bluuebunny/crossref_metadata_2025_split huggingface dataset:
Free Flap Reconstruction Experience and Outcomes in a Low‐Volume Setting over 20 Years
Authors: Klosterman Tristan , Siu Eric , Morris Lisa , Tatum Sherard A. 
Published: September 2014

Objectives:(1) Recognize the potential efficacy of free flap reconstruction performed at a low volume program. (2) Understand how reconstructive microvascular outcomes and success change over 20 years.Methods:A retrospective chart review was performed at a tertiary care academic program on all free tissue flaps from the primary reconstructive surgeon over 20 years (1993‐2013). A total of 135 procedures were obtained from operative notes, billing codes, and chart databases. Outcome variables included overall procedure success, need for surgical revision, and complications. Patients stayed in general surgical intensive care and hospital floor units.Results:Free tissue flaps were successful in 91% of all cases. In the past 13 years, 70 flaps were performed with 3 failures (96% success rate). Take‐back rate was 14% of total cases with a flap recovery rate of 50%. Postoperative failure occurred after 72 hours in 70% of cases. Nearly 60% of patients experienced a complication of any type or severity. Twenty percent of successful flaps had a complication, with half due to partial dehiscence. Systemic complications affected 20% of all cases. The average hospital stay for noncomplicated patients was 13 days. There was 1 postoperative mortality. Fibula and radial forearm were the most common flaps, at 44% and 26%, respectively.Conclusions:Free flap reconstruction of the head and neck can be performed with acceptable outcomes even in low volume settings.
Diagnostic Yield of Computed Tomography in Evaluation of Vocal Fold Paresis: Is It Worth It?
Authors: Paddle Paul M. , Mansor Masaany , Song Phillip , Franco Ramon A. 
Published: September 2014

Objectives:(1) Determine the diagnostic yield of contrast‐enhanced computed tomography (CT) in the evaluation of patients with idiopathic unilateral vocal fold paresis. (2) Determine the proportion of CTs yielding nondiagnostic incidental findings requiring further patient management.Methods:Retrospective cohort. Precision‐based power calculations were performed. All patients of the 2 senior authors who underwent contrast‐enhanced CT for a clinical diagnosis of vocal fold paresis from January 2004 to January 2014 were included. Demographic, history, examination, and investigation data were extracted from outpatient records and CT reports were reviewed. Patients were excluded if there was insufficient history or examination information, if there was a known neurological diagnosis, or if there was vocal fold immobility or bilateral involvement. A diagnostic CT was defined as depicting a pathological lesion along the course of the ipsilateral recurrent or superior laryngeal nerves. Incidental CT findings were defined as those unrelated to paresis and requiring further intervention.Results:A total of 128 patients were included in the study. Three out of 128 patients had a diagnostic CT equating to a diagnostic yield of 2.3% (0.49‐6.7 95% confidence interval [CI]). Thirty‐nine out of 128 patients, or 30.5% (22.6‐39.2 95% CI) had an incidental CT finding requiring further management.Conclusions:Contrast‐enhanced CT has a low yield of 2.3% in the initial evaluation of idiopathic vocal fold paresis. Conversely, CT has a high, 30.5% yield of incidental cervico‐thoracic lesions. This would suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis is not warranted.
Dysphonia and Cystic Fibrosis
Authors: Willis John , Misono Stephanie , Michael Deirdre D. 
Published: September 2014

Objectives:Because cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels are found in human vocal fold epithelium, we aimed to (1) assess the prevalence and severity of dysphonia in patients with cystic fibrosis (CF) and (2) compare these with control patient populations.Methods:Voice samples and the Voice Handicap Index‐10 (VHI‐10) were collected from patients with cystic fibrosis and control patients with and without chronic sinusitis. Voice samples underwent consensus auditory‐perceptual evaluation of voice (CAPE‐V) assessment by blinded speech‐language pathologists. Sinus‐related symptoms were assessed using the SinoNasal Outcome Test (SNOT‐20). Statistical analysis was performed using unpaired t‐tests and one‐way analysis of variance (ANOVA).Results:Thirty‐seven patients participated, including 17 with CF, 10 with chronic sinusitis, and 10 healthy controls. Prevalence of dysphonia by VHI‐10 criteria was 41% in CF, 20% in chronic sinusitis, and 0% in healthy controls. CF patients had worse VHI‐10 scores than healthy controls (P =. 001). There was no significant difference in VHI‐10 or SNOT‐20 between CF and chronic sinusitis patients, but on CAPE‐V assessment, patients with CF had greater overall severity of dysphonia and strain compared with control patients with and without chronic sinusitis (P <. 001) and (P =. 022).Conclusions:Auditory‐perceptual evaluation demonstrated greater severity of dysphonia in patients with cystic fibrosis than in controls. This may identify an area of clinical need as well as an opportunity for improved understanding of the role of CFTR in human voice.
Free Flap Reconstruction Outcomes among Elderly Patients
Authors: Goldman Richard A. , Luginbuhl Adam , Curry Joseph , Cognetti David M. , Krein Howard D. , Heffelfinger Ryan 
Published: September 2014

Objectives:Review a single institution's experience with free flap reconstruction of the head and neck in patients 80 years of age and older.Methods:A retrospective chart review was conducted of patients undergoing free tissue transfer for head and neck reconstruction in patients 80 years of age and older between 2008 and 2013 at a single academic tertiary care hospital. Main outcomes studied were free flap success rate, postoperative complications, discharge disposition, and length of hospital stay. Independent variables included age, type of reconstruction, and comorbid disease. Patients were stratified into high and low comorbidity groups using the Charlson Comorbidity Index, and associations with outcomes were analyzed.Results:A total of 65 patients 80 years of age or older were included in the review. There were 2 free flap failures with a success rate of 97%. Nine patients were 90 years of age or older. The average length of stay was 11 days. There were 11 (17%) flap‐related complications and 18 (28%) medical complications. There was no difference in medical or flap‐related complications between high and low comorbidity groups (P =. 97 and P =. 18, respectively). Patients who experienced flap‐ related complications were more likely to also experience medical complications (P =. 002).Conclusions:Free flap reconstruction in the head and neck remains a viable option in patients of advanced age. In our experience a comparable success rate with those reported in the literature among all patients has been achieved and the level of comorbid disease has not appeared to adversely affect outcomes.
Functional and Histological Evaluation following Canine Vocal Fold Reconstruction Using Combined Thyroid Ala Perichondrium Flaps
Authors: Glab Rachel C. , Gunderson McLean , Hoffman Matthew R. , Maytag Allison L. , Yang David , Jiang Jack J. , Dailey Seth H. 
Published: September 2014

Objectives:(1) Perform vocal fold reconstruction using composite thyroid ala perichondrium (CTAP) flaps in beagles following unilateral vocal fold stripping; (2) Evaluate aerodynamic, acoustic, vibratory, and histologic changes in canines undergoing CTAP‐based vocal fold reconstruction compared to a control group undergoing injury alone.Methods:Unilateral vocal fold stripping was performed on ten beagles. Dogs healed for 1 month and were divided into 2 groups. Dogs in the control group (n = 5) were sacrificed. Dogs in the experimental group (n = 5) underwent ipsilateral vocal fold augmentation with a CTAP flap and recovered for 1 month prior to euthanasia. After euthanasia, larynges were harvested for excised larynx evaluation of vocal fold vibration using aerodynamic, acoustic, and mucosal wave measurements. Histological analysis was then performed on anterior, middle, and posterior sections of the vocal fold. Changes in the injured fold were compared between the control and experimental groups. Comparisons with the contralateral normal fold were made within the control and experimental groups.Results:Phonation threshold pressure was significantly lower in the treatment group (P =. 005). Percentage jitter (P =. 010) and shimmer (P =. 007) were also lower in the treatment group. Open quotient was significantly higher in the control group (P =. 007). Histological staining results were inconsistent, and gross analysis revealed evidence of surgical implantation without restoration of normal vocal fold architecture.Conclusions:CTAP‐based vocal fold augmentation restored glottic closure and vibratory periodicity following vocal fold scarring. Additional investigation on biologic response is warranted. CTAP flaps offer an autologous, vascularized implant that can improve both vocal fold structure and function.
Laryngeal Reinnervation with Refined Nerve‐Muscle Pedicle Implantation Using Electromyography and Coronal Reconstructed Images
Authors: Sanuki Tetsuji , Yumoto Eiji , Nishimoto Kohei , Kodama Haruka , Minoda Ryosei 
Published: September 2014

Objectives:Evaluate the long‐term efficacy of laryngeal reinnervation with refined nerve‐muscle pedicle (NMP) flap implantation combined with arytenoid adduction for unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG), coronal images, and assessment of phonatory function.Methods:We retrospectively reviewed 16 UVFP patients who received refined NMP implantation with arytenoid adduction. Videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic analysis, LEMG, and coronal imaging were performed pre‐ and 2 years after surgery. For LEMG analysis, a four‐point scale was employed to grade motor unit (MU) recruitment where 4+ represented absent recruitment, 3+ represented greatly decreased recruitment, 2+ represented moderately decreased recruitment, and 1+ represented mildly decreased activity with less than full interference pattern. Coronal images were assessed for differences in thickness of the vocal folds during phonation and inhalation.Results:Phonatory function results were significantly improved postoperatively for all patients. In LEMG findings, preoperative MU recruitment evaluation results were 1 patient for 1+, 5 for 2+, 1 for 3+, and 3 for 4+. Postoperative MU recruitment evaluation results were 7 patients for 1+, 3 for 2+, and none for 3+ and 4+. Thinning of the affected fold was evident during phonation in 15 of 16 patients preoperatively. The affected fold was at an equal volume with the healthy fold in 8 of 16 patients postoperatively.Conclusions:LEMG findings and coronal imagine demonstrates that refined NMP implantation results in successful reinnervation of laryngeal muscles in UVFP patients. Refined NMP implantation may provide near‐normal voice function and restored laryngeal muscle tone and volume.
Long‐term Survival of Autologous Fat Grafts into the Vocal Folds
Authors: Campos Guillermo , Mantilla Natalia , Bermudez Sonia 
Published: September 2014

Objectives:Determine whether long‐term survival of fat implanted into the vocal folds is possible.Methods:Nine patients of those treated between 1992 and 2005 by means of bilateral fat injection into the vocal folds responded the call to assess long term results. Initial diagnosis was unilateral vocal fold palsy (6) and superficial sulcus (3). The graft was obtained by means of dissection of fat from the abdominal wall, and injected with an 18 G needle into the body of the vocal folds until 50% over correction was achieved. In palsy cases a higher fat volume was required on the paralyzed side. All patients underwent laryngostroboscopic examination preoperatively and postoperatively, along with postoperative magnetic resonance imaging (MRI) of the larynx, 4 to 14 years after surgery. As far as MRI is concerned, spine echo and fat‐suppressed sequences in axial coronal and sagittal planes were obtained, looking for high intensity areas in T1‐weighted images at the level of the vocal folds.Results:Laryngostroboscopy demonstrated permanent augmentation of the vocal folds with glottic closure improvement. MRI images in all cases showed the presence of enough fat in the body of the vocal folds, acting as support for good size and shape of the structure.Conclusions:Autologous fat cells injected into the vocal folds can survive years after surgery, acting as a permanent filler. Those conditions are in favor of fat grafts to be used as an inexpensive, easy to use, and long‐lasting implant for selected cases of glottic incompetence.
The Furnas‐Mustardé Combination Technique for the Treatment of the Prominent Pinna: Our 17‐Year Experience
Authors: Deleito Javier M. , Talwar Rishi , Garcia‐Purriños Francisco , Guillen Alberto , Delvasto Lorena , Barrios Andres 
Published: September 2014

Objectives:Report a method using a combination of the Furnas and the Mustardé techniques for the treatment of prominent pinna.Methods:All the patients who underwent otoplasty under the supervision of a single surgeon between 1996 to 2013 were included. Surgical technique and complications were analyzed. Major complications were defined as those requiring revision surgery. Mustardé sutures were used to recreate the antihelix and correct upper/middle thirds of the pinna. In the conchal region, both conchal resection and the Furnas conchal‐mastoid sutures were frequently used. Prospective outcome measures included overall benefit and patient satisfaction.Results:A total of 130 patients with protruding ears were operated upon (126 bilateral, 4 unilateral). Therefore, there were 256 primary interventions. Fifteen required a pure Mustardé technique and 4 underwent a pure Furnas technique. Hence, the combined technique was applied to 237 ears. Mean follow‐up was 5 years (6 months‐17 years). Only 9 (3.5%) required revision surgery owing to unsatisfactory results and 1 (0.04%) due to bleeding. Minor complications included suture extrusion in 35 ears (13.6%), some up to 5 years postop, and 2 patients (0.07%) developed a retroauricular keloid (treated successfully with intralesional triamcinolone). Overall benefit perceived by the patients was reported as good in 77% and satisfactory in 18%.Conclusions:We present a technique that combines 2 previously well described techniques, using both cartilage resection in addition to permanent sutures. We believe that the good aesthetic results and acceptable number of complications make this technique an appropriate treatment option for patients with prominent ears.
New Algorithm for Supraglottitis Staging in Adults
Authors: Marom Tal , Tamir Sharon‐Ovnat , Barbalat Irina , Roth Yehudah 
Published: September 2014

Objectives:(1) Critically review the current staging systems of supraglottitis in adults. (2) Suggest a new algorithm for infections involving the supraglottis based on clinical staging considering anatomical subsites and outcome correlation.Methods:We retrospectively identified adult patients with acute supraglottitis during the years of 1990 through 2013 by using International Classification of Disease codes. Patients were graded by using 2 systems: the Scope grading system for epiglottitis, and our new suggested grading system, which relies on the edema in 3 subsites: the epiglottis, the aryepiglottic folds and arytenoids, and the larynx. Those subsites were given the following grades: 0 = no edema, 1 = mild edema, 2 = moderate edema, and 3 = severe edema. Summation of the 3 subsites scores was performed in order to assess the need for airway intervention.Results:A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiberoptic laryngoscopy (or by both modalities). One hundred seventy‐eight patients (62%) had Scope grades of 0 or 1, and 110 patients (38%) had Scope grades of 2 or 3. Of these, 24% required an airway intervention. According to our classification, 236 patients (82%) who had a score of ≤4 were less likely to undergo a securing airway intervention, when compared with the 52 patients (18%) who had a score of ≥5, 4% vs 33%, respectively (P =. 03). All patients graded with ≥8 score required airway intervention.Conclusions:Our new suggested flow chart of decisions is based on an easy grading system, which allows dynamic description of patient progression during sequential examinations, easy information transmission, and decision making.
Rehabilitation of Swallowing Functions by a New Concept of Intralaryngeal Prostheses
Authors: Schultz Philippe , Dupret‐Bories Agnès , Vrana Engin , Riehm Sophie , Guillere Florence , Lavalle Philippe , Debry Christian 
Published: September 2014

Objectives:Describe 2 intralaryngeal prostheses (ILP) designed to treat laryngeal sphincter incompetence. Present the development of these new devices and analyze the improvement of swallowing.Methods:Patients presented with moderate to severe swallowing disorders due to neurological disease or after head and neck cancer treatment were included in this study. All patients required a tracheostomy and a feeding tube to fulfill the inclusion criteria. Two ILP were evaluated: (1) a closed silicone prosthesis (CP), Novatech; (2) a silicon open prosthesis cover with a double flow valves (VP), opened during respiration and closed during swallowing (Newbreez, Protip, France). The devices were inserted under endoscopy. The swallowing functions were assessed from postoperative day 2 and scored using the swallowing performance status scale (SPS).Results:Nineteen patients were included. Eleven patients, presented with neurological disease, received CP. Eight patients suffering from neurological disease (n = 4) or from swallowing disorders after radiotherapy (n = 4) received a VP. CP stopped aspiration in 11 patients, allowing a partial oral feeding in 6 patients and the withdrawal of the prostheses after a partial neurological recovery in 4 patients. VP decreased laryngeal aspiration of food or saliva, allowing to continue partial oral feeding and to speak with a whispered voice.Conclusions:CP prevents laryngeal aspiration, allowing swallowing reeducation during the phase of neurological recovery. VP is still on assessment in order to propose to patients with moderate swallowing disorders to keep laryngeal phonation and respiration.
Grafts Are Superior to Sutures for Nasal Tip Projection: A Meta‐analysis of Goodes Ratio
Authors: Cole Eric , Natili Angelia S. 
Published: September 2014

Objectives:(1) Discuss relevant tip projection ratios involved in surgical planning of rhinoplasty. (2) Implement findings of meta‐analysis in cosmetic surgery planning.Methods:Meta‐analysis of journal articles through June 2013. Intervention: Cosmetic rhinoplasty for underprojected tip. Outcome Measurements: Pre‐ and postoperative Goode Ratio in cosmetic rhinoplasty patients. Null hypothesis: None of 3 techniques provides superior tip projection among: suture, internal graft, and external graft.Results:External graft techniques, such as Sheen shield grafting, were found to significantly increase tip projection over suture only techniques. External vs suture: P =. 017. (2) Internal graft techniques, such as columellar strut grafting, approached significance in increased tip projection over suture only technique. Internal vs suture: P =. 053. (3) Internal and external graft techniques did not differ significantly, but external graft techniques displayed a tendency to increase tip projection more. External vs internal: P =. 360.Conclusions:(1) Meta‐analysis of the Goode Ratio has never been reported in the literature. (2) No technique has been proven to have significance in the past. (3) External grafts produce a significant change in nasal tip projection over suturing, and internal grafts approach significance. (4) This research allows the surgeon to rank techniques in order of magnitude of change desired.
Thyroid Cartilage Implantation for Unilateral Vocal Fold Paralysis: Voice Assessment and Surgical Outcomes
Authors: Hsu Cheng‐Ming 
Published: September 2014

Objectives:Medialization laryngoplasty is a standard surgical treatment for unilateral vocal fold paralysis (UVFP). This study presents the surgical outcome of thyroid cartilage implantation (TCI), an external medialization laryngoplasty, using thyroid cartilage as the implant.Methods:This retrospective clinical series study aimed to analyze the surgical outcomes and safety of laryngoplasty with TCI for UVFP. Seventeen patients with UVFP who underwent laryngoplasty with TCI were examined preoperatively and at 1, 3, and 6 months postoperatively by video laryngostroboscopy. Their voice was evaluated by subjective evaluation and acoustic analysis.Results:After surgery, 16 of the 17 (94.1%) patients reported their subjective and objective improvements in voice quality after a follow‐up period of at least 6 months. Glottal incompetence and vocal performance were markedly improved after this surgery. There was a significant decrease in voice grading (from 2.47 to 1.29, subjective improvement) (P =. 002), and the maximum phonation time was significantly longer after surgery (from 3.63 to 7.80 seconds, objective improvement) (P =. 001).Conclusions:Laryngoplasty with TCI represents a simple, safe, and effective surgical treatment for UVFP. The advantages include voice improvement, low cost and minimal invasiveness.
Transnasal Office‐Based Laryngeal Surgery Using a Distal‐Chip Endoscope with a Working Channel
Authors: Shoffel‐Havakuk Hagit , Halperin Doron , Yosef Liron , Lahav Yonatan 
Published: September 2014

Objectives:The advanced technology of distal‐chip flexible naso‐endoscope (“chip‐on‐the‐tip” processor), with high resolution digital video recording, allows for more accurate diagnosis, treatment, and follow‐up of patients with laryngeal disease. Using this instrument with a working channel introduces a new surgical tool, allowing for a variety of transnasal surgical procedures under topical anesthesia. The aims of the study were to: (1) Describe the spectrum of treatment options for laryngeal pathologies using distal‐chip flexible naso‐endoscope. (2) Describe the variety of accessories that can be used. (3) Assess the relative advantages, limitations and risks.Methods:A retrospective series reviewing medical files of patients treated with the distal‐chip endoscope during 2010 through 2013 for benign laryngeal conditions. Compliance, complications, surgical notes and long term outcome were documented.Results:Forty‐six patients were treated by office‐based laryngeal surgery during the study period. Surgeries performed: Diagnostic biopsies of the glottis, subglottis, and trachea and treatment of papillomatosis, fibrovascular lesions, granulation tissue, keratosis, stenosis, vocal cord paralysis, and cysts. Instruments used: anesthesia catheter, grasping forceps, injection needles, and lasers. No significant adverse effects or complications were documented. The only factor influencing procedure success was patient cooperation and ability to resist gag reflex. Most patients had transnasal surgery; few had combined transnasal and transoral procedures.Conclusions:The distal chip endoscope with a working channel enables the laryngeal surgeon to perform relatively complex procedures as an office‐based surgery while avoiding the consequences of general anesthesia and operating room costs.