Publications by authors named "Dominic Vernon"

13 Publications

  • Page 1 of 1

Aerosol and droplet generation from orbital repair: Surgical risk in the pandemic era.

Am J Otolaryngol 2021 Jul-Aug;42(4):102970. Epub 2021 Feb 27.

Indiana University Department of Otolaryngology - Head and Neck Surgery, USA.

Introduction: The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device.

Material And Methods: The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300-10.000 μm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control.

Results: No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling.

Discussion And Conclusions: Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.
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http://dx.doi.org/10.1016/j.amjoto.2021.102970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912556PMC
June 2021

Aerosol and droplet generation from mandible and midface fixation: Surgical risk in the pandemic era.

Am J Otolaryngol 2021 Jan - Feb;42(1):102829. Epub 2020 Nov 5.

Indiana University Department of Otolaryngology - Head & Neck Surgery, 1130 W Michigan St, FH 400, Indianapolis, IN 46202, USA.

Purpose: The COVID-19 pandemic has led to concerns over transmission risk from healthcare procedures, especially when operating in the head and neck such as during surgical repair of facial fractures. This study aims to quantify aerosol and droplet generation from mandibular and midface open fixation and measure mitigation of airborne particles by a smoke evacuating electrocautery hand piece.

Materials And Methods: The soft tissue of the bilateral mandible and midface of two fresh frozen cadaveric specimens was infiltrated using a 0.1% fluorescein solution. Surgical fixation via oral vestibular approach was performed on each of these sites. Droplet splatter on the surgeon's chest, facemask, and up to 198.12 cm (6.5 ft) away from each surgical site was measured against a blue background under ultraviolet-A (UV-A) light. Aerosol generation was measured using an optical particle sizer.

Results: No visible droplet contamination was observed for any trials of mandible or midface fixation. Total aerosolized particle counts from 0.300-10.000 μm were increased compared to baseline following each use of standard electrocautery (n = 4, p < 0.001) but not with use of a suction evacuating electrocautery hand piece (n = 4, p = 0.103). Total particle counts were also increased during use of the powered drill (n = 8, p < 0.001).

Conclusions: Risk from visible droplets during mandible and midface fixation is low. However, significant increases in aerosolized particles were measured after electrocautery use and during powered drilling. Aerosol dispersion is significantly decreased with the use of a smoke evacuating electrocautery hand piece.
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http://dx.doi.org/10.1016/j.amjoto.2020.102829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832379PMC
December 2020

Impact of the COVID-19 Global Pandemic on the Otolaryngology Fellowship Application Process.

Otolaryngol Head Neck Surg 2020 10 9;163(4):712-713. Epub 2020 Jun 9.

Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.

On March 11, 2020, the World Health Organization declared coronavirus disease 2019 a global pandemic. In addition to massive social disruption, this pandemic affected the traditional fellowship interview season for otolaryngology subspecialties, including head and neck surgical oncology, facial plastic and reconstructive surgery, laryngology, rhinology, neurotology, and pediatric otolaryngology. The impact on the fellowship interview process, from the standpoint of the institution and the applicant, necessitated the use of alternative interview processes. This change may alter the future of how interviews and the match proceed for years to come, with nontraditional methods of interviewing becoming a mainstay. While the impact this pandemic has on the fellowship match process is not yet fully realized, this commentary aims to discuss the challenges faced on both sides of the equation and to offer solutions during these unprecedented times.
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http://dx.doi.org/10.1177/0194599820934370DOI Listing
October 2020

Telehealth Opportunities for the Otolaryngologist: A Silver Lining During the COVID-19 Pandemic.

Otolaryngol Head Neck Surg 2020 07 19;163(1):112-113. Epub 2020 May 19.

Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Indiana University, Indiana, USA.

The utilization of telemedicine has seen a relatively slow progression over the past 50 years in the US health care system. Technological challenges limiting the ease of use of robust video platforms have been a major factor. Additionally, the perception by many health care providers that telehealth is reserved for only the rural population or that it provides limited value due to the inability to perform in-depth physical examinations contributes to the slow adoption. The COVID-19 pandemic, with its massive disruption in social interaction by way of "stay at home" orders, is serving as a catalyst for improving telehealth. Large health systems are investing millions of dollars and increasing telehealth visit numbers 100-fold to access patients. The "telehealth movement" is here to stay and will undoubtedly be incorporated into providers' daily lives years after the COVID-19 pandemic. By embracing virtual access to health care, otolaryngologists will be able to influence improvements to these systems and broaden access options for patient care well into the future.
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http://dx.doi.org/10.1177/0194599820929641DOI Listing
July 2020

Lateral Crural Insertion Graft for External Nasal Valve Collapse.

Facial Plast Surg Aesthet Med 2020 Mar/Apr;22(2):110-111

Division of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.

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http://dx.doi.org/10.1089/fpsam.2019.29010.verDOI Listing
August 2020

Nasal bone fractures and the use of radiographic imaging: An otolaryngologist perspective.

Am J Otolaryngol 2019 Nov - Dec;40(6):102295. Epub 2019 Sep 9.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, United States of America. Electronic address:

Objective: To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures.

Study Design: An 8-question survey on isolated nasal bone fractures was designed.

Setting: Surveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups.

Results: 140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1-5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as 'rarely' or 'never' helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated.

Conclusions And Relevance: Otolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a "no x-ray policy" in this setting may result in better resource utilization.
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http://dx.doi.org/10.1016/j.amjoto.2019.102295DOI Listing
April 2020

Regional Reconstruction of Orbital Exenteration Defects.

Semin Plast Surg 2019 May 26;33(2):120-124. Epub 2019 Apr 26.

Division of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, The Johns Hopkins University School of Medicine, Maryland.

Aggressive disease such as invasive fungal infections or malignancies may necessitate orbital exenteration. The defects of orbital exenteration are often complex involving adjacent structures. Rehabilitation of the orbital exenteration defect poses unique challenges to the reconstructive surgeon. Various options have been described ranging from secondary intention to microvascular free tissue reconstruction. Here the authors review local/regional options for reconstruction of orbital exenteration defects.
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http://dx.doi.org/10.1055/s-0039-1685475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486381PMC
May 2019

Extra-ocular movement restriction and diplopia following orbital fracture repair.

Am J Otolaryngol 2018 Jan - Feb;39(1):34-36. Epub 2017 Aug 25.

Oculofacial Plastics and Orbital Surgery, Indianapolis, IN, United States; Oculofacial Plastics and Orbital Surgery, Louisville, KY, United States.

Purpose: To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used.

Methods: A chart review was conducted identifying all patients >18years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision.

Results: Ten patients were identified with a mean time to primary orbital fracture repair at 9days (range 1-48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia.

Conclusions: Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.
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http://dx.doi.org/10.1016/j.amjoto.2017.08.008DOI Listing
August 2018

Application of Ultrasonic Aspirators in Rhinology and Skull Base Surgery.

Otolaryngol Clin North Am 2017 Jun 31;50(3):607-616. Epub 2017 Mar 31.

Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indiana University, Fesler Hall, 1130 West Michigan Street, Suite 400, Indianapolis, IN 46202, USA. Electronic address:

Ultrasonic aspirators (UAs) are increasingly being used in rhinology and skull base surgery. The use of ultrasonic vibration for the removal of bony tissue transfers minimal heat to surrounding tissues and is relatively atraumatic to nearby soft tissue structures. This article details the development and application of this technology in septoturbinoplasty, endoscopic dacryocystorhinostomy (DCR), and skull base surgery. The benefits and limitations of UAs compared with conventionally powered instruments are discussed.
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http://dx.doi.org/10.1016/j.otc.2017.01.011DOI Listing
June 2017

Reconstruction of midface defect from idiopathic destructive process using Medpor implant.

Am J Otolaryngol 2017 May - Jun;38(3):351-353. Epub 2017 Jan 18.

Indiana University School of Medicine, Indianapolis, IN, Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address:

Importance: Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19year old female, creating a unique defect requiring repair.

Objective: Demonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant.

Design: Case report.

Results: The patient presented with a 7month history of an idiopathic progressive deformity of the right cheek. Computed tomography of the paranasal sinuses revealed extensive bone loss of the right midface and orbit. The patient underwent facial reconstruction using a customized Medpor (Stryker Corp, Kalamazoo, MI) implant. At 6month follow-up the patient and physician were both pleased with the patient's overall appearance. The patient did have some residual lower lid retraction present as well as some lateral pull at the lateral canthus outward from the orbit itself.

Conclusions: Preoperative planning for midface reconstruction requires a deep understanding of the aesthetic, functional, and supportive roles this structure holds. Computer assistance allows the creation of custom made implants, providing the reconstructive surgeon with innovative options for reconstruction with minimal morbidity to the patient. As the technology around the design and creation of the custom implants continues to improve, the role of computer assistance in reconstruction will become more prominent.
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http://dx.doi.org/10.1016/j.amjoto.2017.01.007DOI Listing
April 2018

Nasal Reconstruction in the Vasculopathic Patient-Saddle Up.

JAMA Otolaryngol Head Neck Surg 2017 05;143(5):512-513

Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis.

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http://dx.doi.org/10.1001/jamaoto.2016.3491DOI Listing
May 2017

An infant with right eye proptosis. Juvenile psammomatoid ossifying fibroma (JPOF).

JAMA Otolaryngol Head Neck Surg 2014 May;140(5):471-2

Indiana University School of Medicine, Indianapolis.

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http://dx.doi.org/10.1001/jamaoto.2014.257DOI Listing
May 2014

RNA localization in Xenopus oocytes uses a core group of trans-acting factors irrespective of destination.

RNA 2013 Jul 3;19(7):889-95. Epub 2013 May 3.

Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana 46556, USA.

The 3' untranslated region of mRNA encoding PHAX, a phosphoprotein required for nuclear export of U-type snRNAs, contains cis-acting sequence motifs E2 and VM1 that are required for localization of RNAs to the vegetal hemisphere of Xenopus oocytes. However, we have found that PHAX mRNA is transported to the opposite, animal, hemisphere. A set of proteins that cross-link to the localization elements of vegetally localized RNAs are also cross-linked to PHAX and An1 mRNAs, demonstrating that the composition of RNP complexes that form on these localization elements is highly conserved irrespective of the final destination of the RNA. The ability of RNAs to bind this core group of proteins is correlated with localization activity. Staufen1, which binds to Vg1 and VegT mRNAs, is not associated with RNAs localized to the animal hemisphere and may determine, at least in part, the direction of RNA movement in Xenopus oocytes.
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http://dx.doi.org/10.1261/rna.038232.113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683923PMC
July 2013
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