Otolaryngologist (ear, nose, throat)
34 years of experience
Video profile
Accepting new patients
Northeast Ann Arbor
Ann Arbor Veterans Affairs Medical Center
2215 Fuller Rd
Ann Arbor, MI 48105
734-769-7100
Locations and availability (3)

Education ?

Medical School Score
Wayne State University (1976)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Skull Fractures
Castle Connolly America's Top Doctors® (2006 - 2008, 2010 - 2014)
Castle Connolly America's Top Doctors® for Cancer (2005 - 2007, 2009 - 2012, 2014)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology
American Board of Facial Plastic and Reconstructive Surgery

Affiliations ?

Dr. Marentette is affiliated with 5 hospitals.

Hospital Affilations

Score

Rankings

  • St. Joseph Mercy Oakland
    Otolaryngology
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 3 of 4 crosses
    Top 50%
  • St. Joseph Mercy Hospital Ann Arbor
  • University of Michigan Health System
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • University of Michigan Hospitals & Health Centers *
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Marentette has contributed to 42 publications.
    Title Olfactory Groove Meningioma: Discussion of Clinical Presentation and Surgical Outcomes Following Excision Via the Subcranial Approach.
    Date December 2011
    Journal The Laryngoscope
    Excerpt

    To describe surgical outcomes and radiographic features of olfactory groove meningiomas treated by excision through the subcranial approach. Special emphasis is placed on paranasal sinus and orbit involvement.

    Title Perioperative Lumbar Drain Placement: an Independent Predictor of Tension Pneumocephalus and Intracranial Complications Following Anterior Skull Base Surgery.
    Date April 2011
    Journal The Laryngoscope
    Excerpt

    To measure the effect of routine perioperative lumbar drain placement during anterior skull base surgery on the frequency of: 1) tension pneumocephalus and 2) total intracranial complications.

    Title Usefulness of Percutaneously Injected Ethylene-vinyl Alcohol Copolymer in Conjunction with Standard Endovascular Embolization Techniques for Preoperative Devascularization of Hypervascular Head and Neck Tumors: Technique, Initial Experience, and Correlation with Surgical Observations.
    Date September 2010
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Few reports have described the embolization of head and neck lesions by using direct percutaneous techniques. We report our preliminary experience in the direct percutaneous embolization of hypervascular head and neck tumors by using Onyx in conjunction with standard endovascular embolization techniques. We describe the technical aspects of the procedure and its efficacy in reducing intraoperative blood loss.

    Title Modified Trans-oral Approach with an Inferiorly Based Flap.
    Date June 2010
    Journal Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
    Excerpt

    The trans-oral approach allows direct access to pathologies of the anterior craniocervical junction. However, the classic midline incision of the posterior pharyngeal wall can be surgically burdensome and limits lateral exposure. We reviewed the medical records of nine patients undergoing the trans-oral approach. The sites of the pathology ranged from the clivus to C2, and surgical exposure ranged from the clivus to C3. Each operation utilized an inferiorly based flap. None of the patients experienced vascular or neurologic complications, and no patient had a cerebrospinal fluid fistula, pseudomeningocele, or meningitis postoperatively. The trans-oral approach with an inferiorly based flap can therefore be safely and effectively performed with minimal oropharyngeal and neurologic morbidity. Not only does a U-shaped flap allow adequate exposure from the lower half of the clivus to C3, a flap improves lateral exposure, provides a clear operating field, and allows superficial mucosal closure not directly overlying the operative field.

    Title Cerebrospinal Fluid Leak with Recurrent Meningitis Following Tonsillectomy.
    Date April 2010
    Journal Journal of Neurosurgery. Pediatrics
    Excerpt

    The authors report an unusual case of bilateral large petrous apex cephaloceles in a 14-year-old boy with a history of recurrent meningitis. Although these lesions are rare and usually asymptomatic, surgical correction is recommended if they are associated with a persistent CSF leak. In this patient, the extensive bilateral cranial defects were not adequately treated by an intracranial approach alone. Repair of a defect in the posterior pharyngeal wall, the site of a prior tonsillectomy, ultimately resulted in repair of the CSF fistula.

    Title Glomus Cell Tumor of the Orbit.
    Date January 2010
    Journal Archives of Ophthalmology
    Title The Transglabellar/subcranial Approach for Surgical Excision of Periocular Second Tumors in Retinoblastoma.
    Date November 2008
    Journal Orbit (amsterdam, Netherlands)
    Excerpt

    PURPOSE: To evaluate the use of transglabellar/subcranial approach for surgical resection of periocular second non-ocular tumors in retinoblastoma patients. METHODS: Seven retinoblastoma patients with periocular second tumor involving anterior skull base underwent surgical resection by transglabellar/subcranial approach in a single center. The medical records of these patients were retrospectively evaluated. RESULTS: The most common presenting symptom in retinoblastoma patients with periocular second tumor was difficulty in maintaining the prosthesis in three patients (43%), followed by epistaxis in one (14%), palpable orbital mass in one (14%), persistent periocular swelling in one (14%), and visual loss in one (14%) patient. Periocular second tumors were leiomyosarcoma in three (43%) patients, osteosarcoma in three (43%), and sphenoid wing meningioma in one (14%) patient. Surgical resection by the transglabellar/subcranial approach was the only treatment in one (14%) patient with sphenoid wing meningioma and was combined with chemotherapy in three (43%) patients, and with both external beam radiotherapy and chemotherapy in three (43%) patients. Surgical margins were negative in three (43%) patients and microscopically positive in four (57%) patients. Complications were minor, including cerebral spinal fluid (CSF) leak in one (14%) patient and CSF leak and subgaleal hematoma in one (14%) patient. After 31 months mean follow-up, three (43%) patients were alive and four patients (57%) were dead. CONCLUSIONS: Retinoblastoma patients with periocular second tumors have a poor prognosis. The transglabellar/subcranial approach can be used for surgical resection of periocular second tumor involving skull base with low morbidity.

    Title Extracranial Nasopharyngeal Craniopharyngioma: Case Report.
    Date April 2007
    Journal Neurosurgery
    Excerpt

    OBJECTIVE: Craniopharyngiomas (CPs) are benign tumors that almost always occur in a suprasellar location, making complete resection difficult and often necessitating radiotherapy. A case of CP presenting in an unusual location in an 8-year-old boy highlights the goals of CP treatment. CLINICAL PRESENTATION: An 8-year-old boy sought treatment for symptoms of nasal obstruction and snoring. He also had a history of mild developmental delay, and his father had a thyroglossal duct cyst resected in his own youth. After tonsillectomy and adenoidectomy failed to improve the patient's symptoms, nasal endoscopy and biopsy revealed an intranasal CP. After this treatment, he experienced chronic thin brown nasal discharge. Magnetic resonance imaging further revealed tumor invading the sphenoid body and the clivus and that the tumor had no intracranial extension. INTERVENTION: The child underwent surgical resection via a Le Fort I osteotomy approach. Complete resection was accomplished based on intraoperative frozen section pathological examination and postoperative magnetic resonance imaging results. CONCLUSION: CP with no intracranial extension is a very rare but benign tumor. We recommend vigorous attempts to resect such tumors completely to minimize the chance of recurrence and the possible need for radiotherapy. Although radiotherapy controls CP growth quite well, it has its own risks that should be avoided if possible. Cranial base techniques may facilitate total resection.

    Title Radial Forearm Free Tissue Transfer Reduces Complications in Salvage Skull Base Surgery.
    Date March 2005
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: Patients who undergo skull base resection after prior surgery or radiation may be at high risk for complications when local flaps alone are used for reconstruction. To determine whether the complication rate could be reduced, fasciocutaneous free tissue transfer was used to reinforce the dural closure in patients who had prior skull base surgery or radiation. METHODS: This study is a case series of 20 patients (14 males, 6 females, aged 8-79 years of age with a mean of 47.7 years) from 1997 to 2001 who had prior skull base surgery or radiation, and underwent salvage skull base resection without large volume defects. All patients had a radial forearm free tissue transfer to reinforce the dural closure. Six patients had an osseous component to the forearm flap to provide vascularized bone to the orbital rim. RESULTS: The overall local complication rate was 35%. Three patients (15%) had major complications including 1 case of meningitis, 1 case of cerebrospinal fluid leak, and 1 case of a flap requiring venous salvage. There were no flap failures, 1 idiopathic median nerve palsy, and no pathologic radius bone fractures. CONCLUSION: Reconstruction with fasciocutaneous free tissue transfer for high-risk patients with low-volume dural defects following skull base resection can minimize the risk of major postoperative complications. EBM RATING: C.

    Title Restoration of the Orbital Aesthetic Subunit in Complex Midface Defects.
    Date December 2004
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES/HYPOTHESIS: Although various options exist for restoration of the orbital defect in complex craniofacial resections, the aesthetic appearance and functional result of the orbit are optimized when the bony orbital architecture, orbital volume, and facial contour are specifically addressed. The study describes an approach using free tissue transfer for restoration of the native orbital aesthetic subunit. STUDY DESIGN: Retrospective case series. METHODS: Nineteen patients (male-to-female ratio, 14:5; mean age, 52 y [age range, 8-79 y]) in the study period between 1997 and 2001 had orbital defects that could be classified into one of the following categories: 1) orbital exenteration cavities only, 2) orbital exenteration cavities with resection of less than 30% of the bony orbital rim, or 3) radical orbital exenteration cavities with resection of overlying skin and bony malar eminence. Group 1 had reconstructions with fasciocutaneous forearm flaps; group 2, with osseocutaneous forearm flaps; and group 3, with osseocutaneous scapula flaps. RESULTS: Eighteen of 19 patients achieved a closed orbital reconstruction with restoration of the orbital aesthetic subunit. Among 16 patients with more than 4 months of follow-up, 10 patients had minimal or no resulting facial contour deformity and 8 patients engaged in social activities outside the home on a frequent basis. Five of the nine patients who were working before their surgery were able to return to work. CONCLUSION: Patients with complex midface defects involving the orbit can undergo free tissue transfer and have successful restoration of the native orbital aesthetic subunit without an orbital prosthesis.

    Title Craniofacial Approaches to Midfacial Fractures.
    Date June 2004
    Journal Archives of Facial Plastic Surgery : Official Publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies
    Title Urokinase-type Plasminogen Activator Receptor Expression in Adenoid Cystic Carcinoma of the Skull Base.
    Date March 2003
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    BACKGROUND: Head and neck adenoid cystic carcinoma (ACC) is a malignancy of the salivary and lacrimal glands with a variable growth pattern and propensity for perineural spread. Involvement of the skull base indicates a poor prognosis. Despite surgical resection and adjuvant radiotherapy, tumor recurrence and metastases are common. The urokinase-type plasminogen activator and its receptor (uPAR) have an important role in tumor invasion and metastasis. The expression of uPAR is predictive of poor outcomes in many tumors. This study examines the expression of human uPAR in ACCs involving the skull base. OBJECTIVES: To determine uPAR expression in ACCs of the skull base by immunohistochemical analysis and compare expression with tumor histologic findings and clinical outcomes. STUDY DESIGN: Analysis of uPAR in archival ACC specimens and a retrospective medical chart review. SETTING: Multidisciplinary cranial base program at a university medical center with tertiary referral pattern. RESULTS: Ten (83%) of 12 tumors stained positive for uPAR. Three of 3 patients who died of ACC and 6 of 6 patients alive with disease expressed uPAR. Only 1 of 3 patients free of disease was uPAR positive. CONCLUSIONS: In most patients with ACC of the skull base, uPAR was expressed. Its expression seems to be a negative prognostic factor. However, the small study sample limits our observations. Additional study of uPAR expression in ACC at other anatomic sites is required.

    Title Correction of Nonsyndromal Craniosynostosis.
    Date August 2001
    Journal Facial Plastic Surgery Clinics of North America
    Excerpt

    Correction of craniosynostosis requires close collaboration between the craniofacial surgeon and the neurosurgeon. Typically, nonsyndromal craniosynostosis patients will require only one operation to correct the cranial vault deformity. The procedures usually are undertaken between 3 and 6 months of age. Any gaps are filled in with new bone because the dura is highly osteogenic. The early correction of these deformities can avoid future facial deformities as a result of restricted skull base growth causing maxillary and secondary mandibular deformities.

    Title Radiation Concurrent with Gemcitabine for Locally Advanced Head and Neck Cancer: a Phase I Trial and Intracellular Drug Incorporation Study.
    Date March 2001
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    PURPOSE: To examine the feasibility and dose-limiting toxicity (DLT) of once-weekly gemcitabine at doses predicted in preclinical studies to produce radiosensitization, concurrent with a standard course of radiation for locally advanced head and neck cancer. Tumor incorporation of gemcitabine triphosphate (dFdCTP) was measured to assess whether adequate concentrations were achieved at each dose level. PATIENTS AND METHODS: Twenty-nine patients with unresectable head and neck cancer received a course of radiation (70 Gy over 7 weeks, 5 days weekly) concurrent with weekly infusions of low-dose gemcitabine. Tumor biopsies were performed after the first gemcitabine infusion (before radiation started), and the intracellular concentrations of dFdCTP were measured. RESULTS: Severe acute and late mucosal and pharyngeal-related DLT required de-escalation of gemcitabine dose in successive patient cohorts receiving dose levels of 300 mg/m(2)/wk, 150 mg/m(2)/wk, and 50 mg/m(2)/wk. No DLT was observed at 10 mg/m(2)/wk. The rate of endoscopy- and biopsy-assessed complete tumor response was 66% to 87% in the various cohorts. Tumor dFdCTP levels were similar in patients receiving 50 to 300 mg/m(2) (on average, 1.55 pmol/mg, SD 1.15) but were barely or not detectable at 10 mg/m(2). CONCLUSION: A high rate of acute and late mucosa-related DLT and a high rate of complete tumor response were observed in this regimen at the dose levels of 50 to 300 mg/m(2), which also resulted in similar, subcytotoxic intracellular dFdCTP concentrations. These results demonstrate significant tumor and normal tissue radiosensitization by low-dose gemcitabine. Different regimens of combined radiation and gemcitabine should be evaluated, based on newer preclinical data promising an improved therapeutic ratio.

    Title Use of Hydroxyapatite Bone Cement to Prevent Cerebrospinal Fluid Leakage Through the Frontal Sinus: Technical Report.
    Date September 1999
    Journal Neurosurgery
    Excerpt

    OBJECTIVE: To test the efficacy of a simple technique of frontal sinus obliteration during low frontal craniotomy using hydroxyapatite cement instead of more traditional methods, such as pericranial flaps, free muscle or adipose grafts, lumbar drainage, or fibrin glue. METHODS: Eight patients undergoing low frontal craniotomy for intradural surgery had the frontal sinus obliterated by careful removal of mucosa followed by filling of the sinus with hydroxyapatite bone cement. No other adjuncts for preventing cerebrospinal fluid leakage through the sinus were used. RESULTS: At an average follow-up of 9 months, there were no cerebrospinal fluid leaks, infections, instances of resorption, or cosmetic deformities. CONCLUSION: Hydroxyapatite bone cement seems to be a simple and effective method for frontal sinus obliteration and prevention of cerebrospinal fluid leakage.

    Title Critical Pathways in Anterior Cranial Base Surgery.
    Date August 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    New advances in anterior cranial base surgery have dictated the need for a comprehensive, multidisciplinary approach in the treatment of lesions of this area, necessitating multiple modes of diagnostic and surgical techniques. Traditional consideration of the complex problems presented by neoplastic involvement of the anterior cranial base predicated on isolated syndrome analysis is no longer sufficient to adequately assess tumor pathology. To address these complex problems, we discuss a method of localization of pathology based on anatomic structure and function as well as the corresponding surgical approach to the anterior cranial base.

    Title Incidence and Management of Tension Pneumocephalus After Anterior Craniofacial Resection: Case Reports and Review of the Literature.
    Date April 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Subcranial Approach to Tumors of the Anterior Cranial Base: Analysis of Current and Traditional Surgical Techniques.
    Date March 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Tumors of the anterior cranial base have previously required a craniofacial resection to allow adequate tumor extirpation. An analysis of current and traditional techniques demonstrates a significant reduction in operative time, complication rate, and intensive care unit and total hospital length of stay with the use of the subcranial approach as compared with the traditional frontal craniotomy and lateral rhinotomy approach. The subcranial approach is both cost and time efficient and provides comparable morbidity and mortality rates.

    Title Nasopharyngeal Mucocele: a Common Lesion in an Uncommon Location.
    Date November 1998
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Outcome Analysis of the Transglabellar/subcranial Approach for Lesions of the Anterior Cranial Fossa: a Comparison with the Classic Craniotomy Approach.
    Date July 1997
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    The classic approach to anterior skull base lesions uses bifrontal craniotomies together with lateral rhinotomies. This approach requires frontal lobe retraction and is associated with postoperative anosmia and the development of frontal lobe encephalomalacia. The transglabellar/subcranial approach permits removal of anterior skull base lesions without frontal lobe retraction and avoids facial scars. No studies to date, however, have directly compared the two approaches in terms of patient morbidity. The present retrospective study compares the two approaches when used for the removal of anterior skull base lesions in terms of estimated blood loss, number of transfusions, number of days in the hospital and intensive care unit, and postoperative complications. Twenty patients with anterior skull base lesions were examined. The classic approach was used on 10, and the transglabellar/subcranial route was used on 10. When compared with the classic approach, the transglabellar/subcranial approach resulted in a lower estimated blood loss and subsequent transfusion rate, fewer days in the hospital and intensive care unit, and lower numbers and less severe types of complications. Furthermore, visualization of the tumors before resection with the transglabellar/subcranial approach allowed preservation of olfaction in virtually all of these patients. Although this study represents a small sample population, the results are sufficiently impressive to favor the transglabellar/subcranial approach for the removal of a variety of anterior skull base lesions.

    Title Supplemental Maxillomandibular Fixation with Miniplate Osteosynthesis.
    Date March 1995
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Monocortical miniplate fixation provides biomechanical fixation of mandibular fractures. The ability of this system to adequately fixate fractures clinically has not been fully accepted. We analyzed our use of supplemental maxillomandibular fixation with miniplate osteosynthesis during a 5-year period, in 287 patients with 499 mandible fractures. A retrospective, matched pairing of identical fractures fixated with identical plating-schemes was carried out. Sixty-five pairs of patients undergoing intraoral monocortical plating were identified. Patients in group 1 were treated with supplemental maxillomandibular fixation after surgery, whereas patients in group 2 were treated without postoperative maxillomandibular fixation. The rate of major complications was 11% with supplemental maxillomandibular fixation and 9% without supplemental maxillomandibular fixation (p > 0.05). The total rate of complications was 17% with supplemental maxillomandibular fixation and 20% without supplemental maxillomandibular fixation (p > 0.05). No statistically significant outcome advantage could be attributed to the use of maxillomandibular fixation.

    Title Intraoral Monocortical Miniplating of Mandible Fractures.
    Date July 1994
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: Intraoral monocortical miniplate fixation of mandibular fractures provides simultaneous visualization of the fracture and occlusal relation, while almost eliminating external incisions and potential compromise of the marginal mandibular nerve. We sought to analyze the outcome of our patients treated with this technique and compare this with literature standards for mandible fracture repair outcome. DESIGN: A retrospective analysis of outcomes for a case series. SETTING: All treatment performed in inner city, level 1 or 2 trauma rated, teaching hospitals. PATIENTS: During a 5-year period, 287 patients with 499 mandible fractures were treated with intraoral miniplates. Follow-up criteria was available for a retrospective analysis of 246 patients with 432 fractures of the mandible. INTERVENTION: Intraoral monocortical plating techniques were used to treat 313 of these 432 mandibular fractures. MAIN OUTCOME MEASURES: All complications of bone union, occlusion, wound infection, and dehiscence were graded and tabulated. RESULTS: On analysis of the miniplated fractures, 1.2% of the patients had delayed union, 0.4% had non-union, 6.5% had postoperative wound infection develop, and 4.1% had varying degrees of malunion. Complication rates are comparable with most reported studies of bicortical and monocortical plating of mandible fractures. CONCLUSIONS: Monocortical miniplate fixation is a reliable method of providing rigid fixation. It offers a reasonable alternative to bicortical plating in most mandible fractures.

    Title A Practical Methodology to Analyze Facial Deformities.
    Date December 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Despite much information about various methods to analyze the face, a practical stepwise methodology has not been firmly established in otolaryngology teaching programs. A general guideline for facial analysis would be helpful to individuals not totally familiar with facial analysis for assessing facial deformities resulting from to traumatic, neoplastic, or developmental causes. This article attempts to distill and integrate previously established guidelines for facial analysis into eight major steps to provide a preliminary and practical methodology for initial facial assessment.

    Title Injuries of the Hard Palate and the Horizontal Buttress of the Midface.
    Date November 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Traumatic injuries to the hard palate occurred in 20% of all Le Fort midfacial fractures. The side of a palatal split was directly related to the side that received the highest Le Fort injury. In a symmetric midfacial injury, the palate had a true midline split. Repair of palatal injuries from blunt trauma involved either wire and splinting (eight patients) or miniplate fixation without a splint (11 patients). There were fewer complications in those treated by the miniplate fixation technique (two of 11), as compared to those treated with wire and splinting (four of eight). In miniplate fixation of midfacial fractures, attention is focused on the reconstruction of the supporting buttresses of the midface, both vertical and horizontal. In regard to the palate, this requires union of the inferior horizontal buttress. Gunshot wounds accounted for 21% of the patients and resulted in large bony disruption of the palate, which required free soft tissue and bone grafts for repair of the inferior horizontal buttress.

    Title Rehabilitation of the Lower Cranial Nerves.
    Date September 1993
    Journal Neurosurgery Clinics of North America
    Excerpt

    Brain stem lesions frequently cause dysfunction of the lower cranial nerves. Even with successful treatment, dysfunction may remain. Various methods for rehabilitating the patient with persistent lower cranial nerve dysfunction are presented.

    Title Lag Screw Fixation in the Upper Craniomaxillofacial Skeleton.
    Date March 1993
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Rigid internal fixation of the craniomaxillofacial skeleton has become commonplace in osseous reconstructive procedures of the face. While miniplates are useful in many traumatic, reconstructive, and congenital anomaly cases, they are often unnecessary. Lag screw fixation is routinely used in the mandible and has the advantage of maximal stability when compared with other fixation techniques. These principles can similarly be applied in a variety of situations in the upper facial skeleton, including fracture and bone graft fixation, as well as in pediatric craniofacial surgery. We review the technique and appropriate indications and demonstrate via case examples this diversity of applicability for using lag screw techniques. Finally, results of 83 cases in which this technique has been used will be reviewed, including complications.

    Title The Coronal Approach. Anatomic and Technical Considerations and Morbidity.
    Date March 1993
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    The coronal flap has recently become a preferred approach for the otolaryngologist-head and neck surgeon requiring access to the craniofacial skeleton and orbit. The variety of cases in which it has proven indispensable include craniofacial reconstruction, facial trauma, and tumor resection. This method of exposure has become particularly useful with increased indications for rigid internal fixation and primary bone grafting in the management of complex facial fractures. Our experience is reviewed in terms of indications for and benefits of the coronal approach, with a detailed description of the technique emphasizing anatomic planes and neurovascular structures. Careful attention to the latter should allow prevention of potential complications.

    Title Calvarial Bone Graft Harvest. Techniques, Considerations, and Morbidity.
    Date February 1993
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    The importance of calvarial bone grafting in craniomaxillofacial trauma and facial reconstructive surgery is now widely recognized. Numerous harvesting techniques have evolved to optimize the desired thickness, size, shape, and curvature for a particular reconstructive need. At the same time, donor site selection and morbidity must be considered. This report includes a discussion of several currently utilized calvarial bone graft harvesting techniques, with emphasis on minimizing complications and morbidity. Choice of optimal harvesting technique and donor site for specific reconstructive situations will likewise be discussed. Finally, the specific morbidity in our multi-institutional calvarial bone graft harvest series of 121 patients and over 350 grafts will be reviewed.

    Title Rhabdomyosarcoma of the Infratemporal Fossa: Diagnostic Dilemmas and Surgical Management.
    Date November 1991
    Journal American Journal of Otolaryngology
    Excerpt

    We present a rare case of embryonal rhabdomyosarcoma in the infratemporal fossa presenting as an atypical facial pain syndrome. Radiographic imaging of the patient is discussed, and magnetic resonance imaging is recommended as the diagnostic modality of choice when mass lesions of the infratemporal fossa are suspected. Finally, a temporal approach to the infratemporal fossa is described, along with its advantages as an application for tumor resection in this anatomic region.

    Title Traumatic Anterior Fossa Cerebrospinal Fluid Fistulae and Craniofacial Considerations.
    Date June 1991
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Traumatic cerebrospinal fluid fistulae may present a diagnostic and treatment challenge to the head and neck surgeon. The clinical presentation may be obscured by associated injuries. This article serves as a guide in the understanding, diagnosis, and management of patients with dural fistulae of the anterior cranial fossa.

    Title Monocortical Miniplate Fixation of Mandibular Angle Fractures.
    Date March 1991
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Noncompression monocortical miniplate fixation of mandibular fractures has become a reliable method of providing rigid fixation and eliminating the need for intermaxillary fixation. Recent studies, using a variety of internal fixation techniques, have described high complication rates at the mandibular angle. This article compares the use of one miniplate vs two miniplates in treatment of angle fractures. Since September 1985, 61 patients with 63 mandibular angle fractures have been treated with miniplates. Forty-four fractures were fixed with two miniplates. Six complications (3.1%) occurred, five of which were in the one-miniplate group. The complication rate in the double-miniplate group is the lowest reported of any plating technique. The use of two miniplates has proved to be an effective method of treating mandibular angle fractures.

    Title Complex Odontoma of the Maxillary Sinus with a Complete Dentition.
    Date January 1990
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Bone Grafting Techniques in Craniofacial Trauma.
    Date December 1989
    Journal Facial Plastic Surgery : Fps
    Title The Mandibular Swing Stabilization of the Midline Mandibular Osteotomy.
    Date November 1988
    Journal The Laryngoscope
    Title Three-dimensional Ct Reconstruction in Midfacial Surgery.
    Date March 1988
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Correct preoperative planning is an essential aspect of any surgical procedure and it is equally important when midfacial reconstruction is contemplated. Conventional methods include standard radiographic views, plain tomography, photography, and computerized tomography. All of these methods produce a two-dimensional image of the patient. Three-dimensional computerized tomographic reconstruction allows the surgeon to visualize the entire facial skeletal deformity. The three-dimensional image produced also allows comparison of the deformity to surrounding normal structures, and thus makes the correction of facial asymmetrics more precise. This new modality is particularly useful in the preoperative planning for patients with zygomaticomaxillary defects that result from either trauma or maxillectomy. Illustrative examples of patients in whom autogenous bone graft zygomaticomaxillary reconstruction was performed, after trauma and subsequent to subtotal maxillectomy, are presented. The amount and exact placement of the grafts was determined preoperatively from the analysis of the three-dimensional CT reconstruction, and the surgical planning was thereby simplified.

    Title Profile Planning Based on Alterations in the Positions of the Bases of the Facial Thirds.
    Date May 1986
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    To analyze the profile properly, the size and position of the bases of the facial thirds must be known. In this study an average face was created by standard cephalometrics. The bases of the facial thirds were then moved in the horizontal or vertical direction, and the soft tissue profile was drawn to correspond to the skeletal changes. The results show how underlying skeletal abnormalities influence the profile. The terms used to describe the size and position of the bases serve as an aid in profile planning.

    Title Extended Fronto-orbital Approaches to the Anterior Cranial Base: Variations on a Theme.
    Date
    Journal Skull Base Surgery
    Excerpt

    Combined frontal, orbital and zygomatic osteotomies have expanded the skull base surgeon's repertoire of approaches to the anterior skull base. Techniques borrowed from craniofacial surgery provide for extensive exposure of the orbit and anterior fossa while minimizing brain retraction. This article emphasizes the variations on the theme of fronto-orbital craniotomy that allow this approach to be adapted to the precise location and extent of the lesion to be excised. Familiarity with these versatile techniques is an important part of the skull base surgeon's armamentarium.

    Title Osteoradionecrosis of the Anterior Cranium.
    Date
    Journal Skull Base Surgery
    Excerpt

    Osteoradionecrosis occurs in approximately 10% to 15% of patients following radiation therapy for head and neck cancer. In these patients, it is most commonly reported in sites involving the mandible, but it has also been reported in the maxilla, sphenoid, and temporal bones. The majority of these cases are related to some type of trauma such as dental extraction or intraoral biopsies. However, approximately 40% of these entities occur spontaneously and are felt to be secondary to cell kill in intermediate tissues such as bone and periosteum. Our literature review yielded no previously reported cases of osteoradionecrosis involving the anterior cranium. The following two cases present patients who experienced osteoradionecrosis of their frontal bone flaps following subcranial approaches for tumor resection. Both patients suffered from carcinomas involving the ethmoid sinuses; one tumor was a moderately well-differentiated squamous cell carcinoma, the other a mucinous adenocarcinoma. One patient's radiation therapy consisted of external beam photons; the other patient received external beam neutrons. Treatment for these patients, as well as possible causative factors regarding their osteoradionecrosis, are discussed.

    Title Craniofacial Resection: Decreased Complication Rate with a Modified Subcranial Approach.
    Date
    Journal Skull Base Surgery
    Excerpt

    The authors have successfully utilized a modified subcranial approach to the anterior skull base, based upon the procedure first described by Joram Raveh, as an alternative to standard craniofacial resection. The complication rate of this procedure in 31 consecutive cases (28 tumors, 2 congenital malformations, and 1 mucocele) has been 19.4% with no permanent complications, no deaths, no new neurological deficits, no brain injuries, no infections, and no seizures. Minor complications without permanent sequelae included two cases of tension pnenmocephalus, a subdural hygroma, two transient cerebrospinal fluid leaks, and a case of bacterial meningitis secondary to fecal contamination of a lumbar drain in a child. Average length of hospitalization was 7.1 days (range 2 to 16 days). The overall complication rate is considerably below the complication rate for other reported craniofacial procedures. We describe the technique we have used and the results. The subcranial approach as described herein provides wide exposure of the anterior cranial base without brain retraction, does not require prolonged operating times or hospitalization, and has a potentially lower complication rate than reported for other transfrontal transbasal approaches.

    Title Esthesioneuroblastoma: Results and Outcomes of a Single Institution's Experience.
    Date
    Journal Skull Base : Official Journal of North American Skull Base Society ... [et Al.]
    Excerpt

    Objectives: Analysis of outcomes of a cohort of patients with esthesioneuroblastoma. Design: Retrospective cohort analysis. Setting: Patients presenting with esthesioneuroblastoma from 1994 to 2006 in a tertiary care academic medical center. Patients: Fifteen consecutive patients diagnosed as having esthesioneuroblastoma were treated during this time period using a subcranial resection. The mean follow-up is 75 months (range, 2 to 240 mos). Results: The overall survival was 100% and the overall disease-free survival was 49% and 24% at 5 and 15 years, respectively. Patients treated with radiation therapy following surgical resection had a 5- and 15-year disease-free survival of 83.3% compared with a 5- and 15-year disease-free survival of 26.7% and 0%, respectively, for patients whose initial treatment was surgery alone. The mean time to recurrence was 82.1 months. None of the patients had a decrease in Karnofsky Performance Score following subcranial resection. Conclusions: Patients with esthesioneuroblastoma whose initial treatment consists of surgical resection followed by radiation therapy have a longer disease-free survival than patients treated with surgery alone. However, initial treatment modality did not have an effect on survival. Long-term, close follow-up is necessary to identify recurrences, which can be treated with a high degree of success.

    Title Sinonasal Undifferentiated Carcinoma: a 13-year Experience at a Single Institution.
    Date
    Journal Skull Base : Official Journal of North American Skull Base Society ... [et Al.]
    Excerpt

    We present our experience with sinonasal undifferentiated carcinoma at the University of Michigan over 13 years and review prior published data. We conducted a retrospective review of 19 patients who presented to a tertiary care academic center multidisciplinary skull base clinic with sinonasal undifferentiated carcinoma between 1995 and 2008. Overall survival was 22% at 5 years, and the estimated 5-year distant metastasis-free survival was 35%. At 2 years, local control was 83%, regional control was 50%, and distant control was 83%. Local control was best in those patients treated nonsurgically, as was median survival, though this was not statistically significant. Nodal disease in the neck, either at presentation or at recurrence, was noted in 26% of patients. Survival for sinonasal undifferentiated carcinoma remains poor. It is possible that up-front radiation or chemoradiation will lead to better local control rates, though surgery remains a mainstay of treatment. In all cases, the cervical nodes should be addressed with primary treatment.

    Title Complete Devascularization of a Juvenile Angiofibroma by Direct Percutaneous Embolization with Only Ethylene Vinyl Alcohol Copolymer (onyx) Through a Single Needle Placement.
    Date
    Journal Journal of Neurointerventional Surgery
    Excerpt

    Embolization of a juvenile angiofibroma (JNA) is commonly performed prior to surgical resection. Traditionally, it has been performed from an intra-arterial approach with particulate material. A novel technique is described in which a JNA was completely devascularized prior to surgical removal by direct percutaneous embolization with only ethylene vinyl alcohol. A midfacial degloving and medial maxillectomy/maxillotomy was then performed and the tumor extirpated with blunt finger dissection and the assistance of an endoscope, with 200 ml of blood loss.

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