Publications by authors named "Eli Gordin"

23 Publications

  • Page 1 of 1

Factors Associated with Lymph Node Count in Mucosal Squamous Cell Carcinoma Neck Dissection.

Laryngoscope 2021 07 4;131(7):1516-1521. Epub 2021 Jan 4.

Department of Otolaryngology Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objective/hypothesis: Decreased lymph node count (LNC) from neck dissection (ND) for mucosal head and neck squamous cell carcinoma (HNSCC) patients is correlated with decreased survival. Advanced age and low BMI due to undernutrition from dysphagia from advanced T-stage tumors are common in patients with HNSCC. We studied the relationship between these two well-described causes for immune dysfunction and LNC in patients undergoing neck dissection.

Study Design: We conducted a retrospective review at a single tertiary care institution of patients with HNSCC that underwent neck dissection from 2006 to 2017.

Methods: Stepwise linear and logistic regression analyses were performed on 247 subjects to identify independent significant factors associated with 1) the LNC per neck level dissected; 2) advanced T-stage. One-way ANOVA was utilized to demonstrate differences between the p16 positive and negative subgroups.

Results: Low BMI (<23 vs. ≥23) (P = .03), extra nodal extension (ENE) (P = .0178), and advanced age (P = .005) were associated with decreased LNC per neck level dissected on multivariable analysis. Higher T-stage (P = .0005) was correlated with low BMI (<23) after controlling for the effects of tobacco, smoking, sex, ECE, and p16 status. p16+ patients, on average had higher BMI, were younger and produced a higher nodal yield (P < .0001, .007, and .035).

Conclusions: Patient intrinsic factors known to correlate with decreased immune function and worse outcomes, including p16 negative status, advanced age, and low BMI from undernutrition and ENE are associated with low nodal yield in neck dissections. LNC may be a metric for anti-tumor immune function that correlates with prognosis and T-stage.

Level Of Evidence: 3 Laryngoscope, 131:1516-1521, 2021.
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http://dx.doi.org/10.1002/lary.29353DOI Listing
July 2021

Care in the time of coronavirus: Ethical considerations in head and neck oncology.

Head Neck 2020 Jul 21;42(7):1519-1525. Epub 2020 May 21.

Psychiatry, Division of Ethics in Science and Medicine, University of Texas-Southwestern Medical Center, Dallas, Texas, USA.

As COVID-19 continues to challenge the practice of head and neck oncology, clinicians are forced to make new decisions in the setting of the pandemic that impact the safety of their patients, their institutions, and themselves. The difficulty inherent in these decisions is compounded by potentially serious ramifications to the welfare of patients and health-care staff, amid a scarcity of data on which to base informed choices. This paper explores the risks of COVID-19 incurred while striving to uphold the standard of care in head and neck oncology. The ethical problems are assessed from the perspective of the patient with cancer, health-care provider, and other patients within the health-care system. While no single management algorithm for head and neck cancer can be universally implemented, a detailed examination of these issues is necessary to formulate ethically sound treatment strategies.
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http://dx.doi.org/10.1002/hed.26272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280596PMC
July 2020

Head and neck oncology during the COVID-19 pandemic: Reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks.

Oral Oncol 2020 06 6;105:104684. Epub 2020 Apr 6.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.

The COVID-19 pandemic demands reassessment of head and neck oncology treatment paradigms. Head and neck cancer (HNC) patients are generally at high-risk for COVID-19 infection and severe adverse outcomes. Further, there are new, multilevel COVID-19-specific risks to patients, surgeons, health care workers (HCWs), institutions and society. Urgent guidance in the delivery of safe, quality head and neck oncologic care is needed. Novel barriers to safe HNC surgery include: (1) imperfect presurgical screening for COVID-19; (2) prolonged SARS-CoV-2 aerosolization; (3) occurrence of multiple, potentially lengthy, aerosol generating procedures (AGPs) within a single surgery; (4) potential incompatibility of enhanced personal protective equipment (PPE) with routine operative equipment; (5) existential or anticipated PPE shortages. Additionally, novel, COVID-19-specific multilevel risks to HNC patients, HCWs and institutions, and society include: use of immunosuppressive therapy, nosocomial COVID-19 transmission, institutional COVID-19 outbreaks, and, at some locations, societal resource deficiencies requiring health care rationing. Traditional head and neck oncology doctrines require reassessment given the extraordinary COVID-19-specific risks of surgery. Emergent, comprehensive management of these novel, multilevel surgical risks are needed. Until these risks are managed, we temporarily favor nonsurgical therapy over surgery for most mucosal squamous cell carcinomas, wherein surgery and nonsurgical therapy are both first-line options. Where surgery is traditionally preferred, we recommend multidisciplinary evaluation of multilevel surgical-risks, discussion of possible alternative nonsurgical therapies and shared-decision-making with the patient. Where surgery remains indicated, we recommend judicious preoperative planning and development of COVID-19-specific perioperative protocols to maximize the safety and quality of surgical and oncologic care.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136871PMC
June 2020

Regional flap practice patterns: A survey of 197 head and neck surgeons.

Auris Nasus Larynx 2020 12 26;47(6):1088-1090. Epub 2019 Dec 26.

Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, MA, United States.

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http://dx.doi.org/10.1016/j.anl.2019.11.004DOI Listing
December 2020

Management of Skull Fractures and Calvarial Defects.

Facial Plast Surg 2019 Dec 29;35(6):651-656. Epub 2019 Nov 29.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Scalp and calvarial defects can result from a myriad of causes including but not limited to trauma, infection, congenital malformations, neoplasm, and surgical management of tumors or other pathologies. While some small, nondisplaced fractures with minimal overlying skin injury can be managed conservatively, more extensive wounds will need surgical repair and closure. There are many autologous and alloplastic materials to aid in dural and calvarial reconstruction, but no ideal reconstructive method has yet emerged. Different reconstructive materials and methods are associated with different advantages, disadvantages, and complications that reconstructive surgeons should be aware of. Herein, we discuss different methods and materials for the surgical reconstruction of calvarial defects.
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http://dx.doi.org/10.1055/s-0039-3399522DOI Listing
December 2019

Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons.

Am J Otolaryngol 2020 Jan - Feb;41(1):102291. Epub 2019 Oct 30.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States of America.

Objectives: To describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications.

Methods: The design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications.

Results: Among 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced "very few" complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have "very few" complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course.

Conclusions: Practice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported "very few" complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.
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http://dx.doi.org/10.1016/j.amjoto.2019.102291DOI Listing
April 2020

Aggressive Necrotizing Fasciitis of the Head and Neck Resulting in Massive Defects.

Ear Nose Throat J 2019 Apr-May;98(4):197-200. Epub 2019 Apr 15.

2 Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA.

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http://dx.doi.org/10.1177/0145561319839789DOI Listing
December 2019

Systematic Review of Supraclavicular Artery Island Flap vs Free Flap in Head and Neck Reconstruction.

Otolaryngol Head Neck Surg 2019 02 9;160(2):215-222. Epub 2018 Oct 9.

1 Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA.

Objective: The aim of this systematic review is to compare the surgical outcomes of supraclavicular artery island flap (SCAIF) and free tissue transfer (FTT) in head and neck reconstruction.

Data Sources: PubMed, Web of Science, and EMBASE databases.

Review Methods: Independent screening and data extraction were performed by 2 authors. Only studies that directly compared SCAIF and FTT were included. Data were pooled with random-effects meta-analysis to determine the standardized mean differences (SMDs), risk differences, and 95% confidence intervals (CIs). Heterogeneity was assessed using the I statistics. The Methodological Index for Non-Randomized Studies tool was used to evaluate extent of bias in studies.

Results: The initial query yielded 661 results, of which 4 comparative studies remained for final analysis. The pooled sample sizes for the SCAIF and FTT cohorts were 100 and 84, respectively. SCAIF was associated with reduction of operative time by a large effect size (SMD, 1.65; 95% confidence interval, 0.78-2.52). The harvested flap areas and perioperative complications, including rates of total flap loss, partial flap necrosis, and recipient/donor site dehiscences, were comparable between the 2 procedures with low to high heterogeneity among studies.

Conclusion: SCAIF requires less operative time and has comparable short-term perioperative results to FTT. The findings of this study support the viability of SCAIF as an alternative to FTT and provide evidence for its inclusion in the reconstructive armamentarium of major head and neck ablation and trauma.
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http://dx.doi.org/10.1177/0194599818803603DOI Listing
February 2019

Holmium Laser for Endoscopic Treatment of Benign Tracheal Stenosis.

Int Arch Otorhinolaryngol 2018 Jul 14;22(3):203-207. Epub 2017 Jul 14.

Department of Facial Plastics, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, United States.

 Laryngotracheal stenosis is a difficult problem with varied etiology and various treatment options. The holmium laser represents another tool for the treatment of benign tracheal stenosis.  To determine the utility of holmium laser treatment for benign tracheal stenosis with regards to safety and efficacy.  This was a retrospective case study examining patients with benign tracheal stenosis from 1998-2016 who underwent holmium laser treatment. Determining the safety of this procedure was the primary goal, and complications were monitored as a surrogate of safety.  A total of 123 patients who underwent holmium laser treatment for benign tracheal stenosis were identified. In total, 123 patients underwent 476 procedures, with follow-up ranging from 1 month to 14 years. No intraoperative or post-operative complications were identified as a direct result of the use of this particular laser.  The holmium laser is an effective and safe laser to use for tracheal stenosis treatment. It is a contact laser with a short acting distance, which reduces the risk of injury to distal airway structures. Given the favorable experience reported here, the holmium laser should be considered when tracheal surgery is attempted.
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http://dx.doi.org/10.1055/s-0037-1604201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033607PMC
July 2018

Neoadjuvant Chemotherapy for Hypopharyngeal Squamous Cell Carcinoma and Personalized Medicine in Head and Neck Cancer.

Authors:
Eli Gordin

Ann Surg Oncol 2018 Apr 16;25(4):848-849. Epub 2018 Jan 16.

Department of Otolaryngology - Head and Neck Surgery, University of Texas, Southwestern Medical Center, Dallas, TX, USA.

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http://dx.doi.org/10.1245/s10434-017-6258-8DOI Listing
April 2018

Prophylactic Midface Lift in Midfacial Trauma.

Facial Plast Surg 2017 Jun 1;33(3):347-351. Epub 2017 Jun 1.

Otolaryngology and Facial Plastic Surgery Associates - Facial Plastics, Fort Worth, Texas.

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http://dx.doi.org/10.1055/s-0037-1602165DOI Listing
June 2017

Intraoperative nerve monitoring during parathyroid surgery: The Fort Worth experience.

Head Neck 2017 08 3;39(8):1662-1664. Epub 2017 May 3.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas.

Background: Avoidance of recurrent laryngeal nerve (RLN) injury during parathyroid surgery is of paramount important. The purpose of this study was to determine if intraoperative nerve monitoring allowed for decreased rates of RLN injury during parathyroid surgery.

Method: Between 1997 and 2016, 213 patients undergoing parathyroidectomy were retrospectively analyzed to determine postoperative recurrent nerve injury. Eighty-seven patients did not have intraoperative nerve monitoring, whereas 126 patients did.

Results: Based on the number of patients presenting with nerve injury during the postoperative period operated on with and without nerve monitoring, it was found that the difference in the 2 modalities was not statistically significant (P > .05).

Conclusion: Routine use of intraoperative nerve monitoring during parathyroid surgery may not yield any additional benefit in preventing injury to the RLN.
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http://dx.doi.org/10.1002/hed.24812DOI Listing
August 2017

Systematic Review and Meta-analysis of Studies Evaluating Functional Rhinoplasty Outcomes with the NOSE Score.

Otolaryngol Head Neck Surg 2017 05 7;156(5):809-815. Epub 2017 Feb 7.

1 State University of New York, Brooklyn, New York, USA.

Objective To provide aggregate data regarding the ability of functional rhinoplasty to improve nasal obstruction as measured by the Nasal Obstruction Symptom Evaluation (NOSE) score. Data Sources PubMed, EMBASE, Cochrane databases. Review Methods A search was performed with the terms "nasal obstruction" and "rhinoplasty." Studies were included if they evaluated the effect of functional rhinoplasty on nasal obstruction with the NOSE score. Case reports, narratives, and articles that did not use the NOSE score were excluded. Functional rhinoplasty was defined as surgery on the nasal valve. This search resulted in 665 articles. After dual-investigator independent screening, 16 articles remained. Study results were pooled with a random effects model of meta-analysis. Change in NOSE score after surgery was assessed via the mean difference between baseline and postoperative results and the standardized mean difference. Heterogeneity was assessed and reported through the I statistic. Results Patients in the included studies had moderate to severe nasal obstructive symptoms at baseline. The NOSE scores were substantially improved at 3-6, 6-12, and ≥12 months, with absolute reductions of 50 points (95% CI, 45-54), 43 points (95% CI, 36-51), and 49 points (95% CI, 39-58), respectively. All of these analyses showed high heterogeneity. Conclusions Nasal obstruction as measured by the NOSE survey is reduced by 43 to 50 points (out of 100 points) for 12 months after rhinoplasty. Our confidence in these results is limited by heterogeneity among studies, large variability in outcomes beyond 12 months, and the inherent potential for bias in observational studies.
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http://dx.doi.org/10.1177/0194599817691272DOI Listing
May 2017

Concurrent external and intraluminal vacuum-assisted closure in head and neck necrotizing fasciitis.

Laryngoscope 2017 06 13;127(6):1361-1364. Epub 2017 Jan 13.

Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A.

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http://dx.doi.org/10.1002/lary.26399DOI Listing
June 2017

The role of parotidectomy in the treatment of auricular squamous cell carcinoma.

Otolaryngol Head Neck Surg 2015 Jun 8;152(6):1048-52. Epub 2015 Apr 8.

Department of Facial Plastic and Reconstructive Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, USA

Objective: We analyze parotid specimens in patients treated with prophylactic parotidectomy for squamous cell carcinoma of the auricle greater than or equal to 2 cm to determine rates of metastasis and the efficacy of elective resection.

Study Design: Case series with chart review.

Setting: Cancer treatment center in Fort Worth, Texas, from 1998 to 2013.

Subjects And Methods: The study included 104 patients between ages 36 and 97 years with primary auricular squamous cell carcinoma greater than or equal to 2 cm, with no evidence of adenopathy or parotid involvement on imaging. Patients underwent local excision and ipsilateral parotidectomy. The primary cancer was analyzed for vascular involvement, perineural invasion, and cartilage involvement, while the parotid specimen was analyzed for cancer positivity.

Results: Thirty-nine parotid (37.5%) samples were positive for carcinoma. Of these, 16 patients had primary auricular carcinomas with vascular involvement, 17 had perineural invasion, and 4 had cartilage involvement. Thirty-two of 77 affected men and 7 of 27 affected women had positive parotid specimen. Vascular involvement (P = .0006) and perineural invasion (P = .0027) of the primary lesion were significantly higher in patients with a positive parotid specimen. Cartilage involvement and sex were not statistically significant.

Conclusions: Elective parotidectomy is beneficial in patients with squamous cell carcinoma of the auricle at least 2 cm in size, especially in lesions having perineural invasion and vascular involvement. For patients with positive parotid specimens, we recommend postoperative external beam radiation therapy and close surveillance.
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http://dx.doi.org/10.1177/0194599815579885DOI Listing
June 2015

Facial nerve trauma: evaluation and considerations in management.

Craniomaxillofac Trauma Reconstr 2015 Mar;8(1):1-13

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm.
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http://dx.doi.org/10.1055/s-0034-1372522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329040PMC
March 2015

Management of carotid artery trauma.

Craniomaxillofac Trauma Reconstr 2014 Sep;7(3):175-89

Division of Vascular Surgery, John Peter Smith Hospital, Fort Worth, Texas.

With increased awareness and liberal screening of trauma patients with identified risk factors, recent case series demonstrate improved early diagnosis of carotid artery trauma before they become problematio. There remains a need for unified screening criteria for both intracranial and extracranial carotid trauma. In the absence of contraindications, antithrombotic agents should be considered in blunt carotid artery injuries, as there is a significant risk of progression of vessel injury with observation alone. Despite CTA being used as a common screening modality, it appears to lack sufficient sensitivity. DSA remains to be the gold standard in screening. Endovascular techniques are becoming more widely accepted as the primary surgical modality in the treatment of blunt extracranial carotid injuries and penetrating/blunt intracranial carotid lessions. Nonetheless, open surgical approaches are still needed for the treatment of penetrating extracranial carotid injuries and in patients with unfavorable lesions for endovascular intervention.
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http://dx.doi.org/10.1055/s-0034-1372521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4130758PMC
September 2014

Subcutaneous vs intramuscular botulinum toxin: split-face randomized study.

JAMA Facial Plast Surg 2014 May-Jun;16(3):193-8

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

IMPORTANCE Much has been published regarding rejuvenation of the upper face with botulinum toxin A injection; however, the optimal target tissue layer has not been specifically examined. OBJECTIVE To seek a difference between subcutaneous (SC) and intramuscular (IM) administration. DESIGN, SETTING, AND PARTICIPANTS Prospective, randomized study at a tertiary care university facial plastic surgery practice. Nineteen patients who underwent botulinum toxin A treatment to the forehead were randomized so that each patient received IM injection on one side of the face and SC injection on the contralateral side. INTERVENTION Patients were assessed on the basis of eyebrow elevation before treatment, and at 2 weeks, 2 months, and 4 months following injection. Patients also completed a subjective questionnaire examining discomfort during injection, bruising, and tenderness, as well as their perception of their appearance after treatment. MAIN OUTCOME AND MEASURE Eyebrow height measurements between SC and IM techniques. RESULTS There was no difference in eyebrow height measurements between SC and IM techniques (0.00 [95% CI, -0.02 to 0.02]). Patients did report greater discomfort when receiving IM injections compared with SC injections (-0.76 [95% CI, -1.53 to 0.0005]). Patient satisfaction scores did not demonstrate a statistically significant difference between IM and SC techniques when measured on the first and second posttreatment visits; however, there was a trend toward significance on the final follow-up visit. CONCLUSIONS AND RELEVANCE Subcutaneous injection of botulinum toxin A is equally effective in achieving paralysis of the underlying frontalis muscle as IM botulinum toxin A administration. In addition, the SC route may result in less pain to patients receiving botulinum toxin A injection for rejuvenation of the upper face.
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http://dx.doi.org/10.1001/jamafacial.2013.2458DOI Listing
January 2015

Microvascular free tissue reconstruction in the patient with multiple courses of radiation.

Laryngoscope 2014 Oct 2;124(10):2252-6. Epub 2014 May 2.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas, U.S.A.

Objectives/hypothesis: To assess the feasibility of microvascular free tissue transfer in the multiply irradiated patient.

Study Design: Retrospective cohort analysis of 48 patients in a tertiary care, private practice setting.

Methods: Inclusion criteria were defined as patients who received multiple courses of radiation and underwent subsequent free tissue reconstruction to manage treatment-related complications (n = 24) or defects following additional oncologic surgery (n = 24). The main outcome measures included total and partial flap necrosis, hardware exposure, and pharyngocutaneous fistula. The minimum follow-up was 6 months.

Results: One case of total flap failure, two cases of partial skin paddle necrosis, one case of poor wound healing of the surrounding tissue to the flap, six cases of hardware exposure, 11 cases of fistula with eight requiring operative intervention, three cases requiring and additional free flap to supplement reconstruction, and one stroke.

Conclusions: Microvascular free tissue transfer to the head and neck is expected to provide a successful reconstruction in patients who have received multiple courses of radiation and who develop second primary tumors, recurrence of disease, or who suffer from late complications of their radiation therapy.
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http://dx.doi.org/10.1002/lary.24681DOI Listing
October 2014

Frontal sinus osteoma removal with the ultrasonic bone aspirator.

Laryngoscope 2012 Apr 28;122(4):736-7. Epub 2012 Feb 28.

Department of Otolaryngology-Head and Neck Surgery, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Osteomas, the most common skull tumors, are typically excised through either an open or endoscopic ostectomy using a high-speed drill, a technically challenging procedure that can result in injury to adjacent soft tissue structures. Osteoma removal through ultrasonic bone emulsification and aspiration (UBA) offers the advantages of decreased blood loss, preservation of adjacent soft tissue structures, and precise bone removal. UBA was used to successfully remove a forehead osteoma without injury to adjacent nerves and with a satisfactory cosmetic outcome. We describe skull osteoma removal with an ultrasonic bone aspirator, which offers potential advantages over conventional bone removal techniques.
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http://dx.doi.org/10.1002/lary.23202DOI Listing
April 2012

Parotid gland trauma.

Facial Plast Surg 2010 Dec 17;26(6):504-10. Epub 2010 Nov 17.

Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Jefferson Medical College, Philadelphia, PA, USA.

Parotid trauma can lead to both short and long-term complications such as bleeding, infection, facial nerve injury, sialocele, and salivary fistula, resulting in pain and disfigurement. Facial injuries inferior to a line extended from the tragus to the upper lip should raise concern for parotid injury. These injuries can be stratified into three regions as they relate to the masseter muscle. Injuries posing the greatest risk of damage to Stensen's duct include those anterior to the posterior border of the masseter and necessitate exploration. When the duct is disrupted, emphasis should be placed on primary repair or re-creation of the papilla; however, proximal ductal lacerations can be treated by ligation of the proximal segment. Isolated parenchymal injury can be treated with more conservative means. Sialocele and salivary fistula can frequently be managed nonoperatively with antibiotics, pressure dressings, and serial aspiration. Anticholinergic medications and the injection of botulinum toxin represent additional measures before resorting to surgical therapies such as tympanic neurectomy or parotidectomy.
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http://dx.doi.org/10.1055/s-0030-1267725DOI Listing
December 2010

Recombinant human tissue factor pathway inhibitor prevents thrombosis in a venous tuck model.

Laryngoscope 2010 Nov;120(11):2172-6

Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Objectives/hypothesis: Microvascular free tissue transfer has become a mainstay of reconstruction after resections for head and neck cancer. With current techniques, free flap failure is typically low; however, failure rates have been reported as high as 10%. Most thrombotic failures occur within the first few days postoperatively and tend to involve the venous anastomoses. We evaluated the efficacy of recombinant human tissue factor pathway inhibitor (rhTFPI), an anticoagulant that directly inhibits the extrinsic coagulation pathway, using a rat model of microvenous thrombosis.

Study Design: Prospective, randomized.

Methods: Sprague-Dawley rats were randomly assigned to either rhTFPI or saline groups. We performed a venous tuck procedure in the common femoral vein. Prior to closure, the anastamosis was irrigated with either rhTPFI (20 μg/mL) or normal saline. Survival of the anastomosis was measured via clinical assessment at regular postoperative intervals. After a postoperative period of 48 hours, sites were intraoperatively assessed and the vessels harvested.

Results: There was a significant increase in vessel patency in rats treated topically with rhTFPI compared to controls receiving saline. There was no increase in bleeding complications in the treated group versus controls.

Conclusions: Our data suggests that the use of topical rhTPFI increases venous anastomotic patency rates in vivo. The topical means of administration is attractive, as there seems to be a low percentage of systemic complications as is often seen with anticoagulation therapies. Future studies will investigate the potential efficacy in patients undergoing microvascular free tissue transfer.
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http://dx.doi.org/10.1002/lary.20898DOI Listing
November 2010

Reconstruction of the radial forearm free flap donor site using integra artificial dermis.

Microsurgery 2011 Feb 11;31(2):104-8. Epub 2010 Oct 11.

Department of Otolaryngology - Head & Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.

Autologous skin grafting to the donor site in patients who undergo radial forearm free flap reconstruction (RFFF) is associated with cosmetic and functional morbidity. Integra artificial dermis (Integra Lifesciences, Plainsboro, NJ) is a bovine collagen based dermal substitute that can be used as an alternative to primary autologous skin transplantation of the donor site. We describe a staged reconstruction using Integra followed by ultrathin skin grafting that results in highly aesthetic and functional outcomes for these defects. A retrospective review of 29 patients undergoing extirpative head and neck oncologic resection were examined. Integra graft placement was performed at the time of RFFF harvest followed by autologous split thickness skin grafting at 1 to 5 weeks postoperatively. Healing fully occurred within 4-6 weeks with negligible donor site complications, excellent cosmesis, and minimal scar contracture. Composite reconstruction with Integra artificial dermis offers advantages over traditional methods of coverage for select cases of radial forearm free flap donor site closures.
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http://dx.doi.org/10.1002/micr.20833DOI Listing
February 2011
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