Publications by authors named "Nathan H Boyd"

6 Publications

  • Page 1 of 1

Airway Management in Substernal Goiter Surgery.

Ann Otol Rhinol Laryngol 2021 May 25:34894211014794. Epub 2021 May 25.

Department of Otolaryngology-Head & Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.

Objective(s): To review the experience of 3 hospitals with airway management during surgery for substernal goiter and identify preoperative factors that predict the need for advanced airway management techniques.

Methods: A retrospective chart review between 2009 and 2017 of patients with substernal goiter treated surgically at 1 of 3 hospitals was performed.

Results: Of the 179 patients included in the study, 114 (63.7%) were female, the mean age was 55.1 years (range 20-87). Direct laryngoscopy or videolaryngoscopy was successful in 162 patients (90.5%), with fiberoptic intubation used for the remaining 17 patients. Thirty-one patients (17.4%) required >1 intubation attempt; these patients had larger thyroids (201.3 g, 95% CI 155.3-247.2 g) than those intubated with 1 attempt (144.7 g, 95% CI 127.4-161.9 g,  = .009). Those who required >1 attempt had higher BMI (38.3, 95% CI 34.0-42.6 vs. 32.9, 95% CI 31.5-34.3,  = .02). Mallampati score was found to be a predictor of >1 attempt, though tracheal compression and tracheal shift were not found to be predictors of >1 attempt, nor was the lowest thyroid extent. BMI was the only independent factor on multivariable logistic regression of needing >1 attempt (odds ratio 1.056, 95% CI 1.011-1.103,   .015).

Conclusions: The majority of patients undergoing surgery for substernal goiter can be intubated routinely without the need for fiberoptic intubation. Thyroid-specific factors such as lowest thyroid extent and mass effect of the gland on the trachea do not appear to be associated with difficult intubation, whereas classic patient factors associated with difficulty intubation are.

Level Of Evidence: VI.
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May 2021

Predicting nodal metastases in papillary thyroid carcinoma using artificial intelligence.

Am J Surg 2021 May 13. Epub 2021 May 13.

Department of Pathology, MSC08 4640, University of New Mexico, Albuquerque, NM, 87131, USA.

Background: The presence of nodal metastases is important in the treatment of papillary thyroid carcinoma (PTC). We present our experience using a convolutional neural network (CNN) to predict the presence of nodal metastases in a series of PTC patients using visual histopathology from the primary tumor alone.

Methods: 174 cases of PTC were evaluated for the presence or absence of lymph metastases. The artificial intelligence (AI) algorithm was trained and tested on its ability to discern between the two groups.

Results: The best performing AI algorithm demonstrated a sensitivity and specificity of 94% and 100%, respectively, when identifying nodal metastases.

Conclusion: A CNN can be used to accurately predict the likelihood of nodal metastases in PTC using visual data from the primary tumor alone.
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May 2021

The Gun Violence Epidemic: Time for Perioperative Physicians to Act.

J Cardiothorac Vasc Anesth 2018 06 6;32(3):1097-1100. Epub 2018 Mar 6.

Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR.

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June 2018

Use of the Teres Major Muscle in Chimeric Subscapular System Free Flaps for Head and Neck Reconstruction.

JAMA Otolaryngol Head Neck Surg 2015 Sep;141(9):816-21

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Health Science Center, Albuquerque.

Importance: We present what we believe to be the first case series in which the teres major muscle is used as a free flap in head and neck reconstruction.

Objectives: To describe our experience with the teres major muscle in free flap reconstruction of head and neck defects and to identify advantages of this approach.

Design, Setting, And Participants: A retrospective review was performed at 2 tertiary care centers between February 1, 2007, and June 30, 2012. Data analysis was conducted from July 31, 2014, through December 1, 2014.

Intervention: Teres major muscle free flap for use in head and neck reconstruction.

Main Outcomes And Measures: Indications for use, complications, and outcomes including donor site morbidity.

Results: The teres major free flap was used in 11 patients as a component of chimeric subscapular system free flaps for a variety of complex head and neck defects. The teres major muscle was used to fill soft-tissue defects of the neck, face, and nasal cavity; it provided substantial soft-tissue volume but was less bulky than the latissimus dorsi muscle. The teres major muscle was also used to provide protection for vascular anastomoses and/or great vessels and to enhance soft-tissue coverage of the mandibular reconstruction plate. In addition, the muscle was selected as a substrate for skin grafting where inadequate neck skin remained. Flap survival occurred in 10 of 11 flaps (91%). Two flaps (18%) demonstrated venous congestion that was managed successfully. Two patients (18%) developed minor recipient-site complications (submental fistula and infection with recurrent wound dehiscence and plate exposure). All donor sites healed well, with chronic, mild shoulder pain noted in 2 patients (18%) and no postoperative seromas observed in any patient.

Conclusions And Relevance: Addition of the teres major muscle to a subscapular system free flap is an option for reconstruction of a variety of complex head and neck defects, particularly when a moderate amount of soft tissue is required. In select cases, the teres major muscle may have advantages over the latissimus dorsi muscle.
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September 2015

The importance of international medical rotations in selection of an otolaryngology residency.

J Grad Med Educ 2011 Sep;3(3):414-6

Background: The objective of this study was to determine the extent of interest in international electives among prospective otolaryngology residents and to determine whether the availability of international electives affected students' interest in ranking a particular residency program.

Methods: A 3-part survey was given to all medical students enrolled in the 2008 otolaryngology match via the Electronic Residency Application Service. Part 1 elicited demographic information. Part 2 explored general interest in international rotations. Part 3 involved ranking several factors affecting students' choice of residency programs. This survey was developed at our institution, with no formal validation. Participation was anonymous and voluntary.

Results: A total of 307 students entered the otolaryngology match, and 55 surveys (18%) were completed. Twenty-five of 55 students (55%) had completed an international elective during or prior to medical school, and 51 of 55 respondents (93%) had a "strong" or "very strong" desire to participate in an international elective during residency; 48 of 55 students (87%) had a "strong" or "very strong" desire to participate in international surgical missions after residency. Future practice goals had no correlation with interest in international rotations, either during or after residency training. Respondents ranked 8 factors that had an impact on residency program selection in the following order of importance: operative experience, location, lifestyle, research opportunities, didactics, international electives, prestige of program, and salary.

Conclusion: Interest in international medicine among prospective otolaryngologists was high in this subset of respondents but did not appear to affect residency program selection.
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September 2011

Assessing the efficacy of tragal pumping: a randomized controlled trial.

Otolaryngol Head Neck Surg 2011 Jun 18;144(6):891-3. Epub 2011 Feb 18.

Department of Head & Neck Surgery, Kaiser Permanente Medical Center, Oakland, CA 94611, USA.

Objective: Tragal pumping is the practice of pushing on the tragus to raise pressure in the external auditory canal. This is a study to determine if tragal pumping improves middle ear penetration of ototopical medications via a patent pressure equalization tube.

Study Design: Prospective, randomized controlled trial.

Setting: Tertiary referral center.

Subjects And Methods: Children with chronic otitis media scheduled for routine placement of bilateral pressure equalization tubes were offered enrollment in the study. After pressure equalization tube insertion, an otic preparation of 0.3% ofloxacin solution dyed with methylene blue was applied sequentially to both ear canals by the operating surgeon. Tragal pumping was performed on the experimental ear, and the opposite ear served as a control. A second operator, blinded to the randomization process, used an operating microscope to determine if otic drops had entered the middle ear as demonstrated by methylene blue staining of the promontory mucosa.

Results: Twenty-four patients with a mean age of 3.6 years were enrolled in the study. Middle ear penetration of otic drops was present in 33% (8/24) of control ears and in 75% (18/24) of experimental ears, resulting in a statistically significant difference (P = .0094).

Conclusion: Tragal pumping improves the middle ear penetration of ototopical medications via a patent pressure equalization tube.
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June 2011