bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporalis Tendon Transposition for Dynamic Facial Reanimation following Radical Oncologic Resection
Authors: Nagel Thomas H. , Howard Brittany E. , Donald Carrlene B. , Crujido Lisa R. , Hayden Richard E. 
Published: August 2013

Objectives:Report a patient series in which a temporalis tendon transposition was performed for facial paralysis following radical oncologic resection. 1) Describe the modifications in technique of temporalis tendon transfer associated with concurrent cancer resection. 2) Evaluate the effect of complex defects and their reconstruction on facial reanimation outcomes.Methods:Retrospective review of 10 patients who underwent orthodromic temporalis tendon transposition for dynamic facial reanimation of their facial paralysis following radical cancer resection from January 2010 through February 2013. Data was collected for parotid malignancy, defect composition, reconstructive details, postoperative course, complications, and outcomes.Results:All patients underwent radical parotidectomy with facial nerve sacrifice and resection of adjacent soft and/or bony tissue for parotid malignancy. Complex defects included cutaneous loss necessitating concurrent flap reconstruction (n=5), partial or total temporal bone resection (n=6), and mandibulectomy (n=2). All patients underwent dynamic reanimation with temporalis tendon transposition through a nasolabial incision. Facial reanimation was performed at the same time as the resection in 6 cases and in a delayed setting in 4 cases. There was no difference in outcomes in these two patient groups. Due to tumor involvement, six resections included sacrifice of the internal maxillary artery without resultant compromise of the temporalis transfer. During the follow‐up period, all patients had improved facial symmetry at rest and developed voluntary motion with post‐procedure facial training therapy.Conclusions:Temporalis tendon transposition is a reliable, straightforward option for dynamic facial reanimation in the oncologic patient. Radical resection does not prohibit using this technique.
Tension Pneumocephalus after Endoscopic Sinus Surgery: A Technical Report of Multiportal Endoscopic Skull Base Repair
Authors: Bly Randall A. , Morton Ryan , Kim Louis , Moe Kris S. 
Published: August 2013

Objectives:Large skull base defects and cerebrospinal fluid (CSF) leak repairs are traditionally performed through a transnasal endoscopic approach or an open craniotomy approach. While this is often successful, when the defect is adjacent to the crista galli it can be very difficult to seal the medial portions of the defect. Our objective is to report our experience using a novel multiportal (transnasal and transorbital) endoscopic technique to repair large, bilateral anterior cranial fossae defects using an intracranial “brain sling.”Methods:Reviews of the literature and medical records were performed.Results:Endoscopic transnasal and transorbital repair of large bilateral anterior cranial fossae skull base defects was performed using acellular radiated cadaver dermis and collagen matrix through a multiportal approach. The visualization and surgical access through transorbital portals permitted an intracranial extradural/intradural repair using a single, large section of reconstruction material. It was introduced through a portal distant to the site of injury to avoid enlarging the region of damage, and fashioned so that forces of gravity maintained its proper position. All leaks were repaired successfully with one surgical procedure, and there were no surgical complications in the cohort.Conclusions:The “brain sling” technique is applicable to the reconstruction of large skull base defects of any etiology and may be important for oncologic reconstruction. By using a multiportal approach, instrumentation could be performed without blocking the endoscopic view, and multiple viewing angles of the pathology could be used to improve the surgical efficacy.
Transoral Endoscopic Assisted ORIF of Orbital Rim Fractures
Authors: Brickman Todd M. , Jeyakumar Anita S. 
Published: August 2013

Objectives:1) Evaluate the feasibility of a purely transoral approach to infraorbital rim fractures using endoscopic assistance. 2) Analyze the patient outcomes of cosmesis and the success rate of reduction and fixation.Methods:A retrospective review was conducted in 16 midface facial fracture patients that presented to a level one trauma center in 2011‐2012 involving orbital rim fractures that did not require orbital floor exploration. All patients had open reduction internal fixation (ORIF) of midface facial fractures (medial and lateral buttress, and orbital rim) through a transoral approach utilizing endoscopic assistance. The zygomatic‐frontal (ZF) suture line fractures were repaired through a superior blepharoplasty incision. Orbital rim ORIF was accomplished with modified curved and ladder plates from stock midface vendor plating systems. The plates were fabricated to be positioned laterally on the orbital rim and then course inferiorly to the inferior orbital nerve (ION) and medially fixated to the medial buttress bridging the orbital rim fracture.Results:All patients had acceptable reduction and fixation of orbital rim fractures with cosmetically acceptable results. There was no plate extrusion or infection or worsening of ION parasthesias, with six patients having immediate post‐operative improvement in their ION parathesia. No post‐operative enophthalmos or diplopia was noted and no revision surgery was needed.Conclusions:A transoral endoscopic approach for carefully selected midface fractures involving the orbital rim is feasible with acceptable results. Future work is needed to develop a prefabricated plate that can be stocked in mid‐face plating systems.
Validated Assessment Tools for Reconstructing Facial Defects in Simulation
Authors: Sajan Javad A. , Hilger Peter A. , Sidman James D. , Walsh William E. , Chaffin Phillip L. , Reihsen Troy , Sweet Robert 
Published: August 2013

Objectives:1) Create a 3D functional organosilicate model for assessing facial reconstruction that is valid and has high inter‐rater reliability. 2) Perform a prospective blinded study using 3D and 2‐dimensional (2D) models for evaluating facial reconstruction.Methods:A 3D organosilicate model of a human adult face was built with a corresponding 2D paper model. Surgical subspecialty trainees from six institutions prospectively drew a z‐plasty on the paper model and the organosilicate model. Next, the subjects each performed a z‐plasty on the organosilicate model with surgical instruments and suture. Three blinded reviewers rated two drawings and one scar revision per subject.Results:Forty‐three trainees encompassing 3 PGY1, 10 PGY2, 13 PGY3, 11 PGY4, 3 PGY5, and 3 PGY6 (fellows) completed the study. Subjects were placed into three groups, novices (PGY1+PGY2), intermediates (PGY3+PGY4), and experts (PGY5+PGY6). Experts performed better than intermediates and intermediates better than novices for performing the z‐plasty and drawing on the organosilicate model. This statistically significant difference between groups was determined by one‐way ANOVA (p =<.05) and Tukey post‐hoc test p=<.05 and showed substantial inter‐rater reliability agreement among the three raters with an average Cohen's Kappa=0.76. On the 2D paper model the experts performed better than novices (p=<.05); however, there was no difference between experts and intermediates (p=0.98).Conclusions:We have created a 3D organosilicate model for facial reconstruction that is valid and shows high inter‐rater reliability. The 3D model was able to detect a difference between experts and intermediates where the 2D model could not.
The Clinical Evaluation of a Tonsil Patch Using Biodesign Tissue Grafts
Authors: Melder Patrick C. 
Published: August 2013

Objectives:The current study is a follow‐up to a previous study determining the efficacy of a truly novel material for use during tonsillectomy to improve post‐operative pain. The goal of the current study is to further evaluate its use and analyze possible post‐operative pain reduction using the material.Methods:This is a prospective single blinded evaluation of Biodesign tissue grafts (COOK Medical) with patients serving as self‐controls. This study involved adult patients undergoing tonsillectomy for chronic tonsillitis or as part of Uvulopalato‐pharyngoplasty (UPPP) for sleep apnea surgery. Biodesign was fashioned and then sutured into the right tonsillar fossa using a combination of 2.0 polysorb (Covidien) and 2.0 chromic suture. The left tonsil was closed without Biodesign. If a palatoplasty was performed, it was left to granulate with secondary intention. Post‐operatively, the patients filled out a diet and narcotic log for 14 days and a visual analog pain scale for 10 days. A total of 25 patients were studied in this prospective, single blinded study.Results:Closure technique is important in reducing post‐operative pain with Biodesign. Closure of the tonsillar fossa resulted in higher pain than without closure. Further, time for placement remains a barrier for wide‐spread adoption. The tissue grafts integrated well into the native tissue, and there were no incidents of aspiration.Conclusions:The tissue handles well and would be amenable for coverage of other soft‐tissue defects in the upper aerodigestive tract.
The Effect of Duty Hour Regulation on Resident Surgical Case Volume in Otolaryngology
Authors: Curtis Stuart H. , Miller Robert H. , Weng Cindy , Gurgel Richard K. 
Published: August 2013

Objectives:Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and to analyze trends in surgical case volume for each of the Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996‐2011.Methods:Operative logs were obtained from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996‐2011. Key indicator volumes before and after resident duty hour regulations (2003) were compared. A paired t‐test was performed to evaluate the overall difference in operative volume. The Wilcoxon signed rank test evaluated differences between individual procedures per time period. Linear association of the average volume of each key indicator per year was performed using linear regression.Results:The average total number of key indicator cases per graduating resident was 441 in 1996‐2003 compared to 500 cases in 2004‐2011, and the average number of key indicator cases (total key indicator cases/number of key indicators) was 31.5 in 1996‐2003 compared to 36.2 in 2004‐2011 (P = 0.0012). The linear association for the change in average number of key indicator cases per year was not statistically significant (P = 0.1990). Sub‐analysis of individual key indicators showed a statistically significant (P < 0.05) increase in volume between pre‐ and post‐duty hour regulation for bronchoscopy, ethmoidectomy, mastoidectomy, parotidectomy, and thyroid/parathyroidectomy and a decrease in flaps and stapes/ossiculoplasty.Conclusions:Implementation of the 2003 duty hour regulations has not reduced the total volume of key indicator cases for graduating otolaryngology residents. Overall and many specific key indicator operative volumes have increased.
Endoscopic Endonasal Management of Nonfunctioning Pituitary Adenomas with Cavernous Sinus Invasion: Our Experience
Authors: Ferreli Fabio , Turri‐Zanoni Mario , Gallo Stefania , Bignami Maurizio , Tomei Giustino , Locatelli Davide , Castelnuovo Paolo 
Published: August 2013

Objectives:1) Review the management of Non‐Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS), currently in balance between radiotherapy, surgical decompression of neural structures, and wait‐and‐see policy. 2) Report our experience in the surgical removal of these lesions through an endoscopic endonasal trans‐sphenoidal approach (EETSA).Methods:From 1999 to 2010, 56 cases of NFPA with CS invasion were treated through an EETSA. The Knosp classification was used to describe CS involvement as evidenced by preoperative magnetic resonance imaging (MRI) and intraoperatively. Extent of resection was evaluated on postoperative contrast‐enhanced MRI, as well as the surgical and visual outcomes. Endocrinological remission was defined according to the most recent consensus criteria.Results:EETSA was performed using direct para‐septal, trans‐ethmoidal, or trans‐ethmoidal‐pterygoidal approach. The surgical procedure was well tolerated by all patients. At discharge, visual disturbance was improved in 30 (81%) patients who had complained of visual impairment preoperatively. Normalization or improvement of previous hypopituitarism was obtained in 55% of cases. A gross‐total or subtotal resection was reached in 51/56 patients. The recurrence‐free survival was 87.5%, with a mean follow‐up of 61 months. No major intraoperative or postoperative complications occurred.Conclusions:Surgical removal using an EETSA is a minimally‐invasive, safe, and effective procedure for the management of NFPA invading the CS, able to solve the mass effect, preserving or restoring visual function, and obtain an adequate long‐term tumor control. However, close screening of pituitary function and appropriate neuroradiological follow‐up should be performed after surgery for early detection of tumor recurrence or regrowth.
Errors in Otolaryngology Revisited
Authors: Shah Rahul , Boss Emily F. , Brereton Jean , Roberson David W. 
Published: August 2013

Objectives:1) Know the areas of risk for errors in otolaryngology. 2) Be able to discuss the implications of errors in otolaryngology. A decade ago, a survey study of errors in otolaryngology identified areas of risk and proposed a classification schema for errors. This study used a similar methodology to obtain current data for comparison.Methods:An anonymous online survey was distributed via the AAO‐HNS weekly email. Respondents were asked to describe any event in their practice that they felt should not have happened. Events were classified using the prior schema.Results:445 (66%) of 681 respondents reported an event within the past six months. Mean age of affected patients was 41±24 years. An adverse consequence occurred in over half of events with corrective action taken in 82.8%. 68% of respondents subsequently changed their practice patterns. Domains with the most reported errors were technical (27.9% of all events, 71% with major morbidity), administrative (12.2%, 3.7%), errors in testing (10.8%, 8.3%), and surgical planning (9.9%, 45.5%). There were 8 wrong site surgeries, 23 cranial nerve injuries (91.3% major morbidity), and 9 errors during endoscopic sinus surgery (55.6% major morbidity). There were 4 deaths.Conclusions:Otolaryngologists remain vulnerable to error‐related adverse events. The domains with the greatest risk for error‐related major morbidity have changed little and include errors in surgical planning, equipment‐related errors, and technical errors (surgery near cranial nerves and endoscopic sinus surgery). Awareness of high‐risk areas may help us focus more preventive efforts in these domains.
Impact of the Gene Expression Classifier on Surgeon‐Patient Decision Making in Indeterminate Thyroid Nodules
Authors: Parker Charles A. , Steward David L. 
Published: August 2013

Objectives:1) Describe the impact the gene expression classifier has on management of indeterminate thyroid nodules. 2) Define patient and nodule characteristics which influence further testing with the gene expression classifier (GEC) versus diagnostic thyroidectomy (DT).Methods:A retrospective chart review was performed on 273 patients who underwent fine‐needle aspiration (FNA) for thyroid nodules from November 2011 to January 2013. We further analyzed 68 patients with cytological indeterminate aspirates. These patients were offered serial observation with repeat FNA, GEC testing, or DT. Demographic data, cytologic and histologic findings, and management outcomes will be discussed.Results:In 68 patients with indeterminate cytology, 47% underwent GEC testing, 52% chose DT, and 1% elected for continued observation. The mean age in patients who underwent GEC testing was 57 years and 49 years in those who elected DT (p<0.05). Patients with a Bethesda classification of suspicious for malignancy were more likely to undergo DT, whereas those with a diagnosis of atypical of undetermined significance (AUS) or follicular neoplasm (FN) were more likely to obtain the GEC test (p<0.05). Those factors not found to be statistically significant were gender and size of the nodule (p>0.05). Thirty‐seven percent of patients with an AUS or FN diagnosis who obtained the GEC test underwent a DT. However, of those patients with an AUS or FN diagnosis who did not obtain the GEC test, 97% underwent a DT (p<0.0001).Conclusions:Use of the GEC significantly reduced the surgical rate among patients with a Bethesda classification of AUS or FN.
Laser‐Assisted Lithotripsy in the Minimally Invasive Treatment of Sialolithiasis
Authors: Phillips James D. , Withrow Kirk 
Published: August 2013

Objectives:In the minimally invasive treatment of sialolithiasis, lasers can be used to fracture stones, allowing for the endoscopic extirpation of larger lesions. The purpose of the current study was to evaluate outcomes following the use of the holmium YAG laser for intracorporeal salivary lithotripsy.Methods:Review of prospectively collected data regarding patients who underwent interventional sialoendoscopy for sialolithiasis was performed, recording patient demographics, surgical findings, and clinical outcomes. Patients who were treated with intracorporeal laser lithotripsy were compared with those who had simple basket retrieval or endoscopic assisted open removal. Patients were surveyed by phone for current symptom follow‐up.Results:Thirty‐one patients (average age 56, range 14‐84) were treated for sialolithiasis with endoscopic techniques at our academic institution from 2011‐2012. Sialoliths averaged 5.9 mm in size (range 2‐20mm), arising from the submandibular ducts (n=20), parotid (n=10), or both (n=1). The holmium YAG laser was used in 16 patients. Of these cases, 6 patients required additional maneuvers to open the duct to allow for stone extraction compared to 10 cases in which the laser was not used. At last follow‐up, 77% of patients who had laser assistance reported improvement of symptoms compared with 56% of the non‐laser group. Complications in all patients included ductal stenosis (n=1), residual stone fragments (n=2), salivary fistula (n=1), and the need for additional procedures (n=6).Conclusions:The results of our series indicate that intracorporeal laser assisted lithotripsy is an effective addition to the armamentarium of sialoendoscopy.
Post‐discharge Complications Predict Reoperation and Mortality after Otolaryngology Surgery
Authors: Chen Michelle M. , Roman Sanziana A. , Sosa Julie A. , Judson Benjamin L. 
Published: August 2013

Objectives:1) Determine procedure‐specific rates of post‐discharge complications and their risk factors in the first 30 days following inpatient otolaryngology surgery. 2) Evaluate association between post‐discharge complications and risk of reoperation.Methods:A retrospective cohort study of the ACS‐NSQIP database (2005‐2011) was used to identify 48,028 adult patients who underwent one of eight groups of inpatient otolaryngology procedures and examine demographic and clinical characteristics. Outcomes of interest included postoperative complications, unplanned reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi‐square tests, student's t tests, and multivariate logistic regression.Results:Laryngectomy, lip, and tongue/floor of mouth surgery had the highest post‐discharge complication rates (8.0%, 7.4%, and 4.1%, respectively). The most common complications were surgical site infections (46.4%), other infections (33.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00‐1.02), longer operative time (OR, 1.64; 95% CI, 1.34‐2.01), hospital stay >1 day (OR, 1.49; 95% CI, 1.20‐1.86), and American Society of Anesthesiologists (ASA) class >3 (OR, 1.46; 95% CI, 1.19‐1.79) were independently associated with post‐discharge complications. Patients with complications were more likely to die (0.9% vs 0.1%, P<. 001) or have a reoperation (10.4% vs 1.2%, P<. 001). On multivariate analysis, post‐discharge complications were independently associated with reoperation (OR, 6.55; 95% CI, 3.94‐10.87).Conclusions:This is the first study of overall post‐discharge events after otolaryngology surgery. Post‐discharge complication rates in otolaryngology are procedure‐specific and associated with reoperation. Targeted procedure‐specific triage and follow‐up plans for high‐risk patients could improve outcomes.
Role of Intraoperative Ropivacaine in Post‐tonsillectomy Pain Control: Randomized Control Trial Using a Paired Design
Authors: ChiaChing Yao William , Corbitt Christian A. , Bender Melissa E. , Takashima Masayoshi 
Published: August 2013

Objectives:1) Evaluate the efficacy of ropivacaine in post‐tonsillectomy pain management in adults using a paired design. 2) Evaluate the timing of intraoperative ropivacaine administration in post‐tonsillectomy pain control.Methods:A prospective double‐blinded randomized control trial with a paired design was performed on 25 consecutive adults undergoing a tonsillectomy. One side was injected with saline and the other side with ropivacaine. Patients were also pre‐randomized into those receiving injections immediately before or after the tonsillectomy. Laterality of the injection was alternated and all surgery performed by the senior author. Patient responses were obtained via telephone interview and written questionnaire.Results:3/25 patients were excluded from the study. 16/22 patients had pain lateralize to one side during recovery. There was no statistically significant difference in pain control between ropivacaine and normal saline. Local anesthetic decreased pain in 7/22 patients while more pain was experienced on the side with local anesthetic in 9/22 patients. 6/22 patients had no difference in pain. The time to equalization of pain based on laterality was 8.8 and 6.8 days, respectively, in the pre‐ and post‐tonsillectomy group.Conclusions:Multiple studies have examined the role of local anesthetic in controlling post‐tonsillectomy pain with equivocal results. This is the first study examining the role of local anesthetic in tonsillectomies using a paired design. Administration of ropivacaine does not affect post‐tonsillectomy pain. Moreover, timing of injection does not have an effect on postoperative pain. We recommend against the use of intraoperative ropivacaine for pain control in patients undergoing tonsillectomy.