bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost‐Effective Management of Patients with Sinus Headache, Facial Pain, and Pressure: A Decision Analytic Approach
Authors: Ewbank Clifton , Dodick David W. , Lal Devyani 
Published: August 2013

Objectives:1) To study patients presenting to a tertiary otolaryngology clinic with primary complaints of sinus headache, facial pain, and/or pressure. 2) To perform a computer‐based decision analysis of these patients to maximize treatment effectiveness and minimize cost.Methods:A computer‐based decision analytic approach was used to model cost‐effectiveness (CE) of treatment of 253 adult patients presenting to a tertiary ear, nose, and throat (ENT) clinic over a two‐year period. Chief complaints were sinus headache and/or facial pain/pressure. Analysis of demographics and treatment data was performed. Management was classified into three categories: 1) maximal medical therapy (MMT) alone, 2) MMT followed by endoscopic sinus surgery (ESS) due to refractory disease, and 3) referral to neurology for pain without apparent sinus etiology. Established treatment algorithms were integrated with CPT based treatment costs to create a 66‐point decision tree that provides a comprehensive picture of CE of various modes of treatment for facial pain.Results:For patients without evidence of sinus disease, referral to neurology for facial pain saved $33.61 per patient for pain management. ESS resulted in a significant improvement in CE only with demonstrable sinus disease (C/E=26.37; p=0.027). Other trends observed include a non‐significant reduction in cost and effectiveness of using MMT first in patients without clinical evidence of sinus disease (C/E=12.98; p=0.064).Conclusions:Our model demonstrates favorable CE of determining the etiology of facial pain as early as possible and proceeding with MMT or with referral to neurology, accordingly. ESS should only be offered to patients with true sinus disease refractory to MMT.
Development and Validation of a Health‐Related Quality‐of‐Life Comorbidity Index
Authors: Levine Corinna G. , Weaver Edward M. 
Published: August 2013

Objectives:Comorbidity indexes adjust for comorbidity confounding on a specific outcome, but no index is designed specifically for a quality of life (QOL) outcome. The Functional Comorbidity Index was previously designed to predict physical function. The goals of this study: 1) Develop a Quality of Life Comorbidity Index (QOLI) designed specifically to predict QOL (measured using SF‐36 component scores) in sleep apnea patients; 2) Compare the ability to predict QOL between the QOLI, the Functional Comorbidity Index, and another commonly used index.Methods:A random sample of 300 subjects, selected from prospectively enrolled sleep apnea patients between 2004‐07, was split into a model‐development cohort (n=200) and a validation cohort (n=100). Additional comorbidities suspected to impact QOL were selected as candidate variables to add to the Functional Comorbidity Index. Multivariate linear regression using predictive stepwise modeling was applied to determine which candidate variables maximized the ability to predict QOL (adjusted R2). The resultant QOLI was tested in the validation cohort, and the ability to predict QOL was compared to other comorbidity indexes.Results:The QOLI model that best predicted QOL added smoking, illicit drug use, migraine, fibromyalgia, allergies, and sinusitis to the Functional Comorbidity Index. The ability to predict QOL (adjusted R2) was better in the QOLI by 10% compared to the Functional Comorbidity Index and by 18% compared to the Charlson Comorbidity Index.Conclusions:The QOLI is useful to predict quality of life and is a more robust predictor of QOL than other comorbidity indexes in obstructive sleep apnea patients.
AlloDerm with Split‐Thickness Skin Graft for Coverage of the Forearm Free Flap Donor Site
Authors: Wester Jacob L. , Pittman Amy , Litton Tyler , Gross Neil D. , Wax Mark K. 
Published: August 2013

Objectives:A major cause of forearm donor site morbidity after free flap harvest is lack of split‐thickness skin graft (STSG) take. AlloDerm alone has been shown to allow healing of the donor site, albeit prolonged healing. We sought to evaluate the use of STSG with AlloDerm as compared to STSG alone.Methods:Patientswho underwent fasciocutaneous free flap harvest and had composite grafting at the donor site using AlloDerm+STSG were identified at an academic medical center from 2011‐2012. 166 patients with a STSG alone acted as a control group. Morbidity data and aesthetic results were collected.Results:Eighty patients (50M, 30F) received AlloDerm+STSG. Overall donor site morbidity in the AlloDerm+STSG group was 27.5%, compared to 23.5% in the STSG only group, P = 0.53. Complete STSG loss (5% vs. 3%, P = 0.48), tendon exposure (5% vs. 5.4%, P = 1.0), functional impairment (2.5% vs. 1.8%, P = 0.66), infection (8.8% vs. 9.6%, P = 1.0), hematoma/seroma (5% vs. 3.6%, P = 0.73), and paresthesia (1.3% vs. 3.6%, P = 0.43) were not significant. No patients in the AlloDerm+STSG group required a second STSG after complete loss compared to 3 of 5 patients in the STSG only group, P = 0.17. Aesthetic results were superior in the AlloDerm+STSG group as rated by the surgeon (3.5 vs. 2.6, P = 0.03) and patients (3.7 vs. 2.9, P = 0.05) on a scale of 1‐5.Conclusions:Our results suggest that AlloDerm with STSG can provide thicker coverage of the forearm defect after fasciocutaneous free flap harvest and superior cosmetic results. There is no significant difference in other associated morbidity.
Comparison of Radial Forearm Free‐Flap Donor Site Dressing Modalities with Temporary Forearm Immobilization
Authors: Rangarajan Sanjeet V. , Melon David E. , Old Matthew O. , Teknos Theodoros N. , Agrawal Amit , Ozer Enver , Chio Eugene G. 
Published: August 2013

Objectives:1) Compare the success and complication rates of two dressing techniques for radial forearm free‐flap donor sites in patients undergoing short term limb immobilization. 2) Recognize the observed benefit of short‐term donor limb immobilization in this population.Methods:This was a prospective, randomized, controlled study of patients undergoing radial forearm free flap reconstruction of head and neck oncologic post‐ablative defects from 2010 to 2013 at a single tertiary care center. Participants’ donor sites were covered with split‐thickness skin grafts and were randomized into two arms: static pressure dressing and negative pressure dressing groups. All participants underwent immobilization of the donor arm using a custom‐fit removable volar splint for 30 days. Data were collected at 2 postoperative time points.Results:Fifty‐four patients underwent radial forearm and were enrolled in the study. Twenty‐seven patients (50%) received negative pressure dressings, and 27 patients (50%) received static pressure dressings. 100% of enrolled patients were immobilized with custom volar splints. Follow‐up data were available for 40 (74%) patients at the time of this writing. The overall complication rate was 20% (n = 8). Within the group of patients with medical co‐morbidities, 25% (n = 2) demonstrated donor site morbidity.Conclusions:This study reaffirms both techniques as viable methods for covering radial forearm donor sites; however, there are differences between them in cost and convenience for the patient. Additionally, this follow‐up study demonstrates that 30‐day immobilization may improve donor site outcome regardless of dressing strategy, as evidenced by an overall decrease in donor site morbidity compared to previously published results on non‐immobilized patients.
Completion Node Dissection Based on Risk of Nonsentinel Metastasis in Head and Neck Cutaneous Melanoma
Authors: Fritsch Valerie A. , Cunningham Joan , Lentsch Eric J. 
Published: August 2013

Objectives:Data describing the clinical implications of withholding completion lymph node dissection (CLND) from low‐risk patients with sentinel lymph node (SLN)‐positive melanoma are virtually non‐existent, possibly due to the intuitiveness of the notion that only patients with positive non‐SLNs will benefit from CLND. Furthermore, none of the published risk stratification models have exclusively analyzed patients with cutaneous melanoma of the head and neck (CMHN). Our objectives were: 1) Identify features associated with a low risk of non‐SLN positivity in CMHN, and 2) Analyze the effect of CLND on disease‐specific survival (DSS) among patient subgroups stratified by risk of non‐SLN metastasis.Methods:Using the Surveillance Epidemiology and End Results database, we identified 350 patients with SLN‐positive CMHN. Of these, 210 underwent CLND and were classified based on non‐SLN status. Clinicopathologic characteristics were compared between non‐SLN positive and non‐SLN negative subgroups. DSS was compared between SLN biopsy (SLNB)‐only and SLNB+CLND groups by Kaplan‐Meier analyses and the log‐rank test.Results:Minimal tumor thickness and non‐ulceration were associated with the lowest risk of non‐SLN positivity (P < 0.025). Only 1 of 19 melanomas ≤1mm had non‐SLN metastasis; however, patients <age 60 in this subgroup who underwent SLNB‐only had a 5‐year DSS rate of <25% vs. >90% among similar patients who underwent CLND (P < 0.0025). DSS was similar in the SLNB‐only and SLNB+CLND groups when melanomas were ulcerated or >2mm thick (P > 0.25).Conclusions:Selecting patients for CLND based on risk of NSLN metastasis may be an inappropriate strategy. In CMHN, CLND should not be withheld based on low risk features.
Cricothyrotomy Simulator with Computational Skill Assessment for Procedural Skill Training in the Developing World
Authors: White Lee , Bly Randall A. , D'Auria Daniella , Aghdasi Nava , Bartell Paul , Cheng Lei L. , Hannaford Blake 
Published: August 2013

Objectives:Cricothyrotomy is a life‐saving procedure performed when an airway cannot be established through less invasive techniques. The goals of this study were to 1) design and build a low‐cost simulator that teaches essential anatomy, and 2) provide a method of data collection for performance evaluation and guided instruction.Methods:The design of the simulator was optimized for materials that are low‐cost and widely available and for accurate anatomical landmarks. It was designed to electronically record instrument contact with critical anatomical locations throughout the procedure. Three simulators were constructed, and data were collected during 20 procedures performed by participants of varying surgical experience level. Surveys were completed by all participants to assess the perceived quality of the simulator. Three experts graded the recorded procedures by completing an Objective Structured Assessment of Technical Skills (OSATS) survey.Results:A simulator was designed and built. Procedural data of 20 subjects were collected. The survey data showed the majority of participants answered “moderate” or “very” on questions related to 1) anatomical accuracy (85%), 2) realism (50%), 3) improved understanding of procedure (65%), and 4) useful for practice (85%). The OSATS data correlated with task time.Conclusions:A cricothyrotomy simulator for use in a low‐resource environment was designed and produced. It collects data that can be used for performance evaluation and instruction. These were analyzed against OSATS data. A study of 20 subjects, 12 of whom were experts, demonstrated that it was realistic, anatomically accurate, and useful for practice and improving procedure knowledge.
Surgeon Dependent Variation in Perioperative Costs for Tonsillectomy and Adenoidectomy in Children
Authors: Meier Jeremy D. , Andrews Seth , Park Albert H. , Srivastava Rajendu 
Published: August 2013

Objectives:1) Identify the major expenses for routine tonsillectomy and adenoidectomy (T&A) at a children's hospital. 2) Identify sources for the greatest inter‐surgeon cost variation.Methods:A standardized activity based hospital accounting system was used to determine total facility costs per encounter (not including physician costs) for T&A cases at a tertiary children's hospital from 2008‐2011. Facility costs were subdivided into categories including operating room (OR), same day services (SDS), room and care (R&C), OR supplies, recovery room, pharmacy, anesthesia, and imaging. Average costs/case were determined for each surgeon who performed >50 cases. Stepwise regression analysis was performed to determine cost categories that provided the most significant inter‐surgeon variation.Results:The study cohort included 3,454 T&A's by 14 different surgeons (we excluded 8 surgeons who combined performed only 102 T&A's). The mean cost per T&A encounter was $1,620. The largest cost categories included OR ($479/case, 28% of total costs), SDS ($332, 19% of total costs), and R&C ($260, 16% of total costs). The average cost by surgeon per case varied from $1,163 to $2,059/case (P<0.05). The most significant categories with inter‐surgeon mean costs/case variation included OR ($358‐$643/case), R&C ($26‐$508/case), and OR supplies ($25‐$491/case).Conclusions:A majority of T&A expenses are accounted by OR, SDS, and R&C costs. Significant inter‐surgeon differences in costs for T&A were identified. Differences in OR, R&C, and OR supplies accounted for the greatest inter‐surgeon variation. Studies identifying the reasons for inter‐surgeon cost variations for T&A and their association to patient outcomes are warranted.
An Evidence‐Based Approach to Oncologic Scalp Reconstruction
Authors: Janus Jeffrey R. , Mirzoyev Sultan , Tombers Nicole , Moore Eric J. 
Published: August 2013

Objectives:Describe an algorithm for oncologic scalp reconstruction based on a single institution's surgical experience and analysis of outcomes.Methods:This is a single institution, retrospective review of patients requiring oncologic scalp ablation with subsequent reconstruction from 1992‐2012. Demographics include patient age, sex, immunosuppressive state, and type of malignancy. Measured endpoints include defect size/location/depth, the reconstruction method used, concomitant surgery (ie lymphadenectomy), adjunctive chemotherapy or radiotherapy, complication rate, and length of follow‐up.Results:A total of 140 patients are reviewed with an average age of 70.4 years; 76% being male. Approximately 51% of all patients required postoperative radiation, chemotherapy, or both. Defect widths range from 0.7cm to 24cm, with an average of 7.5cm. Depths range from full‐thickness skin to full‐thickness skull, the majority being up to pericranium (30%). Reconstruction varies from simple granulation to free tissue transfer. The overall complication rate for both primary and reoperative reconstruction is approximately 11%. Specific complications, spanning from hematoma to total flap failure, are statistically enumerated. Complication rates more than doubled when patients received radiation, chemotherapy, or both (14.1% versus 6.5%). Average length of follow‐up is 2.4 years.Conclusions:The armamentarium of scalp closure techniques is vast and can range from conservative therapy to free tissue transfer. Exposure to chemotherapy and radiation increases complication probability, propounding the need for healthy tissue coverage and tension free closure. Complication rates do not change signigicantly for primary versus revision surgery. Defect size plays only a minor role in complication rate, provided the appropriate method of reconstruction.
Facial Pain Secondary to Occult Head and Neck Tumors
Authors: Van Abel Kathryn M. , Starkman Sidney J. , Price Daniel L. 
Published: August 2013

Objectives:1) Review the natural history of occult head and neck malignancy presenting with facial pain. 2) Evaluate the risk factors, diagnostic workup, and management of facial pain in the setting of occult malignancy.Methods:A retrospective chart review was conducted of all patients who presented to a tertiary care center between 1980 and 2010 with the chief complaint of facial pain and a delayed diagnosis of a head and neck cancer. Clinical, radiographic, and pathologic data were reviewed.Results:Thirty‐eight patients met inclusion criteria. Initial diagnoses consisted of trigeminal neuralgia, herpetic neuralgia, temporo‐mandibular joint disorder, and atypical facial pain. Average delay to diagnosis was 18.4 months (1.9 ‐ 76.8 mo). Twenty‐two patients had negative magnetic resonance imaging or computed tomography imaging between onset of symptoms and tumor diagnosis, with an average of 1.05 non‐diagnostic scans per patient. Tumor etiologies included squamous cell carcinoma (39.5%), adenocarcinoma (10.5%), adenoid cystic carcinoma (7.9%), and acinic cell carcinoma (7.9%). Primary intervention consisted of surgical tumor removal (66%); chemotherapy, radiation therapy, or both (26%); gamma knife (5%); and conservative therapy (3%). Thirty‐two out of the 33 patients (97.0%) who underwent therapy reported partial or complete resolution of their facial pain.Conclusions:Occult tumors of the head and neck may present as symptomatic facial pain in the absence of other clinical or radiographic findings and should be considered in the workup of facial pain. Therapeutic and palliative interventions often result in marked improvement of pain symptoms.
Feasibility Animal Study of Novel ICG Sentinel Node Detection Technique in Head and Neck Region
Authors: Araki Koji , Mizokami Daisuke , Tomifuji Masayuki , Yamashita Taku , Kosuda Shigeru , Shiotani Akihiro 
Published: August 2013

Objectives:Sentinel node biopsy (SNB) allows head and neck surgeons to avoid unnecessary neck dissection. The popular SNB method using radioisotope (RI) has some drawbacks, such as the strict legal regulations for RI use in Japan. Recently, the SNB technique using real time indocyanine green (ICG) fluorescence image has become prevalent in breast cancer testing. Some reports demonstrated improved detection sensitivity with this method. However, the major problem of ICG method is its quick migration through the lymphatic system, which results in a limited diagnostic time window and detection of downstream subsequent nodes. To overcome this problem, we modified the ICG detection method by making ICG‐colloid and demonstrated the feasibility of this technique in a mouse model.Methods:ICG‐colloid was formed by mixing ICG and phytate colloids, which are commercially available as a kit for 99mTc‐radiocolloid. Twenty microliters of ICG or ICG‐colloid was injected into the tongue of a nude mouse, and the fluorescent images were observed with time until 48Hrs after injection. The fluorescence intensity in detected SN was analyzed.Results:In ICG injected animals, SNs were detected soon after injection, and second echelon lymph nodes were detected after 30‐60min. In ICG‐colloid injected animals, SNs were also detected after 30‐60 min, and no second echelon lymph node was detected. Peak fluorescence intensity was 6‐12Hr in both animal groups. No SN was detected after 24Hr in ICG animals, whereas SNs were still detectable in ICG‐colloid animals.Conclusions:SNB using ICG‐colloid technique may have advantages of prolonged diagnostic time window and prevention of downstream subsequent node detection.
Decreased Healthcare Use after Implementation of Postoperative Serum Calcium Algorithm following Total and Completion Thyroidectomy
Authors: Galloway Tabitha L. , Chang C. W. David 
Published: August 2013

Objectives:Evaluate healthcare use after the implementation of an algorithm to manage postoperative serum calcium in patients undergoing total or completion thyroidectomy.Methods:On June 1, 2010, standardized postoperative calcium monitoring algorithm was implemented at the University of Missouri for all patients undergoing total or completion thyroidectomies. Patients were selected for analysis if the following CPT codes were billed for their hospital stay: 60240, 60252, 60260, and 60271. Patient data were collected in a retrospective fashion for 18 months prior to and 18 months after the date of implementation. The three primary outcomes assessed were post‐procedure length of stay, non‐planned readmissions or emergency visits within 30 days, and readmissions specifically for hypocalcemia.Results:A total of 80 patients in the pre‐algorithm group (December 1, 2008 ‐ May 31, 2010) were compared with 102 patients in the post‐algorithm group (June 1, 2010 ‐ December 31, 2011). The average length of stay went from 2.938 days to 1.5 days (p<0.0001). Total readmissions for all non‐planned procedures and all emergency department visits within 30 days post‐procedurally went from 11.25% to 6.86% of patients (p=0.2995). Readmissions for hypocalcemia went from 5% to 1% of patients (p=0.4071).Conclusions:Using a calcium monitoring algorithm postoperatively following total and completion thyroidectomy demonstrated a statistically significant decrease in the length of stay after procedure and a trend toward overall decrease in emergency department visits, all non‐planned readmissions, and readmissions for symptomatic hypocalcemia.
Microanatomy of Peripheral Facial Nerve Revisited
Authors: Vong Angela , Pereira Lucio M. , Lin Ho‐Sheng , Shkoukani Mahdi A. 
Published: August 2013

Objectives:Describe extraparotid course of the facial nerve via microsurgical dissection. Analyze branch distribution and endpoint muscle innervation.Methods:Ten cadaveric hemifaces dissected under surgical microscopes. Facial nerve was identified from stylomastoid foramen to muscle. MAS measured number, length, and width at border of parotid, at level of the pes anserinus, and muscle border (frontalis, orbicularis oculi, zygomaticus major, and depressor anguli muscles). Analysis of variance and Student T test were performed.Results:At parotid border, zygomatic and buccal branches branched more often than temporal or marginal mandibular branches (2.7 +1.0, 2.9 + 0.7 vs 1.8 +1.2, 2.1 +0.9 mm respectively; p=0.06), branch diameter (1.1+0.3, 1.0+0.5 vs 0.9+0.3, 0.9+0.3 mm respectively p=0.238). At muscle border, similar results were found for zygomatic and buccal branches compared to temporal or marginal mandibular branches (2.3+1.3, 3.1+1.0 vs 1.3+0.5,1.3+0.5mm; P = 0.001), diameter (0.9+0.4, 1.0+0.4 vs 0.8+0.3, 0.7+0.3mm; p=0.737). Zygomaticotemporal pes showed more branching and greater diameter compared to cervicofacial, (7.6+2.2 vs 2.6+0.5mm; P =.0001) and (2.5+0.9 vs 1.9+0.4mm; p=0.10) respectively. Branch length from pes to muscle was consistent, the longest being temporal, zygomatic, marginal mandibular, and buccal (9.6 + 1.2, 8.3 +1.4, 8.0 +1.3, 7.4 +0.9 cm respectively; p=0.007). Anastomosis between temporal/zygomatic and zygomatic/buccal branches were found more consistently across all specimens than buccal/marginal mandibular anastomosis.Conclusions:Consistently fewer branches of the marginal mandibular branch at parotid border and at muscle border, and fewer anastomoses, may be the reasons for increased morbidity from surgical injury. Histologic analysis will further elucidate the number of innervations to the muscles of facial function.