Publications by authors named "Belachew Tessema"

29 Publications

  • Page 1 of 1

Solid-variant aneurysmal bone cysts in the craniofacial skeleton: the role of genomic analysis.

Childs Nerv Syst 2022 Aug 31;38(8):1615-1619. Epub 2022 Jan 31.

Division of Neurosurgery, Connecticut Children's, Hartford, CT, USA.

Background: Solid variant aneurysmal bone cysts (SVABCs) are a rare but well-described subtype of ABCs. While classic ABCs are readily identified radiographically, SVABCs lack these characteristic radiographic features and thus have a wide differential diagnosis on presentation (including Ewing sarcoma, Langerhans cell histiocytosis, osteosarcoma, metastasis, and giant cell tumor). Genomic/molecular analyses are often necessary for the diagnosis of SVABCs, with USP6 rearrangements being a characteristic finding. We present two cases in which genomic analysis was critical in the diagnosis of SVABCs and revealed unique gene fusions that may provide insight into SVABC pathogenesis.

Case Descriptions: Two 13-year old male children presented to our institution with new mass lesions involving the craniofacial skeleton. Magnetic resonance imaging (MRI) in both cases revealed predominantly solid, avidly enhancing masses, one of the squamous portion of the temporal bone, and the other arising from the sphenopalatine foramen with extension into the ipsilateral maxillary and ethmoid sinuses. Histopathology displayed predominantly solid morphology, and next generation sequencing (NGS) revealed a FAT1-USP6 gene fusion in the temporal lesion, and a MIR22HG-USP6 gene fusion in the maxillofacial lesion, the latter of which was not identified on fluorescence in situ hybridization (FISH). These findings were most consistent with a diagnosis of SVABC in each case.

Conclusions: These two cases highlight novel gene fusions in atypically located SVABCs and emphasize the ability of NGS to more accurately and consistently identify USP6 gene fusions, particularly in SVABCs that may otherwise be indistinguishable from alternative pathologies.
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http://dx.doi.org/10.1007/s00381-022-05447-1DOI Listing
August 2022

Continuation of telemedicine in otolaryngology post-COVID-19: Applications by subspecialty.

Am J Otolaryngol 2021 May-Jun;42(3):102928. Epub 2021 Jan 20.

University of Connecticut Health Center, Department of Otolaryngology-Head and Neck Surgery, United States of America.

Objective: The purpose of this paper is to review the literature and compile key clinically relevant applications of telemedicine for use in otolaryngology relevant to the post-COVID-19 era.

Study Design: Systematic Literature Review.

Data Sources: Pubmed and Google Scholar.

Review Methods: Pubmed and Google Scholar were queried using combined key words such as "telemedicine," "covid" and "otolaryngology." The searches were completed in March-August 2020. Additional queries were made with particular subspecialty phrases such as "rhinology" or "otology" to maximize yield of relevant titles. Relevant articles were selected for abstract review. Applicable abstracts were then selected for review of the full text.

Results: Initial search identified 279 results. These were screened for relevance and 100 abstracts were selected for review. Abstracts were excluded if they were not in English, not related to otolaryngology, or if the full text was unavailable for access. Of these, 37 articles were selected for complete review of the full text.

Conclusion: The sudden healthcare closures during the COVID-19 pandemic resulted in a sharp increase in the use of telemedicine, particularly in subspecialty fields. Otolaryngologists are at a unique risk of infection resulting from the examination of the head and neck and aerosol-generating procedures due to the predilection of viral particles for the nasal cavities and pharynx. The COVID-19 pandemic may have served as a catalyst to implement telemedicine into clinical practice, however identifying ways to integrate telemedicine long term is key for a sustainable and viable practice in the post-COVID-19 era. Although many states are now finding themselves on the down-sloping side of their infection rate curve, many others remain at the apex. Additionally, the risk of future waves of this pandemic, or the onset of another pandemic, should not be overlooked. Practice modification guidelines that mitigate infection risk by utilizing telemedicine would be useful in these instances. Telemedicine can help to reduce infection spread by limiting unnecessary in-person interactions and help conserve personal protective equipment (PPE) by facilitating remote care with the added benefits of expanding care to broad geographic areas, limiting cost, time, and travel burden on patients and families, and enabling consistent follow up.
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http://dx.doi.org/10.1016/j.amjoto.2021.102928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816955PMC
May 2021

Efficacy of Povidone-Iodine Nasal and Oral Antiseptic Preparations Against Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2).

Ear Nose Throat J 2021 Apr 21;100(2_suppl):192S-196S. Epub 2020 Sep 21.

Veloce BioPharma, Fort Lauderdale, FL, USA.

Introduction: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the global pandemic of coronavirus disease 2019 (COVID-19). From the first reported cases in December 2019, the virus has spread to over 4 million people worldwide. Human-to-human transmission occurs mainly through the aerosolization of respiratory droplets. Transmission also occurs through contact with contaminated surfaces and other fomites. Improved antisepsis of human and nonhuman surfaces has been identified as a key feature of transmission reduction. There are no previous studies of povidone iodine (PVP-I) against SARS-CoV-2. This study evaluated nasal and oral antiseptic formulations of PVP-I for virucidal activity against SARS-CoV-2. This is the first report on the efficacy of PVP-I against the virus that causes COVID-19.

Methods: Povidone iodine nasal antiseptic formulations and PVP-I oral rinse antiseptic formulations from 1% to 5% concentrations as well as controls were studied for virucidal efficacy against the SARS-CoV-2. Test compounds were evaluated for ability to inactivate SARS-CoV-2 as measured in a virucidal assay. SARS-CoV-2 was exposed directly to the test compound for 60 seconds, compounds were then neutralized, and surviving virus was quantified.

Results: All concentrations of nasal antiseptics and oral rinse antiseptics evaluated completely inactivated the SARS-CoV-2.

Conclusions: Nasal and oral PVP-I antiseptic solutions are effective at inactivating the SARS-CoV-2 at a variety of concentrations after 60-second exposure times. The formulations tested may help to reduce the transmission of SARS-CoV-2 if used for nasal decontamination, oral decontamination, or surface decontamination in known or suspected cases of COVID-19.
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http://dx.doi.org/10.1177/0145561320957237DOI Listing
April 2021

In Vitro Efficacy of a Povidone-Iodine Nasal Antiseptic for Rapid Inactivation of SARS-CoV-2.

JAMA Otolaryngol Head Neck Surg 2020 11;146(11):1054-1058

University of Connecticut School of Medicine, Farmington.

Importance: Research is needed to demonstrate the efficacy of nasal povidone-iodine (PVP-I) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Objective: To evaluate the in vitro efficacy of PVP-I nasal antiseptic for the inactivation of SARS-CoV-2 at clinically significant contact times of 15 and 30 seconds.

Interventions: The SARS-CoV-2, USA-WA1/2020 strain, virus stock was tested against nasal antiseptic solutions consisting of aqueous PVP-I as the sole active ingredient. Povidone-iodine was tested at diluted concentrations of 0.5%, 1.25%, and 2.5% and compared with controls. The test solutions and virus were incubated at mean (SD) room temperature of 22 (2) °C for time periods of 15 and 30 seconds.

Design And Setting: This controlled in vitro laboratory research study used 3 different concentrations of study solution and ethanol, 70%, as a positive control on test media infected with SARS-CoV-2. Test media without virus were added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol, 70%, was tested in parallel as a positive control and water only as a negative control.

Main Outcomes And Measures: The primary study outcome measurement was the log reduction value after 15 seconds and 30 seconds of given treatment. Surviving virus from each sample was quantified by standard end point dilution assay, and the log reduction value of each compound was compared with the negative (water) control.

Results: Povidone-iodine nasal antiseptics at concentrations (0.5%, 1.25%, and 2.5%) completely inactivated SARS-CoV-2 within 15 seconds of contact as measured by log reduction value of greater than 3 log10 of the 50% cell culture infectious dose of the virus. The ethanol, 70%, positive control did not completely inactivate SARS-CoV-2 after 15 seconds of contact. The nasal antiseptics tested performed better than the standard positive control routinely used for in vitro assessment of anti-SARS-CoV-2 agents at a contact time of 15 seconds. No cytotoxic effects on cells were observed after contact with each of the nasal antiseptics tested.

Conclusions And Relevance: Povidone-iodine nasal antiseptic solutions at concentrations as low as 0.5% rapidly inactivate SARS-CoV-2 at contact times as short as 15 seconds. Intranasal use of PVP-I has demonstrated safety at concentrations of 1.25% and below and may play an adjunctive role in mitigating viral transmission beyond personal protective equipment.
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http://dx.doi.org/10.1001/jamaoto.2020.3053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499242PMC
November 2020

Reducing transmission of SARS-CoV-2 in ophthalmology with nasal and oral decontamination.

Ther Adv Ophthalmol 2020 Jan-Dec;12:2515841420951392. Epub 2020 Aug 26.

ProHealth Ear Nose and Throat, Farmington, CT, USA.

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http://dx.doi.org/10.1177/2515841420951392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453452PMC
August 2020

Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses.

J Prosthodont 2020 Aug 24;29(7):599-603. Epub 2020 Jul 24.

Department of Otolaryngology, University of Connecticut Health Center, Farmington, CT.

Purpose: To evaluate the in vitro inactivation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with hydrogen peroxide (H O ) and povidone-iodine (PVP-I) oral antiseptic rinses at clinically recommended concentrations and contact times.

Materials And Methods: SARS-CoV-2, USA-WA1/2020 strain virus stock was prepared prior to testing by growing in Vero 76 cells. The culture media for prepared virus stock was minimum essential medium (MEM) with 2% fetal bovine serum (FBS) and 50 µg/mL gentamicin. Test compounds consisting of PVP-I oral rinse solutions and H O aqueous solutions were mixed directly with the virus solution so that the final concentration was 50% of the test compound and 50% of the virus solution. Thus PVP-I was tested at concentrations of 0.5%, 1.25%, and 1.5%, and H O was tested at 3% and 1.5% concentrations to represent clinically recommended concentrations. Ethanol and water were evaluated in parallel as standard positive and negative controls. All samples were tested at contact periods of 15 seconds and 30 seconds. Surviving virus from each sample was then quantified by standard end-point dilution assay and the log reduction value of each compound compared to the negative control was calculated.

Results: After the 15-second and 30-second contact times, PVP-I oral antiseptic rinse at all 3 concentrations of 0.5%, 1.25%, and 1.5% completely inactivated SARS-CoV-2. The H O solutions at concentrations of 1.5% and 3.0% showed minimal viricidal activity after 15 seconds and 30 seconds of contact time.

Conclusions: SARS-CoV-2 virus was completely inactivated by PVP-I oral antiseptic rinse in vitro, at the lowest concentration of 0.5 % and at the lowest contact time of 15 seconds. Hydrogen peroxide at the recommended oral rinse concentrations of 1.5% and 3.0% was minimally effective as a viricidal agent after contact times as long as 30 seconds. Therefore, preprocedural rinsing with diluted PVP-I in the range of 0.5% to 1.5% may be preferred over hydrogen peroxide during the COVID-19 pandemic.
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http://dx.doi.org/10.1111/jopr.13220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361576PMC
August 2020

SARS-CoV-2 Viral Inactivation Using Low Dose Povidone-Iodine Oral Rinse-Immediate Application for the Prosthodontic Practice.

J Prosthodont 2020 Jul 16;29(6):459. Epub 2020 Jun 16.

Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT.

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http://dx.doi.org/10.1111/jopr.13207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322989PMC
July 2020

Povidone-Iodine Use in Sinonasal and Oral Cavities: A Review of Safety in the COVID-19 Era.

Ear Nose Throat J 2020 Nov 10;99(9):586-593. Epub 2020 Jun 10.

University of Connecticut School of Medicine, Farmington, USA.

Objectives: Approaches to nasal and oral decontamination with povidone-iodine (PVP-I) have been published to reduce nosocomial spread of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). The safety of PVP-I topically applied to the nasal and oral cavity is addressed by a literature review. The specific efficacy of PVP-I against coronaviruses and its potential efficacy against SARS-CoV-2 is discussed.

Methods: A review was performed utilizing PubMed and Cochrane Databases. All citations in protocols for nasal and oral PVP-I use regarding COVID-19 were independently reviewed.

Results: Povidone-iodine has been safely administered for up to 5 months in the nasal cavity and 6 months in the oral cavity. Concentrations less than 2.5% in vitro do not reduce ciliary beat frequency or cause pathological changes in ciliated nasal epithelium, upper respiratory, or mucosal cells. Adverse events with oral use have not been reported in conscious adults or children. Allergy and contact sensitivity is rare. Chronic mucosal use up to 5% has not been shown to result in clinical thyroid disease. PVP-I is rapidly virucidal and inactivates coronaviruses, including SARS-CoV and Middle East Respiratory Syndrome (MERS).

Conclusions: Povidone-iodine can safely be used in the nose at concentrations up to 1.25% and in the mouth at concentrations up to 2.5% for up to 5 months. Povidone-iodine rapidly inactivates coronaviruses, including SARS and MERS, when applied for as little as 15 seconds. There is optimism that PVP-I can inactivate SARS-CoV-2, but in vitro efficacy has not yet been demonstrated.
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http://dx.doi.org/10.1177/0145561320932318DOI Listing
November 2020

Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse.

J Prosthodont 2020 Jul 16;29(6):529-533. Epub 2020 Jun 16.

Department of Otolaryngology, University of Connecticut Health Center, Farmington, CT.

Purpose: To investigate the optimal contact time and concentration for viricidal activity of oral preparation of povidone-iodine (PVP-I) against SARS-CoV-2 ('corona virus') to mitigate the risk and transmission of the virus in the dental practice.

Materials And Methods: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) USA-WA1/2020 strain, virus stock was tested against oral antiseptic solutions consisting of aqueous povidone-iodine (PVP-I) as the sole active ingredient. The PVP-I was tested at diluted concentrations of 0.5%, 1%, and 1.5%. Test media without any virus was added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol (70%) was tested in parallel as a positive control, and water only as a negative control. The test solutions and virus were incubated at room temperature (22 ± 2 °C) for time periods of 15 and 30 seconds. The solution was then neutralized by a 1/10 dilution in minimum essential medium (MEM) 2% fetal bovine serum (FBS), 50 µg/mL gentamicin. Surviving virus from each sample was quantified by standard end-point dilution assay and the log reduction value (LRV) of each compound compared to the negative (water) control was calculated.

Results: PVP-I oral antiseptics at all tested concentrations of 0.5%, 1%, and 1.5%, completely inactivated SARS-CoV-2 within 15 seconds of contact. The 70% ethanol control group was unable to completely inactivate SARS-CoV-2 after 15 seconds of contact, but was able to inactivate the virus at 30 seconds of contact.

Conclusions: PVP-I oral antiseptic preparations rapidly inactivated SARS-CoV-2 virus in vitro. The viricidal activity was present at the lowest concentration of 0.5 % PVP-I and at the lowest contact time of 15 seconds. This important finding can justify the use of preprocedural oral rinsing with PVP-I (for patients and health care providers) may be useful as an adjunct to personal protective equipment, for dental and surgical specialties during the COVID-19 pandemic.
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http://dx.doi.org/10.1111/jopr.13209DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300649PMC
July 2020

Congenital Salivary Gland Anlage Tumor: An Unusual Anterior Skull Base Mass in the Neonatal Period.

Pediatr Neurosurg 2017 12;52(3):185-188. Epub 2017 May 12.

Department of Surgery, Division of Neurosurgery, Connecticut Children's Medical Center, Hartford, CT, USA.

Congenital salivary gland anlage tumor (SGAT) is a benign nasopharyngeal mass that presents with respiratory distress in infancy. Prior case reports have characterized SGAT as a lesion of the nasopharynx without intracranial extension. We report a unique case of SGAT extending through the anterior skull base and discuss the differential diagnosis and management of this unusual entity.
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http://dx.doi.org/10.1159/000464296DOI Listing
May 2018

Medical Management of Frontal Sinusitis.

Otolaryngol Clin North Am 2016 Aug 18;49(4):927-34. Epub 2016 Jun 18.

Division of Otolaryngology, Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA; The Connecticut Sinus Institute, 21 South Road, Suite 112, Farmington, CT 06032, USA. Electronic address:

Rhinosinusitis is a term that has long been used to describe a diverse disease entity that encompasses several related but distinct conditions involving the paranasal sinuses. Frontal sinusitis represents one such entity with its own unique treatment considerations. Like rhinosinusitis as a whole, the role of medical management in the treatment of frontal sinusitis cannot be overlooked. Contemporary medical management of frontal sinusitis requires recognition of the unique disease process with implementation of targeted therapies aimed at addressing the specific pathophysiology.
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http://dx.doi.org/10.1016/j.otc.2016.03.016DOI Listing
August 2016

Biomaterials in Rhinology.

Otolaryngol Head Neck Surg 2016 Apr 23;154(4):606-17. Epub 2016 Feb 23.

Division of Otolaryngology, George Washington University, Washington, DC, USA

Introduction: Many different kinds of rhinologic biomaterials, both nonabsorbable and absorbable, have been developed over the years to improve outcomes following endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. In particular, these products have been designed to prevent postoperative bleeding, optimize the wound healing process, and reduce inflammation. This review evaluates the most recent evidence on biomaterials used in rhinology, focusing on these outcomes after ESS.

Data Sources: MEDLINE, Scopus, Google Scholar, and Clinicaltrials.gov.

Review Methods: A primary literature search based on the listed databases was performed with combinatorial search terms. Studies were considered for review if they met a set of inclusion and exclusion criteria.

Conclusions: Some products have performed better than others in clinical trials, although significant heterogeneity among studies does not allow for selection of a clearly superior biomaterial. While nonabsorbable biomaterials are still effective in achieving certain outcomes, newer, absorbable substances may be just as effective and avoid the morbidity associated with nasal packing removal. Steroid-eluting biomaterials have shown promising early results in reducing inflammation and promoting wound healing.

Implications For Practice: Certain absorbable biomaterials, such as chitosan gel and fibrin glue, have performed well with respect to postoperative hemostasis and wound healing, although they do not address mucosal inflammation. Steroid delivery systems may play an increasingly important role in reducing disease recurrence after ESS, although more studies are needed to assess long-term outcomes.
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http://dx.doi.org/10.1177/0194599815627782DOI Listing
April 2016

Neck recurrence and mortality in esthesioneuroblastoma: Implications for management of the N0 neck.

Laryngoscope 2016 06 26;126(6):1373-9. Epub 2015 Nov 26.

Department of Otolaryngology, Connecticut Sinus Institute, UConn Health, Farmington, Connecticut, U.S.A.

Objectives/hypothesis: To review the literature on neck recurrence in esthesioneuroblastoma.

Study Design: PubMed database.

Methods: A PubMed database search was performed using keywords "esthesioneuroblastoma," "olfactory neuroblastoma," and "esthesioneuroblastoma neck metastasis." Articles written in English with greater than 10 subjects that had data regarding the association of neck recurrence and mortality and/or the association of neck recurrence with Kadish stage were included for analysis.

Results: Thirteen studies met inclusion criteria with information regarding the association of neck recurrence and mortality, and 15 studies had data associating neck recurrence and Kadish stage. The neck recurrence rate was 14.1% in studies analyzing mortality. Among those patients who developed regional metastases, mortality was 60%. Of patients without regional recurrence, the mortality rate from disease was 26% (P < 0.0001) and overall mortality was 32% (P < 0.0001). The rate of neck recurrence within each Kadish stage was 0%, 11%, 21%, and 18% for Kadish stages A, B, C, and D, respectively. The trend toward an increased incidence of neck recurrence from stage A to stage D is statistically significant, with P value 0.003.

Conclusion: The rate of neck recurrence in esthesioneuroblastoma is close to 15%. There is a strong association of recurrence with Kadish stage B and C. Mortality from disease in patients with recurrence in cervical lymph nodes is significant when compared to those who never develop neck disease. Prospective studies are needed to evaluate a potential role for elective neck dissection versus elective neck radiation for patients with esthesioneuroblastoma.

Level Of Evidence: N/A. Laryngoscope, 126:1373-1379, 2016.
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http://dx.doi.org/10.1002/lary.25803DOI Listing
June 2016

Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure.

Am J Rhinol Allergy 2015 May-Jun;29(3):207-10

Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Shreveport, Shreveport, Louisiana, USA.

Background: A cerebrospinal fluid (CSF) leak, commonly presenting as rhinorrhea, is a well-recognized complication of lateral skull base surgery. Failure of conservative treatment measures in these cases necessitates surgical intervention.

Objective: Our aim is to demonstrate that endoscopic endonasal closure of the eustachian tube is a reasonable alternative to more traditional techniques for management of recalcitrant postoperative CSF rhinorrhea after removal of middle and posterior cranial fossa lesions.

Methods: A retrospective chart review was performed for patients who presented with CSF rhinorrhea after lateral skull base surgery at a tertiary medical center over a 17-year period, from 1997 to 2014. Nine patients managed with endoscopic endonasal closure of the eustachian tube were evaluated for preoperative hearing status, approach to lateral skull base surgery, pathology, size and location of the tumor, timing and presentation of CSF leak, methods of treatment, length of hospital stay, complications, and success of the procedure.

Results: Of the nine patients included in this review, seven were managed successfully with endoscopic endonasal eustachian tube closure. Of those seven, one required a revision procedure. Average length of postoperative stay was 5.8 days. There were no major complications. Follow up of greater than 100 months has been achieved since the first procedure.

Conclusion: Endoscopic endonasal eustachian tube closure is a safe, minimally invasive and effective method for obliteration of the eustachian tube orifice. The algorithm for management of recalcitrant postoperative CSF rhinorrhea after lateral skull base surgery should include endoscopic endonasal closure of the eustachian tube.
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http://dx.doi.org/10.2500/ajra.2015.29.4146DOI Listing
February 2016

Chronic rhinosinusitis osteoblasts differ in cellular properties from normal bone.

Int Forum Allergy Rhinol 2015 Feb 19;5(2):124-31. Epub 2014 Dec 19.

Department of Otolaryngology, University of Connecticut Health Center, Farmington, CT.

Background: Osteitis, characterized by bony thickening and remodeling, is often considered a hallmark of recalcitrant rhinosinusitis. However, there is limited literature examining the bone in chronic rhinosinusitis (CRS) pathology. In this study we cultured osteoblasts from bone harvested during sinus surgery as well as from nondiseased controls to compare their cellular properties.

Methods: Sinus bone was collected during sinus and skull-base surgery and placed in proliferation media. Outgrowth of cells occurred at 2 weeks and the cells were confirmed to be osteoblasts by alkaline phosphatase staining. Cellular adhesion was determined by replating and counting adhered cells at 4 hours. Proliferation of cells plated for 24 hours was assayed by measuring [(3) H]-thymidine incorporation. Calcium content was measured by changing cells to differentiation media and measuring the calcium content on days 7, 14, and 21.

Results: Alkaline phosphatase assay showed more than 90% of osteoblasts staining in all samples. Osteoblasts from patients with CRS had significant decreases in adhesion (p < 0.01) compared to osteoblasts from skull-base patients. There was a significant (p < 0.05) increase in calcium content in rhinosinusitis samples compared with the nondiseased sinus bone samples.

Conclusion: To date, this is the first known study that shows a direct comparison of osteoblast properties between patients with and without CRS. Our results indicate that there are fundamental phenotypic differences in adhesion and mineralization between osteoblasts in patients with CRS compared to controls.
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http://dx.doi.org/10.1002/alr.21434DOI Listing
February 2015

Modified subtotal lothrop procedure for extended frontal sinus and anterior skull base access: a cadaveric feasibility study with clinical correlates.

J Neurol Surg B Skull Base 2013 Jun 15;74(3):130-5. Epub 2013 Mar 15.

Department of Otolaryngology-Head and Neck Surgery, University of Miami, Leonard Miller School of Medicine, Miami, Florida, USA.

Objective The endoscopic modified Lothrop procedure (EMLP) is an established approach for recalcitrant frontal sinus disease and anterior skull base exposure. However, in select cases, this technique may involve unnecessary resection of sinonasal structures. In this study, we propose a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the anterior skull base and complex frontal sinus disease for which access to the bilateral frontal sinus posterior table is required. Methods A cadaveric dissection with photo documentation was performed at an academic medical center on four cadaver heads using standard endoscopic techniques to demonstrate the MSLP and its feasibility. Results The endoscopic MSLP allowed ample access for instrumentation in each of the dissections using a 30- or 70-degree endoscope. Adequate bilateral access to the posterior table of the frontal sinus was gained in all cases without the need for dissection of the contralateral frontal sinus recess (FSR). Conclusion The MSLP appears to be a feasible technique for exposure of the anterior skull base and accessing complex frontal sinus pathology. This modification provides similar anterior skull base exposure and surgical maneuverability as the EMLP while limiting surgical dissection to one FSR, thereby preserving as much of the natural mucociliary drainage pathways as possible.
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http://dx.doi.org/10.1055/s-0033-1338264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709960PMC
June 2013

Complementary and integrative treatments: upper respiratory infection.

Otolaryngol Clin North Am 2013 Jun 12;46(3):335-44. Epub 2013 Feb 12.

Deparment of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, CT 06030, USA.

The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold. Because no known cure exists for a URI, numerous products are available, each marketed with the promise of alleviating the associated symptoms and/or shortening the duration of illness. The evidence supporting these claims is variable and is the focus of this article, with an emphasis on complementary and integrative therapies.
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http://dx.doi.org/10.1016/j.otc.2012.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118453PMC
June 2013

Complementary and integrative treatments: allergy.

Otolaryngol Clin North Am 2013 Jun 1;46(3):295-307. Epub 2013 Feb 1.

University of Connecticut School of Medicine, Farmington, CT 06030, USA.

Allergic rhinitis (AR) is a global disease affecting hundreds of millions internationally. Substantial pharmacologic gains have been made in the treatment of allergy, including antihistamines, steroids, and leukotriene inhibitors. Pharmacology and immunotherapy are the 2 primary choices in an otolaryngologist's armamentarium of allergy treatment. Outside of these options lie complementary and integrative medicine, including various herbs and supplementation along with acupuncture. Some of these methods have shown great efficacy in treating AR and others have failed to show any improvement. This article reviews AR and some of the more common therapies used to care for the disease.
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http://dx.doi.org/10.1016/j.otc.2012.12.005DOI Listing
June 2013

Graduated endoscopic multiangle approach for access to the infratemporal fossa: a cadaveric study with clinical correlates.

Otolaryngol Head Neck Surg 2012 Aug 2;147(2):369-78. Epub 2012 Apr 2.

Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07103, USA.

Objective: The infratemporal fossa (ITF) has historically been one of the most difficult regions of the skull base to access surgically. Available open approaches are complex, are associated with high morbidity, and do not always afford optimal visualization. Endoscopic access to the ITF improves visualization for management of many sinonasal and lateral skull base lesions involving this region. The purpose of this study is to evaluate a graduated multiangle approach for endoscopic access to this area using a cadaveric model.

Study Design And Setting: Cadaveric study at an academic medical center.

Methods: Endoscopic dissection was performed on a total of 10 sides of 5 fresh cadaveric heads. Four different approaches to the ITF were studied: ipsilateral endonasal, endoscopically assisted Caldwell-Luc, contralateral endonasal via septotomy, and endoscopically assisted Gillies transtemporal. High-quality endoscopic pictures and high-definition videos of each technique were obtained in order to document the differences in access achieved with each approach.

Results: The combination of the 4 different endoscopic techniques allowed complete access to all areas of the ITF. The endoscopically assisted Caldwell-Luc improved anteroposterior access, the contralateral septotomy approach resulted in excellent far lateral access, and the endoscopically assisted Gillies approach allowed posterosuperior visualization and instrumentation.

Conclusion: Endoscopic access to the ITF can be accomplished by each of the 4 methods described. A multiangle, graduated approach can provide surgeons the ability to customize surgical access depending on the location of a specific lesion within the ITF.
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http://dx.doi.org/10.1177/0194599812442612DOI Listing
August 2012

Community-acquired methicillin-resistant Staphylococcus aureus in nasal vestibular abscess.

Int Forum Allergy Rhinol 2011 Sep-Oct;1(5):379-81. Epub 2011 May 9.

Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA.

Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is a recognized entity that is increasingly responsible for skin and soft tissue infections. However, it is not the usual pathogen isolated in nasal vestibular abscess.

Methods: We present a series of 13 consecutive patients presenting to a tertiary care center with nasal vestibular abscess over a 2.5-year period.

Results: All abscesses were cultured and 100% (13/13) grew S. aureus. Of the S. aureus isolates, 92% (12/13) were MRSA. Antibiotic susceptibilities of the MRSA isolates were as follows: 100% were susceptible to rifampin, trimethoprim-sulfamethoxazole, and tetracycline, 75% to clindamycin, 58% to fluoroquinolones, and 17% to erythromycin.

Conclusion: MRSA is an important pathogen in the community. It is therefore critical to appreciate its potential predominance in nasal vestibular abscess. Clinicians should obtain cultures, modify antibiotic therapy as warranted, and initiate empiric therapy to include MRSA coverage for nasal vestibular abscess.
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http://dx.doi.org/10.1002/alr.20061DOI Listing
June 2012

Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection.

Int J Pediatr Otorhinolaryngol 2012 Mar 23;76(3):439-42. Epub 2012 Jan 23.

University of Miami Center for Sinus and Voice, Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.

To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150 min and the estimated blood losses were 150, 400, and 130 mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9 mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.
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http://dx.doi.org/10.1016/j.ijporl.2011.11.005DOI Listing
March 2012

The role of alternative medicine in rhinology.

Facial Plast Surg Clin North Am 2012 Feb;20(1):73-81

Department of Surgery, Division of Otolaryngology, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.

Complementary and alternative medicine (CAM) includes treatments from traditional Chinese medicine, homeopathy, naturopathy, herbal medicine, Ayurvedic medicine, mind-body medicine, chiropractic or osteopathic manipulations, and massage. More than 40% of patients in the United States use CAM, with 17% of CAM use related to otolaryngology diagnoses, but nearly half of CAM users do not communicate their use of these medications to their physicians. Perioperative risk of bleeding is a particular concern in surgical specialties, and knowledge of these therapies and their potential adverse effects is critical.
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http://dx.doi.org/10.1016/j.fsc.2011.10.008DOI Listing
February 2012

Endoscopic management of sinonasal hemangiopericytoma.

Otolaryngol Head Neck Surg 2012 Mar 2;146(3):483-6. Epub 2011 Nov 2.

Connecticut Sinus Institute, University of Connecticut, Farmington, Connecticut, USA.

Objective: Sinonasal hemangiopericytomas (SNHPCs) are rare perivascular tumors with low-grade malignant potential. Traditionally, these tumors have been treated with open approaches such as lateral rhinotomy, Caldwell-Luc, or transfacial approaches. Increased experience with endoscopic management of benign and malignant sinonasal tumors has led to a shift in management of SNHPC. The authors present their experience in the largest series of patients with SNHPC managed endoscopically.

Study Design And Setting: Case series at a tertiary care medical center.

Subjects And Method: A retrospective chart review of all patients undergoing endoscopic management of SNHPC at the University of Miami between 1999 and 2008 was conducted. All endoscopic resections were performed with curative intent.

Results: Twelve patients with the diagnosis of SNHPC were treated endoscopically. Mean age was 62.5 years (range, 51-83 years). There were 6 men and 6 women. The mean follow-up was 41 months (range, 15-91 months). Seven (58.3%) presented with nasal obstruction, whereas 4 (41.6%) had epistaxis as their initial presenting symptom. Preoperative angiography or embolization was not performed in any case. Mean estimated blood loss was 630 mL (range, 100-1500 mL). Six patients underwent endonasal endoscopic anterior skull base resection; 4 had complete endoscopic resection all with negative margins. None underwent postoperative adjuvant treatment. No recurrence or metastatic disease was observed in this patient population.

Conclusion: Endoscopic management of SNHPC is a feasible approach and did not compromise outcomes in this experience. In this series, familiarity with advance endoscopic sinus surgery was necessary to manage these patients. Postoperative adjuvant therapy was not necessary in this cohort.
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http://dx.doi.org/10.1177/0194599811427660DOI Listing
March 2012

Observations of recurrent laryngeal nerve injury and recovery using a rat model.

Laryngoscope 2009 Aug;119(8):1644-51

Department of Otolaryngology, the New York Eye and Ear Infirmary, New York and New York Medical College, Valhalla, USA.

Objectives/hypothesis: To evaluate standardized recurrent laryngeal nerve (RLN) injuries using a rat model via minimally invasive transoral electromyography (ToL EMG) and histologic studies.

Methods: Forty-two female Sprague Dawley rats weighing 200 g to 250 g underwent crush injury to the right RLN using a calibrated pressure clip (0.61 N or 1.19 N) for 60 seconds. Following injury, serial ToL EMGs were performed on abductor and adductor laryngeal muscles during respiratory cycles and spontaneous vocal fold abduction on day 4 and then weekly for 6 weeks. Vocal fold motion associated with spontaneous respiration was graded from 0 to 4. Rats were sacrificed at different time points for histologic evaluation of injured nerves.

Results: EMG signals showed fibrillation potentials on day 4 in all experimental conditions. Crushed RLN, regardless of force, exhibited polyphasic potentials at 2 weeks postinjury. Normal motor unit potentials and recruitment patterns were observed in EMG signals at 4 weeks for all 0.61 N clip animals. Six weeks following crush injury, motor unit potentials having normal appearance were observed in most animals. Synkinetic EMG signals were observed at 5 weeks and 6 weeks in the 1.19 N clip animals. Endoscopic evaluation of vocal fold mobility was consistently normal at 6 weeks only following 0.61 N crush injury.

Conclusions: This model is useful to simulate intraoperative RLN injuries and to better understand the electrophysiologic events during nerve recovery. The severity of injury to the RLN dictates histologic, neurologic and functional recovery of the laryngeal motor system. This model is useful to evaluate the efficacy of systemic and local neurotropic agents in the treatment of RLN injury.
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http://dx.doi.org/10.1002/lary.20293DOI Listing
August 2009

Development of the ethmoid sinus and extramural migration: the anatomical basis of this paranasal sinus.

Anat Rec (Hoboken) 2008 Nov;291(11):1535-53

Department of Anatomy and Cell Biology, SUNY Downstate Medical Center, Brooklyn, New York 11203, USA.

Frontal and/or maxillary sinusitis frequently originates with pathologic processes of the ethmoid sinuses. This clinical association is explained by the close anatomical relationship between the frontal and maxillary sinuses and the ethmoid sinus, since developmental trajectories place the ethmoid in a strategic central position within the nasal complex. The advent of optical endoscopes has permitted improved visualization of these spaces, leading to a renaissance in intranasal sinus surgery. Advancing patient care has consequently driven the need for the proper and accurate anatomical description of the paranasal sinuses, regrettably the continuing subject of persistent confusion and ambiguity in nomenclature and terminology. Developmental tracking of the pneumatization of the ethmoid and adjacent bones, and particularly of the extramural cells of the ethmoid, helps to explain the highly variable adult morphology of the ethmoid air sinus system. To fully understand the nature and underlying biology of this sinus system, multiple approaches were employed here. These include CT imaging of living humans (n = 100), examination of dry cranial material (n = 220), fresh tissue and cadaveric anatomical dissections (n = 168), and three-dimensional volume rendering methods that allow digitizing of the spaces of the ethmoid sinus for graphical examination. Results show the ethmoid sinus to be highly variable in form and structure as well as in the quantity of air cells. The endochondral bony origin of the ethmoid sinuses leads to remarkably thin bony contours of their irregular and morphologically unique borders, making them substantially different from the other paranasal sinuses. These investigations allow development of a detailed anatomical template of this region based on observed patterns of morphological diversity, which can initially mask the underlying anatomy. For example, the frontal recess, ethmoid infundibulum, and hiatus semilunaris are key anatomical components of the ethmoid structural complex that are fully documented and explained here on the basis of the template we have developed, as well as being comprehensively illustrated. In addition, an exhaustive 2000-year literature search identified original sources of nomenclature, in order to help clarify the persistent confusions found in the literature. Modified anatomical terms are suggested to permit proper description of the ethmoid region. This clarification of nomenclature will permit better communication in addition to eliminating redundant terminology. The combination of anatomical, evolutionary, and clinical perspectives provides an important strategy for gaining insight into the complexity of these sinuses.
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http://dx.doi.org/10.1002/ar.20775DOI Listing
November 2008

Evaluation of functional recovery of recurrent laryngeal nerve using transoral laryngeal bipolar electromyography: a rat model.

Ann Otol Rhinol Laryngol 2008 Aug;117(8):604-8

Department of Otolaryngology, New York Eye and Ear Infirmary, New York, NY 10003, USA.

Objectives: We developed a standardized method of minimally invasive transoral laryngeal (ToL) bipolar electromyography (EMG) for evaluation of recurrent laryngeal nerve (RLN) recovery after a controlled crush injury in a rat model.

Methods: Ten 200- to 250-g Sprague-Dawley rats underwent a controlled crush injury to the left RLN performed with 60 seconds of use of a calibrated aneurysm clamp with a closing force of 0.61 N. Serial ToL bipolar EMG was performed on adductor muscles and the posterior criocoarytenoid muscle during spontaneous vocal fold motion under anesthesia. Each animal underwent ToL EMG immediately after surgery and 1, 3, and 6 weeks after surgery.

Results: The EMG signals showed normal motor unit potentials and recruitment patterns 3 weeks after crush injury. Endoscopic evaluation of vocal fold mobility yielded consistently normal findings 6 weeks after crush injury.

Conclusions: We have developed a standardized method of crush injury to the rat RLN model and a minimally invasive transoral bipolar spontaneous EMG technique to serially evaluate and follow nerve injury and recovery in rats. This model is intended to simulate intraoperative RLN injury, to elucidate the electrophysiological events that occur during nerve recovery, and to form the basis for studying agents to enhance such recovery.
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http://dx.doi.org/10.1177/000348940811700810DOI Listing
August 2008

Glomus tumors in patients of advanced age: a conservative approach.

Laryngoscope 2008 Feb;118(2):270-4

Department of Otolaryngology, New York Eye and Ear Infirmary. New York, NY 10003, USA.

Objectives: Identify and discuss controversies in the management of paragangliomas in elderly patients. Assess and evaluate a conservative treatment strategy involving limited surgical resection and vigilant monitoring of the outcome measures of tumor control, peritreatment morbidity, symptom resolution, and hearing preservation.

Study Design: Retrospective case review.

Methods: All of the patients in this study were over age 60 with temporal bone glomus tumors. Primary outcome assessment included length of hospitalization, perioperative morbidity, symptom resolution, hearing preservation, and long-term tumor control.

Results: Twelve female patients with mean age of 74.5 years (range 61-85 years) with follow-up from 24 months to 33 years (mean/median: 5/7.8 years) were identified. Nine (75%) of the patients presented with pulsatile tinnitus. Seven patients (58%) underwent surgical excision of the middle ear component of the paraganglioma. Tumors extending to the jugular foramen were purposely not resected. Five patients (45%) had relative or absolute contraindications to surgical resection and were treated with observation or primary radiation therapy. Post-treatment audiometric evaluation confirmed stable or improved hearing. Pulsatile tinnitus resolved in all patients. No patient experienced cranial nerve deficits, extended hospitalization, or blood transfusions. All patients were followed closely with radiological imaging. The majority of patients demonstrated no disease or stable disease, while two patients demonstrated tumor growth 6 years after diagnosis.

Conclusion: A prolonged natural history and the morbidity associated with surgical intervention have led to controversies in the treatment of glomus tumors in an elderly population. Our experience supports recent limited reports advocating conservative surgical excision and vigilant long-term monitoring in this population.
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http://dx.doi.org/10.1097/MLG.0b013e318158194bDOI Listing
February 2008

Tongue paresthesia and dysgeusia following operative microlaryngoscopy.

Ann Otol Rhinol Laryngol 2006 Jan;115(1):18-22

Department of Otolaryngology, The New York Eye and Ear Infirmary, New York, New York, USA.

Objectives: This study was performed to assess the overall incidence and duration of alterations in tongue sensation and taste after operative microlaryngoscopy, and the relation of these symptoms to operative time.

Methods: We performed a retrospective review of information regarding tongue symptoms in patients who completed standard post-microlaryngoscopy follow-up at 1 week, 1 month, and 3 months.

Results: One hundred patients (54 male and 46 female; mean age, 46 years; age range, 14 to 83 years) met the inclusion criteria. Eighteen patients had positive findings at 1 week: 15 complained of paresthesia and 3 of dysgeusia. The symptoms decreased over time without treatment (4% of patients at 1 month and 1% of patients at 3 months). Only 1 case of dysgeusia persisted past 3 months. Gender was found to be a significant independent risk factor for the development of symptoms (odds ratio, 5.63; 95% confidence interval, 1.36 to 31.29; p = .013). Patients whose operations lasted longer than 1 hour were almost 4 times more likely to develop tongue-related symptoms than those with an operative time less than 30 minutes, although these findings did not achieve statistical significance (odds ratio, 3.91; 95% confidence interval, 0.62 to 30.95; p = .182).

Conclusions: Alterations in tongue sensation and taste, most likely due to lingual nerve injury, are common after microlaryngoscopy, especially in female patients. They also tend to be associated with longer operative times. Although transient in nearly every case, lingual paresthesia and dysgeusia should form part of the preoperative discussion with the patient.
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http://dx.doi.org/10.1177/000348940611500103DOI Listing
January 2006

Objective computerized versus subjective analysis of facial synkinesis.

Laryngoscope 2005 Dec;115(12):2118-22

Department of Otolaryngology-Head and Neck Surgeryand Department of Communicative Sciences, The New York Eye and Ear Infirmary, New York, New York 10003, USA.

Objectives/hypothesis: To compare the sensitivity of an objective, computerized approach to measurement of facial synkinesis with that for a subjective approach and to examine the test-retest reliability of these approaches.

Study Design: Prospective, nonrandomized, and blinded.

Methods: Remote facial motion at the upper eyelids and oral commissures during a closed-lip smile and eyelid closure were measured using a commercially available computerized motion analysis system. Thirty healthy adults with normal facial nerve function were enrolled to establish normative data and a threshold value for synkinesis. Thirty consecutive patients were analyzed based on the synkinesis threshold value. Blinded subjective evaluations by two observers were also performed independently on the same patients.

Results: Facial synkinesis was detected significantly more frequently with objective than subjective analysis for eyelid closure; no significant differences between approaches were shown for the closed-lip smile. Interestingly, five (17%) patients developed early synkinesis within 3 months from the onset of the facial nerve injury. The test-retest reliability of all objective measures was excellent for both expressions. Close agreement in percent of patients with synkinesis between test and retest subjective evaluations was obtained for both observers for both expressions.

Conclusions: The objective, computerized approach to detection of facial synkinesis has excellent reliability and is more sensitive than the subjective approach to assessment to the presence of facial synkinesis associated with eyelid closure. The finding of early synkinesis suggests that central nervous reorganization plays a role in regeneration of the facial nerve.
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http://dx.doi.org/10.1097/01.mlg.0000182811.49686.76DOI Listing
December 2005
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