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  • 1
    Online Resource
    Online Resource
    Evaluation of capsular contracture following immediate prepectoral versus subpectoral direct-to-implant breast reconstruction
    Springer Science and Business Media LLC ; 2020
    In:  Scientific Reports Vol. 10, No. 1 ( 2020-01-24)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 10, No. 1 ( 2020-01-24)
    Abstract: Capsular contracture is a common adverse outcome following implant breast reconstruction, often associated with radiation treatment. The authors hypothesize that muscle fibrosis is the main contributor of breast reconstruction contracture after radiation. Retrospective chart review identified patients that underwent DTI reconstruction with pre-or post-operative breast irradiation. Signs of capsular contracture were assessed using clinic notes and independent graders reviewing two-dimensional images and anatomic landmarks. Capsular contracture rate was greater in the subpectoral vs. prepectoral group (n = 28, 51.8% vs. n = 12, 30.0%, p = 0.02). When compared to prepectoral DTI reconstruction in irradiated patients, subpectoral implant placement was nearly 4 times as likely to result in capsular contracture (p  〈  0.01). Rates of explantation, infection, tissue necrosis, and hematoma were comparable between groups. We also found that when subpectoral patients present with breast contracture, chemoparalysis of the muscle alone can resolve breast asymmetry, corroborating that muscle is a key contributor to breast contracture. As prepectoral breast reconstruction is gaining popularity, there have been questions regarding outcome following radiation treatment. This study suggest that prepectoral breast reconstruction is safe in an irradiated patient population, and in fact compares favorably with regard to breast contracture.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-020-58094-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2615211-3
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  • 2
    Online Resource
    Online Resource
    Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Plastic & Reconstructive Surgery Vol. 145, No. 5 ( 2020-05), p. 898e-908e
    Details
    In: Plastic & Reconstructive Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 145, No. 5 ( 2020-05), p. 898e-908e
    Abstract: Continued evolution of implant-based breast reconstruction involves immediate placement of the implant above the pectoralis muscle. The shift to prepectoral breast reconstruction is driven by goals of decreasing morbidity such as breast animation deformity, range-of-motion problems, and pain, and is made possible by improvements in mastectomy skin flap viability. To define clinical factors to guide patient selection for direct-to-implant prepectoral implant reconstruction, this study compares safety endpoints and risk factors between prepectoral and subpectoral direct-to-implant breast reconstruction cohorts. The authors hypothesized that prepectoral direct-to-implant breast reconstruction is a safe alternative to subpectoral direct-to-implant breast reconstruction. Methods: Retrospective chart review identified patients who underwent prepectoral and subpectoral direct-to-implant breast reconstruction, performed by a team of five surgical oncologists and two plastic surgeons. Univariate analysis compared patient characteristics between cohorts. A penalized logistic regression model was constructed to identify relationships between postoperative complications and covariate risk factors. Results: A cohort of 114 prepectoral direct-to-implant patients was compared with 142 subpectoral direct-to-implant patients. The results of the penalized regression model demonstrated equivalence in safety metrics between prepectoral direct-to-implant and subpectoral direct-to-implant breast reconstruction, including seroma ( p = 0.0883), cancer recurrence ( p = 0.876), explantation ( p = 0.992), capsular contracture ( p = 0.158), mastectomy skin flap necrosis ( p = 0.769), infection ( p = 0.523), hematoma ( p = 0.228), and revision ( p = 0.122). Conclusions: This study demonstrates that prepectoral direct-to-implant reconstruction is a safe alternative to subpectoral direct-to-implant reconstruction. Given the low morbidity and elimination of animation deformity, prepectoral direct-to-implant reconstruction should be considered when the mastectomy skin flap is robust. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
    Type of Medium: Online Resource
    ISSN: 0032-1052
    URL: Article
    DOI: 10.1097/PRS.0000000000006721
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2037030-1
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  • 3
    Online Resource
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    Type 3 Laryngeal Clefts Presenting with Upper Airway Obstruction without Aspiration
    Wiley ; 2024
    In:  The Laryngoscope Vol. 134, No. 2 ( 2024-02), p. 977-980
    Details
    In: The Laryngoscope, Wiley, Vol. 134, No. 2 ( 2024-02), p. 977-980
    Abstract: Traditionally, otolaryngologists are taught that the defining clinical feature of a laryngeal cleft is aspiration. However, in a small subset of patients—even those with extensive clefts—the sole presenting feature may be airway obstruction. Here, we report two cases of type III laryngeal clefts that presented with upper airway obstruction without aspiration. The first patient was a 6‐month‐old male with history of tracheoesophageal fistula (TEF) who presented with noisy breathing, initially thought to be related to tracheomalacia. Polysomnogram (PSG) demonstrated moderate OSA and modified barium swallow (MBS) was negative for aspiration. In‐office laryngoscopy was notable for a mismatch of tissue in the interarytenoid region. A type III laryngeal cleft was identified on bronchoscopy, and airway symptoms resolved after endoscopic repair. The second patient was a 4‐year‐old male with a diagnosis of asthma who presented with progressive exercise‐induced stridor and airway obstruction. In‐office flexible laryngoscopy revealed redundant tissue in the posterior glottis and MBS was negative for aspiration. He was found to have a type III laryngeal cleft on bronchoscopy and his stridor and upper airway obstruction resolved after endoscopic repair. While aspiration is the most common presenting symptom of a laryngeal cleft, it is important to consider that patients can have a cleft in the absence of dysphagia. Laryngeal cleft should be included in the differential diagnosis for patients with obstructive symptoms not explained by other etiologies and in those with suspicious features on flexible laryngoscopy. Laryngeal cleft repair is recommended to restore normal anatomy and relieve obstructive symptoms. Laryngoscope , 134:977–980, 2024
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v134.2
    DOI: 10.1002/lary.30849
    Language: English
    Publisher: Wiley
    Publication Date: 2024
    detail.hit.zdb_id: 2026089-1
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  • 4
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    Online Resource
    Incorporating Virtual Reality to Improve Otolaryngology Resident Wellness: One Institution's Experience
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 9 ( 2021-09), p. 1972-1976
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 9 ( 2021-09), p. 1972-1976
    Abstract: Burnout is defined as work‐related emotional exhaustion, depersonalization, and decreased sense of accomplishment. Virtual reality (VR) has emerged as an effective treatment modality for various conditions related to anxiety, however, few studies have assessed its role for stress management in residents. We hypothesize that VR‐based mindfulness meditation can reduce resident burnout in real‐world settings. Study Design Prospective randomized crossover trial. Methods Resident participants completed the validated Maslach Burnout Inventory (MBI). One group used a VR‐based meditation app; the second group received no intervention. After a 2‐month rotation, all subjects completed an MBI and crossed over to the other arm. Wilcoxon rank‐sum tests were used to compare MBI scores before and after intervention, and to compare results by gender and postgraduate year. Mann‐Whitney U tests were used to assess qualitative differences between participants. Results Eighteen residents completed the study. Five participants were female and 13 were male. Weekly use of VR‐guided meditation and paced breathing was associated with a significant decrease in emotional exhaustion ( P  = .009), and on subgroup analysis, male gender specifically was associated with a decrease in emotional exhaustion ( P  = .027). In the post‐intervention survey, 42.9% subjects reported that VR encouraged them to employ paced breathing techniques, 71.4% reported that they would use the technology if regularly available, and 21.4% reported they would use paced breathing in the future. Conclusion VR‐based therapy may serve as a successful tool in stress management and reduce the rate of burnout among otolaryngology residents. Level of Evidence NA Laryngoscope , 131:1972–1976, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.9
    DOI: 10.1002/lary.29529
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2026089-1
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  • 5
    Online Resource
    Online Resource
    Review of literature of saddle nose deformity reconstruction and presentation of vomer onlay graft
    Wiley ; 2020
    In:  Laryngoscope Investigative Otolaryngology Vol. 5, No. 6 ( 2020-12), p. 1039-1043
    Details
    In: Laryngoscope Investigative Otolaryngology, Wiley, Vol. 5, No. 6 ( 2020-12), p. 1039-1043
    Abstract: Saddle nose deformity is a well‐described condition that most commonly results from trauma or prior surgery. For larger saddle nose deformity defects, bone grafts are a reconstructive option that provide adequate structure for repair. One new technique for repair of these deformities is a vomerian bone onlay graft. We aim to provide a review of literature on autogenous repair of saddle nose deformities, as well as introduce a new technique in which the vomer bone is used as an onlay bone graft. Methods Literature review and case series. Five cases in which vomer onlay grafts were used for repair of saddle nose deformity were reviewed between January 2013 and December 2015. Aesthetic outcomes and postoperative complications were evaluated at subsequent follow‐up visits in clinic. Results In all cases where vomer bone was harvested, the vomer onlay graft provided adequate structure to traverse the saddle nose deformity. No postoperative complications were observed in an 18 month follow‐up period. Conclusion Vomerian bone onlay grafts are a reconstructive option for saddle nose deformity and nasal dorsum defects. While septal cartilage is commonly used, and ethmoidal bone has been previously described as an option for composite graft reconstruction, vomer bone onlay grafting has not been well described in the literature. This method may be of use when previous nasal surgery has been performed and standard septal cartilage is not possible to harvest. The aesthetic outcomes following nasal dorsum reconstruction using onlay grafts are favorable, but long‐term outcomes of these grafts require further study. Level of Evidence IV.
    Type of Medium: Online Resource
    ISSN: 2378-8038 , 2378-8038
    URL: Issue
    URL: Article
    DOI: 10.1002/lio2.v5.6
    DOI: 10.1002/lio2.475
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2851702-7
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  • 6
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    Food and Drug Administration Guidance Documents and New Medical Devices: The Case of Breast Prostheses
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  American Journal of Therapeutics Vol. 28, No. 1 ( 2021-01), p. e127-e130
    Details
    In: American Journal of Therapeutics, Ovid Technologies (Wolters Kluwer Health), Vol. 28, No. 1 ( 2021-01), p. e127-e130
    Type of Medium: Online Resource
    ISSN: 1075-2765
    URL: Article
    DOI: 10.1097/MJT.0000000000000888
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2026900-6
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  • 7
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    The Impact of Upper Lateral Cartilage Release on Patient‐Perceived Nasal Appearance and Obstruction
    Wiley ; 2022
    In:  The Laryngoscope Vol. 132, No. 6 ( 2022-06), p. 1189-1195
    Details
    In: The Laryngoscope, Wiley, Vol. 132, No. 6 ( 2022-06), p. 1189-1195
    Abstract: Although upper lateral cartilages are commonly released from the dorsum of the septum during spreader graft placement in septorhinoplasty (SRP), there has been a focus on maintaining integrity of connections in the middle vault. Avoiding release of upper lateral cartilages in certain patient groups may represent an early step in this paradigm shift. We aim to assess satisfaction with nasal appearance and correction of nasal obstruction in patients who underwent SRP with spreader graft placement without upper lateral cartilage release and compared it to the traditional upper lateral cartilage release cohort. Study Design Prospective cohort study. Methods A total of 559 patients who underwent SRP with spreader graft placement with upper lateral cartilage release and 30 patients who underwent SRP with spreader graft placement without release between 2012 and 2020 were administered the Nasal Obstruction Symptom Evaluation (NOSE), FACE‐Q Satisfaction with Nose, and FACE‐Q Social Functioning scales pre‐ and postoperatively. Pre‐ and postoperative NOSE FACE‐Q, and negative inspiratory force (NIF) scores and changes were compared between groups. Results Results demonstrated clinically and statistically significant improvement at follow‐up for both groups. There was no significant difference between groups in mean improvement of NOSE, FACE‐Q, and NIF scores at time of last follow‐up. Conclusion SRP with spreader graft placement with and without upper lateral cartilage release provide clinically and statistically significant improvement, and no significant difference in functional outcome. This suggests that upper lateral cartilages do not need to be released to achieve functional improvement and that surgeons should consider whether release is necessary to achieve goals of surgery. Level of Evidence 3 Laryngoscope , 132:1189–1195, 2022
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v132.6
    DOI: 10.1002/lary.29872
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2026089-1
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  • 8
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    Patient‐Perceived Nasal Appearance After Septorhinoplasty With Spreader Versus Extended Spreader Graft
    Wiley ; 2021
    In:  The Laryngoscope Vol. 131, No. 4 ( 2021-04), p. 765-772
    Details
    In: The Laryngoscope, Wiley, Vol. 131, No. 4 ( 2021-04), p. 765-772
    Abstract: Standard spreader grafts (SSGs) are commonly used in septorhinoplasty to treat internal nasal valve narrowing and have been shown to improve nasal airway obstruction. Extended spreader grafts (ESGs) have also been proven effective for correcting nasal deviation. To date, the effectiveness of ESGs using patient‐reported outcome measures has not been demonstrated, and results of ESGs have not been compared to SSGs. This study aims to assess satisfaction and nasal appearance in patients who have undergone septorhinoplasty with SSG versus ESG. Study Design Prospective cohort study. Methods Five hundred sixty‐eight patients who underwent septorhinoplasty with SSGs and 126 patients who underwent septorhinoplasty with ESGs between 2012 and 2018 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale and FACE‐Q Satisfaction With Nose, FACE‐Q Satisfaction With Nostrils, and FACE‐Q Social Functioning scales pre‐ and postoperatively. Pre‐ and postoperative NOSE and FACE‐Q scores, negative inspiratory force (NIF), and changes in these values were compared between groups. Results Results demonstrated clinically and statistically significant improvement at follow‐up for both groups. There was no significant difference between the SSG and ESG groups in mean improvement of NOSE scores, FACE‐Q scores, and NIF at follow‐up of 6 months and at 12 months. Conclusions This study demonstrates that SSGs and ESGs both provide clinically and statistically significant improvement, and no significant difference in functional outcome. Both techniques can be effective. The etiology of the nasal obstruction and/or deformity should be considered when deciding which type of spreader graft to use. Level of Evidence 3 Laryngoscope , 131:765–772, 2021
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v131.4
    DOI: 10.1002/lary.28974
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 9
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    How Many Nodes to Take? Lymph Node Ratio Below 1/3 Reduces Papillary Thyroid Cancer Nodal Recurrence
    Wiley ; 2022
    In:  The Laryngoscope Vol. 132, No. 9 ( 2022-09), p. 1883-1887
    Details
    In: The Laryngoscope, Wiley, Vol. 132, No. 9 ( 2022-09), p. 1883-1887
    Abstract: Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid malignancies; risk of PTC recurrence over a 30‐year period is approximately 30%, of which 70% occur as nodal metastases. Patients with nodal disease who are treated with therapeutic dissection are at higher risk for recurrence, but optimal nodal yield has not been defined. We aim to determine variables predictive of nodal recurrence of PTC within the first 5 years of surgery, with a focus on lymph node ratio (LNR), to inform clinical decision‐making. Methods Retrospective chart review identified 41 patients with nodal recurrence of PTC and 284 without nodal recurrence following thyroid surgery from 2000 to 2015. Cohorts were compared with regards to clinical history, surgical findings, and tumor characteristics. Results The fraction of the patients who underwent therapeutic central or lateral lymph node dissection was significantly higher in the nodal recurrence cohort. Maximum tumor size, presence of extrathyroidal extension, largest lymph node focus, LNR, postoperative thyroglobulin level, and administration of postoperative radioactive iodine were significantly increased in the PTC nodal recurrence group. LNR greater than 0.3 held the highest level of significance as a binary cutoff and captured the larger proportion of patients in the nodal recurrence cohort (68.3%). Conclusion This study demonstrates characteristics to help assess risk of nodal recurrence of PTC and suggests LNR of lower than 0.3 is optimal to reduce risk of recurrence. The next steps include cohort studies to validate findings and weight variable analysis to optimize the extent of surgical therapeutic dissection. Level of Evidence 4 Laryngoscope , 132:1883–1887, 2022
    Type of Medium: Online Resource
    ISSN: 0023-852X , 1531-4995
    URL: Issue
    URL: Article
    DOI: 10.1002/lary.v132.9
    DOI: 10.1002/lary.30084
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 10
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    Abstract 29: Prepectoral Direct-to-Implant Breast Reconstruction: Safety Outcome Endpoints and Delineation of Risk Factors
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Plastic and Reconstructive Surgery - Global Open Vol. 7, No. 4S ( 2019-04), p. 21-21
    Details
    In: Plastic and Reconstructive Surgery - Global Open, Ovid Technologies (Wolters Kluwer Health), Vol. 7, No. 4S ( 2019-04), p. 21-21
    Type of Medium: Online Resource
    ISSN: 2169-7574
    URL: Article
    DOI: 10.1097/01.GOX.0000558303.44145.0e
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 2723993-7
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