1
|
Schopper HK, Gadkaree SK, Lighthall JG. Approach to Major Nasal Reconstruction: Benefits of Staged Surgery and Use of Technology. Facial Plast Surg Clin North Am 2024; 32:199-210. [PMID: 38575278 DOI: 10.1016/j.fsc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article reviews special considerations in complex nasal defects including treatment of adjacent subunit defects, timing of repair with radiation, reconstruction in patients with prior repairs or recurrent disease, and the role of prosthetics. The role of technological advances including virtual surgical planning, 3 dimensional printing, biocompatible materials, and tissue engineering is discussed.
Collapse
Affiliation(s)
- Heather K Schopper
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA.
| | - Shekhar K Gadkaree
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Miami Miller School of Medicine, 1120 Northwest 14th St, Miami, FL 33136, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA
| |
Collapse
|
2
|
Tucker J, Oxford M, Ziai K, Lighthall JG. Utility of Antibiotic Use in Pediatric Facial Fractures: A Systematic Review. Facial Plast Surg Aesthet Med 2024. [PMID: 38656206 DOI: 10.1089/fpsam.2023.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: In regard to antibiotic stewardship, it is important to understand the appropriate time to prescribe antibiotics in pediatric facial fracture management. Objective: To evaluate the utility of antibiotics in pediatric facial fractures and determine situational variables influencing appropriate antibiotic prescription. Methods: A comprehensive literature search was conducted in PubMed, Cochrane, and Web of Science databases for articles published from 2000 to 2022. Inclusion criteria consisted of all studies assessing pediatric facial fractures that mentioned antibiotic use. Results: A total of 13 studies were included in the full review. The reviewed studies comprised 31 pediatric patients ranging from 6 months to 18 years old. Most studies were case reports and case series (N = 9). Antibiotics were prescribed for the majority (96.7%) of patients. Antibiotic regimens varied by timing of administration, antibiotic used, and dosage. Fracture locations also varied widely, including orbital, zygomatic, nasal, mandibular, and maxillary fractures. Conclusions: Additional studies with more substantial evidence are needed to fully understand the situational appropriateness of antibiotic use in pediatric facial fractures.
Collapse
Affiliation(s)
- Jacqueline Tucker
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Madison Oxford
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| |
Collapse
|
3
|
Hoskins M, Bhanja D, Piper M, Strausser SA, Mansfield K, Zheng A, McNutt S, Goss M, Lighthall JG, Burns AS. Training Program Factors Most Important to Women When Selecting an Otolaryngology Residency. Laryngoscope 2024; 134:600-606. [PMID: 37551878 DOI: 10.1002/lary.30877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The aim of the study was to determine factors that female resident physicians find most influential when choosing an otolaryngology residency program. METHODS A three-part survey was sent to current female otolaryngology residents via email evaluating the importance of 19 characteristics impacting program choice. The 19 factors were scored from 1 (least important) to 5 (most important). The participants also ranked their personal top five most influential factors. Data were analyzed using descriptive statistics. RESULTS One-hundred and fifty of 339 contacted residents participated. Most were aged 30-39 (63%), white (70%), and married (43%). Eighty-five percent had no children, and 52% did not plan to have children during residency. The highest scoring factors derived from Likert scale ratings included resident camaraderie (4.5 ± 0.8), resident happiness (4.4 ± 0.8), and case variety/number (4.4 ± 0.8). The lowest scoring factors were number of fellows (2.9 ± 1.1), attitudes toward maternity leave (2.7 ± 1.3), and maternity leave policies (2.4 ± 1.2). The top five most influential factors and the percentage selecting this were resident camaraderie (57%), resident happiness (57%), academic reputation (51%), case variety/number (47%), and early surgical/clinical experience (44%). Gender-specific factors were infrequently selected. However, 51 (34%) ranked at least one gender-specific factor within their top five list. CONCLUSION Non-gender-related factors, like resident camaraderie and surgical experiences, were most valued by women. Conversely, gender-specific factors were less critical and infrequently ranked. Ninety-nine residents (64%) rated exclusively gender-neutral characteristics in their top five list of most influential factors. Our data offer insight into program characteristics most important to female otolaryngology residents, which may assist residency programs hoping to match female applicants. LEVEL OF EVIDENCE NA Laryngoscope, 134:600-606, 2024.
Collapse
Affiliation(s)
- Meloria Hoskins
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Debarati Bhanja
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Molly Piper
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Sarah A Strausser
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Kirsten Mansfield
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Amy Zheng
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Sarah McNutt
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Madison Goss
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Amy S Burns
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| |
Collapse
|
4
|
Heikel T, Lighthall JG. Response to Letter to Editor: Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review. Ann Otol Rhinol Laryngol 2023; 132:1698-1699. [PMID: 37271975 DOI: 10.1177/00034894231176891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Tiffany Heikel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
5
|
Ziai K, Agarwal A, Daher GS, Saadi RA, Lighthall JG. Facial Paralysis Referral Patterns to a Multidisciplinary Facial Nerve Clinic. Facial Plast Surg Aesthet Med 2023; 25:440-441. [PMID: 36724306 DOI: 10.1089/fpsam.2022.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Kasra Ziai
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Aarti Agarwal
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ghazal S Daher
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for medical sciences, Little Rock, Arkansas, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
6
|
Lorenz FJ, LaBarge B, Lighthall JG, Walen SG. Facial plating industry payments: An analysis of the open payments database. Laryngoscope Investig Otolaryngol 2023; 8:847-856. [PMID: 37621298 PMCID: PMC10446273 DOI: 10.1002/lio2.1107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 08/26/2023] Open
Abstract
Objective To compare industry payments from facial plating companies to plastic surgery, oral and maxillofacial surgery (OMFS), and otolaryngology (OHNS). Methods The Open Payments Database was queried from 2016 to 2021 to identify all industry disbursements related to facial plating products from Stryker, Zimmer Biomet, Depuy Synthes Products, Acumed, and KLS Martin. Total dollars, number of payments, and specialists paid were compared between plastic surgery, OMFS, and OHNS. Funding was correlated to estimated case volume and number of licensed surgeons determined by literature review. Results From 2016 through 2021, OMFS received an average of $786,497 annually, followed by plastic surgery ($765,482), and OHNS ($184,484). On average, facial plating companies distributed 2256, 963, and 917 yearly payments to 699 oral and maxillofacial surgeons, 378 plastic surgeons, and 354 otolaryngologists, respectively. Total dollars, number of payments, and specialists paid were significantly different between specialties (p < .05). Facial trauma coverage is 39.6% by plastic surgery, 36.6% by OMFS, and 23.3% by OHNS. There are 7560 licensed oral and maxillofacial surgeons, 4948 plastic surgeons, and 11,778 otolaryngologists in the United States. Decreased payment to OHNS was more than could be accounted for by case volume alone. Conclusions The facial plating industry allocates more funding dollars to OMFS and plastic surgery compared to OHNS. OMFS receives the greatest number of payments to the most specialists compared to plastic surgery and OHNS. Engagement between OHNS and the facial plating industry is a potential area of growth in the future.Level of evidence: Level 4.
Collapse
Affiliation(s)
- F. Jeffrey Lorenz
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Brandon LaBarge
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Jessyka G. Lighthall
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| | - Scott G. Walen
- Department of Otolaryngology–Head and Neck SurgeryPenn State College of MedicineHersheyPennsylvaniaUSA
| |
Collapse
|
7
|
Tucker J, Goldenberg D, Brandon C, King TS, Ziai K, Lighthall JG. Limited Efficacy of Empiric Antibiotics for Pediatric Facial Fractures. J Oral Maxillofac Surg 2023; 81:869-877. [PMID: 37116541 PMCID: PMC10790685 DOI: 10.1016/j.joms.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Controversies exist regarding the role of perioperative antibiotic use in pediatric craniomaxillofacial fracture repair. PURPOSE This study aims to identify factors associated with antibiotic prescribing patterns and measures the association between antibiotic exposure and postoperative infections. STUDY DESIGN, SETTING, SAMPLE In this retrospective cohort study, TriNetX, a research database, was used to gather data on patients under 18 years of age who underwent repair of facial fractures. The records were obtained from 2003 to 2021. Current Procedural Terminology codes for facial fracture procedures were used to identify patients. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE Antibiotic use, defined as a binary categorical variable of whether or not patients received perioperative antibiotics. The secondary predictor variable was timing of antibiotic administration, categorized by pre, intra, and postoperative administration. MAIN OUTCOME VARIABLES Postoperative infection, determined by International Classification of Diseases, 9th and 10th Revision codes within patient charts. COVARIATES Covariates included demographic variables such as age, sex, race, ethnicity, geographic location, and fracture characteristics, such as number of fractures and location of fracture. ANALYSES χ2 analyses were used for categorical variables and two sample t tests for quantitative variables. Multivariable logistic regression was used to evaluate patient infection and antibiotic use with adjustment for covariates. P-values were 2-tailed and statistical significance was defined as P < .05. RESULTS This cohort included 5,413 patients of which 70.4% were male, 74.4% identified as white, and 83.3% identified as non-Hispanic or Latino. There were no differences in postoperative infections in patients who received antibiotics compared to those who did not (0.9 vs 0.5%, respectively, P = .12). Nevertheless, antibiotic prescriptions have increased over the years. After controlling for relevant covariates, antibiotic use did not decrease the odds of infection (adjusted odds ratio 1.1, 95% CI 0.53 to 2.34, P = .79). There was a significant association between the timing of antibiotic use and infection (P = .044), with increased odds of infection when antibiotics were given postoperatively (adjusted odds ratio 3.8, 95% CI 1.2 to 12.07, P = .023). CONCLUSION AND RELEVANCE While antibiotic prescriptions have increased over the years, this study demonstrates there is no difference in postoperative infection rates for pediatric patients prescribed antibiotics and those where were not.
Collapse
Affiliation(s)
- Jacqueline Tucker
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Dana Goldenberg
- Medical Student, College of Medicine, Pennsylvania State University, Hershey, PA
| | - Cameron Brandon
- Resident, Department of Neurosurgery, The Ohio State University, Columbus, OH
| | - Tonya S King
- Statistician, Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Kasra Ziai
- Chief Resident, Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Jessyka G Lighthall
- Associate Professor, Chief, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
| |
Collapse
|
8
|
Lighthall JG. Injectables and Minimally Invasive Rejuvenation of the Face and Neck. Clin Plast Surg 2023; 50:xi-xii. [PMID: 37169417 DOI: 10.1016/j.cps.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Esteem Penn State Health Cosmetic Associates, Facial Nerve Disorders Clinic; Department of Otolaryngology-Head & Neck Surgery, Facial Plastic & Reconstructive Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA.
| |
Collapse
|
9
|
Fedok FG, Lighthall JG. Evaluation and Treatment Planning for the Aging Face Patient. Clin Plast Surg 2023; 50:367-380. [PMID: 37169403 DOI: 10.1016/j.cps.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Facial aging is a multifactorial process that occurs due to alterations in the skin, soft tissue, and bony skeleton. When considering treatments for the aging face and neck, a multifaceted approach targeting each of these areas should be considered. Although surgical intervention remains a key component to the holistic care of the aging face patient, a multitude of minimally invasive techniques is now available to optimize the care of the patient seeking rejuvenation. Proper patient evaluation and counseling on realistic expectations are critical and will be discussed here. A brief overview of common minimally invasive treatments will be presented.
Collapse
Affiliation(s)
- Fred G Fedok
- The Fedok Plastic Surgery and Laser Center, 113 East Fern Avenue, Foley, AL 36535, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive H-091, Hershey, PA 17033, USA.
| |
Collapse
|
10
|
Pool C, Moroco A, Lighthall JG. Utilizing Virtual Surgical Planning and Patient-Specific Cutting Guides as an Adjunct in Microtia Repair with Autologous Costal Cartilage Graft. Plast Reconstr Surg 2023:00006534-990000000-02024. [PMID: 37384846 DOI: 10.1097/prs.0000000000010897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Virtual surgical planning (VSP) has been applied to many aspects of head and neck reconstruction. We describe the use of VSP to create auricular templates in addition to cartilage cutting and suturing guides for microtia repair in two patients with unilateral and bilateral grade 3 microtia. Both patients had satisfactory aesthetic results. This technique allows for increased precision, may decrease operative time, and good cosmetic outcomes.
Collapse
Affiliation(s)
- Christopher Pool
- Penn State Hershey, Department of Otolaryngology - Head and Neck Surgery Hershey, PA
| | - Annie Moroco
- Thomas Jefferson, Depar.4tment of Otolaryngology - Head and Neck Surgery Philadelphia, PA
| | - Jessyka G Lighthall
- Penn State Hershey, Department of Otolaryngology - Head and Neck Surgery Hershey, PA
| |
Collapse
|
11
|
Moroco AE, Patel VA, Saadi RA, Gniady JP, Lighthall JG. Systematic Review of Laryngeal Fractures and Trends in Operative Management. Craniomaxillofac Trauma Reconstr 2023; 16:62-69. [PMID: 36824183 PMCID: PMC9941301 DOI: 10.1177/19433875221074847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on the trends in management of laryngeal fractures following trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 1963 to 2020 were collected. All studies which described laryngeal fractures using the Boolean method and relevant search term combinations, including "Laryngeal", "Fracture", "Operative", and "Management" were collected. Results A total of 588 relevant unique articles were identified for analysis. Of these, 24 articles were deemed appropriate for inclusion in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Laryngeal fractures are rare traumatic injuries that require early identification and evaluation with complex management options. This comprehensive review aims to highlight the breadth of the topic with regard to presentation and clinical management. Though there remains no clear best practice for laryngeal fracture management, we review trends in clinical practice throughout the literature.
Collapse
Affiliation(s)
- Annie E. Moroco
- Department of Otolaryngology – Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Vijay A. Patel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Centers for Cranial Base Surgery & Sinonasal Disorders and Allergy, Pittsburgh, PA, USA
| | - Robert A. Saadi
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - John P. Gniady
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Department of Otolaryngology – Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
12
|
Ziai K, Patel S, Crenshaw M, Saadi R, Goldenberg D, Lighthall JG. Association of Practice Setting and Scholarly Activity With Medicolegal Claims in Otolaryngology-Head and Neck Surgery. Ear Nose Throat J 2023:1455613231158795. [PMID: 36820503 DOI: 10.1177/01455613231158795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To characterize the association between scholarly activity, academic rank, practice setting, and malpractice claims among otolaryngologists over the past decade. METHODS Data was extracted from the two legal databases, WestLaw and LexisNexis. The records were obtained from January 2010 to January 2020. Scopus and PubMed databases were used to identify bibliometric data. RESULTS Of the 102 malpractice cases identified, 77.5% (N = 79) were ruled in favor of the defendant, 13.7% (N = 14) in favor of the plaintiff, and 8.8% (N = 9) were settled outside of the court. A total amount of $46,533,346.82 was rewarded to plaintiffs in 14 cases. Endoscopic sinus surgery was the procedure associated with the most malpractice claims (N = 16). Alleged improper performance (N = 51) was the most common underlying reason for litigation. Of the 102 defendant surgeons, 82 (80.4%) were in community/private settings. Among the 14 cases in that a surgeon was found at fault, 13 (92.8%) were in the community/private setting. Among the surgeons with at least one publication, the mean Hirsch Index (h-index) was 8.2. There was a statistically significant correlation between the mean h-index and litigation outcome (95% CI: -8.9 to -0.9, P = .017). CONCLUSION Our analysis showed that most malpractice litigations were among otolaryngologists practicing in community/private settings. We also found that higher scholarly activity measured by the h-index was associated with verdicts in favor of the defendant/surgeon. This study was limited by not all-inclusive aspects of the legal databases that were used, the small sample size, and the lack of multivariable analysis.
Collapse
Affiliation(s)
- Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburg, Pittsburg, PA, USA
| | - Megan Crenshaw
- Department of Obstetrics, Gynecology & Reproductive Health, Rutgers-Cooperman Barnabas Medical Center, Newark, NJ, USA
| | - Robert Saadi
- Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
13
|
Abstract
OBJECTIVE Botulinum toxin A is known to be effective and safe in managing sialorrhea in pediatric patients; however, there is no consensus on a protocol for optimal injection sites and appropriate dosing for injection. METHODS This review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. PubMed, EMBASE, and other databases were queried to identify articles that evaluated botulinum toxin type A for the treatment of sialorrhea in the pediatric population. A total of 405 studies were identified. After applying inclusion and exclusion criteria, 31 articles were included for review. RESULTS A total of 14 studies evaluated 2-gland injections, and 17 studies evaluated 4-gland injections. Of the 31 studies included, one study assessed incobotulinumtoxinA (Xeomin®) the remaining all used onabotulinumtoxinA (Botox®). For 2-gland injection studies, a combined total of 899 participants were reviewed, where 602 participants received 50 units into their submandibular glands, while 262 participants received 30 to 50 units. Among 4-gland injection studies, there was a combined total of 388 participants, with the most prevalent dosage utilized being 60 to 100 units in 230 participants, followed by 100 units total in 77 participants. The most common adverse event was dysphagia which resolved in nearly all cases. Three studies aimed to examine 2-gland versus 4-gland injections, with 2 of the studies concluding 4-gland injection was superior. CONCLUSIONS The strength of evidence suggests that the dosing of 50 units total of onabotulinumtoxinA to the submandibular glands is safe and effective in the pediatric population. For 4-gland injections, bilateral submandibular and parotid gland injections of 60 to 100 units total is the safe and effective dosage. There is no substantial evidence comparing 4-gland injections to 2-gland injections, but research thus far suggests 4-gland injections to be superior. Future study is needed to evaluate incobotulinumtoxinA and abobotulinumtoxinA dosages in the pediatric population.
Collapse
Affiliation(s)
- Tiffany Heikel
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Shivam Patel
- The Pennsylvania State University,
College of Medicine, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology—Head and
Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center,
Hershey, PA, USA
| | - Sejal J. Shah
- Department of Anesthesiology and
Perioperative Medicine, The Pennsylvania State University, Milton S. Hershey Medical
Center, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive
Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State
University, Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
14
|
Abstract
Substantial controversy exists regarding the timing of intervention and management of patients with orbital floor fractures. Recent advances in computer-aided technology, including the use of 3-dimensional printing, intraoperative navigational imaging, and the use of novel implants, have allowed for improvement in prospective management modalities. As such, this article aims to review the indications and timing of repair, surgical approaches, materials used for repair, and contemporary adjuncts to repair. Indications for orbital floor fracture repair remain controversial as many of these fractures heal without intervention or adverse sequelae. Intraoperative navigation and imaging, as well as endoscopic guidance, can improve visualization of defects mitigating implant positioning errors, thereby reducing the need for secondary corrective procedures. Patient-specific implants may be constructed to fit the individual patient's anatomy using the preoperative CT dataset and mirroring the contralateral unaffected side and have been shown to improve pre-operative efficiency and minimize postoperative complications. With increased data, we can hope to form evidence-based indications for using particular biomaterials and the criteria for orbital defect characteristics, which may be best addressed by a specific surgical approach.
Collapse
Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck
Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck
Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck
Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive Surgery,
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania
State University, Hershey, PA, USA
| |
Collapse
|
15
|
Moroco AE, Daher GS, O'Connell Ferster AP, Lighthall JG. Prevalence of Body Dysmorphic Disorder in an Otolaryngology-Head and Neck Surgery Clinic. Ann Otol Rhinol Laryngol 2022:34894221118772. [PMID: 35962596 DOI: 10.1177/00034894221118772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the prevalence of body dysmorphic disorder (BDD) in a general otolaryngology population presenting to an outpatient clinic. STUDY DESIGN Prospective prevalence study. SETTING Single tertiary academic otolaryngology clinic. SUBJECT AND METHODS New patients over 18 years of age who presented to an academic otolaryngology clinic between August 2018 and May 2021 completed a questionnaire including demographic questions and the validated Body Dysmorphic Disorder Questionnaire (BDDQ). Data collected from the questionnaires were analyzed to assess demographics and prevalence of BDD in an otolaryngology clinic. RESULTS Of the 242 patients queried, 15 patients screened positive for BDD. The screened prevalence of BDD was determined to be 6.2%. None of the patients had previously been diagnosed with BDD. The prevalence of prior mental health diagnoses was 34.3%. These patients had initially presented for a variety of otolaryngologic concerns and had pre-existing diagnoses of anxiety, depression, obsessive-compulsive, bipolar and eating disorders. CONCLUSION The prevalence of BDD in our population of new patients presenting to an academic otolaryngology practice (6.2%) is higher than that of the general population (1.9%).
Collapse
Affiliation(s)
- Annie E Moroco
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ghazal S Daher
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | | | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
16
|
Lighthall JG. Injectables and Nonsurgical Rejuvenation. Facial Plast Surg Clin North Am 2022. [DOI: 10.1016/s1064-7406(22)00049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Fedok FG, Lighthall JG. Evaluation and Treatment Planning for the Aging Face Patient. Facial Plast Surg Clin North Am 2022; 30:277-290. [DOI: 10.1016/j.fsc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Lighthall JG. Injectables and Nonsurgical Rejuvenation of the Face and Neck. Facial Plast Surg Clin North Am 2022; 30:xv-xvi. [DOI: 10.1016/j.fsc.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
19
|
Daher GS, Ziai K, Saadi RA, Pool C, Lighthall JG. Cost Analysis of Cadaveric Versus Autologous Costal Cartilage Grafting in Septorhinoplasty. Facial Plast Surg Aesthet Med 2022; 24:489-490. [DOI: 10.1089/fpsam.2021.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ghazal S. Daher
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Kasra Ziai
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Robert A. Saadi
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christopher Pool
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G. Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| |
Collapse
|
20
|
Patel S, Ziai K, Lighthall JG, Walen SG. Biologics and acellular dermal matrices in head and neck reconstruction: A comprehensive review. Am J Otolaryngol 2022; 43:103233. [PMID: 34537508 DOI: 10.1016/j.amjoto.2021.103233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
Collapse
Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Scott G Walen
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| |
Collapse
|
21
|
Abstract
INTRODUCTION Synkinesis refers to abnormal involuntary facial movements that accompany volitional facial movements. Despite a 55% incidence of synkinesis reported in patients with enduring facial paralysis, there is still a lack of complete understanding of this debilitating condition, leading to functional limitations and decreased quality of life.1 This article reviews the diagnostic assessment, etiology, pathophysiology, rehabilitation, and nonsurgical and surgical treatments for facial synkinesis. METHODS A PubMed and Cochrane search was done with no date restrictions for English-language literature on facial synkinesis. The search terms used were "facial," "synkinesis," "palsy," and various combinations of the terms. RESULTS The resultant inability to control the full extent of one's facial movements has functional and psychosocial consequences and may result in social withdrawal with a significant decrease in quality of life. An understanding of facial mimetic musculature is imperative in guiding appropriate intervention. While chemodenervation with botulinum toxin and neurorehabilitation have continued to be the primary treatment strategy for facial synkinesis, novel techniques such as selective myectomy, selective neurolysis, free-functioning muscle transfer, and nerve grafting techniques are becoming increasingly utilized in treatment regimens. Facial rehabilitation, including neuromuscular retraining, soft tissue massage, and relaxation therapy in addition to chemodenervation with botulinum toxin, remains the cornerstone of treatment. In cases of severe, intractable synkinesis and non-flaccid facial paralysis, surgical interventions, including selective neurectomy, selective myectomy, nerve grafting, or free muscle transfer, may play a more significant role in alleviating symptoms. DISCUSSION A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes. Ultimately, therapy should be tailored to the severity and pattern of synkinesis, and each patient approached on a case-by-case basis. A multidisciplinary approach involving therapists, clinicians, and surgeons is necessary to develop a comprehensive treatment regimen that will result in optimal outcomes.
Collapse
Affiliation(s)
- Tom Shokri
- Facial Plastic and Reconstructive Surgery, 43989The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, 12310The Pennsylvania State University, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, 12310The Pennsylvania State University, Hershey, PA, USA
| | - Jonathan Harounian
- Department of Otolaryngology-Head and Neck Surgery, 12315Temple University Hospital, Philadelphia, PA, USA
| | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Milton S. Hershey Medical Center, 12310The Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
22
|
Benyo S, Saadi RA, Walen S, Lighthall JG. A Systematic Review of Surgical Techniques for Management of Severe Rhinophyma. Craniomaxillofac Trauma Reconstr 2021; 14:299-307. [PMID: 34707790 DOI: 10.1177/1943387520983117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical techniques employed in the treatment of severe rhinophyma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 2010 to 2020 were collected. All studies which described surgical treatment of severe rhinophyma using the Boolean method and relevant search term combinations, including "rhinophyma," "severe," "operative" and "surgery" were collected. Results A total of 111 relevant unique articles met criteria for eligibility analysis. Of these, 85 articles were deemed inappropriate for the literature review due to exclusion criteria. The remaining 26 articles were included in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Severe rhinophyma may present a reconstructive challenge to reestablish normal contour and patent nasal airway. Significant deformity necessitates surgical correction. The present article reviews the current literature and provides a summary and stepwise explanation of established surgical techniques for addressing the cosmetic and functional deficits these patients encounter.
Collapse
Affiliation(s)
- Sarah Benyo
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Scott Walen
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
23
|
Saadi RA, Snyder D, Shokri T, Lighthall JG. Postoperative outcomes of autologous rib graft for microtia repair in children: A NSQIP study. Int J Pediatr Otorhinolaryngol 2021; 146:110733. [PMID: 33940315 DOI: 10.1016/j.ijporl.2021.110733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/03/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effect of surgical specialty and patient factors on 30-day postoperative outcomes and complications for children undergoing autologous costochondral grafting for microtia reconstruction. METHODS The American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) database was searched from 2012 through 2017 for patients who underwent autologous rib grafting (CPT 21230). The group was further filtered for coexisting ICD 9 or 10 code for microtia (744.23, Q17.2) as an indication for surgery. Outcomes analyzed included patient demographics, medical comorbidities, admission type (inpatient vs. outpatient), operative time, surgeon specialty, length of hospital stay (LOS), complications, and readmission. RESULTS A total of 375 pediatric patients were identified of which 157 were female and 218 were male. Mean age at time of surgery was 9.6 years. Postoperative complications and readmission occurred in 5.6% and 3.5% of patients, respectively. Surgical site infection was the most common complication. Average operative time was 246.9 min. When comparing Otolaryngology to Plastic Surgery with multivariate analysis, there was no difference in admission type (OR 1.00, p = 0.993), complication rate (OR 0.91, p = 0.744), readmission (OR 0.68, p = 0.576), operative time (p = 0.471) or total LOS (p = 0.266). CONCLUSION The present study demonstrated postoperative complications and readmission rates following microtia repair as reported by the NSQIP-P database. Overall complication and readmission rates were low. No significant risk factors were identified on multivariate analysis. There were no differences between surgical specialty for complication rate, operative time, hospital stay or readmission when accounting for demographic data and comorbidities.
Collapse
Affiliation(s)
- Robert A Saadi
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA.
| | - David Snyder
- Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Tom Shokri
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology - Head and Neck Surgery, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
24
|
Pool C, Goyal N, Lighthall JG. Novel Use of the Buccal Fat Pad for Sinocutaneous Fistulae Closure and a Review of Reconstructive Options. Ann Otol Rhinol Laryngol 2021; 131:295-302. [PMID: 34032126 DOI: 10.1177/00034894211014299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sinocutaneous fistulae (SCF) are abnormal communications between the paranasal sinuses and the overlying skin. They may be difficult to manage due to facial geometry, scar contraction, and poor tissue vascularity. We describe a novel use of the buccal flap and review the literature to examine management options for this disease process. METHODS A PubMed/MEDLINE literature search was performed for studies published between January 1, 1950 and April 29, 2020 that describe management strategies for SCF. The clinical record, imaging, and operative reports were reviewed of the case in which the buccal fat flap was used in reconstruction. RESULTS A total of 359 articles were retrieved. After removing duplicate articles, non-English studies, animal studies, duplicate articles and studies that mentioned SCF without specific mention of management strategies, 51 articles were reviewed. Management paradigms throughout the articles include (1) removal of infection, (2) ensuring patency of sinus outflow tracts, (3) tensionless multilayered closure using well vascularized tissue, and (4) prevention or minimization of future risk factors for fistula formation. CONCLUSION This article informs surgeons on reconstructive options for sinocutaneous fistulae including a novel description of the buccal fat flap.
Collapse
Affiliation(s)
- Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Neerav Goyal
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
25
|
Shokri T, Lighthall JG. Perfusion dynamics in pedicled and free tissue reconstruction: Infrared thermography and laser fluorescence video angiography. Am J Otolaryngol 2021; 42:102751. [PMID: 33485567 DOI: 10.1016/j.amjoto.2020.102751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Preoperative planning, design, and perioperative monitoring of microsurgical free flaps is of paramount importance to successful reconstruction. Infrared Thermography provides an indirect method by which vascular perfusion may be monitored and has previously shown efficacy in detection of cutaneous perforators. In a proof-of-concept study, we assessed the utility of infrared thermography in delineating angiosomes and monitoring for adequate tissue perfusion in the preoperative, intraoperative, and postoperative setting. This technology was compared to conventional indocyanine green fluorescence angiography (ICG-FA). METHOD Four patients undergoing locoregional pedicled or free flap reconstruction were assessed using ICG-FA and Forward-looking infrared (FLIR) thermography in standardized conditions. Monitoring of flap angiosomes and tissue perfusion using both fluorescent pixel intensity and thermography was then performed implementing proprietary software. CONCLUSION Our study is unique in that tissue perfusion intraoperatively was assessed with both thermography and indocyanine green fluorescence angiography (ICG-FA), which represents a previously established system. We demonstrate that smartphone compatible thermal cameras may be used as an adjunct to clinical exam, as well as other monitoring technologies, providing further information in not only selection of perforators, in the operative setting, but also in the early detection of poor flap viability secondary to microvascular compromise allowing for timely salvage.
Collapse
|
26
|
Abstract
Objective: To evaluate the safety profile, including adverse drug reactions and operative complications, of liposomal bupivacaine (LB) use for local anesthesia during functional septorhinoplasty. Study Design: Retrospective review. Subject and Methods: A database query was conducted for patients >18 years of age who underwent septorhinoplasty from January 1, 2019, to August 1, 2020. Adverse drug reactions and postoperative outcomes were compared between patients who received locally administered LB and patients who received standard local anesthetic at the completion of the surgery. Results: A total of 95 cases were included in our data analysis. No significant differences were found in adverse reactions overall (6.3% vs. 3.1%, p = 0.51) or complications, including rate of infection (3.2% vs. 3.1%, p = 1), cartilage warping (1.6% vs. 0%, p = 1), graft resorption (0% vs. 0%, p = 1), septal hematoma (0% vs. 0%, p = 1), and need for revision surgery (4.8% vs. 3.1%, p = 1) between LB and control groups. Conclusion: LB demonstrated an acceptable safety profile when compared with standard local anesthetics during septorhinoplasty, with no significant difference in systemic or local adverse drug reactions or postoperative complications.
Collapse
Affiliation(s)
- Ghazal Staity
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Christopher Pool
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| |
Collapse
|
27
|
Ziai K, Patel S, Thomas S, Shokri T, Lighthall JG. A Century in Review: Medicolegal Implications of Facial Nerve Paralysis. Facial Plast Surg Aesthet Med 2020; 23:417-421. [PMID: 33347787 DOI: 10.1089/fpsam.2020.0390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Importance: It is important to recognize factors that may mitigate the risk of a potential lawsuit and increase knowledge and awareness of physicians. Objective: To evaluate and characterize facial nerve paralysis litigation claims and related potential causes. Design, Setting, and Participants: These data were extracted from the two main computerized legal databases: WestLaw and LexisNexis. The data were queried on April 2, 2020. The records from 1919 to 2020 were obtained from a population-based setting. A total of 186 cases were included. Data were gathered for all alleged cases of facial nerve paralysis. Main Outcomes and Measures: There was a continuous rise in the amount of malpractice payments with the highest mean amount being in the past decade. Results: From 1919 to 2020, a total of 186 malpractice cases for facial nerve damage were identified. A total amount of $89,178,857.99 was rewarded to plaintiffs in 66 cases. The mean amount of paid malpractice claim was $1,351,194.80. Improper performance/treatment was the most common reason for alleged litigation (n = 97). This was followed by misdiagnosis/delayed diagnosis (n = 47), and failure of informed consent (n = 34). The highest number of malpractice claims with a total of 53 cases was from 1991 to 2000. The highest mean amount per payment was in the past decade (2011-2020) with a mean of $3,841,052.68. Conclusions and Relevance: Over the past century, improper performance/procedure, delayed/misdiagnosis, and failure of informed consent were the most common reasons for litigations related to facial nerve paralysis.
Collapse
Affiliation(s)
- Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Shivam Patel
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Sydnie Thomas
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
28
|
Abstract
OBJECTIVE Congenital anomalies of the external ear may present a reconstructive challenge, particularly when normal chondrocutaneous components of the auricle fail to develop. Our goal was to develop a novel technique for lobule reconstruction of a congenitally absent earlobe with photographic documentation of the technique. METHODS Informed consent for perioperative photography and publication of case details was obtained. A postauricular, turnover flap with ipsilateral conchal cartilage grafting was performed to reconstruct the lobule, and a superiorly based, postauricular, rotation advancement flap was used to close the donor site defect. RESULTS Perioperative photographs are included demonstrating technique and cosmetic results. CONCLUSIONS Malformations rarely involve the lobule or lower third of the ear primarily. Literature regarding lobule reconstruction for congenital malformations is scarce. We present a novel technique for lobule reconstruction of a congenitally absent earlobe performed in a single stage that avoids a visible neck scar and allows for simultaneous conchal cartilage harvest. The technique demonstrated satisfactory cosmesis regarding contour and overall appearance and these results remained stable at 1-year follow up.
Collapse
Affiliation(s)
- Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, 12310The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, 12310The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, 12310The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| |
Collapse
|
29
|
Fedok FG, Lighthall JG, Rihani J. Life in an Academic Practice Versus a Solo Private Practice: How Different Are They? Facial Plast Surg Clin North Am 2020; 28:503-514. [PMID: 33010869 DOI: 10.1016/j.fsc.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Facial plastic surgery has thrived in both academic and private settings. In this article, 3 surgeons comment on a variety of selected topics that are pertinent to their lives as academic and private practice surgeons.
Collapse
Affiliation(s)
- Fred G Fedok
- Department of Surgery, University of South Alabama Mobile, Fedok Plastic Surgery, 113 East Fern Avenue, Foley, AL 36535, USA.
| | - Jessyka G Lighthall
- Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Penn State College of Medicine, 500 University Drive H-091, Hershey, PA 17033, USA
| | - Jordan Rihani
- Facial Plastic Surgery Institute, Southlake, TX 76092, USA
| |
Collapse
|
30
|
Patel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr 2020; 14:100-109. [PMID: 33995830 DOI: 10.1177/1943387520950096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Study Design The present study is a systematic review of the literature. Objective The goal of this study is to review our experience and the current literature on airway management techniques in maxillofacial trauma. Methods Independent searches of the PubMed and MEDLINE databases were performed from January 1, 2019 to February 1, 2019. Articles from the period of 2008 to 2018 were collected. All studies which described both airway management and maxillofacial trauma using the Boolean method and relevant search term combinations, including "maxillofacial," "trauma," and "airway," were considered. Results A total of 452 relevant articles in total were identified. Articles meeting inclusion criteria by abstract review included 68 total articles, of which 16 articles were focused on airway management techniques for maxillofacial trauma in the general population and were deemed appropriate for inclusion in the literature review. Conclusions Establishing an effective and stable airway in patients with maxillofacial trauma is of paramount concern. In both the acute setting and during delayed reconstruction, special considerations must be taken when securing a reliable airway in this patient population. The present article provides techniques for securing the airway and algorithms for utilization of these techniques, including both during the initial evaluation and the definitive operative management.
Collapse
Affiliation(s)
- Akshilkumar Patel
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert Saadi
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology - Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
31
|
Abstract
The aim of the study is to: (1) evaluate national trends in care of facial paralysis, namely Bell's palsy, patients to identify the types of treatments patients are receiving and treatment gaps and (2) identify if newer, more complex surgical therapies published in the literature are being employed. Data were collected from the MarketScan Commercial Claims and Encounters Database by Truven Health. From the database, all inpatient and outpatient claims with International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes for facial paralysis/dysfunction between 2005 and 2013 were extracted. Trends in medical and surgical management were evaluated specifically cataloging the use of steroids, antivirals, botulinum toxin, surgical and rehabilitation service current procedural terminology codes. A total of 42,866 of patients with a formal diagnosis of Bell's palsy were identified with 39,292 (92%) adults and 3,754 (8%) children (< 18 years old), respectively. Steroids were provided to 50.1% of children and 59.8% of adults and antivirals were prescribed to 26.2 and 39.4% of the children and adults, respectively. Within the first 2 years after diagnosis, 0.5% of children and 0.9% of adults received surgery, 0.1% of children and 0.8% of adults received botulinum toxin treatments, and 10.9% of children and 21.5% of adults received rehabilitation services. Despite the limitations of a claims database study, results showing trends in care of facial paralysis are still nonsurgical with many patients receiving no treatment at all. Although limited literature has shown an increase in the use of pharmacotherapy as well as techniques including physiotherapy, chemodenervation, and various surgical therapies, these interventions may be underutilized.
Collapse
Affiliation(s)
- Tom Shokri
- Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Robert Saadi
- Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| | - Jessyka G Lighthall
- Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
32
|
Shokri T, Lighthall JG. Telemedicine in the Era of the COVID-19 Pandemic: Implications in Facial Plastic Surgery. Facial Plast Surg Aesthet Med 2020; 22:155-156. [PMID: 32302225 DOI: 10.1089/fpsam.2020.0163] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
33
|
Tsay AJ, Paine AR, Lighthall JG, Choi KY, Hebel J, Flamm A. A possible pitfall of Mohs surgery in collision tumor diagnosis: A case of a squamous cell carcinoma of the scalp overlying a metastatic breast lesion of the skull. JAAD Case Rep 2020; 6:119-121. [PMID: 32016155 PMCID: PMC6992889 DOI: 10.1016/j.jdcr.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Annie J Tsay
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Allison R Paine
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jessyka G Lighthall
- Section of Facial Plastic and Reconstructive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Karen Y Choi
- Division of Otolaryngology-Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Jeanette Hebel
- Dermatology Associates of Lancaster, Lancaster, Pennsylvania
| | - Alexandra Flamm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
34
|
Saadi R, Loloi J, Schaefer E, Lighthall JG. Outcomes of Cadaveric Allograft versus Autologous Cartilage Graft in Functional Septorhinoplasty. Otolaryngol Head Neck Surg 2019; 161:779-786. [PMID: 31385746 DOI: 10.1177/0194599819866812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Our goal was to elucidate the efficacy and outcome profile of cadaveric allografts (homograft costal cartilage) in functional septorhinoplasty as compared with autografts (quadrangular cartilage, conchal cartilage, and autologous costal cartilage). STUDY DESIGN Retrospective chart review. SETTING Otolaryngology division of the Penn State Health Milton S. Hershey Medical Center. SUBJECTS AND METHODS A chart review of a single surgeon's practice was conducted with Current Procedural Terminology codes for septorhinoplasty (30410, 30420, 30430, 30435, 30450, 30465) from August 1, 2014, to August 1, 2017. All patients underwent functional septorhinoplasty for a chief complaint of nasal obstruction. Outcomes were collected up to 12 months following the operation and included the validated Nasal Obstruction Symptom Evaluation (NOSE), infection rate, malposition/warping of the graft, need for revision surgery, and graft loss. RESULTS A total of 171 cases were included in our data analysis. On multivariate analysis, there were no significant differences between patients who had autografts and those who had allografts in 3-, 6-, or 12-month postoperative NOSE score. Preoperative NOSE score was the only covariate to demonstrate a significant positive relationship to postoperative NOSE score. Regarding outcomes between autograft and allograft, no significant differences were found in rate of graft resorption (3.4% vs 5.6%, P = .680), graft warping (3.4% vs 0%, P = .309), infection (0% vs 1.9%, P = .316), or need for revision surgery (4.3% vs 5.6%, P = .709). CONCLUSION Autologous grafting is often the first choice in septorhinoplasty because of its presumed resistance to infection and resorption. Similar to autologous grafts, allografts are resistant to infection and resorption and demonstrate prolonged efficacy following functional septorhinoplasty.
Collapse
Affiliation(s)
- Robert Saadi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Justin Loloi
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Eric Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| |
Collapse
|
35
|
|
36
|
Abstract
Orbital apex syndrome (OAS) is a rare ocular complication following craniomaxillofacial trauma. This traumatic syndrome is a combination of features seen in both superior orbital fissure syndrome and traumatic orbital neuropathy due to nerve impingement. Due in part to the rarity of this disorder, the optimal treatment of traumatic OAS has yet to be determined. We present a case in which traumatic OAS was caused by direct compression due to a displaced fracture segment from the superior orbit. The patient was successfully treated with a combination of emergent decompression and urgent reconstruction suggesting that this may be an effective strategy in OAS resulting from direct nerve compression as a result of craniomaxillofacial fracture.
Collapse
Affiliation(s)
- Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Brad E Zacharia
- Department of Neurosurgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
37
|
Loyo M, Butts SC, Khan S, Brenner MJ, Allcroft R, Lighthall JG, Ishii LE. Assessment of Duration of Facial Plastic Ambulatory Surgery and Risk of Complications: A Systematic Review. JAMA FACIAL PLAST SU 2019; 21:167-168. [PMID: 30476941 DOI: 10.1001/jamafacial.2018.1636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Myriam Loyo
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Sydney C Butts
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University Hospital of Brooklyn/SUNY Downstate and Kings County Hospital Center, Brooklyn, New York
| | - Sami Khan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, New York
| | - Michael J Brenner
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor
| | - Roger Allcroft
- Allcroft Facial Plastic Surgery, Northampton, Massachusetts
| | - Jessyka G Lighthall
- Facial Plastic and Reconstructive Surgery, Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Lisa E Ishii
- Facial Plastic and Reconstructive Surgery Division, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland.,Associate Editor
| |
Collapse
|
38
|
Abstract
This article examines 6 questions about facial paralysis answered by 3 experts in their field of facial plastic surgery. The topics covered include routine assessment, neuromuscular training, nonsurgical management, and the future of this field. All the authors answered these questions in a "How I do it" manner to provide the reader with a true understanding of their thoughts and techniques. This article provides a practical resource to all physicians and practitioners treating patients with facial paralysis on some of the most common questions and issues.
Collapse
Affiliation(s)
- Travis T Tollefson
- Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, UC Davis Medical Center, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA 95817, USA
| | - Tessa A Hadlock
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive H-091, Hershey, PA 17033, USA.
| |
Collapse
|
39
|
Abstract
Facial aging involves a combination of volume loss and descent, loss of skin elasticity, dynamic lines due to facial mimetic muscle action, and development of static rhytids. Although surgery remains an option for treatment, minimally invasive aesthetic procedures continue to gain popularity with the use of neuromodulators and soft tissue fillers being the most sought-after procedures. Although these may be used in isolation to treat specific concerns, they are often combined to address multiple facets of aging. Multiple different neuromodulators and fillers are commercially available. Although relatively effective and safe, a thorough understanding of their indications, compositions, and potential adverse effects is paramount. This article will review the available aesthetic products for minimally invasive periorbital rejuvenation with botulinum toxin and injectable fillers. Although it will not focus on other therapies aimed at facial rejuvenation, such as resurfacing techniques or surgical interventions, it is important to note that an individualized treatment plan may combine multiple therapies to optimize patient outcomes and satisfaction.
Collapse
Affiliation(s)
- Jessyka G Lighthall
- Division of Otolaryngology-Head & Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
40
|
Saadi R, Oberman BS, Lighthall JG. Dog-Bite-Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature. Craniomaxillofac Trauma Reconstr 2017; 11:249-255. [PMID: 30574267 DOI: 10.1055/s-0037-1604073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/09/2017] [Indexed: 10/19/2022] Open
Abstract
Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite-related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1,069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study.
Collapse
Affiliation(s)
- Robert Saadi
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| | | | - Jessyka G Lighthall
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, The Pennsylvania State University, Hershey, Pennsylvania
| |
Collapse
|
41
|
|
42
|
Abstract
Prophylactic antibiotic use in facial plastic surgery is a highly controversial topic primarily due to the lack of evidence in support of or against antibiotic use. In this section the authors present the available literature on the most commonly performed procedures within facial plastic surgery in an attempt to see if the data support or contradict the need for antibiotic prophylaxis in facial plastic surgery.
Collapse
Affiliation(s)
- Javier González-Castro
- Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, PO Box 16423, San Juan, PR 00908, USA.
| | - Jessyka G Lighthall
- Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, 500 University Drive H091, Hershey, PA 17033, USA
| |
Collapse
|
43
|
Abstract
Complications and prevention of complications in brow lift are presented. A discussion of anatomic features of the brow introduces the article in keeping with the focus that a thorough understanding of the anatomy, patient variations, and potential complications is requisite for surgeons performing forehead rejuvenation. The varying approaches to brow lift are discussed. Complications reviewed are bleeding, nerve injury, scarring, alopecia, brow asymmetry, and brow elevation overcorrection or undercorrection.
Collapse
Affiliation(s)
- Jessyka G Lighthall
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health and Science University, Mailcode: SJH-01, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | | |
Collapse
|
44
|
Affiliation(s)
| | | | - Mark K. Wax
- Oregon Health and Science University Portland, Oregon, USA
| |
Collapse
|
45
|
Lighthall JG, Cain R, Ghanem TA, Wax MK. Effect of Postoperative Aspirin on Outcomes in Microvascular Free Tissue Transfer Surgery. Otolaryngol Head Neck Surg 2012; 148:40-6. [DOI: 10.1177/0194599812463320] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Examine if outcomes and complication rates for free flaps vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation. Study Design Case series with chart review. Setting Oregon Health and Science University, an academic medical center. Subjects and Methods A case series with chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, reexploration, and salvage. Chi-square analysis was performed to identify differences based on type of postoperative antithrombotic therapy. Results A total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received aspirin, 48 received low molecular weight heparin or a combination of agents, and 16 received a heparin drip. The overall complication rate was 38%, with significantly more complications in the aspirin group compared with no prophylaxis ( P = .002). There was no significant difference in bleeding complications ( P = .192) or flap failure ( P = .839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group ( P = .039). Conclusion Postoperative thromboprophylaxis with aspirin after microvascular free tissue transfer does not provide an improvement in free flap survival and may be associated with a higher complication rate. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.
Collapse
Affiliation(s)
- Jessyka G. Lighthall
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Rachel Cain
- College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Tamer A. Ghanem
- Department of Otolaryngology–Head and Neck Surgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Mark K. Wax
- Department of Otolaryngology–Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
46
|
Abstract
Objective: The Accreditation Council for Graduate Medical Education’s (ACGME) structuring of resident education attempts to utilize mentoring relationships to augment trainee development. The purpose of the current study is to better understand the nature of the mentor-mentee relationship and find areas that should be strengthened or de-emphasized. Method: The Mentorship Program in the Department of Otolaryngology–Head and Neck Surgery at Oregon Health and Science University has existed for 10 years. Mentor-mentee pairs are assigned upon matriculation. Pairs are required to meet biannually at minimum. Guidelines for discussion topics are provided. All residents and faculty participants were surveyed online. Results: Nineteen mentors and 24 mentees completed the survey, a 100% response rate. Mentor personality traits most important to residents were honesty/integrity (93%) and supportiveness (88%), while the least important characteristics were race (100%) and gender (83%). Mentor-mentee pairs discussed a wide variety of topics. At the completion of training, only 26% of residents felt comfortable with transition to private practice and contract negotiations. These topics were also the least frequently discussed. Eighty-three percent of trainees sought additional mentorship from other faculty. Eighty-seven percent of mentors would not care if mentees changed mentors. Overall, 82% of participants endorsed continuing the program. Conclusion: Mentorship programs are an effective tool in facilitating resident development. Residents would prefer choosing their own mentor and value honesty and supportiveness. Topics relating to private practice and contract negotiations were the areas of greatest discomfort for residents and the least frequently discussed. This represents an area for improvement.
Collapse
|
47
|
Malkoski SP, Haeger SM, Cleaver TG, Rodriguez KJ, Li H, Lu SL, Feser WJ, Barón AE, Merrick D, Lighthall JG, Ijichi H, Franklin W, Wang XJ. Loss of transforming growth factor beta type II receptor increases aggressive tumor behavior and reduces survival in lung adenocarcinoma and squamous cell carcinoma. Clin Cancer Res 2012; 18:2173-83. [PMID: 22399565 DOI: 10.1158/1078-0432.ccr-11-2557] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Lung adenocarcinoma and lung squamous cell carcinoma (SCC) are the most common non-small cell lung cancer (NSCLC) subtypes. This study was designed to determine whether reduced expression of TGFβ type II receptor (TGFβRII) promotes lung adenocarcinoma and SCC carcinogenesis. EXPERIMENTAL DESIGN We examined TGFβRII expression at the protein and mRNA levels in human NSCLC samples and assessed the relationship between TGFβRII expression and clinicopathologic parameters. To determine whether sporadic TGFβRII deletion in airway epithelial cells induces NSCLC formation, we targeted TGFβRII deletion alone and in combination with oncogenic Kras(G12D) to murine airways using a keratin 5 (K5) promoter and inducible Cre recombinase. RESULTS Reduced TGFβRII expression in human NSCLC is associated with male gender, smoking, SCC histology, reduced differentiation, increased tumor stage, increased nodal metastasis, and reduced survival. Homozygous or heterozygous TGFβRII deletion in mouse airway epithelia increases the size and number of Kras(G12D)-initiated adenocarcinoma and SCC. TGFβRII deletion increases proliferation, local inflammation, and TGFβ ligand elaboration; TGFβRII knockdown in airway epithelial cells increases migration and invasion. CONCLUSIONS Reduced TGFβRII expression in human NSCLC is associated with more aggressive tumor behavior and inflammation that is, at least partially, mediated by increased TGFβ1 expression. TGFβRII deletion in mouse airway epithelial cells promotes adenocarcinoma and SCC formation, indicating that TGFβRII loss plays a causal role in lung carcinogenesis. That TGFβRII shows haploid insufficiency suggests that a 50% TGFβRII protein reduction would negatively impact lung cancer prognosis.
Collapse
Affiliation(s)
- Stephen P Malkoski
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Pathology, Colorado School of Public Health, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
Objective: Examine if flap outcomes and complication rates in free tissue transfer surgery performed by a single microvascular surgeon vary when postoperative aspirin is used as pharmacologic thromboprophylaxis compared with no anticoagulation. Method: A retrospective chart review was performed using a prospectively maintained microvascular reconstructive database to identify cases of free tissue transfer between February 2006 and April 2010. Outcome variables included complications, flap failure, re-exploration, and salvage. Chi square analysis was performed to identify differences based on type of postoperative antithrombotic therapy. Results: A total of 390 consecutive free tissue transfer procedures were performed; 184 received no postoperative thromboprophylaxis, 142 received only aspirin, and 54 received a combination of agents. The overall complication rate was 38% with significantly more complications in the aspirin group compared with no prophylaxis ( P = .002). There was no significant difference in bleeding complications ( P = .192) or flap failure ( P = .839) between aspirin and no anticoagulation. There were more postoperative revisions in the aspirin group ( P = .039) with a trend toward a higher salvage rate in these cases ( P = .058) when compared with the no prophylaxis group. Conclusion: Postoperative thromboprophylaxis with aspirin after microvascular free tissue transfer is associated with a higher complication rate without an increase in bleeding or improvement in free flap survival in our series. Prospective, randomized studies are required to elucidate the role of postoperative pharmacotherapy for prophylaxis against microvascular thrombosis.
Collapse
|
49
|
Malkoski SP, Cleaver TG, Lu SL, Lighthall JG, Wang XJ. Keratin promoter based gene manipulation in the murine conducting airway. Int J Biol Sci 2010; 6:68-79. [PMID: 20140084 PMCID: PMC2815352 DOI: 10.7150/ijbs.6.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 01/15/2010] [Indexed: 01/06/2023] Open
Abstract
Systems capable of targeting genetic manipulations to keratin-positive airway basal cells are more poorly developed than systems targeting other airway epithelial cell populations and this has likely hindered development of animal models of diseases such as lung squamous cell carcinoma. Although keratin promoter driven-Cre recombinase constructs are potentially useful for targeting these cells, these constructs have substantially higher activity in the skin and oral epithelium than in the airways. We developed a method for delivering RU486, the conditional activator of Cre recombinase progesterone receptor (CrePR) fusion proteins to the lung and then examined the activity of three keratin-driven CrePR constructs in the conducting airways. We also developed a technique for survival bronchioalveolar lavage on non-ventilated animals to examine the effects of the acetone/oil vehicle required to deliver RU486 to the lung. K5CrePR1 and K14CrePR1 constructs differ only in the keratin promoter used to target CrePR1 expression while K5Cre*PR contains a truncated progesterone receptor designed to reduce RU486-independent Cre activity. While all three constructs demonstrate RU486-inducible Cre activity in the conducting airways, both construct activity and tightness of regulation vary considerably. K5Cre*PR is the most tightly regulated Cre driver making it ideal for targeting somatic mutations to the airway epithelia while K5CrePR1 and K14CrePR1 may be better suited to studying diseases of the conducting airways where gene targeting of keratin expressing cells and their derivatives is desired.
Collapse
Affiliation(s)
- Stephen P Malkoski
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Health Sciences Center, Aurora, CO, USA.
| | | | | | | | | |
Collapse
|