Publications by authors named "Moustafa Mourad"

50 Publications

Surgical Adjuncts to Rhinoplasty: An Algorithmic Approach.

Aesthetic Plast Surg 2020 10 7;44(5):1694-1704. Epub 2020 May 7.

Division of Plastic and Reconstructive Surgery, University of Kentucky, Lexington, KY, USA.

Background: Nasal aesthetics can be significantly affected by the interdependence of the surrounding bone and soft tissues of the face. These include the maxilla, septum, frontal bone, mandible, and the soft tissues and cartilage surrounding the nose. Therefore, it is pertinent to analyze and address these critical relationships of the nose in order to achieve a successful rhinoplasty. This work seeks to describe the battery of adjunct procedures available to supplement a rhinoplasty. Furthermore, each preoperative finding or indication for the adjunct is described in an algorithmic fashion.

Methods: A literature search using PubMed, Google Scholar, and a university library database was performed to locate papers describing adjunctive procedures to rhinoplasty. Indications and preoperative analysis were extracted from each paper. If the indication or finding was unclear, supplementary literature describing rhinoplasty and adjunctive analysis were sought in order to supplement our findings.

Results: Sixteen papers in total described adjunctive procedures for rhinoplasty. Each work highlighted a procedure or set of procedures on a surrounding facial feature including the forehead, brow, cheeks, lips, and chin, and neck. In total, 13 adjunct procedures for rhinoplasty are described with their respective indications. Additional literature and techniques were researched to clarify indicated procedures.

Conclusion: The ability to correctly understand the critical relationships of the nose can help the surgeon correctly recognize the indication for a rhinoplasty adjunct procedure, leading to better aesthetic balance and surgical outcomes.

Level Of Evidence Ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-01744-9DOI Listing
October 2020

Safe autologous rib harvest in patients with breast implants; technique and review.

JPRAS Open 2020 Jun 23;24:1-6. Epub 2020 Jan 23.

Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, United States.

Introduction: Autologous rib harvest is a useful technique for rhinoplasty when septal cartilage is inadequate. For patients who have previously undergone augmentation mammoplasty, however, there is theoretical concern about the risk to breast implant integrity during costal cartilage harvest The true risk to patients and their implants from autologous rib harvest is poorly studied Herein, we review our technique and experience with autologous rib harvest after augmentation mammoplasty.

Method: We performed a retrospective review of patients who underwent autologous rib harvest after augmentation mammoplasty between February 1998 and February 2017 at a tertiary care hospital and private practice. We identified basic demographics, implant type, approach to implantation, and any post-operative complications following rib harvest. Surgery was performed using an inframammary approach with a boat-technique for cartilage harvest.

Results: A total of 109 individuals, aged 19-64, were included in our study. There was a 2% rate of post-operative seroma development; no patients developed long-term complications. There was a 5% rate of incidental intraoperative discovery of implant dehiscence or implant entry, all of which were repaired primarily at the time of surgery, and none of which developed post-operative sequelae. There were no cases of pneumothorax, post-operative breast malposition, or other major complications.

Conclusion: Herein, we present the largest cohort of patients to undergo autologous rib harvest after augmentation mammoplasty. Routine intra-operative drain placement and perioperative imaging is unnecessary. Our technique allows harvest of a suitable amount of cartilage, is very cosmetically acceptable to this cosmetically-conscious population, and is safe for patients and their implants.
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http://dx.doi.org/10.1016/j.jpra.2020.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082592PMC
June 2020

Machine Learning and Feature Selection Applied to SEER Data to Reliably Assess Thyroid Cancer Prognosis.

Sci Rep 2020 03 20;10(1):5176. Epub 2020 Mar 20.

Scintillon Institute, San Diego, CA, USA.

Utilizing historical clinical datasets to guide future treatment choices is beneficial for patients and physicians. Machine learning and feature selection algorithms (namely, Fisher's discriminant ratio, Kruskal-Wallis' analysis, and Relief-F) have been combined in this research to analyse a SEER database containing clinical features from de-identified thyroid cancer patients. The data covered 34 unique clinical variables such as patients' age at diagnosis or information regarding lymph nodes, which were employed to build various novel classifiers to distinguish patients that lived for over 10 years since diagnosis, from those who did not survive at least five years. By properly optimizing supervised neural networks, specifically multilayer perceptrons, using data from large groups of thyroid cancer patients (between 6,756 and 20,344 for different models), we demonstrate that unspecialized and existing medical recording can be reliably turned into power of prediction to help doctors make informed and optimized treatment decisions, as distinguishing patients in terms of prognosis has been achieved with 94.5% accuracy. We also envisage the potential of applying our machine learning strategy to other diseases and purposes such as in designing clinical trials for unmasking the maximum benefits and minimizing risks associated with new drug candidates on given populations.
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http://dx.doi.org/10.1038/s41598-020-62023-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7083829PMC
March 2020

Wrap choice during fundoplication.

World J Gastroenterol 2019 Dec;25(48):6876-6879

Department of Surgery, Worcester Royal Infirmary, Worcester WR5 1DD, United Kingdom.

Gastro-oesphageal reflux disease is an increasing health burden. The mainstay of treatment has conventionally been medical therapy but since the introduction of laparoscopic surgery laparoscopic anti-reflux surgery has been increasingly used for intractable symptoms or in patients unwilling to take long term medication. The Nissen 360 degree wrap has traditionally been considered the gold standard operation but can be associated with significant complications. These complications include "gas bloat" and dysphagia and can occur relatively frequently. Various modifications have been described to the original operation and some of these have been described. In addition alternative wraps have been described which seem to have a reduced incidence of complications associated with their use. This editorial discusses the various types of wrap that can be performed and the minimum requirements of the surgical technique. The evidence from a recent meta-analysis of the randomised data has suggested that an anterior wrap is associated with a lower rate of complications and gives just as good control of reflux symptoms. The advantages and disadvantages of an anterior wrap are discussed. The lack of long term follow up data concerns some practitioners and at the moment the choice of wrap carried out still rests with the individual surgeon.
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http://dx.doi.org/10.3748/wjg.v25.i48.6876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938727PMC
December 2019

Management of Facial Scars.

Facial Plast Surg 2019 Dec 29;35(6):666-671. Epub 2019 Nov 29.

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

Scarring is a natural process of healing after damage to the skin that extends to the reticular dermis. While some scars may be socially acceptable, even admirable, scars of the face can be viewed as disfiguring or ugly. Minimizing the appearance of facial scars and optimizing their cosmetic outcome ideally begin before surgery or, in the cause of trauma, at the initial reconstruction. Even when there has been poor initial healing, a scar's appearance can be improved. Herein, we review conservative, medical, and surgical therapies to improve the appearance of facial scars.
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http://dx.doi.org/10.1055/s-0039-3401642DOI Listing
December 2019

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

Pharyngeal Reconstruction with Microvascular Free Tissue Transfer.

Semin Plast Surg 2019 Feb 8;33(1):78-80. Epub 2019 Mar 8.

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

Reconstruction of pharyngoesophageal defects after total laryngectomies and extirpation of hypopharyngeal and upper esophageal carcinomas presents a challenging task. Goals of reconstruction include adequate voice rehabilitation and restoration of normal swallowing. The reconstructive armamentarium contains many options for reconstruction and creation of a new upper digestive tract. This review article focuses on the most commonly used free tissue transfer options for the reconstruction of these defects, with an assessment of their advantages and disadvantages.
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http://dx.doi.org/10.1055/s-0039-1677877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6408241PMC
February 2019

Temporoparietal Fascia Free Flap for Nasoseptal Perforation Repair.

Craniomaxillofac Trauma Reconstr 2018 Sep 25;11(3):238-241. Epub 2017 Aug 25.

Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Nasoseptal perforations can be a challenging defect for the reconstructive surgeon, with repair limited by the surrounding tissue availability and the defect size. In patients with a history of cocaine use, often the integrity of surrounding vasculature is questionable and large defects may not be well suited for local reconstruction. In the otolaryngology literature, several reconstructive options using local tissue and synthetic materials have been described, but there have been no reports of microvascular free flaps utilized in this regard. We present a unique case of a 37-year-old woman with a 3.0 cm × 3.5 cm nasoseptal perforation secondary to cocaine use successfully reconstructed with a temporoparietal fascia free flap anastomosed to the facial artery and vein. Postoperatively, the patient had a well-healed septal defect from the free flap reconstruction This new technique shows promise as a feasible option for patients with large defects and for those with limited local reconstructive options. The ease of harvest and low donor-site morbidity make the temporoparietal fascia flap a suitable option for repair of complex nasoseptal defects.
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http://dx.doi.org/10.1055/s-0037-1604425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078690PMC
September 2018

Acute pancreatitis: current perspectives on diagnosis and management.

J Inflamm Res 2018 9;11:77-85. Epub 2018 Mar 9.

Department of Surgery, Hereford County Hospital, Hereford, UK.

The last two decades have seen the emergence of significant evidence that has altered certain aspects of the management of acute pancreatitis. While most cases of acute pancreatitis are mild, the challenge remains in managing the severe cases and the complications associated with acute pancreatitis. Gallstones are still the most common cause with epidemiological trends indicating a rising incidence. The surgical management of acute gallstone pancreatitis has evolved. In this article, we revisit and review the methods in diagnosing acute pancreatitis. We present the evidence for the supportive management of the condition, and then discuss the management of acute gallstone pancreatitis. Based on the evidence, our local institutional pathways, and clinical experience, we have produced an outline to guide clinicians in the management of acute gallstone pancreatitis.
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http://dx.doi.org/10.2147/JIR.S135751DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849938PMC
March 2018

Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks.

Craniomaxillofac Trauma Reconstr 2018 Mar 1;11(1):71-77. Epub 2016 Nov 1.

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

The objective of this review is to provide an overview on the diagnosis and management of traumatic cerebrospinal fluid (CSF) leaks. This comprehensive review explores controversies associated with the management of CSF leaks as well as a review of the most contemporary literature. The scope of this article covers both traumatic CSF leaks of the middle and anterior cranial fossae.
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http://dx.doi.org/10.1055/s-0036-1584890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790548PMC
March 2018

Options in Repositioning the Asymmetric Brow from Paralysis and Trauma.

Facial Plast Surg 2017 Dec 1;33(6):627-638. Epub 2017 Dec 1.

Department of Otolaryngology, Otolaryngology and Facial Plastic Surgery Associates.

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http://dx.doi.org/10.1055/s-0037-1607975DOI Listing
December 2017

Complications of Skull Base Surgery.

Semin Plast Surg 2017 Nov 25;31(4):227-230. Epub 2017 Oct 25.

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

Approaches to surgical management of skull base pathology and reconstruction of skull base defects have evolved over the past several decades. The goal, however, remains the same-to effectively address the pathology with minimal complications. In this article, the authors try to explore multiple complications of skull base surgery, discussing their incidence, natural course, and prevention. This will prove beneficial in optimal management of patients with a myriad of skull base disorders.
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http://dx.doi.org/10.1055/s-0037-1607203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656445PMC
November 2017

Calvarial Reconstruction.

Semin Plast Surg 2017 Nov 25;31(4):222-226. Epub 2017 Oct 25.

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

Calvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.
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http://dx.doi.org/10.1055/s-0037-1606557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656441PMC
November 2017

Colonic Perforation: A Medical Complication.

Prague Med Rep 2017;118(2-3):100-104

Wye Valley NHS Trust, Hereford, United Kingdom.

Hypothyroidism is a common comorbidity that on acute presentation is often overlooked. It can be an easily managed condition; however non-compliance can have severe consequences. In the presented case it was requirement for emergency surgery that resulted in stoma formation. This case is a first example of the need to include patient's decision making process with regards to medication adherence in the setting of chronic disease.
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http://dx.doi.org/10.14712/23362936.2017.10DOI Listing
February 2018

Pancreatitis: Preventing catastrophic haemorrhage.

World J Gastroenterol 2017 Aug;23(30):5460-5468

Richard PT Evans, Gunraj Pall, Russel's Hall Hospital, Dudley DY1 2HQ, United Kingdom.

Pancreatitis represents nearly 3% of acute admissions to general surgery in United Kingdom hospitals and has a mortality of around 1%-7% which increases to around 10%-18% in patients with severe pancreatitis. Patients at greatest risk were those identified to have infected pancreatic necrosis and/or organ failure. This review seeks to highlight the potential vascular complications associated with pancreatitis that despite being relatively uncommon are associated with mortality in the region of 34%-52%. We examine the current evidence base to determine the most appropriate method by which to image and treat pseudo-aneurysms that arise as the result of acute and chronic inflammation of pancreas. We identify how early recognition of the presence of a pseudo-aneurysm can facilitate expedited care in an expert centre of a complex pathology that may require angiographic, percutaneous, endoscopic or surgical intervention to prevent catastrophic haemorrhage.
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http://dx.doi.org/10.3748/wjg.v23.i30.5460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558110PMC
August 2017

Surgical management of temporal bone osteoradionecrosis: Single surgeon experience of 47 cases.

Am J Otolaryngol 2017 Nov - Dec;38(6):688-691. Epub 2017 Jul 23.

Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Ave, Fort Worth, TX 76104, United States. Electronic address:

Purpose: To report the outcomes of 47 patients with temporal bone osteoradionecrosis treated primarily with surgical resection in order to analyze whether flap type and hyperbaric oxygen use affect wound breakdown.

Materials And Methods: Between January 1998 and January 2016, 47 patients were treated for temporal bone osteoradionecrosis with surgery. Some patients were also treated with hyperbaric oxygen. Resection of grossly necrotic temporal bone was followed by immediate reconstruction with local, regional, or free flaps. Minimum follow-up was 6months. If patients had breakdown of their initial reconstructions, secondary reconstruction was performed with either a regional or free flap. During the post-operative period, wound breakdown, flap complications, and patient survival were noted.

Results: 30 patients developed ORN from primary radiotherapy while 17 had post-operative radiation. It was found that wound breakdown was significantly associated with type of flap reconstruction (p=0.02) with local flap reconstruction portending a poorer prognosis. Hyperbaric oxygen was not associated with decreased wound breakdown (p=0.5).

Conclusions: Surgical treatment can be an effective treatment for temporal bone osteoradionecrosis, without hyperbaric oxygen providing any additional benefit. Reconstruction with regional or free flaps may be a more reliable method to resurface defects compared to local flaps.
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http://dx.doi.org/10.1016/j.amjoto.2017.07.005DOI Listing
July 2018

The role of intraoperative nerve monitoring in tracheal surgery: 20-year experience with 110 cases.

Pediatr Surg Int 2017 Sep 26;33(9):977-980. Epub 2017 Jun 26.

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

Purpose: To determine the utility of intraoperative nerve monitoring (IONM) during tracheal resection or slide tracheoplasty to prevent recurrent laryngeal nerve injury.

Methods: 110 patients underwent tracheal resection or tracheoplasty between 1997 and 2016. During the first 10-year period, IONM was not used while during the second 10-year period, IONM was used. 49 patients had surgery without IONM while 61 had surgery with IONM. During the post-operative period, patients with nerve injury were compared to determine if significant difference existed between the two modalities.

Results: In patients who had surgery without IONM, 7 (14.2%) patients were found to have compromised nerve function whereas 8 (13.1%) patients in the group with IONM had nerve injury. 3 patients regained function in the first group while four regained function in the second. A Fisher's exact test was run on the entire cohort and the difference in vocal fold injury was not found to be statistically significant (p > 0.05).

Conclusion: Based on this single surgeon experience, there may be no protective benefit with the use of IONM during tracheal surgery.
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http://dx.doi.org/10.1007/s00383-017-4119-yDOI Listing
September 2017

Epidemiological Trends of Head and Neck Cancer in the United States: A SEER Population Study.

J Oral Maxillofac Surg 2017 Dec 22;75(12):2562-2572. Epub 2017 May 22.

Professor, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY.

Purpose: This study represents the most recent epidemiologic trends of head and neck cancer (HNC) in the United States. It provides an important discussion on oropharyngeal cancer and cancers related to the human papillomavirus. The objective was to identify trends in HNC (2002 to 2012) within the United States.

Materials And Methods: This study is a retrospective analysis of the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) submission. Using the November 2014 submission of the SEER database and SEER-18 data files, data from 2002 to 2012 were analyzed to determine the most recent epidemiologic trends. HNCs of all subtypes were analyzed together. Laryngeal cancers were further analyzed separately. Oropharyngeal cancers of the base of tongue and tonsil were analyzed independently to attempt to trend HPV-related cancers.

Results: From 2002 to 2012, there were 149,301 cases of HNC recorded in the SEER database. The HNC rate decreased by 0.22% per year (P = .0549) and the rate of laryngeal cancer decreased by 1.9% per year (P < .0001). The rate of oropharyngeal (HPV-related) cancer increased by 2.5% per year (P < .0001). HNC rates increased significantly in Kentucky and Connecticut and decreased in California (P < .05). HPV-related cancers increased significantly in all states except Georgia, Hawaii, and Michigan (P < .05). Laryngeal cancer rates decreased in California, Georgia, New Jersey, and New Mexico (P < .05).

Conclusions: The overall incidence of HNC is decreasing in the United States. There is an increasing incidence of HPV-related cancers of the oropharynx. Meaningful differences in cancer incidence and rate of change exist between men and women. Furthermore, younger groups have a greater decrease of overall HNC, with an overall increase in HPV-related cancer in patients older than 50 years.
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http://dx.doi.org/10.1016/j.joms.2017.05.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053274PMC
December 2017

Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases.

Oral Maxillofac Surg 2017 Sep 2;21(3):335-339. Epub 2017 Jun 2.

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

Purpose: The efficacy of intraoperative nerve monitoring is controversial in the literature. This study of a single surgeon's experience seeks to determine if the use of intraoperative nerve monitoring influences recurrent laryngeal nerve injury during thyroid surgery.

Methods: Six hundred fifty-seven patients with normal pre-operative vocal fold function underwent thyroid surgery without the use of intraoperative nerve monitoring from September 1997 to January 2007, while 761 patients underwent thyroid surgery from February 2007 to February 2016 with routine use of nerve monitoring. Patients were followed for a minimum of 6 months after surgery, and postoperative nerve function was determined by fiberoptic laryngoscopy. A Fisher test was used to determine if nerve injury was statistically different between both groups.

Results: In patients operated on without nerve monitoring, 21 patients were found to have postoperative vocal fold paralysis with nine regaining functioning. In patients operated on with nerve monitoring, 27 were found to have vocal fold dysfunction with 17 regaining function. Fisher test analysis, both with and without patients regaining function, showed no difference in nerve injury between groups (p > 0.05, p > 0.05).

Conclusion: Intraoperative monitoring during thyroidectomy may not prevent injury to the recurrent laryngeal nerve.
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http://dx.doi.org/10.1007/s10006-017-0637-yDOI Listing
September 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 venous thromboembolism in otolaryngology-head and neck surgery.

Head Neck 2017 06 29;39(6):1249-1258. Epub 2017 Mar 29.

Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.

Background: The purpose of this study was to present our systematic review and meta-analysis of the data on venous thromboembolism (VTE; deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in otolaryngology-head and neck surgery (OHNS).

Methods: PubMed and Scopus databases were searched for studies reporting VTE in OHNS. Incidence of VTE and bleeding is reported and meta-analyzed overall and for chemoprophylaxis and squamous cell carcinoma (SCC)/free flap subgroups.

Results: A total of 23 studies were included with a total of 618,264 patients. Incidence of VTE was 0.4%. The incidence of bleeding complications was 0.9%. The addition of chemoprophylaxis did not result in a decreased VTE incidence (odds ratio [OR], 0.86), but produced an increased risk of bleeding (OR, 3.78). The overall OR for VTE in SCC/free flap cases was 6.28.

Conclusion: Chemoprophylaxis may not be necessary in the OHNS non-SCC or free flap patient population and must be balanced against an increased risk of bleeding. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1249-1258, 2017.
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http://dx.doi.org/10.1002/hed.24758DOI Listing
June 2017

Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects.

J Reconstr Microsurg 2017 May 6;33(4):275-280. Epub 2017 Jan 6.

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

 The objective of this study was to determine whether there was a difference in complication rate between cutaneous and mucosal defects reconstructed with the supraclavicular artery flap.  Retrospective review of postoperative complications in 63 patients from 2008 to 2015 with cutaneous and mucosal head and neck defects following oncologic ablation reconstructed with the supraclavicular flap, with a minimum follow-up duration of 6 months. Of the 63 patients, 38 patients had cutaneous defects, whereas 25 had mucosal defects. Patients were followed up postoperatively to determine the presence of wound infection, partial flap necrosis, complete flap necrosis, and fistula formation. Complications in both defect groups as well as a statistical comparison of total complications were analyzed.  Patients with cutaneous defects reconstructed with the supraclavicular flap had significantly lower postoperative complications than those with mucosal defects ( = 0.002). Flap necrosis, both partial and complete, was also lower in this same group ( = 0.0052).  The supraclavicular artery flap may be a more suitable option for patients with cutaneous defects, given the reliability and lower propensity for postoperative complications  The level of evidence is 4.
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http://dx.doi.org/10.1055/s-0036-1597718DOI Listing
May 2017

Evolving management of metaplasia and dysplasia in Barrett's epithelium.

World J Gastroenterol 2016 Dec;22(47):10316-10324

Richard PT Evans, Moustafa Mabrouk Mourad, Simon G Fisher, Simon R Bramhall, Department of Surgery, the Wye Valley NHS Trust, HR1 2ER Hereford, United Kingdom.

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett's oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett's oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett's oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett's epithelium.
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http://dx.doi.org/10.3748/wjg.v22.i47.10316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175244PMC
December 2016

Hepatic and Intra-abdominal Tuberculosis: 2016 Update.

Curr Infect Dis Rep 2016 Dec;18(12):45

Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK.

Mycobacterium tuberculosis (TB) infection affects nearly 10 million people a year and causes 1.5 million deaths. TB is common in the immunosuppressed population with 12 % of all new diagnoses occurring in human immune deficiency virus (HIV)-positive patients. Extra-pulmonary TB occurs in 12 % of patients with active TB infection of which 3.5 % is hepatobiliary and 6-38 % is intra-abdominal. Hepatobiliary and intra-abdominal TB can present with a myriad of non-specific symptoms, and therefore, diagnosis requires a high level of suspicion. Accurate and rapid diagnosis requires a multidisciplinary team (MDT) approach using radiology, interventional radiology, surgery and pathology services. Treatment of TB is predominantly medical, yet surgery plays an important role in managing the complications of hepatobiliary and intra-abdominal TB.
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http://dx.doi.org/10.1007/s11908-016-0546-5DOI Listing
December 2016

The Prognostic Value of Age, Sex, and Subsite in Cutaneous Head and Neck Melanoma: A Clinical Review of Recent Literature.

Iran J Cancer Prev 2016 Jun 8;9(3):e5079. Epub 2016 Jun 8.

Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas.

Context: Cutaneous head and neck melanoma is a challenging disease owing to its aggressive nature and often times advanced stage at presentation. Age, sex, and subsite are three prognostic indicators which can be determined prior to treatment or testing, and can allow the practitioner to counsel the patient before initiating therapy.

Evidence Acquisition: A PubMed search was conducted utilizing various terms relating to the subject matter. Articles over the past 25 years were analyzed and appropriately selected for review.

Results: It appears that patients older than 65 have a decreased overall 5 year survival compared to their younger counterparts. Male patients have poorer prognosis compared to female patients as noted by the decreased overall survival, decreased disease specific survival, and shorter time to distant metastasis. Scalp subsite was most uniformly accepted as having the worst prognosis in the head and neck, and may even serve as an independent prognostic indicator.

Conclusions: Advanced age, male sex, and scalp subsite all portend poor prognosis in patients with cutaneous head and neck melanoma.
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http://dx.doi.org/10.17795/ijcp-5079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038835PMC
June 2016

Increased local recurrence in advanced parotid malignancy treated with mastoidectomy without lateral temporal bone resection.

Oral Maxillofac Surg 2017 Mar 30;21(1):7-11. Epub 2016 Sep 30.

Otolaryngology and Facial Plastic Surgery Associates, 923 Pennsylvania Avenue Suite 100, Fort Worth, TX, USA.

Objective: We analyzed patients with advanced parotid malignancy requiring proximal facial nerve exposure undergoing mastoidectomy versus lateral temporal bone resection to determine differences in local and distant recurrence.

Study Design: The study design is a case series with chart review.

Setting: The setting is in Tertiary care practice in Fort Worth, Texas from January1998 to January 2014.

Subjects And Methods: The study included 120 patients with advanced parotid malignancy, 82 males between 19 and 87 years, and 38 females between 26 and 83 years. Patients with no overt bone involvement were treated with parotidectomy and mastoidectomy for exposure of the proximal facial nerve, and patients with clinically suspected (radiographic imaging or clinical fixation) bone involvement were treated with parotidectomy and lateral temporal bone resection. Follow up ranged from a minimum of 18 months to 11 years following surgery.

Results: Sixty patients were treated with mastoidectomy and 60 were treated with lateral temporal bone resection. In patients treated with mastoidectomy, 13 had local recurrence and 7 had distal recurrence. In patients treated with lateral temporal bone resection, 2 had local recurrence while 9 had distant recurrence. Statistical analysis revealed that patients treated with mastoidectomy developed local recurrence (p = 0.0022) more commonly than those treated with lateral temporal bone resection. There was no significant difference in distant recurrence between both groups (p = 0.5949).

Conclusions: Patients with advanced parotid malignancy should be treated aggressively with parotidectomy and lateral temporal bone resection regardless of bone involvement due to increased risk of local recurrence in those treated with mastoidectomy alone.

Level Of Evidence: Level of evidence is a 4 case series.
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http://dx.doi.org/10.1007/s10006-016-0586-xDOI Listing
March 2017

What Are the Optimal Monitoring Techniques in Head and Neck Microvascular Reconstruction?

ORL J Otorhinolaryngol Relat Spec 2016 27;78(5):241-244. Epub 2016 Jul 27.

Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel and Icahn School of Medicine at Mount Sinai, New York, N.Y., USA.

Purpose: We evaluated the outcomes for widely used systems in terms of accuracy, salvage rates, and added cost compared to conventional monitoring.

Methods: We performed a narrative review of the literature (high-impact report).

Results: The overall free flap success for head and neck reconstruction is at least 95% using any type of monitoring. Salvage rates in decreasing frequency of monitoring techniques are 85% with near-infrared spectroscopy (NIRS), 81% with implantable Doppler, and 61.5% with conventional monitoring. False-positive rates in increasing frequency are 0% for NIRS, 0.4% for conventional monitoring, and <10% for implantable Doppler. Current data show implantable Doppler to be potentially cost-effective for institutions with a failure rate of at least 6%. Buried flaps may be monitored with conventional monitoring using an exteriorized paddle, or using implantable Doppler.

Conclusions: The cost-effectiveness of advanced flap monitoring systems beyond conventional monitoring is related to the success rate of each institution. Cost-effectiveness studies are necessary to determine at what point NIRS becomes advantageous.
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http://dx.doi.org/10.1159/000447950DOI Listing
October 2017

Worldwide 10-Year Systematic Review of Treatment Trends in Fibula Free Flap for Mandibular Reconstruction.

J Oral Maxillofac Surg 2016 Dec 18;74(12):2526-2531. Epub 2016 Jun 18.

Chief, Division of Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel, New York, NY.

Purpose: The purpose of this study was to describe the trends pertaining to the use of the fibula free flap for mandibular reconstruction during the past 10 years.

Materials And Methods: A systematic review for publications on the fibula free flap in mandibular reconstruction in the PubMed and Scopus databases was performed from January 1, 2005 until December 31, 2014. Publications were classified by topic, number of patients, and country of origin. The study period was split into 2 periods. The first 5-year period was compared with the second 5-year period.

Results: Eighty-five publications were identified. There was an increase in publications regarding restorative decision making (11 vs 9), surgical techniques (13 vs 6), outcomes (20 vs 10), and computer-aided design and computer-aided manufacturing (CAD-CAM; 8 vs 2) in the second 5-year period. The number of patients reported also increased in publications on surgical techniques (1,085 vs 59), outcomes (777 vs 254), bisphosphonate-related osteonecrosis of the jaw and osteoradionecrosis (165 vs 28), and CAD-CAM (65 vs 15) in the second 5-year period. The United States, India, China, and Europe produced most of the publications.

Conclusions: In the past 10 years, there was a surge in publications on the use of the fibula free flap for mandibular reconstruction. There was a 1.8-fold increase in the number of publications and a 3.4-fold increase in the number of patients undergoing this method of mandibular reconstruction in the second 5-year period. Publications from the United States, India, and China contributed to a large increase in the number of patients in the second 5-year period. More interest in CAD-CAM technology was seen in the second 5-year period that was not seen in the first 5-year period.
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http://dx.doi.org/10.1016/j.joms.2016.06.170DOI Listing
December 2016

Internal Herniation Through Foramen of Winslow: A Diagnosis Not to Be Missed.

Clin Med Insights Gastroenterol 2016 12;9:31-3. Epub 2016 Jun 12.

Wye Valley NHS Trust, Hereford, UK.

Introduction: Hernias through the foramen of Winslow are extremely rare, accounting for 0.1% of all abdominal hernias. Delayed diagnosis is often observed, resulting in bowel strangulation and high mortality.

Method: We present a case of a patient with strangulated ileum herniated through the foramen of Winslow. Recent literature review was undertaken on "PubMed" as a search platform using the keywords "foramen of Winslow" and "hernia".

Case Summary: A 66-year-old man presented acutely with severe epigastric pain and vomiting. An emergency computed tomography scan revealed a loop of ileum in the lesser sac. At emergency laparotomy, a herniated loop of ileum that had become strangulated at its entry to the lesser sac via the foramen of Winslow was confirmed. The loop of ileum was reduced but was nonviable, which had to be resected with a primary anastomosis. The patient's postoperative recovery was uneventful.

Conclusion: Herniation through the foramen of Winslow is a difficult diagnosis and must not be missed. Early cross-sectional imaging and surgical intervention are advised in order to reduce morbidity.
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http://dx.doi.org/10.4137/CGast.S38453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907339PMC
June 2016