Section on otolaryngology. (Abstracts of Scientific Posters).

OTO1-E. DESCENDING MEDIASTINITIS WITH METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS: A CASE REPORT AND REVIEW OF THE PEDIATRIC LITERATURE. Srikanth Injeti Naidu MD, Aaron Duberstein BS, Rose Mary Stocks, MD, PharmD, and Jerome Thompson MD, MBA. Le Bonheur Children's Hospital and University of Tennessee, Memphis.

Retropharyngeal abscesses are commonly seen and treated in the pediatric population. Complications, however, such as sepsis, airway compromise, and descending mediastinitis are quite rare. We present a case report of a child who developed mediastinitis from a retropharyngeal abscess. Presenting with poor oral intake and activity, a 4-month-old boy developed sepsis and airway compromise from a progressive retropharyngeal infection. He required intubation as well as incision and drainage of the retropharynx and mediastinum. Cervical approach and thoracotomy were used. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the drainage. Diagnostic evaluation, including serial computerized tomography (CT) is discussed. Medical antimicrobial and surgical treatments are also described. A review of the pediatric English literature is presented for descending medistiatinitis. At four months following discharge, the patient is doing well without recurrence. Descending mediastinitis is a rare complication of head and neck infections. To our knowledge, this is the first case of descending mediastinitis with MRSA as a pathogen. High index of suspicion is needed, and serial CTs as well as aggressive drainage procedures may be required to treat and hopefully prevent such complications.

0TO2-E. NASAL MANIFESTATIONS OF SARCOIDOSIS. Perrin C. Clark, MD, and Peter C. Bondy, MD, FACS. Oto-HNS, Naval Medical Center, Portsmouth, VA.

A 54-year-old black woman presented with the chief complaint of increased nasal congestion and right-sided epistaxis over a period of 9 months prior to ENT evaluation. Eight months prior, she was diagnosed with pulmonary sarcoidosis, for which she was being treated with systemic corticosteroids. The patient had no other complaints. Medical history and surgical history were unremarkable. Examination revealed an exterior mass involving the right upper lateral nasal wall, and internal submucosal swelling near the uncinate and attachment of the right middle turbinate. MRI and subsequent CT were done, revealing destruction of the right nasal bone. To clarify the nature of the mass, we performed a nasal endoscopy with biopsy. The lesion was sent for pathologic analysis. What is your diagnosis? The diagnosis is nasal sarcoidosis, in association with pulmonary sarcoidosis. Sarcoidosis is a systemic granulomatous disease of unknown etiology. It affects a variety of systems, including the nose, lungs (most common), ski n, liver, eyes, spleen, and lymph nodes. Although it may affect any ethnic group, it is more prevalent and severe in blacks, usually presenting in the third and fourth decades of life. Diagnosis is based on clinical presentation, histologic evidence of noncaseating granulomas, and exclusion of other granulomatous diseases. Differential diagnosis should include histoplasmosis, tuberculosis, berrylliosis, hypersensitivity penumonitis, lymphoma, and eosinophilic granuloma. Concerning pulmonary sarcoidosis, patients often present asymptomatically, with an incidental noting on x-ray film of bilateral hilar adenopathy. Sarcoidosis of the paranasal sinuses usually presents with nasal obstruction and chronic sinusitis. A consistent finding in the nose is an erythematous, edematous, hypertrophied, friable mucosa. Radiologic studies often show extensive opacification of the sinuses. Our studies displayed a destructive mass arising from the right nasal ethmoidal area, extending into the right inferior turbinate and nasa l septum, with bone destruction in the ethmoids and nasal bone on the right. Interestingly, our patient did not exhibit erythematous, friable mucosa. Histologically, sarcoidosis presents with multiple epithelioid cell granulomas. These are organized collections of mature mononuclear macrophages. Other features may be present, including hyaline fibrosis, leukocyte infiltration, occasional necrosis, and refractile structures in giant cells. These epithelioid cells secrete more than 40 cytokines and mediators, including angiotensin-converting enzyme (ACE). Although a high ACE level is associated with active sarcoidosis, it is not diagnostic. Many disorders, including cirrhosis, diabetes, and hypersensitivity pneumonitis have elevated ACE levels. Schaumann's bodies are seen in the majority of the patients (48%-88%). These are concentric, calcified, laminated structures that indicate chronic granulomatous disease. The histologic findings of our biopsy illustrated a diffuse nonnecrotizing granulomatous process (at 40X and 200X magnification). Higher magnification (400X) showed a predominance of epithelioid histiocytes with scattered lymphocytes. In summary, nasal sarcoidosis should be in the differential diagnosis when the history of nasal obstruction is present, with or without a history of sarcoidosis. Appropriate radiologic and serologic testing should be performed. This should be accompanied by a biopsy to correlate with the rest of the clinical picture.

OTO3-E. AN INTERESTING MUCOCUTANEOUS DISEASE: A CASE OF MUCOCUTANEOUS LEISHMANIASIS IN THE HEAD AND NECK. Diana Chuong, Ziad Deeb, and Mark Fukuda. Washington, DC

A 37-year-old Spanish-speaking man with facial erythema, crusting, and chronic nasal congestion presented to the emergency department. The patient immigrated from Honduras about 14 years ago, and his most recent international travel included only a trip to El Salvador about 6 years prior. After 2 weeks in the hospital and a course of intravenous antibiotic therapy, he was diagnosed with mucocutaneous leishmaniasis by PCR, with confirmation by culturing of promastigotes. Leishmaniasis causes cutaneous, mucosal, and visceral infections that are among the World Health Organization's 6 targeted tropical diseases, and interest in them is increasing in this era of international travel. We are increasingly seeing cases in overseas travelers, military personnel, and especially in HIV-infected persons. Leishmaniasis is endemic in areas of the tropics, subtropics, and southern Europe, in the rain forests in the Americas, and the deserts in western Asia. It is important that we learn to recognize clinical infection, as untreated infection causes life-threatening systemic infection and facial disfigurement. We report our interesting case of mucocutaneous leishmaniasis in the head and neck, and attempt to discuss the complexities of leishmaniasis, including the difficulty in diagnosis of the disease and the use of PCR in our case.

OTO4-E. INPATIENT VERSUS OUTPATIENT PAROTIDECTOMY. Orhan K. Atay, BS, and Ernest M. Myers, MD. Howard University, Washington, DC.

This is a retrospective analysis of outpatients. This study includes 42 patients with a total of 44 parotidecomies from 1986 to 2001 at Howard University Hospital. Within this population were 30 females and 12 males from ages 11 months to 70 years. Of the 42 patients, 33 were under the care of the coauthor, and 9 were treated by other surgeons. These patients were analyzed according to hospitalization course, pathology, safety, and cost effectiveness. We conclude that outpatient parotidectomy can be performed with relatively low morbidity, and and is more cost effective than inpatient parotidectomy.

OTO5-E. ASSESSMENT OF QUALITY OF LIFE IN THE HEAD AND NECK CANCER PATIENT Reynaldo T. Reese, DMD, Anthony T. R. Green, DDS, William Matory, MD, and Andrea Bonnick, DDS. Department of Oral and Maxillofacial Surgery, Howard University, Washington, DC.

In an age where surgical and treatment advances as a whole have improved significantly, it is conceived that there will be increased survival rates and greater control of disease. Thus, the quality-of-life evaluation can and must be used to evaluate important factors for the post-treatment head and neck cancer patient. The quality-of-life surveys have developed into those that focus on the alleviation of suffering, not just fighting disease. The McGill Quality of Life (MQOL) questionnaire was developed in response to the clinical impression and review of literature that suggested a discrepancy between the issues people living with cancer find important to their quality of life and the domains being assessed by current quantitative quality-of-life instruments. This study is focused on determining the significance of the MQOL questionnaire as related to the head and neck cancer patient. Patients were instructed to complete a questionnaire that encompassed physical, psychological, existential, and support domain s. A total of 42 patients being followed at the Howard University Hospital Department of Oral and Maxillofacial Surgery were surveyed for this study.

The MQOL questionnaire does show significance in the assessment of quality of life issues in the post-treatment head and neck cancer patient.

OTO6-E. THE ELECTROMICRODISSECTION NEEDLE TONSILLECTOMY. Gary Y Shaw, MD, and Benji Rideout, MS. Kansas City, MO.

Over half a million tonsillectomies are performed in the US yearly. To date, numerous modalities have been advocated including cold steel, electrocautery, various lasers (CO2, KTP, YAG, etc.), argon beam, coablation, and bipolar scissors, to name a few. Parameters measured typically include surgical blood loss, OR time, postoperative pain, delay in resuming normal diet, and perioperative complications. Introduced in the early 1990s, the microelectrodissection needle has been employed for a variety of procedures. Its purported advantage is precise cautery with minimal tissue thermal necrosis. We employed this device in 25 consecutive tonsillectomies and prospectively measured standard parameters. When compared with other recent clinical series employing different techniques, we found the electromicrodissection needle tonsillectomy to be superior in nearly all parameters measured.