Indication Vindication

Question 1

Indication for supracricoid partial laryngectomy with cricohyoidopexy (SCPL)

Answer 1

Supraglottic carcinomas in which the glottic level or preepiglottic space is involved, when vocal fold mobility is decreased, or with limited thyroid cartilage invasion.

Question 2

Contra-indications for SCPL

Answer 2

“Extended BIPAP SCAM”

(1) subglottic extension greater than 10mm anteriorly and 5mm posteriorly
(2) arytenoid fixation
(3) massive preepiglottic space involvement with involvement of the vallecula
(4) extension to the pharyngeal wall, vallecula, base of tongue, postcricoid region and interarytenoid region
(5) cricoid cartilage invasion

Question 3

ABSOLUTE INDICATIONS for surgery in Grave’s Disease

Answer 3

(1) Significant adverse effects to medications who cannot be blocked before RAI
(2) large thyroid >75gm
(3) neoplasia (suspected or proven) in diffuse toxic nodular goiter

Question 4

RELATIVE INDICATIONS for surgery in Grave’s Disease

Answer 4

(1) women of child-bearing age
(2) lactating women
(3) moderate to severe ophthalmopathy which may be worsened by RAI (due to tissue edema)

Question 5

Indications for Primary Sinonasal Surgery

Answer 5

INFLAMMATORY SINONASAL DISEASE

• Chronic rhinosinusitis (with or without nasal polyposis)
• Recurrent acute rhinosinusitis
• Complications of rhinosinusitis
• Antrochoanal polyps
• Noninvasive fungal ball and eosinophilic fungal rhinosinusitis
• Invasive fungal rhinosinusitis
• Mucoceles
• Silent sinus syndrome

OTHER

• Intractable epistaxis
• Cerebrospinal fluid rhinorrhea and anterior meningoencephaloceles
• Foreign body removal
• Choanal atresia repair
• Headaches and facial pain
• Sinonasal tumors
• Expanded transnasal approaches to the skull base and orbit

Question 6

Indications for adjuvant RT in salivary gland malignancies

Answer 6

“PACHI” the parrot(id)

• perineural invasion
• advanced stage
• close or positive margins
• high-grade histologic types
• evidence of local tissue invasion