Annals of Otology, Rhinology & Laryngology最新文献_第5页

Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation 胸骨-肩胛舌骨游离皮瓣用于双矢量动态面部复原

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419875473

A. Vincent, Scott E. Bevans, J. Robitschek, K. Groom, Marc W. Herr, M. Hohman

{"title":"Sterno-omohyoid Free Flap for Dual-Vector Dynamic Facial Reanimation","authors":"A. Vincent, Scott E. Bevans, J. Robitschek, K. Groom, Marc W. Herr, M. Hohman","doi":"10.1177/0003489419875473","DOIUrl":"https://doi.org/10.1177/0003489419875473","url":null,"abstract":"Background: Dynamic rehabilitation of longstanding facial palsy with damaged, atrophied, or absent facial muscles requires replacement of neural and muscular components. The ideal reconstruction would include a fast-twitch muscle that is small, a reliable donor vessel and nerve, and the potential to provide a natural, synchronous, dentate smile with minimal donor site morbidity. Many flaps have been successfully used historically, but none has produced ideal rehabilitation. Objective: To evaluate the novel sterno-omohyoid, dual-vector flap in rehabilitation of chronic facial paralysis. Results: We performed sterno-omohyoid free tissue transfer for smile reanimation in a 39-year-old male with a history of longstanding right facial palsy following resection of a skull base tumor several years previously. We transferred both muscles with the superior thyroid artery, middle thyroid vein, and ansa cervicalis. The patient developed a dynamic smile by 6 months postoperatively, and he had improved objective facial symmetry. Conclusion: Herein, we demonstrate the first use of the sterno-omohyoid flap for successful facial reanimation. Overall, it is a novel flap in facial reanimation with many advantages over traditional flaps, including the potential to produce a more synchronous, dynamic smile while adding minimal bulk to the face. Future series will better elucidate the potential of the sterno-omohyoid flap.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"25 1","pages":"195 - 200"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85627764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage 颞顶筋膜瓣是修复人工耳蜗创面的有效方法

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419877429

Lucas Leonhard, J. Roche, A. Wieland, G. Pyle

{"title":"The Temporoparietal Fascia Flap is an Effective Strategy for Cochlear Implant Wound Coverage","authors":"Lucas Leonhard, J. Roche, A. Wieland, G. Pyle","doi":"10.1177/0003489419877429","DOIUrl":"https://doi.org/10.1177/0003489419877429","url":null,"abstract":"Objective: To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications. Study Design: Retrospective case series. Setting: Tertiary care, University Hospital. Subjects and Methods: Chart review of all patients who underwent cochlear device implantation over a 5-year period to identify patients and to determine the rate of soft tissue complications. Five patients with major soft tissue complications underwent TPF flap with device salvage or explantation/reimplantation. Results: The rate of major skin complications was 6 out of 281 (2.1%) over 5 years, with 5 patients undergoing TPF flap. The average follow-up was 25.8 months (range, 5-58 months). TPF flap represented the definitive, successful solution for all 5 patients. One postoperative hematoma occurred after TPF flap, with no long-term sequelae. The average hospital length of stay was 2.2 nights (range, 1-5 nights). One patient required IV antibiotics for 4 weeks; the remaining patients were treated with a postoperative course of oral antibiotics. The original device remained in place for 4 patients, while one case required device explantation and staged re-implantation. Post-TPF flap hearing results were equal to if not superior to their preoperative results. Conclusion: Major soft tissue complications following cochlear device implantation are rare. The temporoparietal fascia flap is an excellent option for reconstruction of device site soft tissue dehiscences when local wound care and primary closure are not sufficient, and can potentially prevent explantation of a functional implant.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"41 1","pages":"135 - 141"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76626489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Improving Tracheostomy Care in Resource-Limited Settings 改善资源有限地区的气管切开术护理

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419882972

M. Sandler, Nohamin Ayele, I. Ncogoza, Susan Blanchette, Daphne Munhall, B. Marques, R. Nuss

{"title":"Improving Tracheostomy Care in Resource-Limited Settings","authors":"M. Sandler, Nohamin Ayele, I. Ncogoza, Susan Blanchette, Daphne Munhall, B. Marques, R. Nuss","doi":"10.1177/0003489419882972","DOIUrl":"https://doi.org/10.1177/0003489419882972","url":null,"abstract":"Objectives: Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings. Methods: In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit (“Go-Bags”), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda. Results: An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures. Conclusions: Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"20 1","pages":"181 - 190"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74495219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Electronic Consults in Otolaryngology: A Pilot Study to Evaluate the Use, Content, and Outcomes in an Academic Health System 耳鼻喉科电子咨询:一项评估学术卫生系统使用、内容和结果的试点研究

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419882726

Sapideh Gilani, K. Bommakanti, L. Friedman

{"title":"Electronic Consults in Otolaryngology: A Pilot Study to Evaluate the Use, Content, and Outcomes in an Academic Health System","authors":"Sapideh Gilani, K. Bommakanti, L. Friedman","doi":"10.1177/0003489419882726","DOIUrl":"https://doi.org/10.1177/0003489419882726","url":null,"abstract":"Objectives: To categorize the primary reasons for electronic consults (eConsults) to otolaryngology from primary care physicians (PCPs). To determine how many patients avoided subsequent in-person otolaryngology office visits. Methods: This is a retrospective analysis of a pilot study that took place between 2016 and 2017 regarding eConsults to adult otolaryngology placed by primary care physicians at the University of California, San Diego (UCSD) Medical Center. The complaints were categorized as related to the following: ear, nose, throat or neck. Initial recommendations were classified as (1) providing education only (no intervention), (2) suggesting medical therapy provided by the PCP, or (3) suggesting surgical intervention. Univariate statistics and multinomial logistic regression were used to analyze the association of problem type with the need for follow-up in the otolaryngology offices. The data was analyzed for differences in patient age and gender. Results: The study population included 64 patients (average age 54.6 years, 60.9% male). Within this group, 41% of consults were for ear complaints, 15% for nose complaints, 28% had throat-related complaints, and 16% had neck-related complaints. In-person follow-up was not required for 82.8% of the consults. Overall, 76.9% of ear, 100% of nose, 88.9% of throat, and 70.0% of neck complaints did not require in-person visits. Conclusions: eConsults to otolaryngology were primarily for ear concerns. Of the eConsults, 82.4% did not require in-person follow-up. We therefore conclude that the use of eConsults prevented substantial office visits that would not otherwise be necessary. Efforts should be made to promote the widespread use of eConsults, which may to the more efficient use of resources.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"134 1","pages":"170 - 174"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76420142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 26

Microlaryngeal Teaching Courses: A National Survey on Prevalence, Value, and Barriers to Implementation 微喉教学课程:全国流行程度、价值及实施障碍调查

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419876290

Vaninder K. Dhillon, S. Dailey, L. Akst

{"title":"Microlaryngeal Teaching Courses: A National Survey on Prevalence, Value, and Barriers to Implementation","authors":"Vaninder K. Dhillon, S. Dailey, L. Akst","doi":"10.1177/0003489419876290","DOIUrl":"https://doi.org/10.1177/0003489419876290","url":null,"abstract":"Objective: To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. Method: A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. Result: Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. Conclusion: Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"94 1","pages":"101 - 109"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79029553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times 儿童扁桃体切除术的重访率:入院和出院时间的分析

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-02-01 DOI: 10.1177/0003489419875758

Sapideh Gilani, N. Bhattacharyya

{"title":"Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times","authors":"Sapideh Gilani, N. Bhattacharyya","doi":"10.1177/0003489419875758","DOIUrl":"https://doi.org/10.1177/0003489419875758","url":null,"abstract":"Objective: To determine the association between intraday timing of outpatient pediatric tonsillectomy and revisit outcomes and complications. Study Design: Cross-sectional analysis of New York databases. Setting: Ambulatory surgery, emergency department and inpatient hospital settings. Subjects and Methods: The State Ambulatory Surgery, State Emergency Department and State Inpatient Databases for 2010-2011 were analyzed for revisits. Outcomes assessed were revisits for any reason, bleeding, acute pain or fever, nausea, vomiting and dehydration. The relationships between the hour of admission for surgery, the hour of discharge and the revisit outcomes were analyzed. Results: The study included 33,611 children (mean age, 6.62 years; 45.7% female) and 62.0% were admitted in the early morning. Discharges were most common in the early afternoon (28.3%). Revisit rates were significantly higher for the early evening discharges (6.0%) versus late morning discharges (3.1%) (P < .001). Revisits for bleeding were 1.8% for discharge in the early evening versus 0.6% in the late morning (P < .001). Revisits for fever, nausea, vomiting or dehydration were 1.8% for discharge in the early evening versus 0.9% in the late morning (P = .002). Late afternoon admission was significantly associated with higher revisit rates (10.9%, P < .001). Bleeding revisits were highest for late afternoon admit hour (1.5%, P = .001). Revisits for acute pain were also highest for late afternoon admit hour (2.3%, P = .005). Conclusion: Revisit are significantly higher when the patient is discharged late. Late afternoon surgery is also significantly associated with higher revisit rates. Surgeons may wish to consider these findings when a late tonsillectomy or late discharge is anticipated post-tonsillectomy.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"4 1","pages":"110 - 114"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86898640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 6

How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy 小儿麻醉师如何处理接受扁桃体切除术的OSA患儿

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-01-01 DOI: 10.1177/0003489419874371

Christopher A. Roberts, Raihanah Al Sayegh, Pavithra R Ellison, K. Sedeek, M. Carr

{"title":"How Pediatric Anesthesiologists Manage Children with OSA Undergoing Tonsillectomy","authors":"Christopher A. Roberts, Raihanah Al Sayegh, Pavithra R Ellison, K. Sedeek, M. Carr","doi":"10.1177/0003489419874371","DOIUrl":"https://doi.org/10.1177/0003489419874371","url":null,"abstract":"Objective: The purpose of this study was to describe typical anesthesia practices for children with obstructive sleep apnea (OSA). Study Design: Online survey. Method: A sample of pediatric anesthesiologists received the survey by email. Results: 110 respondents were included. 46.4% worked in a free-standing children’s hospital and 32.7% worked in a children’s facility within a general hospital. 73.6% taught residents. 44.4% saw at least one child with OSA per week, 25.5% saw them daily. On a 100-mm visual analog scale, respondents rated their comfort with managing these children as 84.94 (SD 17.59). For children with severe OSA, 53.6% gave oral midazolam preoperatively, but 24.5% typically withheld premedication and had the parent present for induction. 68.2% would typically use nitrous oxide for inhalational induction. 68.2% used fentanyl intraoperatively, while 20.0% used morphine. 61.5% reduced their intraop narcotic dose for children with OSA. 98.2% used intraoperative dexamethasone, 58.2% used 0.5 mg/kg for the dose. 98.2% used ondansetron, 62.7% used IV acetaminophen, and 8.2% used IV NSAIDs. 83.6% extubated awake. 27.3% of respondents stated that their institution had standardized guidelines for perioperative management of children with OSA undergoing adenotonsillectomy. People who worked in children’s hospitals, who had >10 years of experience, or who saw children with OSA frequently were significantly more comfortable dealing with children with OSA (P < 0.05). Conclusion: Apart from using intraoperative dexamethasone and ondansetron, management varied. These children would likely benefit from best practices perioperative management guidelines.","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"31 1","pages":"55 - 62"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87074169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Response to: Comments on “Nasolacrimal Duct Management During Endoscopic Sinus and Skull Base Surgery” 回复:关于“鼻内镜鼻窦颅底手术中鼻泪管处理”的评论

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-01-01 DOI: 10.1177/0003489419873000

Seth M. Lieberman, Janine M. Rotsides, Alexa M. Franco, R. Casiano

引用次数: 0

An Anatomic Variant of the Ansa Cervicalis Precluding Its Use as a Donor Nerve 颈背神经的解剖变异使其不能作为供体神经使用

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-01-01 DOI: 10.1177/0003489419875975

Alexander Zhu, S. Mohan, J. Richmon, Nate Jowett

引用次数: 2

Validation of the Maxillary Sinus Roof as a Landmark for Navigating the Pediatric Skull Base 上颌窦顶作为儿科颅底导航的一个里程碑的验证

Annals of Otology, Rhinology & Laryngology Pub Date : 2020-01-01 DOI: 10.1177/0003489419867967

S. S. Evans, C. Banks, J. Richman, A. Woolley, D. Cho, B. Woodworth

{"title":"Validation of the Maxillary Sinus Roof as a Landmark for Navigating the Pediatric Skull Base","authors":"S. S. Evans, C. Banks, J. Richman, A. Woolley, D. Cho, B. Woodworth","doi":"10.1177/0003489419867967","DOIUrl":"https://doi.org/10.1177/0003489419867967","url":null,"abstract":"Objective: To define a new anatomic relationship in pediatric sinus surgery, assessing the maxillary roof as a constant safe landmark to avoid skull base injury in the pediatric population. Study Design: Retrospective analysis. Setting: Tertiary care children hospital. Subjects and Methods: A retrospective analysis was performed of all computed tomography scans of the sinuses and facial bones at the emergency department of a tertiary children’s hospital over the course of a year. Radiographic measurements included the lowest cribriform plate and planum sphenoidale (PS) heights, or posterior skull base when not yet pneumatized, as well as the highest maxillary roof height. The nasal floor was used for reference. Statistics were performed via Shapiro-Wilks test with a P-value of .05 indicating statistical significance. Results: Three hundred and seven unique scans were reviewed (38.9% female; n = 122; P = .58). Age stratification was based on previously described sinus growth patterns. In all patients, the maximum maxillary height was inferior to the lowest measured cribriform lamella and PS (P < .001; CI, 98.5%-99%). Inter- and intrarater reliability and accuracy were verified through blinded review and re-review (ρ = .99 and .98 respectively, P ≤ .001). The validity of sole coronal measurements due to incomplete sagittal reformatting was also confirmed (ρ = 1.00, P ≤ .001). Conclusion: Despite variation in sinus growth and development in children, the current study demonstrated the validity of the maxillary sinus roof as a constant safe landmark in the pediatric population, offering a novel anatomic relationship for teaching safety in performing pediatric sinus surgery. Level of Evidence: 4","PeriodicalId":8361,"journal":{"name":"Annals of Otology, Rhinology & Laryngology","volume":"31 1","pages":"12 - 17"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88230731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0