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Surgical Atlas
of
PEDIATRIC
OTOLARYNGOLOGY
Surgical Atlas
of
PEDIATRIC
OTOLARYNGOLOGY
with 900 illustrations
CHARLES D. BLUESTONE, MD
Eberly Professor of Pediatric Otolaryngology
University of Pittsburgh School of Medicine
Director, Department of Pediatric Otolaryngology
Childrens Hospital of Pittsburgh
Pittsburgh, Pennsylvania
RICHARD M. ROSENFELD, MD, MPH

Professor of Clinical Otolaryngology
SUNY Downstate Medical Center
Director, Division of Pediatric Otolaryngology
Department of Otolaryngology
Long Island College Hospital and University Hospital of Brooklyn
Brooklyn, New York
2002
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2002 Charles D. Bluestone and Richard M. Rosenfeld
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Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice
of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since
research and regulation constantly change clinical standards, the reader is urged to check recent publications and the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications.
This is particularly important with new or infrequently used drugs.
P REFACE
Surgical Atlas of Pediatric Otolaryngology is a unique and comprehensive reference for clinicians who care for infants and children with disorders of the
ears, nose, throat, head, neck, and related structures. Over 200 procedures
are described in 650 figures in 900 parts, with step-by-step instructions for
patient preparation, surgical techniques, postoperative care, and prevention
of complications. Major sections cover all relevant procedures including otologic, rhinologic, oral and pharyngeal, and head and neck surgeries,
endoscopy and airway surgery, and plastic and reconstruction surgery.
Osler once quipped, There are only two sorts of doctors: those who
practice with their brains, and those who practice with their tongues. A
third sort had been recruited for this book: those who practice with their
hands. We are fortunate to have recruited the leading experts in the field to
describe in detail how they achieve successful outcomes. All authors are
active surgeons, culled from major childrens hospitals, academic training
programs, and pediatric otolaryngology fellowship programs. Their combined wisdom has been distilled and organized to promote optimal surgical results.
The Surgical Atlas builds upon a superb foundation established by Atlas
of Pediatric Otolaryngology, published in 1995 as a companion to the twovolume classic text Pediatric Otolaryngology. This self-contained work contains 15 new chapters on topics including ossiculoplasty, sphenoid sinus
surgery, nasal and septal deformities, surgery to correct drooling, velopharyngeal insufficiency, soft tissue surgery, and maxillofacial trauma. More
than 40 additional procedures are illustrated with new artwork, and existing illustrations have been redrawn as needed for improved clarity. The text
is completely revised and updated, with extensive reorganization and reformatting for easy access.
vi
Preface
A unique feature of the Surgical Atlas is that technical descriptions are

balanced by in-depth discussions of decision making, patient selection, and
clinical management. We emphasize not only how to cut, but also when to
cut and when not to cut. Anesthetic considerations, patient preparation,
and postoperative care are discussed in detail because they differ in infants
and children as compared with adults. Children have special needs related
to changes in anatomy, physiology, and psychosocial adjustment during
growth and development, and an understanding of these differences can
improve surgical outcomes.
We have structured this book to meet the needs of a diverse audience.
Physicians in training will benefit from ready access to how to information on the gamut of procedures they are likely to encounter in their residence or fellowship. Junior clinicians will have a one-stop refresher for
commonand uncommon procedures needed for everyday patient
care, with advice and clinical pearls from leading surgical authorities.
Senior clinicians will find the book a useful reference for complex or esoteric procedures, with literature citations for additional details. The beautiful line illustrations are a superb didactic aid for clinicians and patients.
We are pleased to have had Jon Coulter prepare most of the artwork that
describes in detail the surgical techniques. His expertise has added consistency and clarity to the text. We are also indebted to our excellent editorial assistants, Deborah Hepple and Billy Tang, for their secretarial support
and help in collating the manuscripts. Mr. Tangs efforts and the cost of
illustrations were supported, in part, by Faculty Development Awards from
the State University of New York Downstate Medical Center in Brooklyn.
Last, we thank Sylvan Stool for his invaluable editorial efforts in the precursor, Atlas of Pediatric Otolaryngology.
We hope the reader will benefit from the fine contributions made by the
authors of this text, and that this atlas will enhance the care of infants and
children who require otolaryngologic surgery.
Charles D. Bluestone, MD
Pittsburgh, PA
Richard M. Rosenfeld, MD, MPH
Brooklyn, NY
January 2002
C ONTRIBUTORS
George Alexiades, MD
New York University Medical Center
New York, New York
Chapter 9: Cochlear Implants
Cuneyt M. Alper, MD
Associate Professor of Otolaryngology
Department of Pediatric Otolaryngology
Chapter 26: Tracheotomy
James S. Batti, MD
Assistant Professor of Pediatric Otolaryngology
University of Connecticut
Connecticut Childrens Medical Center
Hartford, Connecticut
Chapter 4: Ossiculoplasty
Charles D. Bluestone, MD
Eberly Professor of Pediatric Otolaryngology
Director, Department of Pediatric Otolaryngology
Chapter 1: Tympanostomy Tubes and Related Procedures
Chapter 2: Approaches to the Middle Ear and Mastoid
Chapter 3: Myringoplasty and Tympanoplasty
Chapter 4: Ossiculoplasty
Chapter 5: Mastoidectomy and Cholesteatoma
Chapter 6: Perilymphatic Fistula and Eustachian Tube Surgery
Chapter 31: Otoplasty for the Prominent Ear
Margaretha L. Casselbrant, MD, PhD

Professor of Otolaryngology
Chapter 26: Tracheotomy
Kenny H. Chan, MD
University of Colorado School of Medicine
Chairman, Department of Pediatric Otolaryngology
Childrens Hospital
Denver, Colorado
Chapter 25: Endoscopy of the Upper Aerodigestive Tract
Noel L. Cohen, MD
New York University School of Medicine
Chairman, Department of Otolaryngology
New York, New York
William S. Crysdale, MD
University of Toronto
Otolaryngologist-in-Chief
Hospital for Sick Children
Toronto, Ontario
Chapter 11: Nasal and Septal Deformities
Chapter 19: Surgery for Drooling
viii
Contributors
Michael J. Cunningham, MD
Harvard Medical School
Department of OtolaryngologyHead and Neck Surgery
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
Chapter 20: Cervical Adenopathy
Chapter 23: Salivary Gland Surgery
Chapter 24: Thyroidectomy
Robin A. Dyleski, MD
Assistant Professor of Pediatric Otolaryngology
University of Arkansas for Medical Sciences
Vice Chief, Department of Pediatric Otolaryngology
Arkansas Childrens Hospital
Little Rock, Arkansas
Chapter 33: Cleft Lip and Cleft Palate
Roland D. Eavey, MD
Director of Pediatric Otolaryngology
Massachusetts Eye and Ear Infirmary
Chapter 30: Auricular Repair for Microtia
Carlos Gonzalez, MD
Clinical Associate Professor of Otolaryngology
University of Puerto Rico School of Medicine
Chief, Department of Surgery
San Jorge Childrens Hospital
San Juan, Puerto Rico
Chapter 16: Surgery of the Tongue
Charles W. Gross, MD
University of Virginia Health System
University of Virginia Medical Center
Charlottesville, Virginia
Chapter 29: Soft Tissue Surgery
Gady Har-El, MD
Vice Chairman, Department of Otolaryngology
Long Island College Hospital and University Hospital
of Brooklyn
Brooklyn, New York
Chapter 15: Sphenoid Sinus Surgery
Jose N. Fayad, MD
Manhattan Eye Ear and Throat Hospital
Lenox Hill Hospital
New York, New York
Chapter 8: Ear Canal Stenosis and Atresia
Gerald B. Healy, MD
Professor of Otology and Laryngology
Otolaryngologist-in-Chief, Department of
Otolaryngology
Childrens Hospital Boston
Chapter 27: Surgery of the Larynx and Trachea
Norman Friedman, MD
Assistant Professor of Otolaryngology
Denver, Colorado
Raymond L. Hilsinger Jr, MD

Chief, Department of Head and Neck Surgery
Kaiser Permanente Medical Center
Oakland, California
Chapter 7: Facial Nerve Exploration and Repair
Ari J. Goldsmith, MD
Division of Pediatric Otolaryngology
of Brooklyn
Brooklyn, New York
Chapter 17: Tonsillectomy, Adenoidectomy, and UPPP
Andrew J. Hotaling, MD
Professor of Otolaryngology and Pediatrics
Chief, Pediatric Otolaryngology
Loyola University Medical Center
Chicago, Illinois
Chapter 14: Inflammatory Sinonasal Disease
Contributors
Kevin J. Hulett, MD
Loyola University Medical Center
Chicago, Illinois
Chapter 14: Inflammatory Sinonasal Disease
Glenn Isaacson, MD
Chairman, Department of OtolaryngologyHead and
Neck Surgery
Temple University School of Medicine
Philadelphia, Pennsylvania
Chapter 13: Endoscopic Ethmoidectomy and Antrostomy
Robert M. Kellman, MD
Chairman, Department of Otolaryngology and Communication Sciences
SUNY Health Science Center at Syracuse
Syracuse, New York
Chapter 32: Maxillofacial Trauma
Margaret A. Kenna, MD
Associate Professor of Otology and Laryngology
Chapter 12: Congenital Nasal Malformations
John Kim, MD
University of Michigan Health System
Ann Arbor, Michigan
Chapter 34: Craniosynostosis
Charles F. Koopman Jr, MD
Professor of Pediatric Otolaryngology
University of Michigan Medical Center
Chief, Division of Pediatric Otolaryngology
C.S. Mott Childrens Hospital
Ann Arbor, Michigan
Chapter 21: Deep Neck Infections
Greg R. Licameli, MD
Assistant Professor of Otology and Laryngology
Chapter 27: Surgery of the Larynx and Trachea
ix
Scott C. Manning, MD
University of Washington
Chief, Pediatric OtolaryngologyHead and Neck Surgery
Childrens Hospital & Medical Center
Seattle, Washington
Chapter 10: Epistaxis
Lawrence J. Marentette, MD
Associate Professor of Otolaryngology and Neurosurgery
Director, Cranial Base Program
University of Michigan Health System
Ann Arbor, Michigan
Chapter 34: Craniosynostosis
Khosrow Mojdehi, MD
Assistant Professor of Anesthesiology
Director, Division of Pediatric Anesthesiology
Department of Anesthesiology
of Brooklyn
Brooklyn, New York
Chapter 36: Pediatric Anesthesia
Simon C. Parisier, MD
Chairman Emeritus, Department of Otolaryngology
Manhattan Eye Ear and Throat Hospital
Lenox Hill Hospital
New York, New York
Chapter 8: Ear Canal Stenosis and Atresia
Stephen S. Park, MD
Director, Division of Facial Plastic and Reconstructive
Surgery
University of Virginia Medical Center
David M. Polaner, MD
Associate Professor of Anesthesiology
Denver, Colorado
Contributors
Reza Rahbar, DMD, MD

Instructor in Otology and Laryngology
Department of Otology and Laryngology
Chapter 12: Congenital Nasal Malformations
Mark A. Richardson, MD
Professor and Chairman
Oregon Health and Science University
Portland, Oregon
Chapter 22: Congenital Malformations of the Neck
Keith H. Riding, MD
Clinical Professor
University of British Columbia
Staff Otolaryngologist
British Columbia Childrens Hospital
Vancouver, British Columbia
J. Thomas Roland Jr, MD
New York, New York
Richard M. Rosenfeld, MD, MPH
Director, Division of Pediatric Otolaryngology
of Brooklyn
Brooklyn, New York
Chapter 17: Tonsillectomy, Adenoidectomy, and UPPP
Chapter 22: Congenital Malformations of the Neck
Chapter 35: Information for Parents and Caregivers
Robert W. Seibert, MD
Professor of Pediatric Otolaryngology
University of Arkansas for Medical Sciences
Arkansas Childrens Hospital
Little Rock, Arkansas
Chapter 33: Cleft Lip and Cleft Palate
Christopher E. Stevens, MD
Sylvan E. Stool, MD
Emeritus Professor of Otolaryngology
Denver, Colorado
Sherard A. Tatum, MD
Director, Division of Facial Plastic and Reconstructive
Surgery
Department of Otolaryngology and Communication
Sciences
SUNY Health Science Center at Syracuse
Syracuse, New York
Chapter 32: Maxillofacial Trauma
Jon B. Turk, MD
Assistant Professor of Otolaryngology
Director, Facial Plastic and Reconstructive Surgery
Long Island College Hospital
Brooklyn, New York
Chapter 11: Nasal and Septal Deformities
Jay A. Werkhaven, MD
Vanderbilt University Medical Center
Nashville, Tennessee
Chapter 28: Laryngotracheal Laser Surgery
J. Paul Willging, MD
University of Cincinnati College of Medicine
Childrens Hospital Medical Center
Cincinnati, Ohio
Chapter 18: Velopharyngeal Insufficiency
C ONTENTS
OTOLOGIC SURGERY
1. Tympanostomy Tubes and Related Procedures...............................................................................1
a. Tympanocentesis ..............................................................................................................1
b. Myringotomy ...................................................................................................................4
c. Grommet-type tympanostomy tube insertion...................................................................6
d. Permanent tympanostomy tube insertion .........................................................................11
e. Removal of tympanostomy tubes and myringoplasty........................................................16
2. Approaches to the Middle Ear and Mastoid ..................................................................................21
a. Transcanal approach .........................................................................................................21
b. Endaural approach............................................................................................................26
c. Postauricular approach......................................................................................................32
3. Myringoplasty and Tympanoplasty ................................................................................................39
a. Myringoplasty with medial fascia or fat-plug graft............................................................41
b. Transcanal medial fascia or fat-plug graft tympanoplasty ..................................................49
c. Postauricular medial fascia graft tympanoplasty ................................................................49
d. Endaural medial fascia graft tympanoplasty ......................................................................52
e. Lateral fascia graft tympanoplasty .....................................................................................58
f. Cartilage graft tympanoplasty ...........................................................................................66
4. Ossiculoplasty................................................................................................................................75
a. Advancement flap .............................................................................................................78
b. Incus interposition............................................................................................................81
c. Partial ossicular replacement prosthesis.............................................................................82
d. Total ossicular replacement prosthesis...............................................................................83
5. Mastoidectomy and Cholesteatoma ...............................................................................................91
a. Simple mastoidectomy......................................................................................................91
b. Modified radical mastoidectomy.......................................................................................96
c. Radical mastoidectomy.....................................................................................................98
d. Congenital cholesteatoma.................................................................................................103
e. Posterosuperior quadrant acquired cholesteatoma.............................................................111
f. Pars flaccida attic cholesteatoma .......................................................................................117
xii
Contents
6. Perilymphatic Fistula and Eustachian Tube Surgery .......................................................................123

a. Congenital perilymphatic fistula.......................................................................................123
b. Obliteration of the eustachian tube ..................................................................................129
c. Patulous eustachian tube: catheter obstruction .................................................................132
7. Facial Nerve Exploration and Repair .............................................................................................137
a. Intratemporal exploration and decompression ..................................................................139
b. Intratemporal repair, rerouting, and grafting ....................................................................150
c. Extratemporal exploration and repair for lesions...............................................................157
d. Extratemporal exploration and repair after trauma ...........................................................171
e. Extratemporal repair, rerouting, and grafting....................................................................176
8. Ear Canal Stenosis and Atresia.......................................................................................................185
a. Reconstruction of the external ear canal ...........................................................................186
b. Skin grafting of the external auditory canal ......................................................................207
c. Congenital aural atresia ....................................................................................................211
9. Cochlear Implants .........................................................................................................................221
RHINOLOGIC SURGERY
10. Epistaxis.........................................................................................................................................251
a. Local cautery ....................................................................................................................253
b. Anterior packing...............................................................................................................253
c. Endoscopic-guided cautery ...............................................................................................254
d. Posterior packing ..............................................................................................................255
e. Arterial ligation.................................................................................................................257
11. Nasal and Septal Deformities.........................................................................................................259
a. Closed reduction of nasal fracture.....................................................................................260
b. Internal approach for septoplasty......................................................................................264
c. External approach for septoplasty .....................................................................................268
d. Endonasal approach for rhinoplasty..................................................................................282
e. External approach for rhinoplasty.....................................................................................291
12. Congenital Nasal Malformations ...................................................................................................299
a. Transnasal repair of choanal atresia ...................................................................................300
b. Transpalatal repair of choanal atresia ................................................................................306
c. Lateral rhinotomy.............................................................................................................312
d. Sublabial approach............................................................................................................315
13. Endoscopic Ethmoidectomy and Antrostomy................................................................................319
14. Inflammatory Sinonasal Disease ....................................................................................................339
a. Drainage of septal abscess or hematoma ...........................................................................339
b. Antral aspiration and lavage..............................................................................................341
c. Caldwell-Luc procedure....................................................................................................342
d. External ethmoidectomy...................................................................................................344
e. Frontal sinus trephination.................................................................................................346
f. Dacryocystorhinostomy ....................................................................................................348
Contents
xiii
15. Sphenoid Sinus Surgery .................................................................................................................353

a. Transnasal transethmoidal sphenoidotomy .......................................................................355
b. Direct transnasal sphenoidotomy......................................................................................358
ORAL AND PHARYNGEAL SURGERY
16. Surgery of the Tongue....................................................................................................................367
a. Anterior tongue lesions.....................................................................................................367
b. Macroglossia .....................................................................................................................369
c. Base of tongue lesions.......................................................................................................372
d. Frenuloplasty ....................................................................................................................376
17. Tonsillectomy, Adenoidectomy, and UPPP ....................................................................................379
a. Adenoidectomy.................................................................................................................381
b. Tonsillectomy ...................................................................................................................388
c. External carotid artery ligation .........................................................................................397
d. Uvulopalatopharyngoplasty (UPPP) .................................................................................402
18. Velopharyngeal Insufficiency .........................................................................................................407
a. Superiorly based pharyngeal flap.......................................................................................408
b. Rolled pharyngeal flap ......................................................................................................415
c. Posterior pharyngeal wall augmentation ...........................................................................417
d. Sphincteroplasty ...............................................................................................................419
e. Lateral port revision, narrowing........................................................................................422
f. Lateral port revision, enlarging .........................................................................................424
19. Surgery for Drooling......................................................................................................................427
a. Submandibular duct relocation with sublingual gland excision.........................................427
b. Submandibular duct relocation.........................................................................................433
c. Parotid duct ligation .........................................................................................................436
d. Tympanic neurectomy ......................................................................................................438
e. Submandibular duct ligation ............................................................................................438
HEAD AND NECK SURGERY
20. Cervical Adenopathy .....................................................................................................................441
a. Percutaneous needle biopsy...............................................................................................442
b. Cervical lymph node biopsy .............................................................................................448
c. Functional (modified) neck dissection ..............................................................................452
21. Deep Neck Infections ....................................................................................................................465
a. Submandibular space drainage..........................................................................................468
b. Pharyngomaxillary (lateral pharyngeal) space drainage .....................................................472
c. Masticator space drainage .................................................................................................475
d. Parotid space drainage ......................................................................................................477
e. Peritonsillar space drainage ...............................................................................................480
f. Visceral space drainage .....................................................................................................482
g. Retropharyngeal space drainage ........................................................................................482
h. Prevertebral space drainage ...............................................................................................486
i. Vascular (carotid) space drainage ......................................................................................487
j. Danger space drainage...................................................................................................488
xiv
Contents
22. Congenital Malformations of the Neck

a. Thyroglossal duct cyst ......................................................................................................491
b. Cystic hygroma (lymphangioma)......................................................................................496
c. First branchial cleft fistula.................................................................................................499
d. Pre-auricular pit or fistula .................................................................................................502
e. Second and third branchial cleft fistula.............................................................................504
f. Fourth branchial pouch sinus ...........................................................................................507
g. Fibromatosis colli .............................................................................................................512
23. Salivary Gland Surgery ..................................................................................................................515
a. Parotidectomy...................................................................................................................515
b. Submandibular gland excision ..........................................................................................526
c. Plunging ranula excision...................................................................................................532
d. Intraoral ranula excision ...................................................................................................536
24. Thyroidectomy ..............................................................................................................................539
ENDOSCOPY AND AIRWAY SURGERY
25. Endoscopy of the Upper Aerodigestive Tract .................................................................................556
a. Pharyngoscopy..................................................................................................................562
b. Laryngoscopy....................................................................................................................563
c. Bronchoscopy ...................................................................................................................569
d. Esophagoscopy .................................................................................................................578
26. Tracheotomy..................................................................................................................................587
a. Tracheotomy.....................................................................................................................587
b. Tracheocutaneous fistula closure .......................................................................................593
27. Surgery of the Larynx and Trachea.................................................................................................597
a. Arytenoidectomy ..............................................................................................................597
b. Supraglottoplasty ..............................................................................................................602
c. Glottic web excision .........................................................................................................604
d. Posterior glottic stenosis repair..........................................................................................606
e. Laryngeal separation .........................................................................................................608
f. Laryngeal decompression (cricoid split) with hyoid interposition .....................................612
g. Augmentation laryngoplasty with cartilage graft ...............................................................616
h. Augmentation laryngoplasty with cartilage stent...............................................................620
i. Segmental tracheal resection .............................................................................................624
j. Cricotracheal resection......................................................................................................626
28. Laryngotracheal Laser Surgery .......................................................................................................633
a. Epiglottic cysts..................................................................................................................642
b. Vallecular cysts..................................................................................................................644
c. Ventricular cysts................................................................................................................646
d. Intracordal cysts................................................................................................................648
e. Vocal process granulomas .................................................................................................650
f. Laryngeal papillomatosis...................................................................................................652
g. Laryngeal webs .................................................................................................................654
h. Vocal cord nodules ...........................................................................................................658
i. Reinkes edema and vocal cord polyps ..............................................................................660
Contents
xv
j. Laryngeal and subglottic hemangiomas ............................................................................663

k. Subglottic stenosis ............................................................................................................665
l. Tracheal stenosis ...............................................................................................................668
PLASTIC AND RECONSTRUCTIVE SURGERY
29. Soft Tissue Surgery ........................................................................................................................671
a. Lip repair..........................................................................................................................678
b. Auricular repair.................................................................................................................682
c. Nasal repair ......................................................................................................................686
d. Periorbital repair ...............................................................................................................688
e. Parotid duct repair............................................................................................................694
f. Facial nerve repair.............................................................................................................694
g. Scar revision .....................................................................................................................695
30. Auricular Repair for Microtia ........................................................................................................701
31. Otoplasty for the Prominent Ear ...................................................................................................717
32. Maxillofacial Trauma .....................................................................................................................727
a. Coronal incision ...............................................................................................................732
b. Superior lid crease incision ...............................................................................................734
c. Transconjunctival incision ................................................................................................736
d. Vestibular or canine fossa incision ....................................................................................738
e. Extraoral mandibular exposure .........................................................................................740
f. Intraoral mandibular exposure ..........................................................................................744
g. Maxillomandibular fixation ..............................................................................................746
h. Rigid internal fixation.......................................................................................................750
i. Nasoethmoid, naso-orbital ethmoid, and skull base trauma..............................................753
j. Bone grafting....................................................................................................................758
33. Cleft Lip and Cleft Palate Repair...................................................................................................763
a. Unilateral cleft lip repair...................................................................................................765
b. Bilateral cleft lip repair .....................................................................................................770
c. Unilateral lip adhesion......................................................................................................775
d. Bilateral lip adhesion ........................................................................................................778
e. V to Y pushback palatoplasty............................................................................................782
f. Two-flap palatoplasty........................................................................................................785
g. Double reversing Z-plasty (Furlow palatoplasty)...............................................................788
34. Craniosynostosis ............................................................................................................................791
a. Unilateral coronal craniosynostosis ...................................................................................794
b. Bicoronal craniosynostosis ................................................................................................796
c. Metopic craniosynostosis ..................................................................................................798
d. Sagittal craniosynostosis....................................................................................................800
e. Lambdoidal craniosynostosis ............................................................................................802
PATIENT EDUCATION AND ANESTHESIA
35. Information for Parents and Caregivers .........................................................................................807
36. Pediatric Anesthesia .......................................................................................................................823
Index....................................................................................................................................................829

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Surgical Atlas

RICHARD M. ROSENFELD, MD, MPH

Sales and Distribution

U.K., Europe, Scandinavia,

Australia, New Zealand

Singapore, Malaysia, Thailand,

A unique feature of the Surgical Atlas is that technical descriptions are

Margaretha L. Casselbrant, MD, PhD

Raymond L. Hilsinger Jr, MD

Reza Rahbar, DMD, MD

6. Perilymphatic Fistula and Eustachian Tube Surgery .......................................................................123

15. Sphenoid Sinus Surgery .................................................................................................................353

22. Congenital Malformations of the Neck

j. Laryngeal and subglottic hemangiomas ............................................................................663

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