CURRENT Diagnosis Treatment in Otolaryngology—Head Neck Surgery

a LANGE medical book

CURRENT

Diagnosis & Treatment
in Otolaryngology—Head
& Neck Surgery
THIRD EDITION
Edited by
Anil K. Lalwani, MD
Professor
Department of Otolaryngology, Pediatrics, and Physiology & Neuroscience
New York University School of Medicine
New York, New York

New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto


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Dedication
To my parents, Madan and Gulab, for giving me life;
To my in-laws, Rikhab and Ratan, for adding to my life;
To my wife, Renu, who is my life, And, to my children,
Nikita and Sahil, who show me how to enjoy life.
This book is specially dedicated to all of the extraordinarily gifted and
generous teachers in Otolaryngology—Head and Neck Surgery who provide
inspirational leadership and serve as role models for the next generation.
I would like to express my great appreciation for my own mentors
and their spouses for their incredible impact on our lives: Roger
and Marianna Boles, Robert and Janet Schindler, Robert
and Laurie Jackler, and Noel and Baukje Cohen.
Finally, I am deeply indebted to George and Lori Hall, Susan and Bernie
Mendik, Susan Spencer, and Marica and Jan Vilcek for their support and
commitment to excellence in Otolaryngology.


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Contents
Authors ................................................. xi
Preface ................................................. xix

III. NOSE
10. Olfactory Dysfunction

I. INTRODUCTION

1. Anatomy

1

11. Congenital Nasal Anomalies

12. Nasal Trauma
42

13. Nasal Manifestations
of Systemic Disease

52

176

14. Nonallergic & Allergic Rhinitis

180

IV. SINUSES
15. Acute & Chronic Sinusitis

198

7. Hemangiomas of Infancy
& Vascular Malformations

291
291

Jeffrey D. Suh, MD &
Alexander G. Chiu, MD

Bulent Satar, MD & Anil R. Shah, MD, FACS

II. FACE

282

Saurabh B. Shah, MD, FAAOA &
Ivor A. Emanuel, MD, FAAOA

Errol Lobo, MD, PhD &
Francesca Pellegrini, MD

6. Lasers in Head & Neck Surgery

273

Amy K. Hsu, MD &
Ashutosh Kacker, MD, FACS

Ryan J. Burri, MD & Nancy Lee, MD

5. Anesthesia

265

Jeffrey H. Spiegel, MD, FACS &

William Numa, MD

Nancy J. Fischbein, MD &
Kenneth C. Ong, MD

4. Principles of Radiation Oncology

258

Maria V. Suurna, MD

Peter V. Chin-Hong, MD &
Richard A. Jacobs, MD, PhD

3. Radiology

253

Anil K. Lalwani, MD

1

Nripendra Dhillon, MBBS, MS

2. Antimicrobial Therapy for Head
& Neck Infection

253

16. Frontal Sinus Fractures

213

302

Steven D. Pletcher, MD &
Andrew N. Goldberg, MD, MSCE, FACS

213
17. Paranasal Sinus Neoplasms

Joseph L. Edmonds, Jr., MD

309

Aditi H. Mandpe, MD

8. Maxillofacial Trauma

224

Andrew H. Murr, MD, FACS

9. Cutaneous Malignant Neoplasms

V. SALIVARY GLANDS
235

18. Benign Diseases of
the Salivary Glands

C. Patrick Hybarger, MD, FACS

Fidelia Yuan-Shin Butt, MD

v

317
317


vi

CONTENTS

19. Malignant Diseases
of the Salivary Glands

333

29. Clinical Voice Assessment:
The Role & Value of the
Phonatory Function Studies

Adriane P. Concus, MD & Theresa N. Tran, MD

VI. ORAL CAVITY, OROPHARYNX &
NASOPHARYNX
20. Cleft Lip & Palate

345

362

31. Malignant Laryngeal Lesions

456

475

Michael J. Wareing, MBBS, BSc, FRCS(ORL-HNS),
Richard Millard, MBBS, MA, DLO, &
Juveria Siddiqui, MA

377

33. Stridor in Children

481

Philip D. Yates, MB ChB, FRCS

387

34. Laryngeal Trauma

492

Andrew H. Murr, MD, FACS, & Milan R. Amin, MD

394

Richard A. Smith, DDS

26. Temporomandibular Disorders

Michael J. Wareing, MBBS, BSc, FRCS(ORL-HNS),
Richard Millard, MBBS, MA, DLO, &
Seema Yalamanchili, MA

32. Vocal Cord Paralysis

Jeffrey H. Spiegel, MD, FACS &
Jaimie DeRosa, MD

25. Jaw Cysts

449

369

Nancy Lee, MD, Jonathan Romanyshyn, MD,
Nicola Caria, MD, & Jeremy Setton, BA

24. Mandibular Reconstruction

30. Benign Laryngeal Lesions

Adriane P. Concus, MD, Theresa N. Tran, MD
Nicholas J. Sanfilippo, MD, &

Mark D. DeLacure, MD

Uchechukwu C. Megwalu, MD &
Edward John Shin, MD, FACS

23. Benign & Malignant Lesions
of The Oral Cavity, Oropharynx &
Nasopharynx

435

Krzysztof Izdebski, FK, MA, PhD, CCC-SLP, FASHA

Maria V. Suurna, MD

22. Parapharyngeal Space Neoplasms &
Deep Neck Space Infections

435

345

William Y. Hoffman, MD, FACS, FAAP

21. Management of
Adenotonsillar Disease

VIII. LARYNX & HYPOPHARYNX

407

IX. TRACHEA & ESOPHAGUS
35. Congenital Disorders of
the Trachea & Esophagus

501
501

Kelly D. Gonzales, MD & Hanmin Lee, MD

Greg Goddard, DDS

VII. NECK
27. Neck Masses

415
415

Derrick T. Lin, MD & Daniel G. Deschler, MD

28. Neck Neoplasms & Neck Dissection
Aditi H. Mandpe, MD

36. Benign & Malignant Disorders
of the Esophagus
Alexander Langerman, MD
& Marco G. Patti, MD

37. Benign & Malignant Disorders
of the Trachea

426

506

Michael D. Zervos, MD, Heather Melville, MS,
Emmanuel P. Prokopakis, MD, PhD &
Costas Bizekis, MD

523


CONTENTS
38. Airway Management & Tracheotomy

536

Kenneth C. Y. Yu, MD

39. Foreign Bodies

543

Kristina W. Rosbe, MD & Kevin Burke, MD

40. Airway Reconstruction

48. Congenital Disorders
of the Middle Ear

548

Kevin C. Welch, MD &
Andrew N. Goldberg, MD, MSCE, FACS

674

Seema Pai, MD, MPH & Sanjay R. Parikh, MD, FACS

50. Cholesteatoma
556

661

Kevin D. Brown, MD, PhD &
Samuel H. Selesnick, MD, FACS

49. Otitis Media

Kristina W. Rosbe, MD & Kevin C. Huoh, MD

41. Sleep Disorders

vii

682

C.Y. Joseph Chang, MD

51. Otosclerosis

689

Colin L. W. Driscoll, MD &
Matthew L. Carlson, MD

X. THYROID & PARATHYROID

571

42. Disorders of the Thyroid Gland

571

Grace A. Lee, MD &
Umesh Masharani, MRCP (UK)

XIII. INNER EAR
52. Sensorineural Hearing Loss

699
699

Anil K. Lalwani, MD

43. Parathyroid Disorders

592

Michael C. Singer, MD & David J. Terris, MD, FACS

53. The Aging Inner Ear

705

Anil K. Lalwani, MD

XI. OTOLOGY
44. Anatomy & Physiology of the Ear

599
599

John S. Oghalai, MD, &
William E. Brownell, PhD

45. Audiologic Testing

54. Hereditary Hearing Impairment
Nicolas Gürtler, MD

55. Aural Rehabilitation
& Hearing Aids
617

Robert W. Sweetow, PhD &
Jennifer Henderson Sabes, MS

713

721

Robert W. Sweetow, PhD, & Troy Cascia, AuD

56. Vestibular Disorders

729

Jacob Johnson, MD, & Anil K. Lalwani, MD

46. Vestibular Testing

626
57. Diving Medicine

Bulent Satar, MD

739

Allen M. Dekelboum, MD

XII. EXTERNAL & MIDDLE EAR
47. Diseases of the External Ear
Kevin D. Brown, MD, PhD,
Victoria Banuchi, MD, &
Samuel H. Selesnick, MD, FACS

645
645

58. Occupational Hearing Loss

747

George A. Gates, MD & William W. Clark, PhD

59. Temporal Bone Trauma
John S. Oghalai, MD

760


viii

CONTENTS

XIV. SKULL BASE
60. Lesions of the Anterior Skull Base

769
769

Luc G. T. Morris, MD, MS

61. Vestibular Schwannoma
(Acoustic Neuroma)

781

XVII. FACIAL PLASTIC &
RECONSTRUCTIVE SURGERY

800

805

810

67. Implantable Middle
Ear Hearing Devices

829

Michael B. Gluth, MD,
Colin L.W. Driscoll, MD, &
Anil K. Lalwani, MD

72. Scar Revision

906

73. The Aging Face: Rhytidectomy,
Browlift, Midface Lift

912

74. Blepharoplasty

922

Eugene J. Kim, MD &
Corey S. Maas, MD

845

75. Rhinoplasty

928

Douglas D. Leventhal, MD &
Minas Constantinides, MD, FACS

845
76. Hair Transplantation

Betty S. Tsai, MD & Steven W. Cheung, MD

68. Cochlear Implants

899

Richard Zoumalan, MD, Douglas
Leventhal, MD, & W. Matthew White, MD

Robert K. Jackler, MD

XV. MIDDLE EAR &
COCHLEAR IMPLANTS

71. Reanimation of the Paralyzed Face

899

Nathan Monhian, MD, FACS &
Anil R. Shah, MD, FACS

John S. Oghalai, MD

66. Neurotologic Skull Base Surgery

876

Ritvik P. Mehta, MD

Betty S. Tsai, MD & Steven W. Cheung, MD

65. Neoplasms of the
Temporal Bone & Skull Base

70. Disorders of the Facial Nerve

791

Anil K. Lalwani, MD

64. Osseous Dysplasias
of the Temporal Bone

861

Lawrence R. Lustig, MD &
John K. Niparko, MD

Jacob Johnson, MD & Anil K. Lalwani, MD

63. Neurofibromatosis Type 2

69. Anatomy, Physiology, &
Testing of the Facial Nerve

861

Lawrence R. Lustig, MD &
John K. Niparko, MD

Jacob Johnson, MD & Anil K. Lalwani, MD

62. Nonacoustic Lesions of
the Cerebellopontine Angle

XVI. FACIAL NERVE

850

939

Marc R. Avram, MD &
Nicole E. Rogers, MD

77. Local Skin Flaps in
Facial Reconstruction
Judy Lee, MD, & W. Matthew White, MD

945


CONTENTS
78. Microvascular Reconstruction

950

Vasu Divi, MD &
Daniel G. Deschler, MD, FACS

79. Otoplasty & Microtia
Jeffrey B. Wise, MD,
Sarmela Sunder, MD,
Vito Quatela, MD &
Minas Constantinides, MD, FACS

80. Facial Fillers & Implants

ix
975

Anil R. Shah, MD, FACS,
Jeffrey B. Wise, MD, &
Minas Constantinides, MD, FACS

960
Index ................................................. 979

This page intentionally left blank


Authors
Milan R. Amin, MD

Kevin Burke, MD

Assistant Professor
Department of Otolaryngology
New York University School of Medicine
New York, New York
Laryngeal Trauma

Resident in Otolaryngology
Department of Otolaryngology-Head and Neck Surgery
University of California
San Francisco, California
Foreign Bodies

Marc R. Avram, MD

Ryan J. Burri, MD

Clinical Associate Professor
Department of Dermatology
Weill Cornell Medical Center
New York, New York
Hair Transplantation

Instructor in Clinical
Department of Radiation Oncology
Columbia University College of Physicians and Surgeons
New York, New York
Principles of Radiation Oncology

Victoria Banuchi, MD, MPH

Fidelia Yuan-Shin Butt, MD

Resident
Department of Otolaryngology
New York Presbyterian Hospital
New York, New York
Diseases of the External Ear

Adjunct Clinical Assistant Professor
Department of Otolaryngology/Head
and Neck Surgery
Stanford University
Stanford, California
Benign Diseases of the Salivary Glands

Costas S. Bizekis, MD
Nicola Caria, MD

Assistant Professor of Cardiothoracic Surgery
Division of Thoracic Surgery, Department of
Cardiothoracic Surgery

New York University Langone Medical Center
New York, New York
Benign & Malignant Disorders of the Trachea

Varian Oncology Systems
San Francisco, California
Benign & Malignant Lesions of The Oral Cavity,
Oropharynx & Nasopharynx

Matthew L. Carlson, MD

Kevin D. Brown, MD, PhD

Senior Resident
Department of Otolaryngology
The Mayo Clinic
Rochester, Minnesota
Otosclerosis

Assistant Professor
Department of Otorhinolaryngology
Weill Cornell Medical College
New York, New York
Diseases of the External Ear; Congenital
Disorders of the Middle Ear

Troy Cascia, AuD
Clinical Audiologist
Audiology Clinic
University of California

San Francisco Medical Center
San Francisco, California
Aural Rehabilitation & Hearing Aids

William E. Brownell, PhD
Professor and Jake and Nina Kamin Chair of
Otorhinolaryngology
Bobby R. Alford Department of OtolaryngologyHead & Neck Surgery
Baylor College of Medicine
Houston, Texas
Anatomy & Physiology of the Ear

C.Y. Joseph Chang, MD
Clinical Professor
Department of OtorhinolaryngologyHead and Neck Surgery
University of Texas-Houston Medical School
Houston, Texas
Cholesteatoma

xi


xii

AUTHORS

Steven W. Cheung, MD

Allen M. Dekelboum, MD

Associate Professor
Otolaryngology-Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Osseus Dysplasias of the Temporal Bone;
Implantable Middle Ear Hearing Devices

Clinical Professor, Retired
Otolaryngology-Head & Neck Surgery
University of California-San Francisco
California
Instructor Trainer, Emeritus, National Association
of Underwater Instructors, Tampa, Florida;
Instructor Trainer, Divers Alert Network,
Durham, North Carolina.
Diving Medicine

Peter V. Chin-Hong, MD
Assistant Professor of Medicine
University of California-San Francisco
San Francisco, California
Antimicrobial Therapy for Head & Neck Infection

Mark D. DeLacure, MD

Associate Professor, Director of Rhinology
and Skull Base Surgery Fellowship Program
Department of Otorhinolaryngology
University of Pennsylvania
Philadelphia, Pennsylvania

Acute & Chronic Sinusitis

Chief, Division of Head and Neck Surgery and Oncology
Department of Otolaryngology—Head and Neck Surgery
Associate Professor of Plastic Surgery
Institute of Reconstructive Plastic Surgery
Department of Surgery
NYU Clinical Cancer Center
NYU School of Medicine
New York, New York
Malignant Laryngeal Lesions

William W. Clark, PhD

Jaimie DeRosa, MD

Alexander G. Chiu, MD

Director, Program in Audiology and
Communication Sciences
Professor, Department of Otolaryngology
Professor, Program in Audiology and
Communication Sciences (Joint)
Professor, Department of Education (Joint)
Washington University School of Medicine
St. Louis, Missouri
Occupational Hearing Loss

Adriane P. Concus, MD
Participant Physician

The Permanente Medical Group, Inc.
Department of Head and Neck Surgery, Kaiser
South San Francisco
South San Francisco, California
Malignant Diseases of the Salivary Glands; Malignant
Laryngeal Lesions

Department of Otolaryngology
Geisner Medical Center
Danville, Pennsylvania
Mandibular Reconstruction

Daniel G. Deschler, MD, FACS
Associate Professor
Department of Otology and Laryngology
Harvard Medical School, Massachusetts Eye and Ear
Infirmary
Boston, Massachusetts
Neck Masses; Microvascular Reconstruction

Nripendra Dhillon, MBBS, MS
Lecturer in Anatomy
Department of Anatomy
University of California-San Francisco
San Francisco, California
Anatomy

Minas Constantinides, MD, FACS
Assistant Professor and Director of Facial Plastic &
Reconstructive Surgery

Department of Otolaryngology
New York University Langone Medical Center
New York, New York
Rhinoplasty

Vasu Divi, MD
Fellow in Head and Neck Oncology, Skull Base,
and Microvascular Reconstructive Surgery
Massachusetts Eye and Ear Infirmary
Harvard Medical School
Boston, Massachusetts
Microvascular Reconstruction


AUTHORS
Colin L.W. Driscoll, MD

Andrew N. Goldberg, MD, MSCE, FACS

Associate Professor
Department of Otorhinolaryngology
Head and Neck Surgery
Mayo Clinic
Rochester, Minnesota
Otosclerosis; Cochlear Implants

Professor
Otolaryngology-Head and Neck Surgery
University of California-San Francisco
San Francisco, California

Sleep Disorders; Frontal Sinus Fractures

Kelly D. Gonzales, MD
Joseph L. Edmonds Jr, MD
Cinical Assistant Professor
Department of Otolaryngolgogy and Plastic Surgery
Baylor College of Medicine and Weill Cornell Medical
College, University of Texas
Houston, Texas
Hemangiomas of Infancy & Vascular Malformations

Ivor A. Emanuel, MD, FAAOA
Clinical Assistant Professor,
Department of Otolaryngology
University of California-San Francisco
San Francisco, California
Nonallergic & Allergic Rhinitis

Postdoctoral Research Fellow
Department of Surgery
University of California-San Francisco
San Francisco, California
Congenital Disorders of the Trachea & Esophagus

Nicolas Gürtler, MD
Privatdozent (Associate Professor)
Department of Otolaryngology
Cantonal Hospital
Aarau
Switzerland

Hereditary Hearing Impairment

William Y. Hoffman, MD, FACS, FAAP
Nancy J. Fischbein, MD
Associate Professor
Department of Radiology,
Otolaryngology-Head and Neck Surgery,
Neurology, and Neurological Surgery
Stanford University
Stanford, California
Radiology

George A. Gates, MD
Emeritus Professor
Department of Otolaryngology-Head and Neck Surgery
University of Washington
Seattle, Washington
Occupational Hearing Loss

Michael B. Gluth, MD
Assistant Professor
Department of OtolaryngologyHead & Neck Surgery
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Cochlear Implants

Greg Goddard, DDS
Department Oral and Maxillofacial Surgery
University of California-San Francisco
Center for Orofacial Pain

San Francisco, California
Temporomandibular Disorders

Professor and Chief
Division of Plastic and Reconstructive Surgery
University of California-San Francisco
San Francisco, California
Cleft Lip & Palate

Amy K. Hsu, MD
Department of Otorhinolaryngology
Weill Cornell Medical College
New York, New York
Nasal Manifestations of Systemic Disease

Kevin C. Huoh, MD
Chief Resident
Otolaryngology- Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Airway Reconstruction

C. Patrick Hybarger, MD, FACS
Assistant Clinical Professor
Otolaryngology/Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Cutaneous Malignant Neoplasms

xiii

xiv

AUTHORS

Krzysztof Izdebski, FK, MA, PhD, CCC-SLP, FASHA

Alexander Langerman, MD

Associate Clinical Professor
Department of Otolaryngology/Head & Neck Surgery,
Stanford Voice & Swallowing Center
Stanford University School of Medicine
Stanford, California
Clinical Voice Assessment: The Role & Value of the
Phonatory Function Studies

Chief Resident, Section of OtolaryngologyHead and Neck Surgery
Department of Surgery
University of Chicago
Chicago, Illinois
Benign & Malignant Disorders of the Esophagus

Grace A. Lee, MD
Robert K. Jackler, MD
Sewall Professor and Chair, Associate Dean
Otolaryngology-Head & Neck Surgery
Stanford University School of Medicine
Stanford, California

Neurotologic Skull Base Surgery

Richard A. Jacobs, MD, PhD
Emeritus Clinical Professor of Medicine
Department of Medicine
University of California-San Francisco
San Francisco, California
Antimicrobial Therapy for Head & Neck Infection

Jacob Johnson, MD
Assistant Clinical Professor
Department of Otolaryngology-Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Vestibular Schwannoma (Acoustic Neuroma); Vestibular
Disorders; Nonacoustic Lesions of the Cerebellopontine Angle

Ashutosh Kacker, MD, FACS
Associate Professor
Department of Otorhinolaryngology
Weill Cornell Medical College
New York, New York
Nasal Manifestations of Systemic disease

Eugene J. Kim, MD
Private Practice in Otolaryngology
Communal Medial Group
Mountain View, California
Blepharoplasty

Anil K. Lalwani, MD
Professor
Department of Otolaryngology, Pediatrics, and Physiology
& Neuroscience
New York University School of Medicine
New York, New York
Olfactory Dysfunction; Sensorineural Hearing Loss; The
Aging Inner Ear; Vestibular Disorders; Vestibular
Schwannoma (Acoustic Neuroma); Nonacoustic Lesions
of the Cerebellopontine Angle; Neurofibromatosis Type 2;
Cochlear Implants

The Permanente Medical Group
South San Francisco, California
Disorders of the Thyroid Gland

Hanmin Lee, MD
Associate Professor
Department of Surgery
University of California-San Francisco
San Francisco, California
Congenital Disorders of the Trachea & Esophagus

Judy Lee, MD
Department of Otolaryngology
New York University School of Medicine
New York, New York
Local Skin Flaps in Facial Reconstruction

Nancy Lee, MD

Radiation Oncology
Memorial Sloan Kettering Cancer Center
New York, New York
Principles of Radiation Oncology; Benign & Malignant
Lesions of the Oral Cavity, Oropharynx & Nasopharynx

Douglas D. Leventhal, MD
Clinical Instructor
Department of Facial Plastic & Reconstructive Surgery
New York University
New York, New York
Rhinoplasty; The Aging Face: Rhytidectomy, Browlift,
Midface Lift

Derrick T. Lin, MD
Assistant Professor, Department of Otology and
Laryngology
Harvard Medical School, Massachusetts Eye and Ear
Infirmary
Boston, Massachusetts
Neck Masses

Errol Lobo, MD, PhD
Professor
Department of Anesthesia and Perioperative Care
University of California-San Francisco
San Francisco, California
Anesthesia

AUTHORS
Lawrence R. Lustig, MD

Nathan Monhian, MD, FACS

Professor
Department of Otolaryngology-Head & Neck Surgery
University of California-San Francisco
San Francisco, California

Attending Surgeon
Department of Otolaryngology
Long Island Jewish Medical Center
New Hyde Park, New York
Scar Revision

xv

Corey S. Maas, MD
Division of Facial Plastics
University of California-San Francisco Otolaryng-HNS
San Francisco, California
Blepharoplasty

Aditi H. Mandpe, MD
Assistant Clinical Professor
Otolaryngology-Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Paranasal Sinus Neoplasms; Neck Neoplasms & Neck Dissection

Umesh Masharani, MRCP (UK)
Professor of Clinical Medicine
Department of Medicine
University of California-San Francisco
San Francisco, California
Disorders of the Thyroid Gland

Uchechukwu C. Megwalu, MD
Resident
Department of Otolaryngology-Head and Neck Surgery
The New York Eye and Ear Infirmary
New York, New York
Parapharyngeal Space Neoplasms & Deep Neck
Space Infections

Ritvik P. Mehta, MD
Director
Department of Otolaryngology
California Facial Nerve Center
La Jolla, California
Reanimation of the Paralyzed Face

Heather Melville, MS
Research Assistant
Department Genetics and Genomic Sciences
Mount Sinai Medical Center
New York, New York
Benign & Malignant Disorders of the Trachea

Richard Millard, MBBS, MA, DLO
Specialist Registrar
Department of Otolaryngology,Head and Neck Surgery
St Bartholomews Hospital
London
Benign Laryngeal Lesions; Vocal Cord Paralysis

Luc G. T. Morris, MD, MS
Instructor in Surgery
Head and Neck Service, Department of Surgery
Memorial Sloan-Kettering Cancer Center
New York, New York
Lesions of the Anterior Skull Base

Andrew H. Murr, MD, FACS
Professor
Department of Otolaryngology/Head and Neck Surgery
University of California-San Francisco
San Francisco, California
Maxillofacial Trauma

John K. Niparko, MD
George T. Nager Professor
Department of Otolaryngology-Head & Neck Surgery
The Johns Hopkins University, School of Medicine
Baltimore, Maryland
Anatomy, Physiology, & Testing of the Facial Nerve;
Disorders of the Facial Nerve

William Numa, MD

Department of Otolaryngology—Head and Neck Surgery,
New England Medical Center
Tufts University
Boston, Massachusetts
Nasal Trauma

John S. Oghalai, MD
Associate Professor
Bobby R. Alford Department of OtolaryngologyHead and Neck Surgery
Baylor College of Medicine
Houston, Texas
Anatomy & Physiology of the Ear; Temporal Bone Trauma;
Neoplasms of the Temporal Bone & Skull Base

Kenneth C. Ong, MD
Staff Physician
Department of Diagnostic Imaging
Good Samaritan Hospital of San Jose
San Jose, California
Radiology


xvi

AUTHORS

Seema Pai, MD, MPH

Jonathan Romanyshyn, MD

Resident
Department of Otorhinolaryngology-Head & Neck Surgery
Albert Einstein College of Medicine/ Montefiore
Medical Center
Bronx, New York
Otitis Media

Yale University School of Medicine
New Haven, Connecticut
Benign & Malignant Lesions of The Oral Cavity,
Oropharynx & Nasopharynx

Sanjay R. Parikh, MD, FACS
Associate Professor
Otolaryngology-Head and Neck Surgery
University of Washington
Seattle, Washington
Otitis Media

Marco G. Patti, MD
Professor and Director Center for Esophageal Disorders
Department of Surgery
University of Chicago Pritzker School of Medicine
Chicago, Illinois
Benign & Malignant Disorders of the Esophagus

Francesca Pellegrini, MD
Anesthesiologist
Department of Anesthesia
University of Ferrara

Ferrara, Italy
Anesthesia

Steven D. Pletcher, MD
Assistant Professor, Department of Otolaryngology—Head
and Neck Surgery
University of California-San Francisco
San Francisco, California
Frontal Sinus Fractures

Emmanuel P. Prokopakis, MD, PhD
Attending Otorhinolaryngologist
Department of Otorhinolaryngology
University Hospital of Crete
Heraklio, Crete
Greece
Benign & Malignant Disorders of the Trachea

Vito Quatela, MD
Quatela Center for Plastic Surgery
Rochester, New York
Otoplasty & Microtia

Nicole E. Rogers, MD
Private Practice
Metairie, Louisiana
Hair Transplantation

Kristina W. Rosbe, MD
Associate Professor, Driector of Pediatric Otolaryngology

Department of Otolaryngology-Head & Neck Surgery
University of California-San Francisco
San Francisco, California
Foreign Bodies; Airway Reconstruction

Jennifer Henderson Sabes, MS
Research Audiologist
Department of Otolaryngology—Head and
Neck Surgery
University of California-San Francisco
San Francisco, California
Audiologic Testing

Nicholas J. Sanfilippo, MD
Assistant Professor
Department of Radiation Oncology
NYU School of Medicine
New York, New York
Malignant Laryngeal Lesions

Bulent Satar, MD
Associate Professor
Department of Otolaryngology-Head and Neck Surgery
Gulhane Military Medical Academy
Ankara
Turkey
Lasers in Head & Neck Surgery; Vestibular Testing

Samuel H. Selesnick, MD, FACS
Professor and Vice-Chairman

Department of Otorhinolaryngology
Weill Cornell Medical College
New York, New York
Diseases of the External Ear; Congenital Disorders
of the Middle Ear

Jeremy Setton, BA
Medical Student
Department of Radiation Oncology
Memorial Sloan-Kettering Cancer Center
New York, New York
Principles of Radiation Oncology, Benign &
Malignant Lesions of the Oral Cavity,
Oropharynx & Nasopharynx


AUTHORS
Saurabh B. Shah, MD, FAAOA

Jeffrey D. Suh, MD

Chief
Department of Otolaryngology
LDS Hospital
Salt Lake City, Utah
Nonallergic & Allergic Rhinitis

Assistant Professor
Division of Head and Neck Surgery
University of California-Los Angeles

School of Medicine
Los Angeles, California
Acute & Chronic Sinusitis

xvii

Anil R. Shah, MD, FACS
Clinical Instructor
Department of Otolaryngology
University of Chicago
Chicago, Illinois
LASERS in Head & Neck Surgery; Scar Revision;
Facial Fillers & Implants

Edward John Shin, MD, FACS
Associate Professor
Department of Otolaryngology
New York Medical College
Valhalla, New York
Parapharyngeal Space Neoplasms &
Deep Neck Space Infections

Juveria Siddiqui, MA
Department of Otolaryngology
St Bartholomew’s & The Royal London Hospitals
London, United Kingdom
Vocal Cord Paralysis

Sarmela Sunder, MD
Sunder Plastic Surgery

Beverly Hills, California
Otoplasty & Microtia

Maria V. Suurna, MD
Assistant Professor
Department of Otolaryngology
New York University Langone Medical Center
New York, New York
Management of Adenotonsillar Disease; Congenital
Nasal Anomalies

Robert W. Sweetow, PhD
Professor
Department of Otolaryngology
University of California-San Francisco
San Francisco, California
Aural Rehabilitation & Hearing Aids

David J. Terris, MD, FACS
Michael C. Singer, MD
Assistant Professor
Department of OtolaryngologyHead & Neck Surgery
State University of New York-Downstate
New York, New York
Parathyroid Disorders

Richard A. Smith, DDS
Clinical Professor Emeritus
Department of Oral and Maxillofacial Surgery
University of California-San Francisco

San Francisco, California
Jaw Cysts

Professor and Chairman
Department of Otolaryngology
Medical College of Georgia
Augusta, Georgia
Parathyroid Disorders

Theresa N. Tran, MD
Assistant Professor and Attending Physician
Department of Otolaryngology-Head and
Neck Surgery
Albert Einstein College of Medicine;
Beth Israel Medical Center
New York, New York
Malignant Diseases of the Salivary Glands;
Malignant Laryngeal Lesions

Jeffrey H. Spiegel, MD, FACS
Associate Professor
Department of Otolaryngology-Head and
Neck Surgery
Boston University School of Medicine
Boston, Massachusetts
Rhinoplasty; Mandibular Reconstruction

Betty S. Tsai, MD
Resident
Department of Otolaryngology-Head and Neck Surgery

University of California-San Francisco
San Francisco, California
Osseous Dysplasias of the Temporal Bone


xviii

AUTHORS

Michael J. Wareing, MBBS, BSc, FRCS(ORL-HNS)

Philip D. Yates, MB ChB, FRCS

Consultant Otolaryngologist
Department of Otolaryngology
St Bartholomew’s & The Royal London Hospitals
London
Benign Laryngeal Lesions; Vocal Cord Paralysis

Consultant Otolaryngologist / Honorary
Senior Lecturer
Department of Otolaryngology
Freeman Hospital
Newcastle upon Tyne
United Kingdom
Stridor in Children

Kevin C. Welch, MD
Assistant Professor
Department of Otolaryngology—Head and Neck Surgery

Loyola University Stritch School of Medicine
Chicago, Illinois
Sleep Disorders

W. Matthew White, MD
Assistant Professor, Otolaryngology
New York University Langone Medical Center
New York, New York
The Aging Face: Rhytidectomy, Browlift, Midface Lift;
Local Skin Flaps in Facial Reconstruction

Jeffrey B. Wise, MD
Private Practice
Facial Plastic & Reconstructive Surgery
Wayne, New Jersey
Otoplasty & Microtia; Facial Fillers & Implants

Seema Yalamanchili, MA
Department of Otolaryngology
St Bartholomew’s & The Royal London Hospitals
London, United Kingdom
Benign Laryngeal Lesions

Kenneth C. Y. Yu, MD
Staff
Travis Air Force
Vacaville, California
Airway Management & Tracheotomy;
Blepharoplasty

Michael D. Zervos, MD
Assistant Professor of Cardiothoracic Surgery
Department of Cardiothoracic Surgery
New York University School of Medicine
New York, New York
Benign & Malignant Disorders of the Trachea

Richard Zoumalan, MD
Department of Otolaryngology-Head &
Neck Surgery
University of Washington
Seattle, Washington
The Aging Face: Rhytidectomy, Browlift, Midface Lift


Preface
Otolaryngology-Head & Neck Surgery is a unique subspecialty in medicine that deals with medical and surgical management
of disorders affecting the ear, nose, throat, and the neck; the care of the senses including smell, taste, balance and hearing
fall under its domain. As a specialty, it interfaces with other medical and surgical subspecialties including allergy and
immunology, endocrinology, gastroenterology, hematology, neurology, neurosurgery, oncology, ophthalmology, pediatrics,
plastic and reconstructive surgery, pulmonology, radiation oncology, rehabilitation medicine, rheumatology, thoracic surgery,
among others. Further, the specialty encompasses the care of the young and the old, man and woman, as well as benign and
malignant diseases.
Symptoms and diseases affecting the ear, nose, throat, and neck are common and commonly lead to patients seeking medical care. These include sinusitis, upper respiratory tract infections, hoarseness, balance disturbance, hearing loss, dysphagia,
snoring, tonsillitis, ear infections, thyroid disorders, head and neck cancer and ear wax. In this updated third edition of Current
Diagnosis & Treatment in Otolaryngology-Head & Neck Surgery, these and many other diseases are covered in crisp and concise manner. Striking just the right balance between comprehensiveness and convenience, it emphasizes the practical features
of clinical diagnosis and patient management while providing a comprehensive discussion of pathophysiology and relevant
basic and clinical science. With its consistent formatting chapter by chapter, this text makes it simple to locate the practical
information you need on diagnosis, testing, disease processes, and up-to-date treatment and management strategies. The book
will be of interest to both otolaryngologists as well as all of the medical and surgical specialties and related disciplines that treat

patients with head and neck disorders.

OUTSTANDING FEATURES
•
•
•
•
•
•
•

Comprehensive review of basic sciences relevant to otolaryngology
Concise, complete, and accessible clinical information that is up-to-date
Discussion of both medical and surgical management of otolaryngologic disorders
Thorough radiology chapter with more than 150 images
Inclusion of the usual and the unusual diseases of the head and neck
More than 400 figures to better illustrate and communicate essential points
Organization by anatomic region to facilitate quick identification of relevant material

INTENDED AUDIENCE
With its comprehensive review of the sciences and the clinical practice of otolaryngology-head & neck surgery, this second
edition will be invaluable for medical students, housestaff, physicians of all specialties, nurses, physician assistants and ancillary
health care personnel. The book has been designed to meet the clinician’s need for an immediate refresher in the clinic as well
as to serve as an accessible text for thorough review of the specialty for the boards. The concise presentation is ideally suited for
rapid acquisition of information by the busy practitioner.
Anil K. Lalwani, MD

xix

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Section I. Introduction

Anatomy
Nripendra Dhillon, MBBS, MS

The anatomy of the head and neck is rich in complexity as it
is populated with motor and sensory organs, cranial nerves,
major arterial and venous structures in a compact three
dimensional space. This chapter provides a broad and concise
overview to familiarize the novice and yet detailed enough to
serve as a reference for the more knowledgeable clinician.

FACE
Muscles
The muscles of facial expression develop from the second
branchial arch and lie within the skin of the scalp, face, and
neck (Figure 1–1).

A. Occipitofrontalis Muscle
The occipitofrontalis muscle, which lies in the scalp, extends
from the superior nuchal line in the back to the skin of the
eyebrows in the front. It allows for the movement of the scalp
against the periosteum of the skull and also serves to raise
the eyebrows.

B. Orbicularis Oculi Muscle
The orbicularis oculi muscle lies in the eyelids and also

encircles the eyes. It helps to close the eye in the gentle movements of blinking or in more forceful movements, such as
squinting. These movements help express tears and move
them across the conjunctival sac to keep the cornea moist.

C. Orbicularis Oris Muscle
The orbicularis oris muscle encircles the opening of the mouth
and helps to bring the lips together to keep the mouth closed.

D. Buccinator Muscle
The buccinator muscle arises from the pterygomandibular
raphe in the back and courses forward in the cheek to blend
into the orbicularis oris muscle in the lips. It helps to compress
the cheek against the teeth and thus empties food from the vestibule of the mouth during chewing. In addition, it is used while

1

1

playing musical instruments and performing other actions that
require the controlled expression of air from the mouth.

E. Platysma Muscle
The platysma muscle extends from the skin over the mandible through the superficial fascia of the neck into the skin
of the upper chest, helping to tighten this skin and also to
depress the angles of the mouth. Although lying primarily in
the neck, it is grouped with the muscles of facial expression.

Arteries
The blood supply of the face is through branches of the facial
artery (Figure 1–2). After arising from the external carotid

artery in the neck, the facial artery passes deep to the submandibular gland and crosses the mandible in front of the attachment of the masseter muscle. It takes a tortuous course across
the face and travels up to the medial angle of the eye, where it
anastomoses with branches of the ophthalmic artery. It gives
labial branches to the lips, of which the superior labial artery
enters the nostril to supply the vestibule of the nose.
The occipital, posterior auricular, and superficial temporal arteries supply blood to the scalp. They all arise from the
external carotid artery. The superficial temporal artery gives
a branch, the transverse facial artery, which courses through
the face parallel to the parotid duct.

Veins
The superficial temporal and maxillary veins join within the
substance of the parotid gland to form the retromandibular
vein (Figure 1–3). The facial vein joins the anterior division
of the retromandibular vein to drain into the internal jugular
vein. Additional details about the venous drainage pattern of
the scalp and face are provided in the discussion of the veins
of the neck. The facial vein communicates with both the
pterygoid venous plexus and the veins in the orbit. Each of
these has connections to the cavernous sinus, thus allowing
infections to spread from the face into the cranium.


SECTION I

2

INTRODUCTION

Frontalis part,

Occipitofrontalis m.
Temporal fascia

Orbicularis oculi m.
Levator labii superioris m.

Occipitalis part,
Occipitofrontalis m.
Zygomaticus minor m.
Zygomaticus major m.
Orbicularis oris m.

Masseter m.
Parotid gland

Buccinator m.
Mentalis m.
Depressor anguli oris m.

Sternocleidomastoid m.

Risorius m.
Platysma m.

Trapezius m.

Clavicle
Sternum

ᮡ

Figure 1–1. Muscles of the face.

Innervation
A. Sensory Innervation
The sensory innervation of the face is through terminal
branches of the trigeminal nerve (V) (Figure 1–4). Two
imaginary lines that split the eyelids and the lips help to
approximately demarcate the sensory distribution of the
three divisions of the trigeminal nerve.
In addition to the skin of the face, branches of the
trigeminal nerve (V) are also responsible for carrying sensation from deeper structures of the head, including the eye,
the paranasal sinuses, the nose, and the mouth. The details of

this distribution are discussed with the orbit and the pterygopalatine and infratemporal fossae.
1. Ophthalmic division of the trigeminal nerve—The
ophthalmic division of the trigeminal nerve (V1) carries
sensation from the upper eyelid, the skin of the forehead,
and the skin of the nose. Its cutaneous branches, from lateral
to medial, are the lacrimal, supraorbital, supratrochlear, and
nasal nerves.
2. Maxillary division of the trigeminal nerve—The maxillary division of the trigeminal nerve (V2) carries sensation
from the lower eyelid, the upper lip, and the face up to the


ANATOMY
Post. auricular a.
Superficial
temporal a.

Occipital a.
Ascending
pharyngeal a.

Maxillary a.

Int. carotid a.
Facial a.

Carotid sinus
Sup. thyroid a.

Lingual a.

Common carotid a.

Ext. carotid a.

Ascending cervical a.
Vertebral a.
Inf. thyroid a.
Costocervical trunk
Transverse cervical a.

Thyrocervical
trunk

Suprascapular a.
Int. thoracic a.
Brachiocephalic tr.

ᮡ Figure

1–2. Arteries of the neck and face. (Reproduced,
with permission, from White JS. USMLS Road Map: Gross
Anatomy, 2nd edition, McGraw-Hill, 2003.)

zygomatic prominence of the cheek. Its cutaneous branches
are the infraorbital, zygomaticofacial, and zygomaticotemporal nerves.
3. Mandibular division of the trigeminal nerve—The
mandibular division of the trigeminal nerve (V3) carries
sensation from the lower lip, the lower part of the face, the
auricle, and the scalp in front of and above the auricle. Its
cutaneous branches are the mental, buccal, and auriculotemporal nerves.

B. Motor Innervation
The muscles of facial expression are innervated by branches
of the facial nerve (VII). After emerging from the stylomastoid foramen, the facial nerve lies within the substance of the
parotid gland. Here, it gives off its five terminal branches:
(1) The temporal branch courses up to the scalp to innervate
the occipitofrontalis and orbicularis oculi muscles. (2) The
zygomatic branch courses across the cheek to innervate
the orbicularis oculi muscle. (3) The buccal branch travels
with the parotid duct and innervates the buccinator and
orbicularis oris muscles, and also muscles that act on the
nose and upper lip. (4) The mandibular branch innervates
the orbicularis oris muscle and other muscles that act on the
lower lip. (5) The cervical branch courses down to the neck
and innervates the platysma muscle.

CHAPTER 1

3

NOSE & SINUSES
THE NASAL CAVITY
The nose is bounded from above by the cribriform plate
of the ethmoid bone and from below by the hard palate. It
extends back to the choanae, which allow it to communicate
with the nasopharynx. The nasal septum is formed by the
perpendicular plate of the ethmoid and the vomer bones.
The lateral wall of the nose has three bony projections, the
conchae, which increase the surface area of the nasal mucosa
and help to create turbulence in the air flowing through the
nose. This allows the nose to humidify and clean the inhaled
air and also to change the air to body temperature. The
spaces between the conchae and the lateral wall of the nose
are called the meatuses. The middle meatus typically has a
bulge in its lateral nasal wall, the bulla ethmoidalis, which
is created by the presence of ethmoidal air cells. This bulge
is bounded from below by a groove, the hiatus semilunaris.
The mucous membrane of the nasal cavity is primarily ciliated columnar epithelium and is specialized for olfaction in
the roof of the nose and on the upper surface of the superior
concha.

THE PARANASAL SINUSES
Several bones that surround the nose are hollow, and the
spaces contained within, the paranasal sinuses, are named
for the skull bones in which they lie. They are lined by a
mucous membrane that is continuous with the nasal mucosa
through openings with which the paranasal sinuses communicate with the nose. The presence of the sinuses decreases

the weight of the skull and provides resonant chambers for
voice. The secretions of the sinuses are carried into the nose
through ciliary action.
The frontal sinus drains into the anterior part of the hiatus semilunaris via the infundibulum. The maxillary sinus
also drains into the hiatus semilunaris, as do the anterior
and middle ethmoidal sinuses. The posterior ethmoidal
sinuses drain into the superior meatus. The sphenoid sinus
drains into the space above the superior concha called the
sphenoethmoidal recess. The inferior end of the nasolacrimal duct opens in the inferior meatus, allowing tears from
the conjunctival sac to be carried into the nose. The maxillary sinus lies between the orbit above and the mouth below.
The roots of the upper premolar and molar teeth project
into the maxillary sinus, often separated from the contents
of the sinus only by the mucous membrane that lines the
sinus cavity.

Sensory Innervation
The olfactory nerves (I) pass through the cribriform plate
of the ethmoid bone into the olfactory bulb lying in the
anterior cranial fossa, carrying the sensations of smell from
the olfactory mucosa in the roof of the nose (Figure 1–5).


SECTION I

4

INTRODUCTION

Cavernous sinus
Supratrochlear v.

Superficial temporal v.

Supraorbital v.
Ophthalmic veins

Pterygoid venous
plexus
Maxillary v.

Deep facial v.
Posterior auricular v.
Superior labial v.

Retromandibular v.
Posterior division of
retromandibular v.

Inferior labial v.
Anterior division of
retromandibular v.

Facial v.

External jugular v.

Comman facial v.

Internal jugular v.
Subclavian v.

Brachiocephalic v.

ᮡ

Figure 1–3. Veins of the face.

General sensory fibers to the nose are provided by the ophthalmic (V1) and maxillary (V2) divisions of the trigeminal
nerve. Specifically, the sensory innervation of the mucosa
lining the anterior part of the nasal cavity, as well as that
surrounding the olfactory mucosa in the roof of the nose,
is by the ethmoidal branches of the ophthalmic division of
the trigeminal nerve. Sensation from the lateral wall of the
nose is carried by the lateral nasal branches of the maxillary
division of the trigeminal nerve. Sensation from the nasal
septum is carried by the nasopalatine branch of the maxillary
division of the trigeminal nerve.
The sensory innervation of the lining of the frontal
sinus is by the supraorbital branch of the ophthalmic

division of the trigeminal nerve (V1). Sensory innervation
of the sphenoid and ethmoid sinuses is by the ethmoidal
branches of the ophthalmic division of the trigeminal
nerve. Sensory innervation of the maxillary sinus is by the
infraorbital branch of the maxillary division of the trigeminal nerve (V2).

Arteries
The rich blood supply of the nasal cavity is primarily from
the sphenopalatine branch of the maxillary artery that
enters the nose from the pterygopalatine fossa (Figure 1–6).
The superior labial branch of the facial artery supplies the