lymph Node Dissection Sentinel Lymph Node Biopsy Surgical Management of Distant Metastasis Radiation Therapy Chemotherapy Systemic Therapy for Stage IV Melanoma Targeted Therapy Oncolytic Virotherapy Immunotherapy Adjuvant Systemic Therapy Adjuvant Interferon Adjuvant Ipilimumab Adjuvant Nivolumab Adjuvant Targeted Therapy Future Systemic Therapy Investigations Follow-Up/Surveillance References 2 Salivary Glands 81 Physiology of the Salivary Glands Abstract Keywords Key Points Principles of Salivary Gland Secretion Anatomy of the Secretory Unit Secretory Process Mechanisms of Primary Fluid Secretion Mechanisms of Primary Macromolecule Secretion Mechanisms of Ductal Secretion Neuronal Control of Secretion Neurotransmitters and Receptors. Signal Transduction G Proteins Adenylate Cyclase System Phospholipase C System Saliva Flow Rate of Saliva Composition of Saliva Inorganic Component Organic Components Functions of Saliva Lubrication and Protection Buffering and Clearance Maintenance of Tooth Integrity Antibacterial Activity Taste and Digestion Aging and Salivary Gland Dysfunction References 82 Diagnostic Imaging and Fine-Needle Aspiration of the Salivary Glands Abstract Keywords Key Points Anatomy Parotid Glands Submandibular Glands Sublingual Glands Minor Salivary Glands Diagnostic Evaluation Magnetic Resonance Imaging Computed Tomography Ultrasound Image-Guided Tissue Sampling Sialography Nuclear Imaging Conclusion References 83 Inflammatory Disorders of the Salivary Glands Key Points Sialolithiasis Chronic Sialadenitis Infections of the Salivary Glands Acute Suppurative (Bacterial) Sialadenitis Neonatal Suppurative Parotitis Recurrent Parotitis of Childhood Radioiodine-Induced Sialadenitis Viral Infections of the Salivary Glands Human Immunodeficiency Virus Mumps Granulomatous Infections of the Salivary Glands Tuberculous Mycobacterial Disease Nontuberculous Mycobacterial Disease Other Granulomatous Diseases Actinomycosis Cat-Scratch Disease Toxoplasmosis Parasitic Salivary Gland Infections Noninfectious Inflammatory Diseases of the Salivary Glands Sjögren Syndrome Sarcoidosis Kimura Disease Rosai-Dorfman Disease Summary References 84 Benign Neoplasms of the Salivary Glands Abstract Keywords Key Points Embryology Histogenesis of Salivary Gland Neoplasms Associated Factors Genetic Factors Radiation Other Environmental Factors Incidence Patient Evaluation Clinical Features Fine-Needle Aspiration Biopsy Imaging Computerized Tomography and Magnetic Resonance Imaging Ultrasonography Positron Emission Tomography Pleomorphic Adenomas Myoepitheliomas Basal Cell Adenomas Canalicular Adenomas Warthin Tumors Oncocytoma Sebaceous Adenoma Sialadenoma Papilliferum Sclerosing Polycystic Adenosis Other Epithelial Lesions Soft Tissue Lesions Hemangiomas Other Soft Tissue Lesions Sialoblastomas Management of Benign Salivary Gland Neoplasms Parotidectomy Submandibular Gland Excision Excision of Parapharyngeal Salivary Gland Tumors Complications Facial Nerve Paresis or Paralysis Sensory Abnormalities Gustatory Sweating: Frey Syndrome Salivary Fistula References 85 Malignant Neoplasms of the Salivary Glands Keywords Key Points Evaluation of the Patient Physical Examination Parotid Gland Submandibular Gland Sublingual Gland Minor Salivary Glands Radiologic Studies Biopsy Staging Histopathology Mucoepidermoid Carcinoma Adenoid Cystic Carcinoma Polymorphous Adenocarcinoma Acinic Cell Carcinoma Malignant Mixed Tumors Carcinoma Ex Pleomorphic Adenoma True Salivary Gland Malignant Mixed Tumor (Carcinosarcoma) Metastasizing Pleomorphic Adenoma Salivary Duct Carcinoma Primary Squamous Cell Carcinoma Primary Small Cell Carcinoma Other Malignant Tumors Metastases Lymphoma Pediatric Salivary Gland Tumors Prognostic Variables Clinical Variables Histologic Variables Molecular Markers Treatment Surgery Parotidectomy Submandibular Gland Excision Sublingual Gland Excision Minor Salivary Glands Management of the Node-Negative Neck Management of the Node-Positive Neck Radiation Therapy Adjuvant Radiation Therapy Radiation of the Neck Intensity-Modulated Radiation Therapy Definitive Radiation Therapy Neutron Beam Radiotherapy Heavy Ion Radiotherapy Chemotherapy Chemotherapy Alone Concurrent Chemoradiation References 3 Oral Cavity 86 Physiology of the Oral Cavity Abstract Key Points Sensory Function Oral Somesthesia Common Chemical Sense Dental Pain Central Projections of the Trigeminal System Motor Function Muscles of Mastication and Reflex Control Lingual Muscles and Reflexes Jaw-Tongue Reflexes Autonomic Reflexes Mastication Oral Phase of Deglutition Specialized Sensory Systems: Taste Gustatory Sensitivity Gustatory Structures Gustatory Physiology Gustatory Transduction Peripheral Sensitivity Regional Differences Individual Differences Central Gustatory Pathways and Function Interaction Between Saliva and Taste References 87 Oral Mucosal Lesions Key Points Red/White Lesions Leukoedema Definition Etiology and Pathogenesis Clinical Features Histopathologic Features Management Oral Leukoplakia Definition Epidemiology and Etiology Clinical Features Histopathologic Features Treatment Oral Hairy Leukoplakia Oral Lichen Planus Clinical Features Clinical Differential Diagnosis Association With Systemic Diseases Histopathologic Features Treatment Relationship to Oral Squamous Cell Carcinoma Submucous Fibrosis Definition Etiology and Pathogenesis Clinical Features Histologic and Diagnostic Features Treatment Verruciform Xanthoma Definition Etiology and Pathogenesis Clinical Features Histopathologic and Diagnostic Features Treatment Candidiasis Definition Etiology and Pathogenesis Clinical Features Differential Diagnosis Histopathologic and Diagnostic Features Treatment Vesiculobullous and Ulcerative Lesions Pemphigus Vulgaris Definition Etiology and Pathogenesis Clinical Presentation Clinical Differential Diagnosis Histopathologic Features Treatment Mucous Membrane (Cicatricial) Pemphigoid Definition Etiology and Pathogenesis Clinical Features Clinical Differential Diagnosis Histopathologic Features Treatment Herpes Simplex Virus Primary Herpes Simplex Infection Definition. Etiology and Pathogenesis. Clinical Features. Differential Diagnosis. Diagnosis. Treatment. Recurrent Herpes Simplex Infection Definition. Etiology and Pathogenesis. Clinical Features. Differential Diagnosis. Histopathology. Treatment. Recurrent Aphthous Stomatitis Definition Etiology and Pathogenesis Clinical Features Differential Diagnosis Histopathologic Features Treatment Erythema Multiforme Definition Etiology and Pathogenesis Clinical Features Differential Diagnosis Histopathologic Features Treatment Traumatic (Eosinophilic) Granuloma Definition Etiology Clinical Features Differential Diagnosis Histopathologic Features Treatment Pigmented Lesions Melanotic Macules Definition Etiology and Pathogenesis Clinical Features Mucosal Melanotic Macule. Mucosal Melanocytic Nevi. Melanoma Differential Diagnosis Histopathologic Features Treatment Amalgam Tattoo Definition Etiology Clinical Features Differential Diagnosis Histopathologic Features Treatment References 88 Odontogenesis, Odontogenic Cysts, and Odontogenic Tumors Abstract Keywords Key Points Introduction Background Root Development Summary Odontogenic Cysts Classification Pathogenesis Periapical Cyst (Radicular Cyst and Periradicular Cyst) Radiographic Features Microscopic Features Treatment Lateralized Radicular Cyst (Lateral Radicular Cyst and Lateral Periapical Cyst) Residual Cyst Inflammatory Collateral Cyst Dentigerous Cyst (Follicular Cyst) Radiographic Features Microscopic Features Neoplastic Potential Treatment Eruption Cyst Treatment Paradental Cyst Radiographic Features Odontogenic Cyst of Undetermined Origin Definition of the Odontogenic Cyst of Undetermined Origin Lateral Periodontal Cyst Radiographic Features Microscopic Features Treatment Botryoid Odontogenic Cyst Radiographic Features Treatment Gingival Cyst of the Adult Clinical Features Radiographic Features Gingival Cyst of the Newborn (Dental Lamina Cyst, Alveolar Cyst of the Newborn) Microscopic Features Treatment Orthokeratinized Odontogenic Cyst (Keratinizing Odontogenic Cyst, Orthokeratinizing Odontogenic Cyst, Orthokeratinizing Odontogenic Keratocyst) Radiographic Features Microscopic Features Glandular Odontogenic Cyst (Sialo-Odontogenic Cyst) Clinical Features Radiographic Features Microscopic Features Treatment Conclusion: Odontogenic Cysts Malignant Odontogenic Tumors and Malignancies Arising in Odontogenic Cysts or Tumors Microscopic Features Treatment Odontogenic Tumors Unicystic Ameloblastoma Radiographic Features Microscopic Features Definitions, Clarifications, and Treatment Recommendations Simple Unicystic Ameloblastoma Ameloblastoma: Intraosseous Type Definition Radiographic Findings Microscopic Features Natural History and Treatment Management of Mandibular Ameloblastomas Management of Maxillary Ameloblastomas Summary Peripheral Ameloblastoma (Extraosseous Ameloblastoma) Malignant Ameloblastoma Ameloblastic Carcinoma Ameloblastic Fibroma Radiographic Features Microscopic Findings Treatment Ameloblastic Fibro-Odontoma Radiographic Findings Microscopic Findings Treatment Keratocystic Odontogenic Tumor (Odontogenic Keratocyst, Parakeratinizing Odontogenic Keratocyst) Radiographic Features Microscopic Features Treatment Basal Cell Nevus Syndrome (Gorlin Syndrome, Gorlin-Goltz Syndrome, Nevoid Basal Cell Carcinoma Syndrome) Treatment Calcifying Cystic Odontogenic Tumor (Calcifying Odontogenic Cyst, Gorlin Cyst) Radiographic Features Microscopic Features Treatment Dentinogenic Ghost Cell Tumor (Epithelial Odontogenic Ghost Cell Tumor, Odontogenic Ghost Cell Tumor) Calcifying Epithelial Odontogenic Tumor (Pindborg Tumor) Radiographic Findings Microscopic Findings Treatment Odontogenic Myxoma Radiographic Findings Microscopic Findings Treatment and Prognosis Adenomatoid Odontogenic Tumor Radiographic Features Microscopic Features Treatment Odontomas Radiographic Findings Microscopic Findings Treatment Squamous Odontogenic Tumor Odontoameloblastoma References 89 Temporomandibular Joint Disorders Key Points Anatomy Diseases and Disorders Congenital and Developmental Anomalies Trauma Dislocation Neoplasms Intracapsular Disorders Anterior Disk Displacement With Reduction Anterior Disk Displacement Without Reduction Degenerative Joint Disease Ankylosis Temporomandibular Joint Surgery Arthrocentesis Arthroscopy Arthrotomy Myofascial Pain Dysfunction Syndrome Treatment Summary References 90 Benign Tumors and Tumor-Like Lesions of the Oral Cavity Abstract Keywords Key Points Congenital Conditions Torus Lingual Thyroid Developmental Cysts Inflammatory/Traumatic Conditions Fibroma Mucosal Ulcerations Pyogenic Granuloma Necrotizing Sialometaplasia Amyloidosis Benign Neoplasms Papilloma Granular Cell Tumor Neurofibroma Lipoma Hemangioma Ameloblastoma Pleomorphic Adenoma References 91 Malignant Neoplasms of the Oral Cavity Abstract Keywords Key Points Risk Factors Molecular Biology Anatomy of the Oral Cavity Arteriovenous Anatomy Subsites of the Oral Cavity Lips Alveolar Ridge Oral Tongue Retromolar Trigone Floor of the Mouth Buccal Mucosa Hard Palate Pathology Premalignant Lesions Squamous Cell Carcinoma and Squamous Cell Carcinoma Variants Other Pathologies Diagnostic Evaluation Screening History and Physical Examination Preoperative Assessment Preoperative Interventions Staging Prognostic Metrics Second Primary Tumors Treatment Considerations Surgical Treatment of the Primary Lesion Lip Alveolar Ridge Oral Tongue Retromolar Trigone Floor of the Mouth Buccal Mucosa Hard Palate Surgical Treatment of the Mandible Surgical Treatment of the Neck Reconstruction Indications for Free Flap Reconstruction Radiation Role of External Beam Radiation Package Time Reirradiation for Recurrence Chemotherapy Additional Therapies Photodynamic Therapy Chemoprevention Long-Term Management and Rehabilitation Speech and Swallowing Pain Management Palliative Care Follow-Up Complications Recurrence and Salvage Surgery Summary References 92 Reconstruction of the Mandible Abstract Keywords Key Points Introduction Anatomy Goals of Mandibular Reconstruction Reconstructive Options Bone Containing Free Flap Options Fibular Free Flap Planning Formation of the NeoMandible Advanced Technologically Driven Techniques in Mandibular Reconstruction Surgical Design and Simulation in Mandibular Reconstruction Occlusion Reconstruction Bone-Driven Mandibular and Occlusal Reconstruction. Bone-Driven Reconstruction with Delayed Installation of Osseointegrated Implants. Bone-Driven Reconstruction with Immediate Installation of Osseointegrated Implants. Occlusion-Driven Mandibular and Occlusal Reconstruction. Occlusion-Driven Reconstruction with Delayed Installation of Osseointegrated Implants. Occlusion-Driven Reconstruction with a Prefabricated Fibular Flap. Occlusion-Driven Reconstruction with Immediate Installation of Osseointegrated Implants. Outcomes Complications Summary References 93 Prosthetic Management of Head and Neck Defects Abstract Keywords Key Points Maxillofacial Prosthetics and the Radiation Oncology Patient Dental Diagnoses and Oral Surgical Management Preceding Radiation Therapy Prosthodontic Support of the Radiation Oncologist Dental Management During Radiation Therapy Dental Management After Radiation Therapy Overview of Maxillofacial Prosthodontic and Radiation Oncology Interactions Prosthetic Management of Oral Deficits Prosthetic Maxillary Obturation Surgical Obturation Interim Obturation Definitive Obturation Maxillary Reconstruction With Microvascular Grafting Mandibular Resection Prostheses Discontinuity Defects Contemporary Planning of Mandibular Defects Tongue Resection Soft Palate Resection Prosthetic Management of Anatomic Facial Deficits Illustrations Exemplifying the Stepwise Process by Which a Nasal Prosthesis Is Constructed Illustrations Exemplifying the Stepwise Process by Which an Auricular Prosthesis Implant Guide Is Constructed Illustrations Exemplifying the Stepwise Process by Which an Auricular Prosthesis Is Constructed Illustrations Exemplifying the Stepwise Process by Which an Orbital Prosthesis Is Constructed References 94 Malignancies of the Paranasal Sinus Abstract Keywords Key Points Introduction Epidemiology Pathology Squamous Cell Carcinoma Adenocarcinoma Adenoid Cystic Carcinoma Esthesioneuroblastoma Sinonasal Undifferentiated Neoplasm Mucosal Melanoma Rhabdomyosarcoma Genomics of Paranasal Sinus Cancers Presentation and Diagnosis Symptoms and Physical Findings Imaging Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography/Computed Tomography Biopsy Staging Management Surgery Contraindications to Surgery Radiation Chemotherapy Surgical Approaches Open Approaches Caldwell-Luc Incision Lateral Rhinotomy and Variations Medial Maxillectomy Subtotal Maxillectomy and Total Maxillectomy Total Maxillectomy With Orbital Exenteration Anterior Craniofacial Resection Reconstruction Complications Outcomes and Predictors of Outcome Open Approaches Endoscopic Endonasal Sinonasal Cancer Surgery Endoscopic Partial or Medial Maxillectomy Endoscopic Transcribriform Cranial Base Resection Coronal Plane Resections Into the Pterygopalatine or Infratemporal Fossa Orbital Extensions Limits and Contraindications of Endoscopic Sinonasal Cancer Resections Endoscopic Endonasal Reconstruction Endoscopic Surgery Outcomes Conclusion Acknowledgment References 4 Pharynx and Esophagus 95 Benign and Malignant Tumors of the Nasopharynx Abstract Keywords Key Points Diagnostic Approach for Nasopharyngeal Masses Thornwaldt Cyst or Bursa Squamous Papilloma Craniopharyngioma Angiofibroma Growth Patterns Pathologic Features Clinical Features Diagnosis Staging Management Chordoma Adenoid Cystic Carcinoma of the Nasopharynx Nasopharyngeal Carcinoma Epidemiology Etiology Genetic Factors and Nasopharyngeal Carcinoma Family Clusters. Human Leukocyte Antigen Associations. Chromosomal and Genetic Changes. Environmental Factors and Nasopharyngeal Carcinoma Epstein-Barr Virus and Nasopharyngeal Carcinoma Screening for Nasopharyngeal Carcinoma. Clinical Presentation Diagnosis of Nasopharyngeal Carcinoma Histologic Classification of Nasopharyngeal Carcinoma Staging of Nasopharyngeal Carcinoma Computed Tomography and Magnetic Resonance Imaging. Other Staging Investigations. Other Investigations. Treatment of Nasopharyngeal Carcinoma Pretreatment Planning. Radiation. Chemotherapy. Surgery Surgical Treatment of Nasopharyngeal Carcinoma Local Recurrences. Endoscopic and Robotic Approach. Lateral Rhinotomy and Medial Maxillectomy Approach. The Maxillary Swing. Other Surgical Approaches. Surgical Treatment of Regional Recurrences. Prognosis References 96 Malignant Neoplasms of the Oropharynx Abstract Keywords Key Points Anatomy of the Oropharynx Soft Palate Tonsillar Fossae Base of Tongue Posterior Oropharyngeal Wall Lymphatics Pathology Epithelial Precursor Lesions Squamous Cell Carcinoma Lymphoepithelial Carcinoma Salivary Gland Tumors Soft Tissue Tumors Hematolymphoid Tumors Mucosal Malignant Melanoma Squamous Cell Carcinoma Etiology Molecular Biology Clinical Presentation and Patterns of Spread Diagnostic Evaluation Anamnesis Physical Examination Imaging Endoscopy, Biopsy, and Frozen Section Testing for Human Papillomavirus or p16 Staging Therapeutic Management and Outcome Soft Palate Tonsillar Fossae Base of Tongue Posterior Oropharyngeal Wall Surgical Approaches Transoral Approach Transoral Laser Microsurgery Technique. Transoral Robotic Surgery Lateral and Transhyoid Pharyngotomy Mandibular Swing Approach Postoperative Care and Follow-Up Complications Prognostic Factors Unknown Primary Function and Quality of Life Special Treatment Considerations and Future Directions References 97 Transoral Approaches to Malignant Neoplasms of the Oropharynx Abstract Keywords Key Points Anatomy Palatine Tonsils Base of Tongue Soft Palate Posterior Pharyngeal Wall Historical Perspective Transoral Case Selection Physiologic Considerations Anatomic Considerations Tumor Factors Anesthetic Considerations Transoral Equipment Mouth Prop (Must Be Used in Conjunction With Something to Displace the Tongue to Gain Access to the Oropharynx) Tongue Retractors Mouth Gag/Retractor Laryngoscopes Surgical Instruments Robotic Instruments Illumination and Visualization Cutting and Ablation Surgical Robots Transoral Surgical Approach Direct Transoral Resection Transoral Laser Microsurgery Transoral Robotic Surgery Transoral Surgical Procedures Unknown Primary Palatine Tonsillectomy Lateral Oropharyngectomy (See Transoral Lateral Oropharyngectomy Video 97.1) Soft Palate Resection Posterior Oropharyngectomy Base-of-Tongue Resection (See Base-of-Tongue Transoral Resection Video 97.2) Neck Dissection Transoral Oropharyngeal Reconstruction Healing by Secondary Intention or Primary Closure Skin Grafts, Biologic Dressings, or Local Mucosal Flaps Local and Regional Pedicled Flaps Large Regional Pedicled Flaps and Free Flaps Margin Analysis Postoperative Care Airway Drain Management, Antibiotics, and Oral Hygiene Diet and Nutrition Pain, Ambulation, and Anxiety Anticoagulation Functional Outcomes Complications Postoperative Bleeding Neck Abscess Dental Injury and Oral Paresthesias Velopharyngeal Insufficiency and Rhinolalia Delayed Pharyngeal Healing Pneumonia Future Research, Goals, and Applications Future Horizons for TORS Conclusion References 98 Reconstruction of the Oropharynx Abstract Keywords Key Points Options for Reconstruction Healing by Secondary Intention, Primary Closure, and Grafts Local Flaps Regional Flaps Free Tissue Transfer Fasciocutaneous Flaps Visceral Tissue Free Flaps Musculocutaneous Flaps Osteocutaneous Flaps Site-Specific Defects Soft Palate Tonsil and Pharyngeal Wall Tongue Base Reconstruction After Transoral Oropharyngeal Resection Conclusions References 99 Swallowing Function and Implications in Head and Neck Cancer Abstract Keywords Key Points Introduction Oral Preparatory Phase Oral Phase Pharyngeal Phase Neuromuscular Activities Characteristic of the Pharyngeal Swallow Pharyngeal Pressure Generation: Tongue-Base Retraction and Pharyngeal Contraction Airway Protection Cricopharyngeal (Upper Esophageal Sphincter) Opening Signs and Symptoms of Abnormal Swallow Associated With Head and Neck Cancer Impaired/Inefficient Swallowing (Dysphagia) Laryngeal Penetration and Aspiration Evaluation of Swallowing Disorders Screening for Swallowing Disorders Evaluation of Swallowing Clinical Swallow Examination Videofluoroscopy Swallow Study Flexible Endoscopic Evaluation of Swallowing Manometry Ultrasonography Swallowing Disorders Arising From Head and Neck Cancer Treatment Radiotherapy Chemoradiation and Other Systemic Therapy Surgical Treatment Anatomic Considerations Oral Cavity/Tongue Oropharynx/Pharynx Larynx/Hypopharynx Posttreatment Complications Summary References 100 Diagnostic Imaging of the Pharynx and Esophagus Abstract Keywords Key Points Techniques Conventional Radiography Fluoroscopy Traditional Pharyngoesophagogram Modified Barium Swallow Evolution of the Esophagogram Oral Contrast Agents Computed Tomography Magnetic Resonance Imaging Ultrasound Positron Emission Tomography-Computed Tomography Other Nuclear Medicine Radiologic Anatomy Pharynx Esophagus Motility Disorders Pharynx Abnormal Deglutition Cricopharyngeal Dysfunction Esophagus Diminished Peristalsis Connective Tissue Diseases Esophageal Spasm Gastroesophageal Reflux Disease Diverticula Zenker Diverticulum Pharyngeal Pouches Laryngoceles Midesophageal Diverticula Infection and Inflammation Reflux Esophagitis Infectious Esophagitis Caustic Esophagitis Granulomatous Esophagitides Other Esophagitides Supraglottitis Abscess Esophageal Narrowing Webs Strictures Extrinsic Compression Fistulae Tracheoesophageal Fistula Branchial Cleft Anomaly Perforation Other Fistulae Varices Foreign Body Mass Lesions Malignant Neoplasms Nasopharynx Oropharynx Hypopharynx Esophagus Lymph Nodes Benign Neoplasms Nonneoplastic Mucosal Masses Posttreatment Imaging Postoperative Leaks Total Laryngectomy Laryngopharyngectomy Radiation Therapy Monitoring and Surveillance References 101 Neoplasms of the Hypopharynx and Cervical Esophagus Abstract Keywords Key Points Anatomy of the Hypopharynx and Cervical Esophagus Epidemiology Etiology and Biology Clinical Evaluation Patient Symptoms Physical Findings Imaging Pathology Location of Tumors and Patterns of Spread Staging Management Available Modalities for Management of Hypopharyngeal Squamous Cell Carcinoma Available Modalities for Management of Cervical Esophageal Squamous Cell Carcinoma Therapeutic Modalities Early Surgical Techniques Modern Surgical Approaches Partial Pharyngectomy. Partial Laryngopharyngectomy. Supracricoid Hemilaryngopharyngectomy. Open Approach Surgical Outcomes Transoral Endoscopic Carbon-Dioxide Laser Resection. Transoral Robotic Surgery. Total Laryngectomy With Partial or Total Pharyngectomy. Total Pharyngolaryngoesophagectomy. Radiation Therapy Chemotherapy Concomitant Chemoradiotherapy Management of the Neck Quality of Life Summary References 102 Radiotherapy and Chemotherapy of Squamous Cell Carcinomas of the Hypopharynx and Esophagus Abstract Keywords Key Points Introduction Hypopharyngeal Cancer: General Principles Treatment of Early-Stage Hypopharyngeal Squamous Cell Carcinoma Historical Treatment of Advanced Hypopharyngeal Squamous Cell Carcinoma Chemotherapy in Surgically Treated Hypopharyngeal Squamous Cell Carcinoma Larynx-Preserving Treatment Strategies Sequencing of Chemotherapy for Advanced Hypopharyngeal Squamous Cell Carcinoma Role of Altered Fractionation in Radiotherapy for Advanced Hypopharyngeal SCC Radiotherapy Techniques for Hypopharyngeal Squamous Cell Carcinoma Immune Checkpoint Inhibitors Esophageal Cancer: General Principles Treatment of Early-Stage Esophageal Squamous Cell Carcinoma Treatment of Locoregionally Advanced Esophageal SCC Preoperative Therapy Nonsurgical Treatment in Inoperable Patients Nonsurgical Treatment in Operative Patients Chemotherapeutic Regimens for Locoregionally Advanced Esophageal SCC Treatment of Locoregionally Advanced Cervical Esophageal SCC References 103 Reconstruction of the Hypopharynx and Esophagus Abstract Keywords Key Points Patient Population at Presentation Perioperative Counseling Preoperative Evaluation Goals and Principles of Reconstruction Defect Classification Reconstructive Decision Making Local and Regional Skin Flaps Myocutaneous Flaps Visceral Transposition Gastric Transposition Colonic Transposition Revascularized Free Tissue Transplantation Fasciocutaneous Transplantation Radial Forearm Donor Site Anterolateral Thigh Donor Site Other Fasciocutaneous Donor Sites Enteric Transplantation Jejunal Donor Site Gastroomental Donor Site Management of Postsurgical Complications Voice Rehabilitation Posttreatment Speech and Swallowing Outcomes Summary Acknowledgments References 5 Larynx 104 Diagnostic Imaging of the Larynx Abstract Keywords Key Points Normal Airway Technique Anatomy Inflammatory Disease of the Larynx Epiglottitis Croup Retropharyngeal Abscess Laryngomalacia Vocal Cord Paralysis Benign Laryngeal Masses Laryngeal Carcinoma Technique Normal Anatomy Glottic Tumors Subglottic Tumors Supraglottic Tumors Transglottic Tumors Lymph Nodes Posttherapy Larynx Laryngeal Trauma Foreign Bodies References 105 Malignant Tumors of the Larynx Abstract Keywords Key Points Anatomy and Embryology Embryology Anatomy Transglottic Cancer Anterior Commissure Classification of Malignant Tumors of the Larynx Staging Precursor Laryngeal Lesions: Dysplasia Treatment of Precursor Lesions In-Office Treatment of Premalignant Lesions Squamous Cell Carcinoma of the Larynx Epidemiology Risk Factors Tobacco and Alcohol Laryngopharyngeal Reflux Other Toxins Human Papillomavirus Genetic Susceptibility Diet Second Primary Tumors Molecular Biology Pathology Clinical Presentation Cervical Nodal Metastases Distant Metastases Diagnosis and Evaluation History and Physical Examination Imaging Operative Endoscopic Examination Differential Diagnosis Treatment of Squamous Cell Carcinoma Treatment of Glottic Squamous Cell Carcinoma Treatment of the Early Primary Tumor in Glottic Squamous Cell Carcinoma Early Glottic Squamous Cell Carcinoma and the Anterior Commissure Treatment of the Advanced Primary Tumor in Glottic Squamous Cell Carcinoma Treatment of the Neck in Glottic Squamous Cell Carcinoma Treatment of Supraglottic Squamous Cell Carcinoma Treatment of the Early Primary Tumor in Supraglottic Squamous Cell Carcinoma Treatment of the Advanced Primary Tumor in Supraglottic Squamous Cell Carcinoma Treatment of the Neck in Supraglottic Squamous Cell Carcinoma Subglottic Squamous Cell Carcinoma Nonsurgical Treatment of Advanced Laryngeal Cancer (Organ Preservation) Management of the Neck After Nonsurgical Treatment of Advanced Laryngeal Cancer (Organ Preservation) Treatment of Recurrent or Residual Squamous Cell Carcinoma Stomal Recurrence Prognosis and Prognostic Predictors Disease Factors Clinical Features Radiologic Characteristics Histopathologic Characteristics Patient Factors Molecular Markers of Prognosis Follow-Up Survivorship Variants of Squamous Cell Carcinoma Verrucous Carcinoma Basaloid Squamous Cell Carcinoma Spindle Cell Carcinoma Adenosquamous Carcinoma Acantholytic Squamous Cell Carcinoma Papillary Squamous Cell Carcinoma Lymphoepithelial Carcinoma Clear Cell Carcinoma Nuclear Protein in Testis Midline Carcinoma Nonsquamous Malignant Laryngeal Tumors Neuroendocrine Tumors Typical Carcinoid Atypical Carcinoid Small-Cell Carcinoma, Neuroendocrine Type Large-Cell Neuroendocrine Carcinoma Paraganglioma Malignant Salivary Gland–Type Tumors Mucoepidermoid Carcinoma Adenoid Cystic Carcinoma Malignant Tumors of Soft Tissue, Bone, and Cartilage (Sarcomas) Chondrosarcoma Malignant Fibrous Histiocytoma Liposarcoma Malignant Hematolymphoid Neoplasms Extramedullary Plasmacytoma Lymphoma Mucosal Malignant Melanoma of the Larynx Neoplasms of Uncertain Behavior Secondary Tumors of the Larynx Laryngeal Involvement by Tumors From Contiguous Sites Metastases to the Larynx References 106 Management of Early Glottic Cancer Abstract Keywords Key Points Background Definitions: Early Glottic Cancer and Precursor Lesions Diagnosis Endoscopic Imaging Radiology, Bronchoscopy, Esophagoscopy Chest X-Ray, Chest Computed Tomography Magnetic Resonance Imaging and Computed Tomography Positron Emission Tomography Background Etiology Staging Incidence and Survival Treatment Surgery Endoscopic Excision Biopsy Ablative Treatment Photoangiolytic Therapy. Photodynamic Therapy. Laser Excision Open Partial Laryngectomy Voice Considerations Radiotherapy Chemotherapy Follow-up After Treatment Choosing a Treatment Modality Carcinoma in Situ Invasive Squamous Cell Carcinoma Summary References 107 Transoral Laser Microresection of Advanced Laryngeal Tumors Abstract Keywords Key Points Terms and Definitions Five Types of Local Laryngeal Cancer Acronyms Laser Surgery and Transoral Laser Microsurgery in the Treatment of Locally Early, Intermediate, and Advanced Cancers Theoretic Basis of Transoral Laser Microsurgery Transoral Laser Microsurgery Compared With Open Conservation Surgery Instrumentation and Techniques of Transoral Laser Microsurgery Instruments Techniques Evolution of Potassium Titanyl Phosphate Laser Microsurgery Pathology Issues Transoral Laser Microsurgery in Relation to Each of the Five Clinical Categories of Laryngeal Cancer Stratified by Local Extent Very Early Laryngeal Cancer Early Laryngeal Cancer Intermediate Laryngeal Cancer Advanced Laryngeal Cancer Very Advanced Laryngeal Cancer Total Laser Microresection and Neck Dissection Total Laser Microresection and Recurrent Disease Voice Outcomes and Phonosurgical Reconstruction Superficial Lamina Propria Vocal Ligament Paraglottic Musculature Broyles Ligament Voice Therapy Complications of Transoral Laser Microresection Contraindications to Transoral Laser Microresection Results of Transoral Laser Microresection Göttingen Group Results Conclusions Future Directions Appendix on the Clinical Classification Used in This Chapter References 108 Conservation Laryngeal Surgery Abstract Keywords Key Points Conservation Laryngeal Surgery Today Anatomy, Physiology, and Tumor Spread Principles of Organ-Preservation Surgery First Principle: Local Control Second Principle: Accurate Assessment of the Three-Dimensional Extent of Tumor Third Principle: The Cricoarytenoid Unit Is the Basic Functional Unit of the Larynx Fourth Principle: Resection of Normal Tissue to Achieve an Expected Functional Outcome Preoperative Evaluation Clinical Evaluation of the Primary Site Radiologic Evaluation of the Primary Site Tumor Stage Overall Clinical Assessment Surgical Techniques Indications and Contraindications Conservation Laryngeal Surgery for Lesions That Originate in the Glottic Level Vertical Partial Laryngectomies Vertical Hemilaryngectomy Oncologic Results. Surgical Technique. Extended Procedures. Frontolateral Vertical Hemilaryngectomy. Posterolateral Vertical Hemilaryngectomy. Extended Vertical Hemilaryngectomy. Functional Outcome. Key Surgical Points Complications. Epiglottic Laryngoplasty Oncologic Results. Surgical Technique. Key Surgical Points Extended Procedures. Functional Outcome. Complications. Horizontal Partial Laryngectomies Supracricoid Partial Laryngectomy With Cricohyoidoepiglottopexy Oncologic Results. Surgical Technique. Key Surgical Points Extended Procedures. Functional Outcome. Complications. Conservation Laryngeal Surgery for Lesions That Originate in the Supraglottic Level Horizontal Partial Laryngectomies Supraglottic Laryngectomy Oncologic Results. Surgical Technique. Key Surgical Points Extended Procedures. Arytenoid, Aryepiglottic Fold, or Superior Medial Piriform Involvement From Supraglottic Carcinoma. Base-of-Tongue Extension From Supraglottic Carcinoma. Functional Outcome. Complications. Supracricoid Laryngectomy With Cricohyoidopexy Surgical Technique. Key Surgical Points. Extended Procedures. Functional Outcome. Complications. Organ-Preservation Surgery Spectrum for Glottic and Supraglottic Cancer Intraoperative Conversion to Total Laryngectomy Current Organ Preservation Paradigm for Laryngeal Cancer Conservation Laryngeal Surgery and Radiotherapy Postoperative Management Issues Future Developments Summary References 109 Total Laryngectomy and Laryngopharyngectomy Abstract Keywords Key Points Total Laryngectomy Historic Development Indications for Total Laryngectomy Malignant Disease Patient Selection and Workup Preoperative Preparation Surgical Technique (Video 109.1) Resection Incision Design and Stoma Planning. Exposure of Larynx and Neck Dissections. Skeletonization of the Laryngeal Framework. Entry Into the Larynx and Initial Tumor Cuts. Completion of Tumor Resection. Primary Tracheoesophageal Puncture (Optional). Common Modifications of Resection. Repair and Reconstruction Pharyngoplasty. Tracheal Stoma (Cervical Tracheoplasty) Long-Flap Approach. Short-Flap Approach. Sternocleidomastoid Muscle Flaps (Optional). Postoperative Management and Complications Early Complications Drain Failure. Hematoma. Infection. Pharyngocutaneous Fistula. Wound Dehiscence. Late Complications Stomal Stenosis. Pharyngoesophageal Stenosis and Stricture. Hypothyroidism. Rehabilitation Swallowing. Voice Electromechanical Devices. Esophageal Speech. Tracheoesophageal Speech. Artificial Larynx. Total Laryngopharyngectomy Historic Development Indications Piriform Sinus Carcinoma Carcinoma of the Posterior Hypopharyngeal Wall Postcricoid Carcinoma Patient Selection and Workup Surgical Technique Resection Reconstruction Postoperative Management and Complications Postoperative Management Early Complications Late Complications Stricture. Functional Swallowing Problems. Rehabilitation Voice Airway Summary References 110 Radiation Therapy for Cancer of the Larynx and Hypopharynx Abstract Keywords Key Points Overall Synopsis Epidemiology and Etiology Treatment Options Early-Stage Disease Locally Advanced-Stage Disease Overview Anatomy of the Larynx and Hypopharynx Lymphatic Drainage Glottic Lymphatic Drainage Supraglottis Lymphatic Drainage Subglottis Lymphatic Drainage Biomarkers and Molecular Biology Clinical Presentation and Evaluation Larynx Supraglottis Glottis Subglottis Hypopharynx Diagnostic Evaluation/Workup Staging Overall Management Management of the Neck Laryngeal Cancers Glottic Carcinoma in Situ Early-Stage Glottic Cancer (T1 or T2) Radiation Techniques and Dose-Fractionation Schemes Outcome and Prognostic Factors Complications From Radiation Therapy Advanced-Stage Glottic Cancer (T3 or T4, Stage III or IV) Overall Considerations: Balancing Cure, Organ Preservation, and Quality of Life Primary Surgical Approach: Adjuvant Therapy Organ-Preservation Approaches: Combining Chemotherapy With Radiation Therapy Organ-Preservation Approaches: Role of Induction Chemotherapy Organ-Preservation Approaches: Combining Targeted Biologic Agents With Radiation Therapy Selection of Optimal Radiotherapy Dose-Fractionation Scheme With Concurrent Systemic Therapy Radiation Therapy Techniques: General Principles Radiation Therapy Techniques: Patient Setup and Dose-Fractionation Schemes Outcomes and Prognostic Factors Complications From Radiation Therapy Early-Stage Supraglottic Cancer Radiation Techniques and Dose-Fractionation Schemes Outcome and Prognostic Factors Complications From Radiation Therapy Advanced Supraglottic Cancer Radiation Techniques and Dose-Fractionation Schemes Outcome and Prognostic Factors Subglottic Cancers Hypopharyngeal Cancers Overall Management Considerations Early-Stage Hypopharynx Radiation Techniques and Dose-Fractionation Schemes Outcome and Prognostic Factors Complications Advanced-Stage Hypopharynx Radiation Techniques and Dose-Fractionation Schemes Outcome and Prognostic Factors Complications Radiation Therapy for Recurrent Disease After Prior Overlapping Radiotherapy Future Strategies and Directions Alternative Chemoradiation Therapy Strategies: the “RADPLAT” Approach Emerging Technologies: Stereotactic Body Radiotherapy References 111 Vocal and Speech Rehabilitation After Laryngectomy Abstract Keywords Key Points History of Alaryngeal Voice and Speech Physiology of Alaryngeal Voice and Speech Esophageal Voice and Speech Electrolarynx Voice and Speech Tracheoesophageal Voice and Speech Types of Voice Prostheses Indwelling and Nonindwelling Prostheses Surgical Aspects of Alaryngeal Voicing Problem Solving and Prevention Standard Total Laryngectomy Surgical Techniques and Refinements Prevention of Hypertonicity of the Pharyngoesophageal Segment Creation of an Optimally Contoured Stoma Prevention of an Excessively Deep Stoma Pharyngeal Mucosa Closure Postoperative Management Alimentary Care Pulmonary Care Secondary Prosthetic Voice Rehabilitation Prosthetic Voice Rehabilitation and Radiotherapy Voice Prosthesis Replacement and Maintenance Indications for Voice Prosthesis Replacement Replacement for Transprosthetic Leakage Replacement for Periprosthetic Leakage Nonindwelling Voice Prostheses Troubleshooting the Prosthetic Voice Special Notes on Comorbidity and Tracheoesophageal Puncture Tract–Related Complications The Role of Gastroesophageal Reflux as a Risk Factor for Tracheoesophageal Puncture-Tract Enlargement Atrophy of the Tracheoesophageal Puncture/Party Wall and/or Excessive Widening of the Tracheoesophageal Puncture Algorithm to Solve Atrophy and Periprosthetic Leakage Shrinkage Silicone Washer Purse-String Suture Augmentation of the Party Wall Tracheoesophageal Puncture Closure and Repeat Tracheoesophageal Puncture Scarring of the Tracheoesophageal Puncture Tract Infection of the Tracheoesophageal Puncture Tract Hypertrophy of the Tracheoesophageal Puncture Tract Anterior Hypertrophy Posterior Hypertrophy or Esophageal Pocket Partial Prosthesis Extrusion Problems Unrelated to the Prosthesis Hypertonicity of the Pharyngoesophageal Segment Hypotonicity of the Pharyngoesophageal Segment Voice and Speech Therapy Pulmonary Care and Rehabilitation Overview Heat and Moisture Exchangers Treatment Aspects Prevention Aspects Compliance Aspects Early Postoperative Pulmonary Hygiene Hands-Free Speech Conclusions of Pulmonary Rehabilitation Olfaction Rehabilitation Overview Rehabilitation Technique Conclusions of Olfaction Rehabilitation Quality of Life After Total Laryngectomy References 112 Diagnosis and Management of Tracheal Neoplasms Abstract Keywords Key Points Overview Historic Review Primary Tracheal Tumors Benign Primary Tracheal Tumors Tracheal Papillomatosis Granular Cell Tumor Chondroma Leiomyoma Hemangioma Miscellaneous Benign Primary Tumors Malignant Primary Tracheal Neoplasms Squamous Cell Carcinoma Adenoid Cystic Carcinoma Other Malignant Primary Tracheal Tumors Carcinoid Tumors Mucoepidermoid Carcinoma Secondary Tracheal Tumors Diagnosis Symptoms, Signs, and Physical Examination Pulmonary Function Testing Radiographic Evaluation Bronchoscopy Staging Treatment Primary Malignant Tracheal Tumors Anesthetic Management Surgical Management Tracheal Resection and Primary Reconstruction Release Maneuvers Subglottal Resections Carinal Resections Use of Tracheal Substitutes Radiation Therapy Benign Tracheal Tumors Palliative Treatment of Unresectable Malignant Tracheal Tumors Therapeutic Bronchoscopy Results Complications Summary References 6 Neck 113 Differential Diagnosis of Neck Masses Abstract Keywords Key Points History and Physical Examination Anatomy Diagnostic Testing Radiology Anatomic Imaging Functional Imaging Cytologic Analysis Potential Etiologies of Neck Masses Congenital Anomalies Vascular Lesions Nonvascular Lesions Inflammatory and Infectious Lesions Neoplasms Occult Regional Metastatic Squamous Cell Carcinoma Summary References 114 Ultrasound Imaging of the Neck Abstract Keywords Key Points Basics of Ultrasonography Utility and Limitations Brief Description of Technique Thyroid Ultrasound Parathyroid Ultrasound Ultrasonography of Salivary Glands Ultrasonography in Head and Neck Cancer Description of Ultrasound-Assisted Fine-Needle Aspiration Technique On-Site Evaluation of Fine-Needle Aspiration Adequacy Conclusion References 115 Neoplasms of the Neck Abstract Keywords Key Points Introduction Diagnostic Evaluation Imaging Studies Computed Tomography Magnetic Resonance Imaging Positron Emission Tomography Ultrasound Benign Neoplasms of the Neck Vascular Neoplasms Pathology Nomenclature Epidemiology Carotid Paragangliomas History Anatomy and Physiology Etiology Clinical Presentation and Diagnosis Multicentricity. Malignancy. Imaging Studies Classification Management Embolization. Controversy Over Surgery for Multicentric Tumors. Radiation Therapy. Observation. Vagal Paragangliomas Clinical Presentation and Diagnosis Management Arteriovenous Malformations of the Head and Neck Peripheral Nerve Neoplasms Schwannomas Neurofibromas Lipomas Benign Lesions of the Parapharyngeal Space Malignant Neoplasms of the Neck Metastatic Lesions to the Neck Unknown Primary Squamous Cell Carcinoma Melanoma Regional Metastases Distant Metastases Primary Malignant Tumors of the Neck Neoplasms of the Parapharyngeal Space Sarcomas Classification and Staging Treatment Pleomorphic Sarcoma. Rhabdomyosarcoma. Osteosarcoma. Fibrosarcoma. Alveolar Soft Part Sarcoma. Angiosarcoma. Epithelioid Hemangioendothelioma. Chondrosarcoma. Leiomyosarcoma. Liposarcoma. Malignant Hemangiopericytoma. Malignant Peripheral Nerve Sheath Tumor. Synovial Sarcoma. Ewing Sarcoma. Lymphoma Squamous Cell Carcinoma Arising in a Branchial Cleft Cyst Well-Differentiated Thyroid Carcinoma Arising Within the Thyroglossal Duct Cyst Summary References 116 Lymphomas Presenting in the Head and Neck Abstract Keywords Key Points Introduction Epidemiology Clinical Presentation of Lymphomas of the Head and Neck Biopsy Techniques and Specimen Handling Fine-Needle Aspiration Core Needle Biopsy Open Biopsy Prebiopsy Corticosteroids Nodal Lymphomas of the Head and Neck Hodgkin Lymphoma Staging Treatment and Prognosis Complications of Treatment Diffuse Large B-Cell Non-Hodgkin Lymphoma Staging Treatment and Prognosis Indolent Non-Hodgkin Lymphoma Treatment and Prognosis Mantle Cell Lymphoma Treatment and Prognosis Highly Aggressive Lymphomas Treatment and Prognosis Thyroid Lymphomas Staging Treatment and Prognosis Salivary Gland Lymphomas Treatment and Prognosis Paranasal Sinus and Nasal Cavity Lymphomas Therapy and Prognosis Waldeyer Ring Lymphomas Treatment and Prognosis Summary Acknowledgment References 117 Radiation Therapy and Management of the Cervical Lymph Nodes and Malignant Skull Base Tumors Abstract Keywords Key Points Lymphatic System of the Neck Staging of Neck Node Metastasis Incidence and Distribution of Neck Node Metastasis Incidence and Distribution of Lymph Node Metastasis From Clinical and Radiologic Assessment Incidence and Distribution of Pathologic Lymph Node Metastasis Incidence and Pattern of Node Distribution in the Contralateral Neck Recommendations for the Selection of Target Volumes in the Neck Neck Node Delineation and Irradiation Techniques Delineation of the Clinical Target Volume Irradiation Techniques Control of the Node-Negative Neck Control of the N1 to N3 Neck Neck Control After Primary Radiotherapy Neck Control in Human Papillomavirus– Positive Patients Indications for Postoperative Irradiation/Chemoradiation Indications for Postradiotherapy Neck Node Dissection Late Complications After Neck Irradiation Management of Recurrent Disease in the Neck Radiation Therapy and Malignant Skull Base Tumors Radiation: Technical Advances Intensity-Modulated Radiation Therapy Linear Accelerator, Gamma Knife, and CyberKnife Stereotactic Irradiation Proton Beam Treatment of Malignant Cranial Base Tumors Anterior Cranial Base Esthesioneuroblastoma Sinonasal Undifferentiated Carcinoma Middle Cranial Base Chordoma/Chondrosarcoma Nasopharyngeal Carcinoma Other Cranial Skull Base Tumors Complications After Skull Base Irradiation References 118 Neck Dissection Abstract Keywords Key Points Historical Perspective Cervical Lymph Node Groups Division of Neck Levels by Sublevels Correlation of Neck Level Boundaries With Anatomic Markers Depicted Radiologically Neck Dissection Classification Radical Neck Dissection Definition. Indications. Technique Positioning. Incision Planning. Flap Elevation. Dissection of the Posterior Triangle. Anterior Triangle Dissection. Dissection of the Upper Neck Compartments. Modified Radical Neck Dissection Definition. Indications. Technique. Selective Neck Dissection Definition. Rationale. Selective Neck Dissection for Oral Cavity Cancer Definition and Rationale. Technique. Selective Neck Dissection for Oropharyngeal, Hypopharyngeal, and Laryngeal Cancer Definition and Rationale. Technique. Selective Neck Dissection for Cutaneous Malignancies Definition and Rationale. Technique. Selective Neck Dissection for Cancer of the Midline Structures of the Anterior Lower Neck Definition and Rationale. Technique. Extended Neck Dissection Results of Neck Dissection Radical Neck Dissection Modified Radical Neck Dissection Selective Neck Dissection Superselective Neck Dissection Sentinel Lymph Node Biopsy–Guided Neck Dissection Sequelae of Neck Dissection Complications of Neck Dissection Air Leaks Bleeding Chylous Fistula Facial/Cerebral Edema Blindness Carotid Artery Rupture Neck Dissection After Treatment With Chemoradiation Neck Dissection in the Era of Transoral Surgery Minimally Invasive Neck Dissection Summary References 119 Complications of Neck Surgery Abstract Keywords Key Points Wound Complications Incision Planning Wound Dehiscence and Flap Necrosis Seroma Wound Infection Salivary Fistula Scar Formation Lymphedema Vascular Complications Carotid Artery Hemorrhage Internal Jugular Vein Complications Hematoma Nerve Complications Motor Nerves Facial Nerve Vagus Nerve Spinal Accessory Nerve Hypoglossal Nerve Phrenic Nerve Sensory Nerves Lingual Nerve Great Auricular Nerve Cervical Sensory Nerves Sympathetic Nerves Chyle/Chest Chylous Fistula Chylothorax Pneumothorax Conclusion References 120 Penetrating and Blunt Trauma to the Neck Abstract Keywords Key Points Physical Properties of Penetrating Objects Penetrating Injuries From Weaponry Handgun Wounds Rifle Wounds Shotgun Wounds Knife and Bite Injuries Mandatory Versus Elective Exploration Classification Initial Management Diagnostic Evaluation Angiography Management of Vascular Penetration Digestive Tract Evaluation Management of Laryngotracheal Injury Blunt Neck Trauma Summary References 7 Thyroid/Parathyroid 121 Disorders of the Thyroid Gland Abstract Keywords Key Points Physical Examination Physiology of the Thyroid Gland Iodide Transport Thyroglobulin Iodination and Thyroperoxidase Storage and Release of Hormone Circulating Thyroid Hormones Metabolism of Thyroid Hormones Control of Thyroid Function Antithyroid Agents Thyroid Hormone Mechanism of Action Thyroid Function Studies Circulating Thyroid Hormone Measurement Serum Thyrotropin Measurement Serum Thyroglobulin Measurement Thyroid Antibody Status Measurement of Thyroid-Stimulating Antibodies Radioactive Iodine Uptake Test Thyrotoxicosis Pathophysiology Graves Disease Thyroiditis Exogenous Thyrotoxicosis Toxic Thyroid Adenoma Toxic Multinodular Goiter Ectopic Thyrotoxicosis Special Situations in Thyrotoxicosis Subclinical Thyrotoxicosis Thyroid Storm Hypothyroidism Prevalence Etiology Clinical Features Otolaryngologic Manifestations Hearing Loss Vertigo Hoarseness Goitrous Hypothyroidism Transient Hypothyroidism Excessive Iodine Intake Endemic Goiter Familial Hypothyroidism Nongoitrous Hypothyroidism Hypothyroidism After Laryngectomy and Radiotherapy Pituitary and Hypothalamic Hypothyroidism Subclinical Hypothyroidism Diagnosis Prevalence Natural History Effects on Lipids, Hypothyroid Symptoms, and Mood Treatment Nonthyroid Illness Laboratory Diagnosis Management Myxedema Coma Surgery When to Consult an Endocrinologist References 122 Management of Thyroid Neoplasms Abstract Keywords Key Points Surgical Anatomy and Embryology Molecular Basis for Thyroid Neoplasms Molecular Diagnostics and Targeted Therapies Risk Factors and Etiology Tumor Staging and Classification Tumor-Node-Metastasis Classification AMES AGES and MACIS Evaluation of a Thyroid Nodule Clinical Assessment: History and Physical Examination Diagnostic Studies Laboratory Studies Fine-Needle Aspiration Cytology Imaging Thyroid Isotope Scanning Rational Approach to Management of a Thyroid Nodule Review of Thyroid Neoplasms Thyroid Adenoma Clinical Presentation Pathology Management and Prognosis Thyroid Cyst Clinical Presentation Pathology Management and Prognosis Papillary Carcinoma Clinical Presentation Pathology Management and Prognosis Noninvasive Follicular Neoplasm With Papillary-Like Nuclear Features Clinical Presentation Pathology Management and Prognosis Follicular Carcinoma Clinical Presentation Pathology Management and Prognosis Hürthle Cell Tumor Clinical Presentation Pathology Management and Prognosis Medullary Thyroid Carcinoma Clinical Presentation Pathology Management and Prognosis Anaplastic Carcinoma Clinical Presentation Pathology Management and Prognosis Other Forms of Thyroid Cancer Insular Thyroid Carcinoma Lymphoma Metastatic Carcinoma Squamous Cell Carcinoma Surgical Management and Technique Approach to the Thyroid Gland Approach to the Central Neck Special Surgical Situations Management of Regional Lymphatics Intrathoracic Goiter Recurrent Laryngeal Nerve Invasion Extended Surgical Resection Reoperative Thyroid Surgery Extent of Surgery Evolution of Surgical Techniques for Thyroidectomy Special Treatment Situations Children Pregnancy Complications Bleeding Complications Superior Laryngeal Nerve Injury Recurrent Laryngeal Nerve Injury Hypocalcemia Postoperative Management and Special Considerations Thyroid Hormone Replacement and Thyroid-Stimulating Hormone Suppression Therapy Radioactive Iodine Treatment External-Beam Radiotherapy and Chemotherapy Follow-Up Management Summary References 123 Management of Parathyroid Disorders Abstract Keywords Key Points History of the Parathyroid Glands Calcium Physiology Parathyroid Anatomy Embryology Vascular Anatomy of the Parathyroid Gland Etiology and Pathogenesis of Hyperparathyroidism Histopathology of the Parathyroid Glands Treatment of Hypercalcemia Primary Hyperparathyroidism Normocalcemic Primary Hyperparathyroidism Syndromic Hyperparathyroidism Multiple Endocrine Neoplasia Type 1 Multiple Endocrine Neoplasia Type 2A Hyperparathyroidism–Jaw Tumor Syndrome Autosomal Dominant Mild Hyperparathyroidism Familial Hypercalcemic Hypocalciuria Neonatal Severe Hyperparathyroidism Familial Isolated Hyperparathyroidism Symptoms Gland Pathology Surgical Management Preoperative Evaluation Localization Noninvasive Localization Invasive Localization Intraoperative Parathyroid Hormone Measurement Surgical Treatment Anesthesia Standard Neck Exploration Postoperative Care Intraoperative Adjuncts Secondary Hyperparathyroidism Tertiary Hyperparathyroidism Parathyroid Cancer Parathyroid Cysts Management of Asymptomatic Primary Hyperparathyroidism Persistent Hyperparathyroidism Recurrent Hyperparathyroidism Reoperative Parathyroid Surgery Parathyromatosis Nonsurgical Management Permanent Hypoparathyroidism Summary References 124 Surgical Robotics in Otolaryngology Abstract Keywords Key Points History of Robotics Definitions History of Medical Robotics Robot Development in Otolaryngology Clinical Applications Oropharyngeal Surgery Laryngeal and Hypopharyngeal Robotic Surgery Obstructive Sleep Apnea Thyroid Surgery Skull Base Surgery Adoption of Robotic Technology Conclusion References 125 Management of Thyroid Eye Disease (Graves Ophthalmopathy) Abstract Keywords Key Points Epidemiology and Impact Pathophysiology Genetics and Sex Nongenetic Factors Tobacco Thyroid Status Natural History Clinical Features Classification Systems Clinical Evaluation Thyroid Status Eye Evaluation Imaging Treatment: Medical Therapy Mild Graves Ophthalmopathy Moderate to Severe Graves Ophthalmopathy Radiotherapy Thyroidectomy for Graves Ophthalmopathy Surgical Therapy for Graves Ophthalmopathy Endoscopic Orbital Decompression Balanced Orbital Decompression Combined Endoscopic Orbital and Optic Nerve Decompression Open Approaches Transantral Orbital Decompression Combined Endoscopic and Open Approach to Orbital Decompression Ancillary Procedures Extraocular Muscle Surgery Eyelid Surgery Orbital Fat Decompression Summary References VII Otology, Neurotology, and Skull Base Surgery 1 Basic Science 126 Anatomy of the Temporal Bone, External Ear, and Middle Ear Abstract Keywords Key Points Osteology of the Temporal Bone External Ear Tympanic Membrane Middle Ear Facial Nerve Mastoid and Other Pneumatized Regions of the Temporal Bone References 127 Neuroanatomy of the Auditory System Abstract Keywords Key Points Cochlear Anatomy Osteology Membranous Labyrinth and Inner Ear Fluids Hair Cells Innervation Central Auditory Pathways Cochlear Nerve Cochlear Nucleus Superior Olivary Complex Lateral Lemniscus Inferior Colliculus Medial Geniculate Body Auditory Cortex Acknowledgments References 128 Physiology of the Auditory System Abstract Keywords Key Points Sound and Its Measurement Impedance External Ear Middle Ear Mechanics Inner Ear Physiology Auditory Nerve Auditory Brainstem and Midbrain Cochlear Nucleus Superior Olivary Complex Lateral Lemniscus Inferior Colliculus Thalamus and Auditory Cortex Medial Geniculate Body Auditory Cortex Efferent Auditory System Middle Ear Muscle Reflex Pathways Olivocochlear Reflex Pathways Summary Acknowledgments References 129 Anatomy of the Vestibular System Abstract Keywords Key Points Embryology of the Vestibular Apparatus Overall Organization of the Labyrinth: Relationship to Skull and Cochlea Efferent Innervation of the Peripheral Vestibular Apparatus Autonomic Supply of the Peripheral Vestibular Apparatus Blood Supply to Vestibular End Organs End-Organ Anatomy Cellular Morphology of Vestibular Sensory Epithelium Synaptic Morphology of Vestibular Afferents Morphology and Function of Vestibular Afferents Central Pathways of the Vestibular System Terminations of the Vestibular Nerve in the Brain Stem Projections of Vestibular Nerve to Cerebellum Anatomic Subdivisions of Vestibular Nuclei Organization of Vestibular Nerve Inputs to Vestibular Nuclei Other Inputs to Vestibular Nuclei Efferent Projection Pathways From the Vestibular Nuclei References 130 Anatomy and Physiology of the Eustachian Tube Abstract Keywords Key Points Embryology and Postnatal Development Anatomy Physiology Pressure Equalization Mucociliary Clearance and Drainage Middle Ear Protection Summary References 131 Clinical Evaluation and Management of the Eustachian Tube Abstract Keywords Key Points Introduction Eustachian Tube Function Tests Obstructive Eustachian Tube Dysfunction Eustachian Tube Endoscopy Eustachian Tube Pathology on Endoscopy Differential Diagnosis of Aural Fullness—Summary Obstructive Eustachian Tube Dysfunction Management Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube Technique of Balloon Dilation of the Eustachian Tube Risks of Balloon Dilation of the Eustachian Tube Other Interventions for Dilatory Eustachian Tube Dysfunction Patulous Eustachian Tube Dysfunction Treatment of Patulous Eustachian Tube Dysfunction Surgical Treatment of Patulous Eustachian Tube Dysfunction References 132 Cortical Neuroplasticity in Hearing Loss Abstract Keywords Key Points Introduction Neuroplasticity in Pediatric Hearing Loss Overview and Methodology for Studying Neuroplasticity in Pediatric Hearing Loss Typical Development of the Central Auditory Pathways Biomarkers of Central Auditory Development in Children A Brief Sensitive Period for Central Auditory Development in Children Clinical Utility of the P1 Cortical Auditory Evoked Potential Biomarker to Monitor Efficacy of Intervention With Hearing Aids or Cochlear Implants Clinical Utility of the P1 Cortical Auditory Evoked Potential Biomarker in Auditory Neuropathy and Children With Cochlear Nerve Deficiency Clinical Utility of the P1 Cortical Auditory Evoked Potential Biomarker in Children With Multiple Disabilities Cross-Modal Neuroplasticity in Hearing Loss: Evidence From Pediatric Deafness Clinical Significance of Cross-Modal Neuroplasticity in Pediatric Hearing Loss Potential Audiological Intervention to Reverse Cortical Cross-modal Neuroplasticity: Evidence From Cochlear Implantation in a Pediatric Case of Single-Sided Deafness Neuroplasticity in Adult-Onset, Age-Related Hearing Loss Cross-Modal Neuroplasticity in Adult-Onset Deafness Cross-Modal Neuroplasticity in Early-Stage, Age-Related Hearing Loss Can Audiological Intervention Reverse Cross-Modal Neuroplasticity in Age-Related Hearing Loss? Clinical Implications of Cross-Modal Plasticity in Adult-Onset Hearing Loss Summary References 133 Geriatric Otology Abstract Keywords Key Points Aging Basic Principles of Aging Epidemiology of Aging Older Adults and Hearing Loss Epidemiology of Age-Related Hearing Loss Public Health Consequences of Age-Related Hearing Loss Epidemiology of Hearing Health Care Among Older Adults Barriers to Hearing Health Care Age-Related Hearing Loss as a National Public Health Imperative Human Factors and Technical Considerations for Emerging Technologies Innovations in Age-Related Hearing Loss Advancing Cochlear Implantation for Older Adults Public Health Consequences of Geriatric Cochlear Implantation Older Adults and Vestibular Dysfunction Epidemiology of Age-Related Vestibular Dysfunction Public Health Consequences of Age-Related Vestibular Dysfunction Innovative Approaches to Age-Related Vestibular Dysfunction Conclusion References 2 Diagnostic Assessment 134 Diagnostic Audiology and Electrophysiologic Assessment of Hearing Abstract Keywords Key Points Audiologic Test Battery Tests for Hearing Sensitivity or Acuity Pure-Tone Air-Conduction Testing Pure-Tone Bone-Conduction Testing Speech Testing Masking Tests to Evaluate Middle-Ear Function Objective Tests for Differential Diagnostic Applications Otoacoustic Emissions Electrocochleography Testing for Dehiscence of the Superior Semicircular Canal Sonomotor Responses Auditory Brainstem Response Neurodiagnosis With the Auditory Brainstem Response Neurodiagnostic Studies in Patients With Auditory Neuropathy/Dyssynchrony Evaluation of Functional Hearing Loss Summary of Audiologic Testing Sources of Error in Audiologic Testing Errors in Clinical Judgment Technical Errors References 135 Neuroradiology of the Temporal Bone and Skull Base Abstract Keywords Key Points Normal Anatomic Variations Mastoid Tegmen Petrous Apex Jugular Fossa Carotid Artery Pathologic Conditions Temporal Bone External Auditory Canal Middle Ear and Mastoid Inner Ear Petrous Apex Lesions Facial Nerve Cochlear Nerve Cerebellopontine Angle and Internal Auditory Canal Skull Base References 136 Interventional Neuroradiology of the Skull Base, Head, and Neck Abstract Keywords Key Points Materials and Techniques Angiographic Equipment Angiographic Catheters Embolic Agents Provocative Testing to Ensure the Safety of Embolization Endovascular Treatment of Neoplasms Paragangliomas Glomus Tympanicum Tumor Glomus Jugulare Tumor Glomus Vagale Tumor Carotid Body Tumor Juvenile Angiofibroma Meningiomas Other Neoplasms Intra-Arterial Chemotherapy Lesions of Vascular Etiology Epistaxis Facial, Cervical, and Intracranial Arteriovenous Fistulas Dural Arteriovenous Fistulas Facial Vascular Malformations Hemangiomas of the Face and Neck Pseudoaneurysms Tinnitus-Producing Fibromuscular Dysplasia of the Carotid Artery References 137 Otologic Symptoms and Syndromes Abstract Keywords Key Points The Otologic History Hearing Loss Tinnitus Otalgia and Ear Fullness Otorrhea Vertigo The Otologic Physical Exam Tools for Examination Hand-Held Otoscope Binocular Microscopy Pneumatic Otoscopy Tuning Forks Vestibular Exam Cranial Nerve Exam Direct Examination of the Ear The Pinna The External Auditory Canal The Tympanic Membrane The Middle Ear References 3 External Ear 138 Infections of the External Ear Abstract Keywords Key Points Introduction Anatomy of the External Ear Otitis Externa Acute Otitis Externa Chronic Otitis Externa Signs and Symptoms Acute Otitis Externa Chronic Otitis Externa Investigations Microbiology Treatment Acute Otitis Externa Chronic Otitis Externa Complications Malignant Otitis Externa Signs and Symptoms Investigations Treatment Herpes Zoster Oticus Bullous Myringitis Chondritis, Perichondritis, and Cellulitis of the Auricle Erysipelas Furunculosis Keratosis Obturans and Cholesteatoma of the External Auditory Canal References 139 Topical Therapies of External Ear Disorders Abstract Keywords Key Points Introduction History Mechanism of Action Topical Antibiotics Topical Antiinflammatories External Ear Disorders—Acute Bacterial Otitis Externa Definition Signs and Symptoms Topical Therapy Options for Acute Bacterial Otitis Externa Ototopical Antibiotics Evidence-Based Data on Ototopical Antibiotics in Acute Otitis Externa Resistance Associated With Ototopical Antibiotic Therapy Acidifying Agents in Acute Bacterial Otitis Externa Systemic Therapy for Acute Bacterial Otitis Externa Pain Management in Acute Bacterial Otitis Externa Special Considerations in Chronic Bacterial Otitis Externa Indications for Biopsy External Ear Disorders—Malignant Otitis Externa Definition Signs and Symptoms Management Options in Malignant Otitis Externa Ototoxicity Associated With Topical Antibiotics Hypersensitivity Associated With Ototopical Antibiotics External Ear Disorders—Fungal Otitis Externa Definition Signs and Symptoms Topical Therapy Options for Fungal Otitis Externa Acidifying Agents for Fungal Otitis Externa Topical Antifungals for Fungal Otitis Externa Topical Antiseptics for Fungal Otitis Externa Ototoxicity Associated With Topical Antifungal Therapy External Ear Disorders—Myringitis Definition Topical Therapy Options External Ear Disorders—Eczematoid Otitis Externa Definition Signs and Symptoms Management Options in Eczematoid Otitis Externa Steroids for Eczematoid Otitis Externa Classes of Topical Steroids Ototoxicity Associated With Ototopical Steroid Use Antiinflammatory and Immunosuppressive Agents Alternative Agents External Ear Disorders—Viral Infections Definition Management Options External Ear Disorders— Cerumen Impaction Definition Therapy Options Ear Hygiene and the Chronic Draining Ear Middle Ear Disorders—Acute Otitis Media and Otitis Media With Effusion Definition Therapy Future Advances in Topical Therapy Conclusion References 4 Middle Ear, Mastoid, and Temporal Bone 140 Chronic Otitis Media, Mastoiditis, and Petrositis Abstract Keywords Key Points Effects on Mastoid Pneumatization Middle Ear Atelectasis and Adhesive Otitis Media Chronic Otitis Media With Cholesteatoma Diagnosis Pathogenesis Invagination Theory Epithelial Invasion Theory Basal Cell Hyperplasia Theory Squamous Metaplasia Theory Mucosal Traction Theory Complications Management Chronic Otitis Media Without Cholesteatoma Diagnosis Pathogenesis Management Bone Erosion in Cholesteatoma and Chronic Otitis Media Sensorineural Hearing Loss Tympanosclerosis Diagnosis Pathogenesis Management Petrositis Historical Note Anatomy Diagnosis Diagnostic Tests Management Summary References 141 Complications of Temporal Bone Infections Abstract Keywords Key Points Epidemiology Acute Otitis Media Chronic Otitis Media Pathophysiology Diagnosis History Physical Examination Imaging Techniques Lumbar Puncture Treatment Extracranial (Intratemporal) Complications Acute Mastoiditis Coalescent Mastoiditis Etiology Pathology Pathophysiology Diagnosis Treatment Chronic Mastoiditis Etiology Masked Mastoiditis Postauricular Abscess Bezold Abscess Temporal Root Abscess Petrous Apicitis Labyrinthine Fistula Facial Nerve Paralysis Acute Suppurative Labyrinthitis Encephalocele and Cerebrospinal Fluid Leakage Intracranial Complications Meningitis Brain Abscess Subdural Empyema Epidural Abscess Lateral Sinus Thrombosis Otitic Hydrocephalus References 142 Tympanoplasty and Ossiculoplasty Abstract Keywords Key Points Tympanoplasty Functional Considerations Preoperative Evaluation Graft Materials Minimalist Techniques Formal Tympanoplasty Anesthesia Approaches and Incisions Graft Placement Lateral Graft Technique. Medial Graft Technique. Special Considerations Tympanosclerosis Atrophic and Atelectatic Tympanic Membrane Secondary Acquired Cholesteatoma Cartilage Tympanoplasty Pediatric Tympanoplasty Ossiculoplasty Pathophysiology Ossicular Fixation Ossicular Discontinuity Audiometric Correlates Materials Factors That Affect Surgical Decisions Surgical Techniques Ossicular Fixation Ossicular Discontinuity Causes of Ossiculoplasty Failure References 143 Mastoidectomy Abstract Keywords Key Points History Relevant Anatomy Nomenclature Simple Mastoidectomy Canal Wall–Up (Intact Canal) Mastoidectomy Canal Wall–Down Mastoidectomy Radical Mastoidectomy Modified Radical Mastoidectomy Mastoid Obliteration Canal Reconstruction Mastoidectomy Canal Wall–Up Operative Procedure Soft Tissue Exposure of the Antrum Facial Nerve Dissection Opening the Facial Recess Opening the Epitympanum Canal Wall–Down Operative Procedure Intact Versus Canal Wall–Down Mastoidectomy: Advantages and Disadvantages Indications for Intact Versus Canal Wall–Down Procedures Mastoid Obliteration Revision Surgery Otoendoscopy and Mastoidectomy Canal Reconstruction Mastoidectomy Retrograde Mastoidectomy Complications Dura Horizontal Semicircular Canal Fistula Facial Nerve Sigmoid Sinus and Jugular Bulb Injury Mastoidectomy: New Paradigms in Training and Simulation References 144 Middle Ear Endoscopic Surgery Abstract Keywords Key Points Introduction Initial Considerations Equipment Considerations Basic Endoscopic Technique Endoscopic Ear Anatomy Middle Ear Spaces Mesotympanum Protympanum Epitympanum Retrotympanum Hypotympanum Conclusion References 145 Clinical Assessment and Surgical Treatment of Conductive Hearing Loss Abstract Keywords Key Points Mechanical Properties of the Conductive Hearing Pathway Sound Transfer in the Middle Ear Specific Defects in the Conductive Auditory Periphery and Resultant Hearing Loss Diagnostic Evaluation Treatment Conditions of the External Auditory Canal That Contribute to Conductive Hearing Loss Conditions of the Tympanic Membrane That Contribute to Conductive Hearing Loss Conditions of the Middle Ear That Contribute to Conductive Hearing Loss The Expanding Role of Implantable Devices Management of Conductive Hearing Loss in Children Conclusion Acknowledgments References 146 Otosclerosis Abstract Keywords Key Points Histopathology Evaluation History Physical Examination Audiometry Radiology Surgery Stapedotomy Technique Postoperative Care Variations of Surgical Technique Stapedectomy Versus Stapedotomy Laser Versus Microdrill Stapes Prostheses Endoscopic Stapes Surgery Surgical Problems Exposed and Overhanging Facial Nerve Fixed Malleus Solid or Obliterated Footplate Floating Footplate Perilymph Gusher Perforation of the Tympanic Membrane Nerve Damage to the Chorda Tympani Intraoperative Vertigo Postoperative Complications Sensorineural Hearing Loss Reparative Granuloma Vertigo Facial Paralysis Tinnitus Hyperacusis Taste Disturbance Perilymph Fistula Alternative Treatment Hearing Aids Fluoride Therapy Special Considerations Far Advanced Otosclerosis Ménière Disease Stapedectomy in Children Revision Stapedectomy Summary References 147 Management of Temporal Bone Trauma Abstract Keywords Key Points Epidemiology Pathophysiology Classification Evaluation Management of Complications Facial Nerve Injury Summary of Facial Nerve Treatment Algorithm Cerebrospinal Fluid Fistulas Closure of Cerebrospinal Fluid Fistulas Hearing Loss Cholesteatoma and External Auditory Canal Stenosis Carotid Artery Injury References 5 Inner Ear 148 Cochlear Transduction and the Molecular Basis of Auditory Pathology Abstract Keywords Key Points Passive Cochlear Mechanics Physical Dimensions The Traveling Wave Active Cochlear Mechanics Role of Outer Hair Cells in Active Mechanics Prestin (SLC26A5) is Essential for Outer Hair Cell Motility and Active Transduction Conversion of Basilar Membrane Displacement to Radial Shearing Forces Radial Displacement Patterns of the Basilar Membrane Tectorial Membrane Pathophysiology Hair Cell Transduction Hair Cell Stereocilia Hair Bundle Deflections and Receptor Potentials Hair Cell Transduction Channels Transduction Channel Ion Selectivity Gating of Transduction Channels: Tip Links Composition of Stereocilia Defects in Cytoskeletal Proteins Lead to Deafness Dynamic Regulation of Stereocilia Length Interstereociliary Linkages Myosin VI Adaptation of Mechanoelectrical Transduction Currents Effects of Deficiencies of Other Hair Cell Channels on Hearing Defects in Hair Cell–ANF Synapses Lead to Hearing Impairment Auditory Neuropathy Perilymphatic-Endolymphatic Barrier Endolymph Homeostasis Summary Acknowledgments References 149 Genetics of Ear Disorders Abstract Keywords Key Points The Genome DNA Structure and the Genetic Code Gene Structure and Expression Molecular Basis of Patterns of Inheritance Chromosomal Disorders Aneuploidies Chromosomal Rearrangements Single-Gene Disorders Dominant Disorders Recessive Disorders Penetrance and Expressivity Oligogenic Disorders X-Linkage Sporadic Cases Mitochondrial Disorders Complex Traits Genetic Heterogeneity Testing Human DNA Polymerase Chain Reaction Nucleic Acid Hybridization and Southern Blotting DNA Chips Genome-Wide Association Studies Mutation Testing RNA Sequencing Ethical Issues Utility of Molecular Genetics in Otolaryngology References 150 Genetic Sensorineural Hearing Loss Abstract Keywords Key Points Background Classification of Hearing Impairment Diagnosis of Hearing Impairment Epidemiology of Hearing Impairment Historic Background of Genetics Fundamentals of Genetics Patterns of Inheritance Autosomal Dominant Autosomal Recessive X-Linked Inheritance Mitochondrial Inheritance Genetic Hearing Impairment Nonsyndromic Hearing Impairment Autosomal-Recessive Nonsyndromic Hearing Impairment DFNB1 (GJB2). DFNB16. Autosomal-Dominant Nonsyndromic Hearing Impairment DFNA2 (High-Frequency Hearing Loss). DFNA8/12 and DFNA13 (Midfrequency Hearing Loss). DFNA6/14/38 (Low-Frequency Hearing Loss). X-Linked Nonsyndromic Hearing Impairment Mitochondrial Nonsyndromic Hearing Impairment Syndromic Hearing Impairment Autosomal-Dominant Syndromic Hearing Impairment Branchio-Oto-Renal Syndrome Neurofibromatosis Type 2 Stickler Syndrome Waardenburg Syndrome Treacher Collins Syndrome Autosomal-Recessive Syndromic Hearing Impairment Pendred Syndrome Jervell and Lange-Nielsen Syndrome Usher Syndromes Biotinidase Deficiency Refsum Disease X-Linked Syndromes Alport Syndrome Mohr-Tranebjaerg Syndrome Mitochondrial Syndromes Patient Management Diagnosis Genetic Testing Prenatal Testing Treatment Prevention of Hearing Impairment Cultural Considerations Acknowledgments References 151 Otologic Manifestations of Systemic Disease Abstract Keywords Key Points Granulomatous and Infectious Diseases Langerhans Cell Histiocytosis Otologic Manifestations Tuberculosis Granulomatosis With Polyangiitis Otologic Manifestations Sarcoidosis Otologic Manifestations Syphilis Lyme Disease Otologic Manifestations Mycotic Diseases Otologic Manifestations Cytomegalic Inclusion Disease Neoplastic Diseases Multiple Myeloma Otologic Manifestations Leukemia Lymphoma Metastatic Neoplasms Diseases of the Bone Paget Disease Otologic Manifestations Osteogenesis Imperfecta Otologic Manifestations Fibrous Dysplasia Otologic Manifestations Osteopetroses Otologic Manifestations Osteitis Fibrosa Cystica Storage and Metabolic Diseases Mucopolysaccharidoses Otologic Manifestations Gout Otologic Manifestations Ochronosis Otologic Manifestations Collagen Vascular and Autoimmune Diseases Multiple Sclerosis Susac Syndrome Immunodeficiency and Immune-Mediated Disorders Primary or Congenital Immunodeficiency and Immune-Mediated Disorders Otologic Manifestations Acquired Immunodeficiency Syndrome Otologic Manifestations Genetically Determined Defects References 152 Sensorineural Hearing Loss in Adults Abstract Keywords Key Points Clinical Evaluation of the Patient With Hearing Loss History Physical Examination Audiometric Testing Vestibular Testing Laboratory Testing Radiographic Testing Etiology of Sensorineural Hearing Loss Developmental and Hereditary Disorders Hereditary Disorders of Adult Onset Nonsyndromic Hereditary Hearing Loss. Waardenburg Syndrome. Alport Syndrome. Usher Syndrome. Inner Ear Anomalies Large Vestibular Aqueduct Syndrome. Infectious Disorders Labyrinthitis Otitis Media Viral Infections Syphilis Rocky Mountain Spotted Fever Lyme Disease Pharmacologic Toxicity Aminoglycosides Ototopical Preparations. Loop Diuretics Antimalarials Salicylates Nonsteroidal Antiinflammatory Drugs Analgesics and Analgesic/Narcotic Compounds Phospodiesterase-5 Inhibitors Vancomycin Erythromycin Cisplatin and Carboplatin Nitrogen Mustards Vincristine and Vinblastine Eflornithine Deferoxamine Lipid-Lowering Drugs Renal Disorders Trauma Head Injury Noise-Induced Hearing Loss and Acoustic Trauma Barotrauma and Perilymphatic Fistula Irradiation Neurologic Disorders Multiple Sclerosis Idiopathic Intracranial Hypertension Vascular and Hematologic Disorders Migraine Vertebrobasilar Arterial Occlusion Rheologic Disorders and Blood Dyscrasias Immune Disorders Systemic Autoimmune Disorders Cogan Syndrome. Polyarteritis Nodosa. Relapsing Polychondritis. Granulomatosis With Polyangiitis. Other Autoimmune Disorders. Primary Autoimmune Inner Ear Disease Paraneoplastic Syndromes Bone Disorders Otosclerosis Paget Disease Neoplasms Endocrine and Metabolic Disorders Nonorganic Hearing Loss Disorders of Unknown Etiology Age-Related Hearing Loss Meniere Disease and Endolymphatic Hydrops Sudden Sensorineural Hearing Loss Prevalence, Natural History, and Prognosis Etiology of Sudden Sensorineural Hearing Loss Infectious Disorders Viral Infection. Bacterial Infections. Neoplasms Acoustic Neuroma. Other Neoplasms. Trauma and Membrane Ruptures Head Injury. Perilymphatic Fistula. Intracochlear Membrane Breaks. Pharmacologic Toxicity Immunologic Disorders Vascular Disorders Developmental Abnormalities Idiopathic Disorders Meniere Disease. Multiple Sclerosis. Nonorganic Hearing Loss. Treatment Conclusions References 153 Tinnitus and Hyperacusis Abstract Keywords Key Points Tinnitus History and Physical Examination Classification History and Physical Examination Diagnostic Evaluation Standardized Outcome Measures Subjective Nonpulsatile Tinnitus Hearing Loss Subtypes Noise-Induced Hearing Loss Presbycusis Somatic Tinnitus Subtype Typewriter Tinnitus Subtype Tinnitus Comorbidities and Hyperacusis Treatment Patient Education Hearing Amplification Cochlear Implantation Sound Therapy Cognitive Behavioral Therapy Medical Therapy Dietary Supplements, Vitamins, Herbal Remedies Acupuncture Transcranial Magnetic Stimulation Pulsatile Tinnitus Etiology and Diagnostic Approach Vascular Anomalies Anomalies of the Jugular Bulb Sigmoid Sinus Diverticulum Dural Arteriovenous Malformation/Fistula Atherosclerotic Carotid Artery Disease Congenital Carotid Anomalies Idiopathic Intracranial Hypertension Other Vascular Abnormalities and Malformations Vascular Neoplasms Paragangliomas Other Vascular Skull Base Neoplasms Nonvascular Etiologies Semicircular Canal Dehiscence Myoclonus Patulous Eustachian Tube Other Nonvascular Etiologies Conclusion References 154 Noise-Induced Hearing Loss Abstract Keywords Key Points Measurement of Noise Nature of the Hearing Loss Cochlear Damage Research on Noise-Induced Hearing Loss Anatomic Mechanisms That Underlie Noise Damage New Knowledge About Cellular and Molecular Mechanisms of Noise-Induced Hearing Loss Protection via the Cochlear Efferent System Protection via the “Conditioning” or “Toughening” Protocols Pharmacologic and Dietary Protection From Noise-Induced Hearing Loss Susceptibility and Genetic Factors Hair Cell Regeneration and Repair Early Detection of Noise-Induced Hearing Loss Interactive Effects Adverse Vestibular Effects Caused by Noise Other Adverse Effects Caused by Noise Legal Issues Role of the Otolaryngologist Summary Acknowledgments References 155 Infections of the Labyrinth Abstract Keywords Key Points Background Anatomy and Physiology Perinatal Labyrinthine Infections Perinatal Viral Labyrinthine Infections Congenital Cytomegalovirus Congenital Rubella Syndrome Congenital Herpes Simplex Virus Nonviral Perinatal Labyrinthine Infections Congenital Syphilis Congenital Toxoplasmosis Acquired Labyrinthine Infections Meningogenic Labyrinthine Infections Bacterial Meningogenic Labyrinthine Infections. Nonbacterial Meningogenic Labyrinthine Infections Otogenic Labyrinthine Infections Viral Labyrinthine Infections Mumps Labyrinthitis. Measles Labyrinthitis. Varicella-Zoster Virus Labyrinthitis (Ramsay Hunt Syndrome). Human Immunodeficiency Virus and Related Labyrinthine Infections. Acquired Syphilitic Labyrinthine Infections Idiopathic Labyrinthine Infections Acknowledgments References 156 Autoimmune Inner Ear Disease Abstract Keywords Key Points Introduction Epidemiology Pathology and Pathogenesis Diagnosis Clinical Presentation Differential Diagnosis Laboratory Testing and Other Investigations Treatment of Primary Autoimmune Inner Ear Disease Corticosteroids Cyclophosphamide Methotrexate Etanercept Other Treatments Cochlear Implantation Systemic Autoimmune Diseases Associated With Hearing Loss Cogan Syndrome Granulomatosis With Polyangiitis Systemic Vasculitides/Connective Tissue Disorders Susac Syndrome Autoinflammatory Inner Ear Disease Conclusion References 157 Vestibular and Auditory Ototoxicity Abstract Keywords Key Points Aminoglycoside Antibiotics Pharmacokinetics Histopathology Clinical Manifestations Risk Factors for Ototoxicity Mechanisms of Ototoxicity Aminoglycoside Uptake Antineoplastic Agents Cisplatin Pharmacokinetics Clinical Ototoxicity Genetic Predisposition Histopathology Experimental Studies Electrophysiologic Studies Mechanisms of Ototoxicity Protection Against Cisplatin Ototoxicity Carboplatin Difluoromethylornithine Clinical Studies Clinical Trials Animal Studies Conclusions Loop diuretics Therapeutic Uses Ethacrynic Acid Furosemide pharmacokinetics Furosemide-Induced Hearing Loss Other Loop Diuretics Experimental Animal Studies of Loop Diuretic Ototoxicity Furosemide Ethacrynic Acid Human Temporal Bone Studies Analgesics Hydrocodone Common Adverse Reactions Severe Side Effects Hearing Loss from Hydrocodone/ Acetaminophen Abuse Mechanisms Guidelines Methadone Salicylates Animal Studies (Chinchilla) Mechanisms of Tinnitus Production Hearing Loss in Humans Quinine and Related Drugs Quinine Toxicity (Cinchonism) Hearing Loss Animal Studies Erythromycin and Related Macrolide Antibiotics Erythromycin Ototoxic Symptoms Guidelines for Prevention of Erythromycin Ototoxicity Deferoxamine Audiometric Monitoring Therapeutic Index Vancomycin Animal Studies Radiation Ototoxicity Sensorineural Hearing Loss Progression of SNHL Animal Studies Mechanisms of Radiation Damage Ototoxicity Monitoring for Hearing Loss References 158 Pharmacologic and Molecular Therapies of the Cochlear and Vestibular Labyrinths Abstract Keywords Key Points Pathway to the Inner Ear Vascular Communication Cerebrospinal Fluid Communication Middle Ear Communication Round Window Membrane Anatomy Physiology Permeability Kinetics Adhesions Delivery Method Steroids Mechanism of Action Pharmacokinetics Meniere Disease Sudden Sensorineural Hearing Loss Dosing Side Effects Summary Gentamicin Mechanism of Action Pharmacokinetics Clinical Protocols Practical Considerations Dosing Complications Indications and Contraindications Summary Otoprotective Agents Exposure to Ototoxic Medications Noise-induced Hearing Loss Salvage of Spiral Ganglion Neurons Summary Gene Therapy Vectors Delivery Neurotrophin Therapies Otoprotective Therapies Hair Cell Regeneration Stem Cell Therapy Gene Editing Safety Concerns Summary References 6 Auditory Prosthetic Stimulation, Devices, and Rehabilitative Audiology 159 Implantable Hearing Devices Abstract Background Methods Results Conclusion Keywords Key Points Introduction Limitations of Auditory Rehabilitation Using Traditional Hearing Aids Physical Factors Insufficient Gain Acoustic Feedback Distortion of Spectral Shape and Phase Shifts Nonlinear Distortion Occlusion Effects Poor Appearance Poor Transduction Efficiency Human Factors Recruitment and Compression of Dynamic Range Disordered Perception of Pitch and Sound Localization The Promise of Implantable Hearing Devices Middle Ear Implants Basic Design Features Transducer Design Ossicular Coupling Total Versus Partially Implantable Hearing Devices Electromagnetic Middle Ear Implantable Hearing Devices Vibrant Soundbridge Ototronix MAXUM Piezoelectric Middle Ear Implantable Hearing Devices Carina Esteem Osseointegrated Bone-Conducting Hearing Prostheses Introduction Osseointegration: Background Osseointegration: Biophysical Principles Implant Material Implant Design Osseointegration: Biology and Histology Radiologic Implications Osseointegration Operative Technique Baha in Young Children Osseointegration: Complications Baha Results Osseointegrated Bone-Conducting Hearing Prostheses for Unilateral Sensorineural Hearing Loss Alternatives to Percutaneous Bone-Conduction Implants Transcutaneous Bone Anchored Hearing Devices Dental Appliance–Based Bone-Conduction System Conclusion References 160 Cochlear Implantation Abstract Keywords Key Points General Background Patient Evaluation Medical Evaluation and Imaging Auditory Neuropathy/Dyssynchrony Acquired Deafness Physical Examination Chronic Suppurative Otitis Media Imaging Evaluation of Adult Candidates for Cochlear Implants Current Adult Selection Criteria Adult Audiologic Protocol Outcome Expectations for Adults Current Trends Affecting Adult Cochlear Implant Candidacy Combined Electric and Acoustic Stimulation Rehabilitation of Asymmetric Hearing Loss and Single-Sided Deafness Bilateral Cochlear Implants Recommendations for Referral for Adult Cochlear Implant Evaluation Recommendations for Referral for Pediatric Cochlear Implant Evaluation Device Selection Internal Receiver/Stimulators and Electrode Designs Cochlear Nucleus Profile HiRes Ultra MED-EL SYNCHRONY External Sound Processors Factors That Affect Device Choice Need for Special Electrode Arrays Technology Differences in Speech Coding Strategy and Electrode Configuration Compatibility With Magnetic Resonance Imaging Size, Weight, and Aesthetics of External Sound Processors Batteries References 161 Medical and Surgical Considerations in Cochlear Implantation Abstract Keywords Key Points Medical and Surgical Evaluation Jervell and Lange-Nielsen Syndrome Genetic Testing Audiometric Evaluation Diagnostic Therapy Imaging Ear Selection Vaccination for Meningitis Surgical Technique Preparation and Draping Preoperative Antibiotics and Steroids Locating the Receiver/Stimulator Incision and Flap Design Flap Thinning Periosteal Pocket Versus Bone Seat and Tie-Down Holes Mastoidectomy and Facial Recess Adaptive Cochleostomy Round Window Membrane Cochleostomy Extended Round Window Cochleostomy Bony Cochleostomy Securing the Receiver/Stimulator Electrode Insertion Slow Insertion Speed Insertion Vectors Hearing Conservation Ganglion Cell Survival Electric Plus Acoustic Stimulation Special Considerations in Children Otitis Media Labyrinthine Dysplasia Cochlear Nerve Deficiency Auditory Neuropathy Spectrum Disorder Ossified Cochlea Far Advanced Otosclerosis Patients With Compromised Healing Elderly Patients Bilateral Cochlear Implantation Cochlear Implantation for Single-Sided Deafness Cochlear Implantation and Tinnitus Complications Tip Foldover Revision Cochlear Implantation Soft Failure Effects on the Vestibular System Rehabilitation Music Neural Plasticity References 162 Cochlear Implantation in Adults Abstract Keywords Key Points Overview Candidacy Prevention With Vaccination Predictors of Benefit in Adults Cochlear Implantation With Hearing Preservation in Adults Bilateral Cochlear Implantation in Adults Results of Implantation Factors Related to the Measurement of Auditory Performance Tests of Implant Performance Implant Performance in Adults Implant Performance in Older Adults Outcomes After Cochlear Implantation Quality of Life and Cost Effectiveness Quality-of-Life Studies in Adults and the Elderly Auditory Rehabilitation After Cochlear Implantation Efficacy of Auditory Training in Cochlear Implant Rehabilitation Rehabilitation in Adults With Cochlear Implants Maintenance of the Device References 163 Auditory Brainstem Implantation Abstract Keywords Key Points Introduction History Device Hardware Candidacy Evaluation Neurofibromatosis Type 2 Nontumor Patients Special Considerations in Pediatric Auditory Brainstem Implant Radiographic Assessment Surgical Anatomy Operative Technique Postoperative Management Complications Outcomes Outcomes in Neurofibromatosis Type 2 Outcomes in Nontumor Patients Outcomes in Children Summary References 164 Hearing Aid Amplification Abstract Keywords Key Points Indications for Hearing Aid Use Hearing Loss Considerations Communication Disorder and Motivation Otologic and Other Factors Cost Considerations Hearing Aid Technology Evolution of Hearing Aid Technology Hearing Instrument Components Electroacoustic Characteristics Other Hearing Aid Features Hearing Aid Styles Behind-the-Ear Hearing Aids In-the-Ear Hearing Aids Style Considerations Hearing-Assistive Technologies Selection and Fitting Process Target Gain Hearing Aid Selection Ear Considerations Other Considerations Fitting and Verification Fitting Verification Orientation, Counseling, and Follow-Up Outcome Measurement Special Considerations Based on Patient Age Infants and Children Aging Patients Patients With Tinnitus Hearing Aids: Some Rules of Thumb References 7 Vestibular Disorders 165 Principles of Applied Vestibular Physiology Key Points Principles Principle 1: The Vestibular System Primarily Drives Reflexes to Maintain Stable Vision and Posture Anatomic and Physiologic Basis Clinical Importance Principle 2: By Modulating the Nonzero Baseline Firing of Vestibular Afferent Nerve Fibers, Semicircular Canals Encode Rotation of the Head and Otolith Organs Encode Linear Acceleration and Tilt Anatomic and Physiologic Basis Sensory Transduction. Response of the Cupula. Response of the Otoconial Membrane. Encoding by the Afferents. Principle 3: Stimulation of a Semicircular Canal Produces Eye Movements in the Plane of That Canal Anatomic and Physiologic Basis Clinical Importance Principle 4: A Semicircular Canal Normally Is Excited by Head Rotation About the Axis of That Canal, Bringing the Forehead Toward the Ipsilateral Side Anatomic and Physiologic Basis Clinical Importance Principle 5: Any Stimulus That Excites a Semicircular Canal’s Afferents Will Be Interpreted as Excitatory Rotation in the Plane of That Canal Anatomic and Physiologic Basis Clinical Importance Posterior Canal Benign Paroxysmal Positional Vertigo. Superior Canal Dehiscence Syndrome. Nystagmus During Caloric Testing. Principle 6: High Acceleration Head Rotation in the Excitatory Direction of a Canal Elicits a Greater Response Than the Same Rotation in the Inhibitory Direction Anatomic and Physiologic Basis Clinical Importance Principle 7: The Response to Simultaneous Canal Stimuli Is Approximately the Sum of the Responses to Each Stimulus Alone Anatomic and Physiologic Basis Clinical Implications Principle 8: Nystagmus as a Result of Dysfunction of Semicircular Canals Has a Fixed Axis and Direction With Respect to the Head Anatomic and Physiologic Basis Clinical Implications Principle 9: Brainstem Circuitry Boosts Low-Frequency Vestibuloocular Reflex Performance Through Velocity Storage and Neural Integration; Failure of These Mechanisms Suggests Central Pathology Anatomic and Physiologic Basis Velocity Storage. Velocity-to-Position Integration. Clinical Implications Prerotatory and Postrotatory Nystagmus. Head-Shake Nystagmus. Alexander’s Law. Interpreting Rotary Chair Tests. Principle 10: The Utricle Senses Both Head Tilt and Translation, but Loss of Unilateral Utricular Function Is Interpreted by the Brain as a Head Tilt Toward the Opposite Side Anatomic and Physiologic Basis Clinical Importance Principle 11: Sudden Changes in Saccular Activity Evoke Changes in Postural Tone Anatomic and Physiologic Basis Clinical Importance Principle 12: The Normal Vestibular System Can Rapidly Adjust Vestibular Reflexes in Accordance With the Context, but Adaptation to Unilateral Loss of Vestibular Function May Be Slow and Susceptible to Decompensation Anatomic and Physiologic Basis Clinical Implications Static Loss of Vestibular Function Can Be Compensated, But Fluctuating Loss Cannot. Effect of Suppressive Drugs on Vestibular Compensation. Basis of Vestibular Rehabilitation. Appendix Acknowledgments References 166 Evaluation of the Patient With Dizziness Abstract Keywords Key Points Background Fundamentals of Vestibular Function Peripheral Anatomy and Physiology Other Eye Movements Spinal Reflexes Approach to the Patient With Dizziness History Bedside Physical Examination Spontaneous Nystagmus. Skew Deviation. Saccades. Smooth Pursuit. Optokinetic Nystagmus. Vergence. Eye-Head Coordination. Head Impulse Testing. Dynamic Visual Acuity. Post–Head Shaking Nystagmus. Vibration. Positional Testing. Sound and Pressure Testing. Hyperventilation. Gait and Posture Testing. Testing of Central Multisensory Integration. Quantitative Testing Methods for Recording Eye Movements. Nystagmus. Saccades. Smooth Pursuit. Optokinetic Testing. Caloric Testing. Rotational Chair Testing. Quantitative Head Impulse Testing. Vestibular Evoked Myogenic Potentials. Subjective Visual Vertical. Posturography. Electrocochleography. Active Head Movement Analysis Techniques. Audiogram. High-Resolution Temporal Bone Computed Tomography. Magnetic Resonance Imaging. Serologic Tests. Adaptive Capabilities of the Vestibular System References 167 Peripheral Vestibular Disorders Abstract Keywords Key Points Basic Principles of Peripheral Vestibular Physiology Clinical Relevance Historical Background Benign Paroxysmal Positional Vertigo Incidence Diagnosis History Findings on Examination Test Results Treatment With Repositioning Surgical Treatment Vestibular Neuritis Ménière Disease (Idiopathic Endolymphatic Hydrops) History Incidence Pathogenesis Etiology of Ménière Disease Diagnosis Clinical Presentation History Hearing Loss and Tinnitus Investigations Videonystagmography. Head Thrust Testing. Electrocochleography. Dehydrating Agents. Vestibular Evoked Myopotentials. Treatment Dietary Modification and Diuretics Vasodilators Symptomatic Treatment Local Overpressure Therapy Intratympanic Injection. Endolymphatic Sac Surgery Vestibular Nerve Section Labyrinthectomy Superior Canal Dehiscence Syndrome Radiology Diagnostic Tests Treatment Variants Cogan Syndrome Otosyphilis Perilymph Fistulas Trauma Nonpenetrating Trauma Labyrinthine Concussion Blast Trauma Penetrating Trauma Barotrauma Bilateral Vestibular Hypofunction Enlarged Vestibular Aqueduct References 168 Central Vestibular Disorders Abstract Keywords Key Points Introduction Intracranial Complications of Otitic Infections Vestibular Migraine Vestibular Symptoms Nonspecific Dizziness Vertigo Motion Sickness Auditory Symptoms Hearing Loss Tinnitus Distortion Phonophobia Migraine Associated With Neurotologic Symptoms Basilar Migraine Migraine Without Headache Etiology. Management. Vestibular Disorders Associated With Migraine Benign Paroxysmal Positional Vertigo Meniere Disease Benign Paroxysmal Vertigo of Childhood Paroxysmal Torticollis Persistent Postural-Perceptual Dizziness Historical Perspective Diagnosing PPPD Precipitants of PPPD Pathophysiology Treatment Vascular Disorders Initial Evaluation Vertebrobasilar Insufficiency Lateral Medullary Syndrome Lateral Pontomedullary Syndrome Cerebellar Infarction Central Positional Vertigo Cerebellar Hemorrhage Vertebral Artery Dissection Imaging Neoplasms Vestibular Schwannomas Brainstem Neoplasms Cerebellar Neoplasm Cervical Vertigo Disorders of the Craniovertebral Junction Classification Basilar Impression Assimilation of the Atlas Atlantoaxial Dislocation Chiari Malformation Multiple Sclerosis Cerebellar Ataxia Syndromes Focal Seizure Disorders Normal Pressure Hydrocephalus Physiologic Dizziness Motion Sickness Mal de Débarquement Syndrome References 169 Surgery for Vestibular Disorders Abstract Keywords Key Points Rationale for Surgery Procedures for Benign Paroxysmal Positional Vertigo Singular Neurectomy Posterior Semicircular Canal Occlusion Surgery for Superior Semicircular Canal Dehiscence Repair of a Perilymphatic Fistula Specific Operations for Ménière Disease Cochleosacculotomy Endolymphatic Sac Surgery Patient Selection in Ablative Vestibular Surgery Priority of Distinguishing Poor Compensation From Unstable Labyrinthine Disease Clues in the Clinical History Role of Vestibular Testing Therapeutic Trial of Vestibular Rehabilitation Identification of the Offending Labyrinth Identification of Intracranial Pathology Consideration of Other Potential Treatments Residual Hearing and Selection of Procedure Ablative Procedures for Control of Vertigo Labyrinthectomy Vestibular Neurectomy Postoperative Vestibular Compensation References 170 Vestibular and Balance Rehabilitation Therapy Abstract Keywords Key Points Physiologic Rationale for Vestibular and Balance Rehabilitation Static Compensation for Peripheral Vestibular Lesions Dynamic Compensation Assessment of Vestibular Compensation Role of the Clinical History Role of Vestibular Testing Vestibular Rehabilitation: Patient Selection Criteria Vestibular Rehabilitation as a Primary Treatment Modality Vestibular Rehabilitation as an Adjunctive Modality Vestibular Rehabilitation as a Therapeutic Trial Inappropriate Candidates Role of Balance Function Studies in Patient Selection Role of Outcome Measures Patient-Reported Outcome Measures Functional Performance Outcome Measures Vestibular Rehabilitation: Common Techniques Gaze Stability Exercises Vestibular Habituation Exercises Substitution Exercises Postural Control and Gait Exercises Conditioning and Maintenance Activities Maintenance of Initial Results Role of Therapist in Patient Education Vestibular Rehabilitation: Expected Results Acknowledgment References 8 Facial Nerve Disorders 171 Tests of Facial Nerve Function Abstract Keywords Key Points Physical Examination Pathophysiology Imaging Electrodiagnostic Testing Nerve Excitability Test Maximum Stimulation Test Electroneuronography Electromyography Intraoperative Monitoring Unconventional Tests of Facial Nerve Function Acoustic Reflex Evoked Potentials Antidromic Potentials Blink Reflex Magnetic Stimulation Optical Stimulation Transcranial Electrical Stimulation–Induced Facial Motor-Evoked Potentials Topognostic Tests Lacrimal Function Stapedius Reflex Taste Salivary Flow Test Salivary pH References 172 Clinical Disorders of the Facial Nerve Abstract Keywords Key Points Bell Palsy: Spontaneous Idiopathic Facial Paralysis Incidence Etiology Histopathology Central Nervous System Changes Electrophysiology and Testing Nerve Excitability Threshold Maximal Stimulation Test Electroneurography Electromyography Nerve Conduction Velocity Interpretation of Electrical Tests Electromagnetic Stimulation of the Facial Nerve Antidromic Stimulation of the Facial Nerve Imaging of the Facial Nerve Prognosis and Statistics Management Rehabilitation of Facial Paralysis Botulinum Toxin Physical Therapy Facial Reanimation Special Cases of Facial Paralysis Ramsay Hunt Syndrome Congenital Facial Paralysis Spontaneous Facial Paralysis in Children Familial Facial Paralysis Recurrent Paralysis Bilateral Facial Paralysis Progressive Paralysis Traumatic Facial Paralysis Facial Paralysis Associated With Other Conditions Pregnancy Melkersson-Rosenthal Syndrome Human Immunodeficiency Virus Lyme Disease Kawasaki Disease Sarcoidosis Otitis Media Barotrauma Benign Intracranial Hypertension Metabolic Disorders Central Facial Paralysis References 173 Intratemporal Facial Nerve Surgery Abstract Keywords Key Points Surgical Anatomy General Surgical Technique Surgical Approaches Retrolabyrinthine Approach: Brainstem to Internal Auditory Canal Porus Technique Retrosigmoid Approach Technique Advantages and Uses Limitations and Potential Complications Middle Cranial Fossa (Transtemporal) Approach: Internal Auditory Canal Porus to Tympanic Segment Technique Advantages and Uses Limitations and Potential Complications Results With Middle Cranial Fossa Decompression of Bell Palsy Transmastoid Approach: Geniculate Ganglion to Stylomastoid Foramen Technique Advantages and Uses Limitations and Complications Translabyrinthine Approach: Total Facial Nerve Exposure Technique Advantages and Uses Limitation and Complications Combination Approaches Rerouting Partial Rerouting Nerve Repair Facial Nerve Tumors References 174 Rehabilitation of Facial Paralysis Abstract Keywords Key Points Evaluation of Facial Paralysis History and Physical Examination Assessment of Facial Deformity Classification of Facial Paralysis Electromyography in Facial Paralysis Goals of Facial Reanimation Timing of Intervention Facial Nerve Repair and Grafting Primary Neurorrhaphy and Interposition Graft Repair Donor Nerve Options Nerve Transfer Hypoglossal Nerve Transfer Cross-Facial Nerve Transfer Masseteric Nerve Transfer Dual Innervation Strategies Approach to Upper Face Reanimation Brow Upper Eyelid Eyelid Weighting Other Static Procedures Dynamic Procedures Lower Eyelid Canthoplasty/Canthopexy Spacer Grafting Static Sling Procedures Dynamic Procedures Approach to Midfacial Reanimation Oral Commissure and Nasolabial Fold Dynamic Procedures Free Muscle Transfer. Regional Muscle Transfer. Static Procedures Nose Approach to Reanimation of the Lower Face Lower Lip Chin/Neck Management of Synkinesis Adjunctive Aesthetic Procedures References 9 Cranial Base 175 Surgical Anatomy of the Lateral Skull Base Abstract Keywords Key Points Osseous Anatomy of the Lateral Skull Base Anatomy of the Middle Cranial Fossa Anatomy of the Posterior Cranial Fossa Cerebellopontine Angle Internal Auditory Canal Jugular Foramen Anatomy of the Infratemporal Fossa References 176 Surgery of the Anterior and Middle Cranial Base Abstract Keywords Key Points Introduction Surgical Anatomy Anterior Cranial Base Middle Cranial Base Preoperative Considerations Angiography Cerebral Blood Flow Evaluation Preoperative Embolization Other Evaluations Pathology and Management Planning Anesthesia Operative Techniques General Considerations Overview of Approaches Endoscopic Endonasal Surgery Planning the Operative Approach Goal 1. Goal 2. Goal 3. Goal 4. Anterior Cranial Base Approaches Technical Note: Bicoronal Incision Anterior Craniofacial Resection Basal Subfrontal Approach Endoscopic Surgery of the Anterior Skull Base Keyhole Craniotomy Techniques Middle Cranial Base Approaches Division into Central and Lateral Compartments Approaches to the Central Compartment Approaches to the Lateral Compartment Transtemporal Approaches. Infratemporal Approaches. Transfacial Approaches. Intracranial Approaches. Endoscopic Surgery of the Middle Cranial Base Reconstruction Postoperative Concerns Initial Postoperative Care Complications Outcomes References 177 Transnasal Endoscopic-Assisted Surgery of the Anterior Skull Base Abstract Keywords Key Points Surgical Anatomy Anterior Cranial Fossa Nasal Cavity Paranasal Sinuses Nasopharynx Clivus Retroclival Region Preoperative Assessment Operative Technique Instrumentation Transnasal Surgical Approaches to the Skull Base Transsphenoidal Approach Direct Transnasal Access Transseptal Access Transseptal-Transnasal Access Transethmoid Access Transsellar and Parasellar Approaches Transclival Approach Approach to the Clivus and Cavernous Sinus Petrous Apex Access Transcribriform Approach Transcribriform Unilateral Access Transcribriform Bilateral Access Transtuberculum-Transplanum Approach Transmaxillary-Transpterygoidal-Infratemporal Approach Craniocervical Junction Approach Combined Approaches Reconstruction Postoperative Care Complications Summary References 178 Temporal Bone Neoplasms and Lateral Cranial Base Surgery Abstract Keywords Key Points Introduction Diagnosis of Neoplasms of the Temporal Bone Computed Tomography and Magnetic Resonance Imaging Common Neoplasms of the Temporal Bone Benign Neoplasms of the Temporal Bone Paraganglioma Symptoms Diagnostic Evaluation Surgical Approach Radiotherapy Jugular Foramen Tumors Facial Nerve Tumors Diagnostic Evaluation Management and Surgical Approach Epidermoids (Congenital Cholesteatoma) Symptoms Diagnostic Evaluation Surgical Approach Cholesterol Granuloma Diagnosis Management Encephalocele and Cerebrospinal Fluid Leaks Diagnosis Management Malignant Neoplasms of the Temporal Bone Squamous Cell Carcinoma Pertinent Anatomy Symptoms and Signs Staging Management Chordoma Chondrosarcoma Diagnosis Management Lateral Skull Base Surgery Surgical Approaches Sleeve Resection of External Auditory Canal Lateral (Partial) Temporal Bone Resection Subtotal and Total Temporal Bone Resections Infratemporal Fossa Approaches Fisch Type A Approach Fisch Type B and C Approaches Type B Approach. Type C Approach. Complications Intraoperative Complications Postoperative Complications References 179 Neoplasms of the Posterior Fossa Abstract Keywords Key Points Approach to Diagnosis of Neoplasms of the Posterior Fossa Common Cerebellopontine Angle Neoplasms Acoustic Neuroma Natural History Signs and Symptoms Diagnostic Studies Audiometry. Auditory Brainstem Response Testing. Vestibular Tests. Imaging. Meningiomas Signs and Symptoms Diagnostic Studies Audiovestibular Testing. Imaging. Primary Cholesteatomas Signs and Symptoms Diagnostic Studies Auditory Testing. Imaging. Facial Nerve Neuroma Signs and Symptoms Diagnostic Studies Auditory Testing. Electroneurography. Imaging. Other Cranial Nerve Neuromas Glomus Tumors Arachnoid Cysts Hemangiomas Petrous Apex Lesions Cholesterol Granulomas Asymmetric Petrous Apex Pneumatization Mucocele, Mucus Retention Cysts, and Petrous Apex Effusion Petrous Carotid Artery Aneurysms Giant Cell Tumors Miscellaneous Cerebellopontine Angle Lesions Metastatic Tumors Chordomas Chondrosarcomas Lipomas Dermoid Tumors Teratomas Intraaxial Tumors Hemangioblastomas Medulloblastomas Brainstem Gliomas Tumors of the Fourth Ventricle Malignant Choroid Plexus Papillomas and Ependymomas Surgery of the Posterior Cranial Fossa Translabyrinthine Approach Basic Approach Indications Technique Tumor Removal Special Features Retrosigmoid (Suboccipital) Approach Basic Approach Indications Technique Special Features Middle Fossa Approach Basic Approach Indications Technique Special Features Retrolabyrinthine Approach Basic Approach Indications Technique Special Features Transcochlear Approach Basic Approach Indications Technique Special Features Transotic Approach Basic Approach Indications Technique Special Features Extended Middle Fossa Approach Basic Approach Indications Technique Special Features Combined Techniques: Petrosal Approach Basic Technique Indications Technique Special Features Experimental Approaches Approaches for Skull Base Lesions That Require Drainage Translabyrinthine Approach Middle Cranial Fossa Approach Infralabyrinthine Approach Transcanal Infracochlear Approach Selection of Surgical Approach Patient Management and Surgical Complications Preoperative Management Intraoperative Monitoring Postoperative Care Complications Anteroinferior Cerebellar Artery Cerebrospinal Fluid Leaks Meningitis Facial Nerve Injury Ophthalmologic Considerations Selection of Neoplasm Treatment Strategy References 180 Intraoperative Monitoring of Cranial Nerves in Neurotologic Surgery Abstract Keywords Key Points Technical Considerations Instrumentation Recording Electrodes Types of Recording Electrodes Subdermal Needle Electrodes. Intramuscular Hook Wire Electrodes. Other Types of Recording Electrodes. Placement of Recording Electrodes Electrode Placement for Facial Nerve Monitoring. Electrode Placement for Monitoring Auditory Brainstem Responses. Stimulating Electrodes Stimulation Parameters Anesthesia Facial Nerve (7th Nerve) Monitoring Vestibular Schwannoma and Other Cerebellopontine Angle Tumors Electromyography Activity Evoked by Electrical Stimulation (Triggered Electromyography) Use of Stimulation to Map Nerves in Relation to Tumor. Assessment of Functional Status of Nerves After Tumor Removal. Prediction of Good Postoperative Facial Nerve Outcome. Prediction of Poor Postoperative Facial Nerve Outcome. Indication of Declining Facial Nerve Function in Large Vestibular Schwannomas. Spontaneous and Mechanically Evoked Activity (Free-Run Electromyography) Detection of Mechanical Facial Nerve Manipulation. Prediction of Postoperative Facial Nerve Function. Indication of the Depth of Anesthesia. Pitfalls and Limitations of Electromyographic Monitoring. Obtaining an Electromyography Response to Electrical Stimulation After the Nerve Has Been Injured. Confusion Between the Facial Nerve and the Nervus Intermedius. Difficulty in Distinction Between Artifacts and Electromyography. Difficulty of Monitoring During the Use of Electrocautery. Inability to Use Electrical Stimulation in Large Tumors Before Nerve Exposure. Monitoring of Transcranial Corticobulbar Motor Evoked Potentials Methodology for the Monitoring of Corticobulbar Motor Evoked Potentials Pitfalls of Monitoring Corticobulbar Motor-Evoked Potentials. Usefulness of Corticobulbar Motor-Evoked Potential in Predicting Postoperative Outcome. Value of Combining Electromyography and Corticobulbar Motor-Evoked Potentials. Other Methods of Motor Nerve Monitoring Third, 4th, and 6th Nerve Monitoring: Extraocular Muscles Trigeminal Motor Branch Monitoring Monitoring of Lower Cranial Nerves: 9th, 10th, 11th, and 12th Nerves Monitoring of the Glossopharyngeal Nerve Monitoring of the Vagus Nerve Monitoring of the Accessory Nerve Monitoring of the Hypoglossal Nerve Using Corticobulbar Motor Evoked Potentials to Monitor Other Motor Cranial Nerves Cochlear (8th) Nerve Monitoring Auditory Brainstem Response Recording in the Operating Room Stimulus and Recording Parameters, Electrodes, and Placement Interpretation of Responses in Surgical Context Correlation of Intraoperative Auditory Brainstem Response With Postoperative Auditory Function Direct 8th-Nerve Action Potentials Placement of Electrodes Stimulus and Recording Parameters Detection and Interpretation of Changes Conclusion References 181 Radiation Therapy of Benign Tumors of the Cranial Base Abstract Keywords Key Points Principles of Stereotactic Radiation Radiobiology Imaging Treatment of Tumors of the Cranial Base: Review of Stereotactic Radiation for Vestibular Schwannomas Dose Selection Fractionation Versus Nonfractionation Patient Selection Outcome Assessment Tumor Control Initial Posttreatment Effect Long-Term Tumor Control Tumor Control: Large-Volume Vestibular Schwannomas Hearing Outcomes Nonaudiologic Cranial Nerve Morbidity and Tumor Control Facial Nerve Outcomes Trigeminal Nerve Outcomes Vestibular Schwannoma Related to Neurofibromatosis Type 2 Risk of Malignant Transformation After Stereotactic Radiation for NF2-Associated Vestibular Schwannomas Cystic Schwannomas Complications and Failures Hydrocephalus Treatment of Stereotactic Radiation Failures Quality of Life Jugular Foramen Schwannomas Paraganglioma Stereotactic Radiosurgery for Glomus Jugulare Tumors Conclusions References VIII Pediatric Otolaryngology 1 General 182 General Considerations in Pediatric Otolaryngology Abstract Keywords Key Points Introduction History of Pediatric Otolaryngology The Important Differences Between a Child and an Adult Physiology Ventilation/Perfusion Relationships Newborn Heart and Cardiac Output Blood Volume Response to Hypoxia Fluids and Fluid Management Pain Management Sedation The Faces of Children Respiratory System Control of Ventilation Ventilation Reflexes. Laryngeal Sensitivity. Lung Volumes Respiratory Rate Pediatric Otolaryngology Practice Referral Sources Patients Parents History Physical Examination Microscopic Examination of the Ear Flexible Endoscopy Audiology Preparation for Hospitalization and Surgery Hospital Selecting Anesthesia Postoperative Management Genetics and Pediatric Otolaryngology Illustrative Case 1 Illustrative Case 2 Illustrative Case 3 Biosocial Issues in Pediatric Otolaryngology Autism Spectrum Disorders Ethical Dilemmas in Pediatric Otolaryngology Conclusion References 183 Pediatric Speech Disorders Abstract Keywords Speech Sound Disorders Dysarthria Apraxia Articulation Disorders Phonologic Disorders Language Disorders Autism Overlap With Other Disorders ASD, Attention-Deficit/Hyperactivity Disorder, and Sensory Processing Autism Spectrum Disorder and Cognitive Impairment Autism Spectrum Disorder and Hearing Impairment Autism Spectrum Disorder and Specific Language Impairment Role of Pediatric Otolaryngology Where to Refer Speech-Language Pathology Multidisciplinary Autism Spectrum Disorder Clinic Neurology Behavioral Pediatrics and Psychology Audiology Occupational Therapy References 184 Anesthesia in Pediatric Otolaryngology Abstract Keywords Key Points Introduction and General Considerations Preoperative Anesthetic and Risk Assessment Congenital Heart Disease Neurotoxicity Anesthetic Considerations for Common Pediatric Diseases Prematurity Cerebral Palsy Autism Upper Respiratory Tract Infection Reactive Airway Disease Cystic Fibrosis Musculoskeletal Diseases Mitochondrial Myopathies Obesity Diabetes Mellitus Sickle Cell Disease Down Syndrome Genetic Syndromes Associated With a Difficult Airway Preoperative Management Psychological Techniques Parent Present Induction Pharmacologic Techniques Nil Per Os Guidelines Intraoperative Management American Society of Anesthesiologists Standards of Monitoring Definition of General Anesthesia and Levels of Sedation/Analgesia Anesthetic Induction and Maintenance Inhalational Induction Inhalational Agents Intravenous Agents for Induction and Maintenance of General Anesthesia Intramuscular Induction Other Commonly Used Drugs in Anesthesia Opioids Anesthetic Considerations for Common Pediatric Otolaryngology Procedures Airway Management Direct Laryngoscopy and Bronchoscopy Foreign Body Tracheostomy Sleep-Disordered Breathing (See Chapter 186) and Adenotonsillectomy Sleep Endoscopy Anterior Mediastinal Mass Myringotomy and Tympanostomy Tubes Tympanoplasty, Mastoidectomy, and Cochlear Implants Rapid Sequence Induction Extubation Criteria and Deep Extubation Laryngospasm Bronchospasm Postoperative Nausea Prophylaxis Postoperative Management Pain Management Nonopioid Medications The Postanesthesia Care Unit Postanesthesia Care Unit Discharge Criteria Emergence Delirium Postintubation Stridor Conclusion References 185 Nonobstructive Pediatric Sleep Disorders Abstract Keywords Key Points Dyssomnias Insufficient Sleep Syndrome Narcolepsy Sleep-Related Movement Disorders Circadian Rhythm Sleep-Wake Disorders Idiopathic Hypersomnia and Kleine-Levin Syndrome Chronic Insomnia Disorder Limit-Setting Sleep Disorder Parasomnias Sleep Terrors Sleepwalking Confusional Arousals Nightmare Disorder Sleep Paralysis Rapid-Eye-Movement Sleep Behavior Disorder Pediatric Neuropsychiatric Disorders and Sleep Disruption References 186 Evaluation and Management of Pediatric Obstructive Sleep Apnea Abstract Keywords Key Points Historical Perspective Definitions Etiology and Pathogenesis Epidemiology Clinical Features Nighttime Symptoms Daytime Symptoms Predisposing Conditions Obesity Down Syndrome Craniofacial Syndromes Achondroplasia Mucopolysaccharide Storage Diseases Neuromuscular Disease and Cerebral Palsy Other Disorders Physical Examination Ancillary Studies Polysomnography Limitations of Polysomnography Natural History Treatment Medical Surgical Treatment Tonsillectomy and Adenoidectomy Quality of Life Surgical Techniques Postoperative Complications Other Surgical Modalities References 2 Craniofacial 187 Craniofacial Surgery for Congenital and Acquired Deformities Abstract Keywords Key Points Epidemiology Craniofacial Growth Pathophysiology Metabolic Disorders Intrauterine Causes Acquired Craniofacial Deformities Clinical Manifestations Congenital Craniofacial Abnormalities Craniosynostosis Neurodevelopmental Delays Scaphocephaly Trigonocephaly Positional Plagiocephaly/Deformational Plagiocephaly Synostotic Plagiocephaly Brachycephaly Acrocephaly Other Skull Patterns Encephalocele (See Chapter 190) Craniofacial Syndromes Crouzon Syndrome Apert Syndrome Pfeiffer Syndrome Jackson-Weiss Syndrome Saethre-Chotzen Syndrome Carpenter Syndrome Stickler Syndrome 22q11.2 Deletion Syndrome (Velocardiofacial Syndrome) Treacher Collins Syndrome (Mandibulofacial Dysostosis) Hemifacial or Craniofacial Microsomia Trauma Neoplasm Patient Evaluation Craniofacial Team History and Physical Examination Imaging Indications for and Timing of Intervention Surgical Techniques Congenital Craniofacial Abnormalities Incision Fixation Sagittal Synostosis Controversies and Evidence-Based Medicine in Primary Craniosynostosis Surgery Fronto-Orbital Advancement Open Approach Monobloc Advancement Orbital Hypertelorism and Dystopia Distraction Osteogenesis Neoplasm Biomaterials in Skeletal or Cartilaginous Defect Repair Conclusion References 188 Cleft Lip and Palate Abstract Keywords Key Points Introduction Classification of Cleft Lip and Palate Embryology Diagnosis Prenatal Diagnosis Molecular Genetics of Orofacial Clefts Epidemiology Multidisciplinary Cleft Team Nursing Care Anatomy Anatomy of the Cleft Lip Deformity Cleft Palate Deformity Presurgical Considerations Cleft Lip Repair and Cleft Rhinoplasty Definitive Unilateral Lip Repair Surgical Technique: Rotation Flap Surgical Technique: Advancement Flap Closure: Rotation Advancement Flap Primary Rhinoplasty Bilateral Cleft Lip Deformities Cleft Palate Repair Palatoplasty Techniques Basic Principles Complications Surgical Techniques Two-Flap Palatoplasty Double-Opposing Z-Plasty Palatoplasty: Furlow Palatoplasty Special Considerations in Patients With Cleft Palate Robin Sequence Microdeletion 22q11.2 Syndrome Submucous Cleft Palate Ear Disease References 189 Velopharyngeal Dysfunction Abstract Keywords Key Points Introduction Functional Anatomy Causes of Velopharyngeal Dysfunction Chromosome 22q11.2 Deletion Syndrome Assessment Perceptual Speech Analysis Nasometry Aerodynamic Assessment Quality of Life Speech Endoscopy Speech Videofluoroscopy Other Types of Imaging Treatment Speech Therapy Articulation Therapy Resonance Therapy Compensatory Strategies Prosthetic Management Surgical Intervention Levator Repositioning and Intravelar Veloplasty Double-Opposing Z-Plasty Palatoplasty Pharyngeal Flap Operation Sphincter Pharyngoplasty Posterior Wall Augmentation Choice of Surgical Intervention Conclusions References 190 Congenital and Acquired Malformations of the Nose and Nasopharynx Abstract Keywords Key Points Developmental Errors of the Anterior Neuropore Encephaloceles Gliomas Nasal Dermoids Developmental Errors of the Central Midface Complete Agenesis of the Nose (Arhinia) Polyrhinia and Supernumerary Nostril Proboscis Lateralis Craniofacial Clefts Cleft Lip Nasal Deformity Congenital Stenosis of the Nasal Piriform Aperture Nasolacrimal Duct Cysts Bilateral Nasolacrimal Duct Cysts Produce the Most Severe Symptoms Developmental Errors of the Nasobuccal Membrane Choanal Atresia Other Mesodermal and Germline Malformations Intranasal Hemangiomas Nasopharyngeal Teratomas Acquired Malformations of the Nose References 191 Pediatric Facial Fractures Abstract Keywords Key Points Introduction Epidemiology Incidence Etiology Site Distribution Developmental Anatomy Diagnosis Initial Trauma Survey Physical Examination Imaging General Management Principles Timing of Repair Maxillomandibular Fixation Types of Plating Systems Frontal Fractures Orbital Fractures Orbital Roof Fractures Orbital Floor Fractures Midface Fractures Zygoma/Zygomaticomaxillary Complex Fractures Le Fort Fractures Nasoorbitoethmoid Fractures Work-Up and Management of Complex Midface Fractures Nasal Fractures and Nasal Septal Injury Dentoalveolar Trauma Mandible Fractures Condylar Fractures Symphysis and Parasymphysis Fractures Angle and Body Fractures Postoperative Care Conclusion References 3 Hearing Loss and Pediatric Otology 192 Pediatric Otologic Surgery Abstract Keywords Middle Ear and Mastoid Surgery Chronic Suppurative Otitis Media and Tympanic Membrane Repair Cholesteatoma Canal Wall Up Versus Canal Wall Down Mastoid Surgery Mastoid Obliteration Totally Endoscopic Ear Surgery for Cholesteatoma Hearing Rehabilitation and Cholesteatoma Bone Conduction Devices Diagnosis and Indications Conductive Loss Single Sided Deafness Surgical Technique and Timing Complications Summary Cochlear Implantation Etiology Autosomal Recessive Nonsyndromic SNHL Cochleovestibular and Cochlear Nerve Anomalies Congenital Human Cytomegalovirus Infection Surgical Considerations Auditory Deprivation Device Placement and Fixation Explant/Reimplant Ideal Electrode Design in Infants and Children Cochleostomy vs. Round Window Insertion Summary References 193 Early Detection and Diagnosis of Infant Hearing Impairment Abstract Keywords Key Points Epidemiology of Hearing Loss Status of Hearing Loss Diagnosis Before Universal Newborn Hearing Screening History of Newborn Hearing Screening Resistance to Newborn Hearing Screening Studies of Statewide Screening National Newborn Hearing Statements and Current Status of Newborn Hearing Screening Newborn Hearing Screening Methods Diagnostic Auditory Brainstem Response Auditory Steady-State Response Behavioral Testing Comparison of Methods: Strengths and Limitations Evaluation of the Infant With Sensorineural Hearing Loss Interpretation of Middle Ear Fluid in the Infant Congenital Cytomegalovirus Genetic Mutation Imaging Auditory Neuropathy Spectrum Disorder Summary Acknowledgments References 194 Congenital Malformations of the Inner Ear Abstract Keywords Key Points Incidence Classification Malformations Limited to the Membranous Labyrinth Complete Membranous Labyrinthine Dysplasia Limited Membranous Labyrinthine Dysplasia Cochleosaccular Dysplasia (Scheibe Dysplasia) Malformations of the Membranous and Osseous Labyrinth Complete Labyrinthine Aplasia (Michel Aplasia) Cochlear Anomalies Cochlear Aplasia Cochlear Hypoplasia Incomplete Partition (Mondini Deformity) Common Cavity Cochlear Hyperplasia Labyrinthine Anomalies Semicircular Canal Dysplasia Semicircular Canal Aplasia Semicircular Canal Dehiscence Malformations of the Vestibular and Cochlear Aqueducts Enlargement of the Vestibular Aqueduct Enlargement of the Cochlear Aqueduct Developmental Anomalies of the Internal Auditory Canal Wide Internal Auditory Canal Narrow Internal Auditory Canal Anomalies of the Eighth Nerve Molecular Diagnoses Associated With Congenital Inner Ear Malformations Cerebrospinal Fluid Leakage and Meningitis X-Linked Stapes Gusher Syndrome Perilymphatic Fistula Malformations of the Vascular System High Jugular Bulb Aberrant Carotid Artery Inner Ear Malformations in Congenital Aural Atresia Imaging Evaluation and Management Cochlear Implantation References 195 Microtia Reconstruction Abstract Keywords Key Points Introduction Embryology Anatomy Microtia Classification Evaluation Surgical Planning Framework Position Principles Autologous Costal Cartilage Reconstruction Rib Harvest Nagata Technique Brent Technique Timing Alloplastic Reconstruction MedPor/SuPor Prosthetics Complications of Autologous Ear Reconstruction Future Horizons Tissue Engineering Conclusions References 196 Pediatric Cochlear Implantation Abstract Keywords Key Points Overview The Cochlear Implant Team Candidacy Audiologic Considerations Medical/Surgical Considerations Social Considerations Counseling: Developing “Realistic” Expectations Surgical Considerations Relevant to the Pediatric Patient Surgical Technique Complications and Revision Cochlear Implantation Device Activation, Programming, and Follow-Up Assessment Activation of Electrodes Device Programming Follow-Up Assessments Auditory Rehabilitation and Cochlear Implantation Outcome Modes of Communication Children With Special Needs Influence of Family Factors on Child Outcomes References 197 Evaluation and Management of Congenital Aural Atresia Abstract Keywords Key Points Demographics and Associated Deformities Initial Evaluation History and Physical Exam Hearing Evaluation Imaging Initial Counseling Timing and Sequence of Surgical Procedures Grading System for Atresia Surgery Surgical Approach (Figs. 197.8 to 197.15) Complications of Atresiaplasty Combined Microtia Repair and Atresiaplasty Hearing Results Following Atresiaplasty (Tables 197.2 and 197.3) Congenital External Auditory Canal Stenosis Implantable and Nonimplantable Hearing Devices OIBCD—Percutaneous Devices OIBCD—Transcutaneous Devices Active Middle Ear Implants Conclusion References 198 Evaluation and Management of Pediatric Vestibular Disorders Abstract Keywords Key Points Introduction Development and Maturation of the Vestibular System Development of Motor Control Vestibular Disorders in Children Benign Paroxysmal Vertigo of Childhood Middle Ear Effusion/Otitis Media With Effusion Mental Health Disorders Vestibular Impairment Related to Sensorineural Hearing Loss Ototoxicity Acquired Infection Unilateral Sensorineural Hearing Loss Impact of Cochlear Implantation Clinical Evaluation Evaluation of Vestibular End-Organ Function Pediatric Normative Data Tests of Semicircular Canal Function Caloric Testing/Videonystagmography Rotary Chair Testing and Video Head Impulse Testing Tests of Otolithic Function Behavioral Assessment of Vestibular Function Subjective Visual Vertical Evaluation of Balance Screening for Vestibular Impairment in Children With SNHL Impact of Vestibular and Balance Impairment on the Developing Child Exploring Rehabilitative Strategies Summary References 4 Infections and Inflammation 199 Acute Otitis Media and Otitis Media With Effusion Abstract Keywords Key Points Diagnosis Definition, Symptoms, and Signs Physical Examination Tympanometry (Immittance Testing) Acoustic Reflectometry Audiometry (see Chapter 134) Epidemiology Incidence and Prevalence Acute Otitis Media Otitis Media With Effusion Risk Factors Pathophysiology and Pathogenesis Eustachian Tube Function Bacterial Colonization and Biofilms Viruses Immunology Innate Immunity Adaptive Immunity Genetics Allergy Gastroesophageal Reflux Prevention Modification of Environmental Risk Factors Vaccines Vaccines Directed Against Bacterial Otopathogens S. pneumoniae Vaccine. H. influenzae Vaccine. M. catarrhalis Vaccine. Vaccines Directed Against Respiratory Viruses Influenza Vaccine. Respiratory Syncytial Virus Vaccine. Non-Vaccine Approaches to Prevent Acute Otitis Media Treatment Acute Otitis Media Observation With Close Monitoring (Watchful Waiting) Medical Treatment Analgesics. Antibiotics. Decongestants and Antihistamines. Corticosteroids. Surgical Treatment Myringotomy/Tympanocentesis. Myringotomy With Tympanostomy Tube Insertion. Recurrent Acute Otitis Media Antibiotic Prophylaxis Surgical Treatment Myringotomy With Tympanostomy Tube Insertion. Adenoidectomy. Otitis Media With Effusion Observation With Close Monitoring (Watchful Waiting) Medical Treatment Antibiotics. Decongestants and Antihistamines. Corticosteroids. Auto-inflation Hearing Aids Surgical Treatment Myringotomy. Myringotomy With Tympanostomy Tube Insertion. Adenoidectomy. Eustachian Tube Dilatation. Surgical Issues Tympanostomy Tube Insertion Procedure Types of Tympanostomy Tubes and Indications Postsurgical Follow-up Complications and Sequelae Acute Tympanostomy Tube Otorrhea. Prevention of Otorrhea Episodes Occurring in the Immediate Postoperative Period. Treatment of Otorrhea Episodes Occurring Outside the Immediate Postoperative Period. Tympanosclerosis, Atrophy, and Retraction Pockets. Persistent Perforation. Cholesteatoma. Early Extrusion. Tube Blockage. Tube Displacement Into the Middle Ear. Retained Tympanostomy Tubes. Water Precautions. Adenoidectomy Procedure Complications and Sequelae of Otitis Media Intratemporal Complications Hearing Loss and Balance Problems Speech-Language and Child Development Mastoiditis. Intracranial Complications Meningitis Epidural Abscess and Subdural Empyema Brain Abscess Lateral Sinus Thrombosis References 200 Pediatric Chronic Rhinosinusitis Abstract Keywords Key Points Definition and Clinical Presentation Definition Prevalence Clinical Symptoms Quality of Life Pathophysiology (Box 200.2) Genetic Factors Anatomic Factors Bacteriology Biofilms Role of Adenoids Inflammatory Changes Comorbid Diseases (Box 200.3) Allergic Rhinitis Asthma Gastroesophageal Reflux Disease Immunodeficiency Primary Ciliary Dyskinesia Cystic Fibrosis Diagnostic Workup Medical Treatment Antibiotics Steroids Ancillary Treatments Surgical Treatment Adenoidectomy With and Without Sinus Irrigation and Balloon Dilation Functional Endoscopic Sinus Surgery Summary References 201 Pediatric Infectious Disease Abstract Keywords Key Points Pharyngotonsillitis Viral Pharyngitis Epstein-Barr Virus Streptococcal Tonsillitis-Pharyngitis Other Causes of Pharyngotonsillitis Periodic Fever With Aphthous Ulcers, Pharyngitis, and Adenopathy Complications of Tonsillitis Group A β-Hemolytic Streptococcus May Be Complicated by Suppurative and Nonsuppurative Sequelae Croup (Laryngotracheobronchitis) Supraglottitis (Epiglottitis) Bacterial (Exudative) Tracheitis Pertussis Bronchiolitis References 5 Head and Neck 202 Congenital and Inflammatory Neck Masses in Children Abstract Keywords Key Points Introduction Embryology Derivatives of Pharyngeal Arches Derivatives of the Pharyngeal Pouches Development of the Tongue Development of the Thyroid Gland Approach to the Evaluation of Pediatric Neck Masses History Examination Imaging Laboratory Studies Presumptive Diagnosis Biopsy Common and Important Congenital Pediatric Neck Masses Pharyngeal (Branchial) Cleft Anomalies (See Table 202.2) Thyroglossal Duct Cysts Dermoid Cysts Reactive Lymphadenopathy Acknowledgments References 203 Vascular Anomalies of the Head and Neck Abstract Keywords Key Points Introduction Vascular Tumors Hemangiomas of Infancy Clinical Presentation PHACE Syndrome Other Types of Vascular Tumors Congenital Hemangioma Kaposiform Hemangioendothelioma and Tufted Angioma Common Complications of Vascular Tumors Kasabach-Merritt Phenomenon Bone Resorption Hemangioma of Infancy: Treatment Overview Analysis and Treatment of Facial Hemangiomas Medical Therapy Laser Therapy Surgical Therapy Assessment and Treatment of Airway Hemangiomas Vascular Malformations Lymphatic Malformations Diagnostic Evaluation Clinical Assessment and Behavior Associated Conditions Treatment Options Sclerotherapy Surgery Sirolimus Multimodal Therapy Venous Malformations Arteriovenous Malformations Capillary Malformations Summary Acknowledgments References 204 Pediatric Head and Neck Neoplasms Abstract Keywords Key Points Lymphoproliferative Disorders and Histiocytoses Malignant Lymphomas Presentation and Evaluation of Malignant Lymphoma Management of Malignant Lymphoma Hodgkin Lymphoma. Non-Hodgkin Lymphoma. Histopathology Hodgkin Lymphoma. Non-Hodgkin Lymphoma. Posttransplant Lymphoproliferative Disease Management of Posttransplant Lymphoproliferative Disorder Langerhans Cell Histiocytosis Neuroectodermal Tumors Ewing Sarcoma and Peripheral Primitive Neuroectodermal Tumor Neuroblastomas Presentation and Evaluation Management Histopathology and Molecular Biology Mesenchymal Tumors Rhabdomyosarcoma Presentation and Management. Staging. Management. Nonrhabdomyosarcoma Soft-Tissue Sarcomas Teratomas Presentation and Evaluation Management Histopathology and Molecular Biology Carcinomas and Solid Tumors Thyroid Malignancy Evaluation of Thyroid Nodules Management of Thyroid Nodules and Thyroid Malignancies Papillary Thyroid Cancer. Follicular Thyroid Cancer. Medullary Thyroid Cancer. Nasopharyngeal Carcinoma Presentation and Evaluation Management Acknowledgments References 205 Salivary Gland Disease in Children Abstract Keywords Key Points Introduction Anatomy and Physiology History and Physical Examination Evaluation Laboratory Studies Diagnostic Imaging Sialendoscopy Biopsy Infectious Conditions Acute Suppurative Sialadenitis Salivary Gland Abscess Viral Infections Mumps Epstein-Barr Virus Human Immunodeficiency Virus Granulomatous Conditions Atypical Mycobacteria Actinomycosis Cat-Scratch Disease Sarcoidosis Autoimmune, Inflammatory, and Cystic Lesions Sjögren Syndrome Juvenile Recurrent Parotitis Sialolithiasis Necrotizing Sialometaplasia Cysts and Mucoceles Acquired Congenital Sialadenosis Pneumoparotitis Postsurgical Parotitis Salivary Gland Tumors Vascular Anomalies (See Chapter 203) Benign Neoplasms Malignant Neoplasms Sialorrhea Treatment Options for Sialorrhea Botulinum Toxin Injection Pearls and Pitfalls in Pediatric Salivary Gland Surgery Parotid Surgery Submandibular Gland Surgery Sialendoscopy Conclusion Acknowledgments References 6 Pharynx, Larynx, Trachea, and Esophagus 206 Evaluation and Management of the Pediatric Airway Abstract Keywords Key Points Assessment of a Child With Noisy Breathing Characterization of Noisy Breathing History Physical Examination Endoscopy Optional Diagnostic Exams Laryngomalacia Vocal Fold Dysfunction Vocal Fold Paralysis Paradoxical Vocal Fold Motion Laryngeal Web and Atresia Acquired Anterior Laryngeal Webs Subglottic Disease Congenital Subglottic Stenosis Subglottic Infantile Hemangiomas Cysts Laryngeal Cysts Supraglottic Cysts Glottic Cysts Subglottic Cysts Saccular Cysts and Laryngoceles Vallecular Cysts and Thyroglossal Duct Cysts Laryngeal and Laryngotracheoesophageal Clefts Type 1 and 2 Laryngeal Clefts Type 3 and 4 Laryngeal Cleft Bifid Epiglottis Summary References 207 Ankyloglossia and Tight Maxillary Frenula Abstract Keywords Key Points Introduction Historical Context Incidence and Natural History Evaluation and Diagnosis Classification Sequelae: Potential Manifestations in Breastfeeding Patients Ankyloglossia and Speech Mechanical and Social Effects Treatment: Surgical Procedures Surgical Outcomes Ankyloglossia Position Statements Tight Maxillary Frenulum (Lip Tie) Evaluation Classification Sequelae Treatment Surgical Technique Orthodontic Treatment Conclusion References 208 Recurrent Respiratory Papillomatosis Abstract Keywords Key Points Introduction Epidemiology Virology of Human Papillomavirus Transmission Prevention Clinical Features Patient Assessment History Physical Examination Airway Endoscopy Surgical Management Anesthetic Techniques Spontaneous Ventilation Intermittent Apnea-Reintubation Wrapped or “Laser Safe” Endotracheal Tubes Jet Ventilation Adjuvant Treatment Modalities Antiviral Modalities Interferon Cidofovir Photodynamic Therapy Indole-3-Carbinol Celecoxib Mumps Vaccine Antireflux Therapy Bevacizumab Human Papillomavirus Therapeutic Vaccines Staging Severity Registry and Task Force Initiatives Other Considerations Summary References 209 Glottic and Subglottic Stenosis and Related Voice Disorders Abstract Keywords Key Points Embryology Etiology Congenital High Airway Obstruction Syndrome Congenital Glottic Stenosis Congenital Subglottic Stenosis Acquired Subglottic Stenosis External Laryngeal Trauma Internal Laryngeal Trauma Other Causes of Acquired Subglottic Stenosis Other Types of Acquired Stenosis Anterior Glottic Stenosis. Posterior Glottic Stenosis. Supraglottic Stenosis. Diagnosis of Laryngeal Stenosis History and Physical Examination Radiographic Evaluation Endoscopic Examination Pulmonary Function Tests Multidisciplinary Team Approach Management of Laryngeal Stenosis Preoperative Considerations Surgical Management Laser Steroids Mitomycin-C Anterior Cricoid Split Procedure Endoscopic Posterior Cricoid Split Procedure Bilateral True Vocal Fold Immobility Posterior Glottic Stenosis Open Procedures Open Anterior Cricoid Split and Posterior Cricoid Split Grafts Stents Open Expansion Surgery: Laryngotracheal Reconstruction Open Resection Surgery: Cricotracheal Resection With Thyrotracheal Anastomosis Management of Other Types of Laryngeal Stenosis Laryngeal Webs Postoperative Decannulation Summary References 210 Diagnosis and Management of Tracheal Anomalies and Tracheal Stenosis Abstract Keywords Key Points Introduction and Embryology Endoscopy Radiology Tracheal Anomalies Tracheal Agenesis, Atresia, and Webs Tracheoesophageal Fistula Vascular Rings Complete Vascular Rings Incomplete Vascular Rings Tracheomalacia Treatment of Tracheomalacia Stenting. Splinting. Tracheal Stenosis Classification Management Conservative Therapy Endoscopic Therapies. Laser. Dilatation. Cryotherapy. Adjuncts. Open Repair. Complications of Open Repair. Acknowledgment References 211 Aerodigestive Foreign Bodies and Caustic Ingestions Abstract Keywords Key Points Public Health Impact Public Health and Advocacy History Epidemiology Aerodigestive Foreign Bodies Button Batteries Single Use Laundry Detergent Pods Caustic Ingestions Clinical Presentation of Aerodigestive Foreign Bodies Physical Exam Diagnostic Imaging Preoperative Considerations Anesthetic Considerations Bronchoscopy Esophagoscopy Postoperative Management Complications Caustic Ingestions Clinical Presentation of Caustic Ingestion Management Caustic Ingestions Complications Summary References 212 Pediatric Swallowing, Laryngopharyngeal and Gastroesophageal Reflux Disease, Eosinophilic Esophagitis, and Aspiration Abstract Keywords Key Points Normal Swallowing Physiology Clinical Feeding Evaluation of Infants and Young Children Instrumental Evaluation of Swallowing Management of Infants and Children With Swallowing/Feeding Problems Management Decisions in the Neonatal Intensive Care Unit Feeding Strategies for Infants and Children Posture/Position Changes Flow Rates and Thickened Liquids Choice of Nipple and Bottle Systems for Infants Oral Sensorimotor Interventions Sensory-Focused Interventions Future Directions for Evaluation and Intervention Laryngopharyngeal and Gastroesophageal Reflux and Eosinophilic Esophagitis Evaluation of Reflux and Eosinophilic Esophagitis Clinical Presentation of Gastroesophageal Reflux Disease Treatment of Gastroesophageal Reflux Disease and Eosinophilic Esophagitis Approach Conclusion References 213 Pediatric Tracheotomy and Decannulation Abstract Keywords Key Points Introduction and History Indications Preoperative Evaluation Parental Counseling Surgical Technique Tracheotomy Versus Tracheostomy Postoperative Tracheotomy Care Complications Decannulation Conclusion References 214 Laryngotracheal Clefts Abstract Keywords Key Points Introduction Embryology Classification Presentation Diagnosis and Evaluation Management Medical Management Interarytenoid Injection Augmentation Endoscopic Repair Open Repair Conclusion References
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