bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Snoring Change the Palatal Sensation?
Authors: Seol Jeong hun , Kim Jae‐Myung , Cho Jae Hoon , Kim Ki‐Tae , Kim Jin Kook 
Published: February 2015

ObjectivePatients with obstructive sleep apnea syndrome (OSAS) have impaired responses in inspiratory resistive loading during sleep. This may be due, in part, to a change in the upper airway sensation. Therefore, we hypothesized that patients with OSAS had diminished upper airway sensation due to snoring.MethodCase‐control study. Conducted: from May 2011 to March 2012. Participants were selected based on clinical evaluation and polysomnography. Two‐point discrimination was measured with modified calipers in the tongue and soft palate. Independent variables: snoring time components.ResultsComparing polysomnography, patients with impairment of their palatal sensory input in 2‐point discrimination had longer longest‐snoring episodes than those with normal sensation (P =.010). And patients with decreased sensory input in 2‐point discrimination had longer average snoring episode duration than those with normal sensory input (P =. 043). However, the total snoring time and relative snoring time also increased in patients with sensory impairment, but statistical significance was not found (P =. 20, P =. 24 respectively).ConclusionTwo‐point discrimination in the anterior tongue and soft palate was impaired in patients with OSAS. We speculate that this impairment might be due to a primary sensory function abnormality or secondary to nerve damage and/or hypoxemia caused by snoring. Further studies after treatment of OSAS are needed.
Effect of Upper Airway Stimulation on Snoring in Obstructive Sleep Apnea
Authors: Maurer Joachim T. , Hohenhorst Winfried , Knaack Lennart , Baskin Jonathan Z. , Lin Ho‐Sheng , Odland Rick , Anders Clemens 
Published: February 2015

ObjectivePrevious studies showed that electrical stimulation of the hypoglossal nerve can improve obstructive sleep apnea (OSA). This study aims to: 1) Learn whether upper airway stimulation has an effect on snoring in patients with moderate‐to‐severe OSA. 2) Learn whether there is a correlation between the reduction of snoring and obstructive respiratory events.MethodUpper airway stimulation systems were implanted in moderate‐to‐severe OSA patients (inclusion criteria: CPAP failure or intolerance, BMI <32, without complete concentric collapse during drug‐induced‐sleep‐endoscopy). Apnea‐hypopnea‐index (polysomnography) and snoring (5‐level categories by bed‐partner: no, soft, loud, very intense, intolerable by bed partner) were collected at pre‐implant and 2, 4, and 6 months post‐implant.ResultsNine subjects were implanted, and all have completed month 6 visit. All 9 subjects reported loud or very intense snoring at pre‐implant. At the last visit, 4 subjects reduced from loud to no snoring, 4 subjects reduced from loud to soft snoring, and 1 subject reported no change. Reports from bed‐partners were similar. The average AHI among the 9 subjects reduced from 39.4 ± 9.3 (mean ± SD) to 16.7 ± 21.7 (P <. 05).ConclusionPreliminary findings suggest that upper airway stimulation improves snoring along with the improvement of sleep disordered breathing in patients with moderate‐to‐severe OSA.
Strategies to Improve CPAP Adherence: Zhenjiang Experience
Authors: Qian Wei , Haight James , Ma Yongming , Jiang Guochang 
Published: February 2015

ObjectiveHigh dropout rate of CPAP is a big challenge. To improve the CPAP adherence, systemic upper airway management including subjective and objective nasal patency assessment, surgical and medical treatment to upper airway obstruction, and CPAP follow‐up strategies were carried on in the present study.MethodA prospective study. A total of 169 OSA patients (women: 34; mean age, 42.9 years) and 41 healthy subjects (women: 9; mean age, 38 years) were undertaken for polysomnography and subjective and objective nasal patency assessment. CPAP users with upper airway disorder were treated with medication or surgically and followed for up to 3 years.ResultsAverage bilateral nasal cavity volume (2‐5 cm from nostril) was 4.97 mL in OSA subjects and 6.43 in healthy subjects (P <. 01), and average nasal respiratory resistance was 2.03 Pa·cm‐3·s‐1 in OSA subjects and 0.44 in healthy subjects (P <. 01). There was no significant nasal patency difference among mild, moderate, and severe OSA patients. In 59 CPAP users, 27 were treated with nasal steroid spray and/or decongestant, whereas 10 were treated surgically (8 septoplasty and 2 tonsillectomy + UPPP). A total of 38 patients (64%) kept using CPAP over 4 hours per day, 9 (15%) dropped out, and 12 (21%) were lost in the 3 years follow‐up.ConclusionThe incidence of nasal patency disorder was higher in OSA patients. Nasal airway assessment was helpful to foresee and deal with the problems with CPAP treatment, which would encourage patients to adhere to the treatment with medical or surgical interferences.
The Morphology of Nasopharyngeal Inlet in Obstructive Sleep Apnea
Authors: Tanyeri Hasan M. , Aksoy Elif A. , Serin Gediz M. , Polat Senol , Unal Omer F. 
Published: February 2015

ObjectiveRoutine flexible optic laryngoscopy (FOL) displays obstructive sleep apnea (OSA) related airway passages from nasopharynx to hypopharynx. Tip of the flexible endoscope awaiting at the nasopharyngeal inlet allows us to visualize the morphology of this area. We wanted to evaluate the impact of nasopharyngeal inlet (NPI) morphology on OSA severity.MethodThe videos obtained during FOL examinations of NPI were examined in 83 patients (10 women, 73 men). Two main morphologies, wide and narrow, were depicted. The narrow NPI group was further divided into kidney‐shaped, elliptical, and circumferential. The wide NPI group was divided into circumferential and kidney‐shaped.ResultsForty‐five patients had narrow NPI morphology, and 38 had wide NPI morphology. The wide NPI group had 20 circumferential and 18 kidney‐shaped morphologies. The narrow NPI group had 34 kidney‐shaped, 6 circumferential, and 5 elliptical morphologies. Mean RDI of the narrow group was 30.378 ± 22.358, and the wide group was 14.511 ± 13.901. Mean RDI of the narrow circumferential group was 45.317 ± 30.56, the narrow elliptical group was 23.74 ± 10.787, and the narrow kidney‐shaped group was 28.718 ± 21.47. Mean RDI of the wide circumferential group was 11.3 ± 13.203, and the mean RDI of the wide kidney‐shaped group was 17.772 ± 14.586. The wide morphology groups had lower RDI levels compared to the narrow morphology groups (P <. 0005).ConclusionMorphology of nasopharyngeal inlet may be evidence of OSA during routine FOL examinations. Further analysis of the subgroups supported evidence of narrowing by means of increased RDI levels.
Upper Airway Surgery in Patients with Sleep Apnea
Authors: Rocke Daniel , Sharp Scott R. , Puscas Liana , Wiener Dana , Lee Walter T. 
Published: February 2015

Objective1) Evaluate the safety of outpatient and overnight observation of sleep apnea surgery patients using new preoperative screening criteria. 2) Compare the cost‐effectiveness of outpatient and overnight observational sleep apnea surgery compared to surgical intensive care admission using new preoperative screening criteria.MethodRetrospective chart review of patients undergoing sleep apnea surgery at the Durham VA between May 2008 and January 2012. A new preoperative protocol was used to triage postoperative care between intensive, routine, or discharge home. Postoperative complications were assessed in each group, and a cost comparison was conducted between groups.ResultsA total of 115 patients underwent sleep surgery between July 2008 and January 2012. Eleven patients were excluded, leaving 104 patients in the final analysis. The average follow‐up was 3.6 months. The overall complication rate was 12.5%. Fifty‐eight patients were triaged to intensive postoperative care, 21 patients were triaged to routine postoperative care, and 24 patients were not monitored overnight. All of the respiratory and bleeding complications occurred in the immediate postoperative period. All of the complications were adequately handled under the new protocol. The savings over the 3.6 years of this study was $125,275.ConclusionCertain patients with sleep apnea can safely be triaged to less than intensive postoperative care. In institutions like the Durham VA, where all sleep apnea patients were historically triaged to intensive care postoperatively, this will lead to significantly lower cost and more efficient use of scarce postoperative resources.
Dermatitis Artefacta: Facts for a Facial Plastic Surgeon
Authors: Grover Nancy , D’Souza Alwyn 
Published: February 2015

Objective1) To report a large scalp lesion secondary to dermatitis artefacta, requiring reconstruction. 2) To emphasize the need for a multidisciplinary approach involving dermatologist, psychiatrist, and facial plastic surgeon for optimizing outcome. 3) To highlight specific issues in the patient’s care in the perioperative period.MethodCase report of a 44‐year‐old white female patient who presented to our combined dermatology–facial plastic surgery clinic with a large lesion on her scalp and a known diagnosis of dermatitis artefacta.ResultsThe scalp lesion had gradually increased in size over 4 years. Prior to this she was being followed up by the dermatologists for this and other multiple, bizarre ulcerating areas on her face; the patient had associated depression. A diagnosis of dermatitis artefacta was made by the dermatologists and supported by the psychiatrists. She was treated with antibiotics for the excoriating lesions and local dressing for the scalp wound initially. Regional reconstruction of scalp was subsequently carried out to achieve closure of the scalp defect, with the active involvement of the dermatology and psychiatry teams.Conclusion1) Close monitoring is required postoperatively, as these patients can be passively noncompliant with treatment, inducing self‐harm repeatedly because of lack of insight in causing skin damage. 2) Prompt discussion in a multidisciplinary setting with earlier input from facial plastic surgeons will potentially minimize the extent of reconstructive surgery required.
Surgical Skills of Applicants to Residency in Otolaryngology
Authors: Sebelik Merry E. , Challis Mitchell J. , Lewoczko Ken , Stocks Rose Mary S. 
Published: February 2015

Objective1) Measure baseline competence in the performance of a basic surgical task by 4th‐year medical students applying to otolaryngology residency. 2) Determine whether information available in the standardized otolaryngology residency application correlates with competence in performance of the basic surgical task.MethodApplicants to residency in otolaryngology with the University of Tennessee Health Science Center in 2010 and 2011 constituted the study population. During the interview, the applicant was asked to close a simulated incision with sutures. A blinded observer recorded a 15‐point Objective Surgical Assessment of Technical Skill score.ResultsThe OSATS score provided a measure of the suturing skills of individuals applying to residency training in otolaryngology. The OSATS score was incorporated into the calculation of an overall OSCE (Objective Structured Clinical Examination) score modified to focus on surgical skill performance and a professionalism measure. Initial data analysis produced a correlation value (R value) between the OSCE score and data points gleaned from the standardized application (USMLE step I score, prior employment‐related surgical experience, hobbies, musical background, athletic background, research experience that includes performance of surgical procedures).ConclusionIn contrast to other high‐skill professions such as the airline industry, surgical educators have not universally developed a practice of testing prospective trainees for aptitudes that can be deemed critical to surgical competence. This study represents a methodology for assessment of a simple surgical skill to which all applicants to otolaryngology training should have been exposed. It also determines correlation with applicant data commonly used in selection, such as USMLE score.
The Role of Dexmedetomidine in Awake Tracheotomies
Authors: Seibert Jared R. , Roofe Scott B. 
Published: February 2015

ObjectiveUnderstand the different types of sedation and anesthesia (to include dexmedetomidine) used during awake tracheotomies along with side effects. Demonstrate how dexmedetomidine has been safely used at our institution to provide analgesia and sedation without compromising respiratory drive during awake tracheotomies.MethodWe performed a retrospective chart review of awake tracheotomies at our institution between 2008 and 2011. We reviewed operative reports, anesthesia records, and postoperative follow‐up notes. Patients were divided into groups based on indication for tracheotomy and if dexmedetomidine was used during the procedure. We reviewed complications and performed a cost analysis.ResultsSixteen awake tracheotomies were performed at our institution during the observed time period: 9 related to malignancy, 5 due to impending airway obstruction, 1 due to infection, and 1 due to trauma. Dexmedetomidine was used in 6 cases. Ages of patients ranged from 22 to 76 years, with an average age of 53.6 years. No intraoperative complications were reported; however, one of the tracheotomies was performed after a failed planned fiberoptic intubation. Two patients eventually succumbed to their illness postoperatively. A cost analysis was performed demonstrating the variability of medication costs.ConclusionAnesthesia providers at our institution have safely used dexmedetomidine during awake tracheotomies. No complications occurred during these procedures. Although dexmedetomidine is more expensive than other agents, it avoids the respiratory depression of other commonly used anesthetics/analgesics. Further research regarding the use of this medication during awake tracheotomies is needed.
Ultrasound Assessment after Submandibular Sialolithotomy
Authors: Joshi Arjun S. , Sood Amit J. 
Published: February 2015

Objective1) To demonstrate the utility of ultrasound in the assessment of residual submandibular stones after endoscopic‐assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for detection of sialolithiasis of the submandibular glands.MethodFrom August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic‐assisted or purely open sialolithotomy in a tertiary‐level clinic setting. Pre‐ and immediate postoperative ultrasound was performed. Outcomes included presence of residual stones/fragments and proximal ductal dilatation.ResultsTwenty‐two patients with symptomatic submandibular sialolithiasis refractory to sialendoscopic extraction underwent either endoscopic‐assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound immediately after sialolithotomy. Those patients underwent mandatory exploration at the time of the procedure, and 3 of 3 (100%) were demonstrated to have residual sialoliths/ fragments, which were successfully removed. Thirteen of 22 (59%) demonstrated proximal ductal dilatation after stone removal. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow‐up ranging from 6 months to 1 year.ConclusionAfter cases of endoscopic‐assisted or open submandibular sialolithotomy, there is no widely used method to assess for residual stones. As a first, we propose that ultrasound is reliable not only for the presence of stones prior to treatment but also for the assessment of residual stones after submandibular sialolithotomy.
Ultrasound Localization during Submandibular Sialolithotomy
Authors: Joshi Arjun S. , Sood Amit J. 
Published: February 2015

Objective1) To describe a novel office‐based operative technique that has been demonstrated to be successful in stone localization and retrieval of proximally located submandibular sialoliths. 2) To demonstrate the feasibility of the technique and discuss its indications.MethodFrom August 2009 to January 2012, patients with symptomatic submandibular sialolithiasis underwent ultrasound needle localization and open sialolithotomy in a tertiary‐level clinic setting. Outcomes included success of delivery, presence of infection, ductal stenosis, loss of glandular function, or lingual nerve paralysis. Independent variables included size and location of sialoliths.ResultsSixteen in‐office cases of ultrasound‐guided needle localization and open sialolithotomy were performed for patients who had failed sialendoscopy and stone extraction. Follow‐up ranged from 6 months to 1 year. Sixteen of 16 (100%) were successful. The average size of sialoliths was 6.7 mm (range, 5‐11 mm). Mean procedure time was 24 minutes (range, 18‐42 minutes) from needle localization. There were no complications of infection, ductal stenosis, loss of glandular function, presence of additional sialoliths, or permanent lingual nerve paralysis. No patients had salvage submandibular sialadenectomy.ConclusionAfter failing a purely endoscopic approach, proximally located sialoliths of the submandibular gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound‐guided needle localization is a reliable aid to effective transoral sialolithotomy.
Virtual Interactive Presence: An Operative Feasibility Study
Authors: Phillips James D. , Withrow Kirk 
Published: February 2015

ObjectiveWe sought to 1) assess the process required to implement a virtual interactive presence (VIP) system into a standard operating room setting, 2) evaluate the technical performance of the device, and 3) determine the potential utility of the system for guidance of surgical procedures.MethodA feasibility study was conducted at a teaching hospital in 2011. Patients scheduled to undergo otolaryngology procedures were recruited for VIPAAR system (Birmingham, AL) usage to perform standardized exercises during the case. Setup time and observations regarding performance of the system were recorded. Surveys assessing satisfaction level were completed by the staff.ResultsFollowing informed consent, the VIP system was implemented in 8 otolaryngology procedures requiring rigid nasal endoscopy (n = 6) or laryngeal microscopy (n = 2). Average setup time was 4.5 minutes at the outset with an additional 2.4 minutes intraoperatively. One hundred percent of OR staff surveyed (n = 24) agreed that the system was safe. Ninety‐two percent disagreed that the system interfered with their duties. Surgeon responses (n = 8) were uniformly positive toward the system’s safety and its usefulness as a teaching tool. Strengths were noted in the system’s clarity of picture and portability. A weakness was identified in the crowding of a smaller OR space.ConclusionOtolaryngology requires a highly technical skill set based on learned dexterity. Early intraoperative trials indicate VIP technology is a safe and potentially useful adjunct in providing monitored surgical experience to trainees. Potential barriers exist in smaller OR settings. Limitations of the study are sample size and a single surgeon’s experience.
Dorsal Nasal Mucocele: A Delayed Complication of Rhinoplasty
Authors: Tracy Lauren , Badran Karam 
Published: February 2015

ObjectiveTo describe an interesting case of a subcutaneous dorsal nasal mucocele that developed 21 years after primary endonasal rhinoplasty and to list methods by which this delayed complication can be avoided.MethodA 51‐year‐old man presented with a 2‐year history of a slowly growing asymptomatic mass on the nose which was lateral to midline, cephalic to the lower lateral cartilages, and superficial to the upper lateral cartilage while remaining deep to the subcutaneous tissues.ResultsFine needle aspiration was performed and was nondiagnostic, as only epithelial cells were identified. Imaging studies indicated a 1‐cm low‐density, difficult‐to‐characterize nodule on the inner aspect of the right nostril. The patient was taken to surgery, and an open rhinoplasty approach was used to access the mass. It was a well‐demarcated, globular, fluid‐containing cystic structure that did not track to the skin or vestibular surface. The differential diagnosis for nasal lesions in this area include inclusion cysts, benign skin adnexal tumors, dermoid cysts, encephaloceles, and minor salivary gland neoplasms. Pathology demonstrated findings consistent with mucocele.ConclusionIt is likely that the patient had mucosal tissue from the nasal vault trapped subcutaneously during rhinoplasty. Over years, this grew to become cosmetically symptomatic. Prevention of this rare long‐term complication of rhinoplasty requires well‐defined incisions and meticulous attention to wound closure. Treatment herein was via an open rhinoplasty approach.
A Novel Approach to Closure of a Pharyngocutaneous Fistula
Authors: Parker Charles A. , Casper Keith , Thuener Jason 
Published: February 2015

Objective1) Describe a novel approach to the management of a large pharyngocutaneous defect with the vacuum assisted closure (VAC) system. 2) Present photographs demonstrating the application of the VAC system and evolution of the defect. 3) Review other techniques described for the management of pharyngocutaneous fistulas (PCF).MethodCase report of a patient diagnosed with advanced hypopharyngeal cancer who underwent surgical resection and free flap reconstruction. The postoperative course was complicated by delayed flap failure and development of a PCF. This fistula was managed with the VAC device until the wound healed adequately to proceed with adjuvant radiation.ResultsThe patient intially underwent a total laryngopharyngoesophagectomy and reconstruction with an anterior lateral thigh flap. Postoperatively the patient experienced a protracted course of nausea and vomiting, resulting in PCF formation. Because of the location of the PCF near the stoma, the VAC dressing was applied with incorporation of the stoma using a laryngectomy tube with a raised flange and a salivary bypass tube in the pharyngeal defect. The patient was then successfully reconstructed in a delayed fashion after completion of adjuvant radiation with a gastro‐omental free flap. The patient is currently disease free and eating and speaking well.ConclusionThis case illustrates the successful use of the VAC device in a large pharyngocutaneous defect. This novel approach allowed the use of the VAC device despite the dressing being incorporated into the patient’s stoma.