Publications by authors named "Ariel Frost"

8 Publications

  • Page 1 of 1

Evaluation of an interactive virtual surgical rotation during the COVID-19 pandemic.

World J Otorhinolaryngol Head Neck Surg 2021 Apr 24. Epub 2021 Apr 24.

Department of Otorhinolaryngology - Head & Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, U.S.A.

Objective: To evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology - Head and Neck Surgery (OHNS) medical student elective during the COVID-19 pandemic.

Study Design: A virtual OHNS elective was created, with three components: (1) interactive virtual operating room (OR) experience using live-stream video-conferencing, (2) telehealth clinic, (3) virtual didactics.

Setting: OHNS Department at the University of Pennsylvania (May 2020 to June 2020).

Methods: Six medical students from the University of Pennsylvania; five attending otolaryngologists. Two surveys were designed and distributed to participating medical students and attending surgeons. Surveys included 5-point Likert scale items, with 1 indicating "not at all" and 5 indicating "very much so".

Results: Response rate was 100% for both surveys. Students on average rated the educational value of the telehealth experience as 4.2±1.2, and the virtual OR experience as 4.0±0.6. Most students (=5, 83%) indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation (LOR) for residency if needed, while attending surgeons had an average response of 3.0±1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation. A majority of students (=4, 67%) felt they connected enough with faculty during the rotation to ask for mentorship. Half the students (=5, 50%) indicated that the rotation allowed them to evaluate the department's culture either "extremely well" or "somewhat well".

Conclusions: Overall, participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience. With the continued suspension of visiting student rotations due to the COVID-19 pandemic, this virtual model may have continued relevance to medical education.
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http://dx.doi.org/10.1016/j.wjorl.2021.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064875PMC
April 2021

Radiofrequency Rejuvenation of the "Tweener" Patient: Under, Over, or Through the Skin.

Facial Plast Surg 2021 Apr 28;37(2):240-248. Epub 2021 Jan 28.

Division of Facial Plastic Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.

The demand for noninvasive facial rejuvenation continues to increase as younger, well-informed patients enter the aesthetic market. We refer to a subset of these patients as "tweeners," those who present with early signs of neck and facial aging, but who have not yet developed changes significant enough to warrant a traditional excisional surgery approach. Many of these patients are in search of a minimally invasive intervention, a bridge in between observation and surgery. The authors describe their experience with radiofrequency (RF) technology as an in-office tool to address the aging face in a select patient population. This review also attempts to comprehensively search the existing body of literature to describe the RF technologies and devices available for facial rejuvenation. The efficacy and safety profiles of the devices are discussed, and the devices are categorized by their method of RF delivery-over (contact), through (microneedle), and under (percutaneous) the skin.
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http://dx.doi.org/10.1055/s-0041-1722890DOI Listing
April 2021

Intensive Care Versus Nonintensive Care Ward for Postoperative Management of Head and Neck Free Flaps: A Meta-Analysis.

Facial Plast Surg Aesthet Med 2020 Oct 13. Epub 2020 Oct 13.

Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Although advances in surgical technique and medical management have drastically improved outcomes of free flap reconstructive surgery in head and neck patients, there is no clear consensus on appropriate level of postoperative care. The literature was searched systematically for all comparative studies of intensive care unit (ICU) and non-ICU admissions for head and neck patients. The primary outcomes were flap failure rate, flap complications, and hospital length of stay (LOS). Secondary outcomes included cost implications, medical complications, and rates of revision surgery, readmission, and mortality. Nine articles (2510 patients) were included. Patients admitted to non-ICU wards were not significantly at increased risk for free flap failure, flap-related complications, or longer LOS. Total medical complications were found to have a pooled relative risk (RR) of 0.57 [95% confidence interval (CI) 0.40 to 0.83], favoring the non-ICU cohort. In particular, the non-ICU cohort was less likely to develop neuropsychiatric complications (RR 0.34 [95% CI 0.24 to 0.48]) and sepsis (RR 0.18 [95% CI 0.05 to 0.68]) with no difference in cardiovascular or pulmonary complications. Patients admitted to non-ICU wards did not experience higher rates of adverse flap-related outcomes and had decreased risk of developing medical complications in the studies included in this meta-analysis.
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http://dx.doi.org/10.1089/fpsam.2020.0400DOI Listing
October 2020

Iatrogenic Tracheal Injuries: Case Series and Review of the Literature.

ORL J Otorhinolaryngol Relat Spec 2021 9;83(2):123-126. Epub 2020 Dec 9.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Iatrogenic tracheal injuries are an uncommon but serious complication of endotracheal tube intubation. We present two cases that illustrate iatrogenic tracheal injuries presenting hours after the time of their injury. This report addresses the critical diagnostic evaluation and management of iatrogenic tracheal injuries resulting from endotracheal intubation.
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http://dx.doi.org/10.1159/000511712DOI Listing
December 2020

Gore-Tex implant extrusion following revision medialization thyroplasty: Case report and review of the literature.

World J Otorhinolaryngol Head Neck Surg 2020 Sep 19. Epub 2020 Sep 19.

Department of Otorhinolaryngology, Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.

Objective: To review current literature and experience with Gore-TexⓇ implant extrusion following medialization thyroplasty, as well as to report the unique case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty.

Methods: Review of existing literature and description of personal experience with unique case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty.

Results: Review of existing literature found no prior reported cases of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Risk factors for implant extrusion include the pressure of the implant on insertion and the inability to secure the implant. Cases of implant extrusion can be managed operatively via an endoscopic or via an external open approach.

Conclusion: This is the first reported case of Gore-TexⓇ implant extrusion following revision medialization thyroplasty. Careful consideration should be given in revision medialization thyroplasty as additional implant material may cause increased pressure, a risk factor for implant extrusion.
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http://dx.doi.org/10.1016/j.wjorl.2020.08.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502009PMC
September 2020

Interactive Virtual Surgical Education During COVID-19 and Beyond.

Acad Med 2020 11;95(11):e9

Professor, Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, director, Division of Head and Neck Surgery, University of Pennsylvania, and director, Cancer Service Line, Abramson Cancer Center at Pennsylvania Hospital, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1097/ACM.0000000000003609DOI Listing
November 2020

Creation of an Interactive Virtual Surgical Rotation for Undergraduate Medical Education During the COVID-19 Pandemic.

J Surg Educ 2021 Jan-Feb;78(1):346-350. Epub 2020 Jul 1.

Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Objective: During the coronavirus 2019 pandemic, medical student involvement in direct patient care has been severely limited. Rotations mandatory not only for core curricula but also for informing decisions regarding specialty choice have been postponed during a critical window in the application cycle. Existing virtual rotations are largely observational or lack patient-facing components.

Setting: A virtual Otolaryngology - Head and Neck Surgery rotation at the University of Pennsylvania (Philadelphia, Pennsylvania) was implemented for medical students, comprising interactive live-streamed surgeries, outpatient telehealth visits, and virtual small group didactics.

Results: Medical students enrolled in the virtual surgical rotation were able to engage with attending surgeons and operating room staff while remotely viewing surgical procedures captured with first-person audiovisual technology. Students participated in several different aspects of care delivery in both the inpatient and outpatient setting, similar to their typical responsibilities of an in-person rotation.

Conclusions: The authors will continue to develop the virtual surgical education methodology to further disseminate an interactive video-based medical student elective to other procedural specialties and institutions.
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http://dx.doi.org/10.1016/j.jsurg.2020.06.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328635PMC
January 2021

Single-port transoral robotic combined approach with sialendoscopy for sialolithiasis: Case report and review of the literature.

Head Neck 2020 09 4;42(9):E12-E15. Epub 2020 Jul 4.

Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Background: The da Vinci single-port (SP) is utilized in transoral robotic surgery (TORS) procedures for malignant oropharyngeal tumors. We report a case utilizing the da Vinci SP in TORS for sialolith removal.

Methods And Results: A 75-year-old male with chronic right submandibular gland (SMG) sialadenitis underwent combined da Vinci SP TORS approach with sialendoscopy for multiple SMG sialoliths. We were unable to find a previous report of using the da Vinci SP in TORS for SMG sialolith removal.

Conclusion: The da Vinci SP has been utilized in a combined TORS approach with sialendoscopy for SMG sialolith removal. The da Vinci SP's additional arm provides improved retraction, enabling optimal visualization, dissection, and preservation of important structures such as the lingual nerve.
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http://dx.doi.org/10.1002/hed.26356DOI Listing
September 2020