Publications by authors named "Taha Z Shipchandler"

60 Publications

Aerosol and Droplet Generation from Open Rhinoplasty: Surgical Risk in the Pandemic Era.

Facial Plast Surg Aesthet Med 2021 Dec 29. Epub 2021 Dec 29.

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

The coronavirus disease 2019 pandemic has led to concerns over transmission risk from head and neck operations including facial cosmetic surgeries. To quantify droplet and aerosol generation from rhinoplasty techniques in a human anatomic specimen model using fluorescein staining and an optical particle sizer. Noses of human anatomic specimens were infiltrated using 0.1% fluorescein. Droplets and aerosols were measured during rhinoplasty techniques including opening the skin-soft tissue envelope, monopolar electrocautery, endonasal rasping, endonasal osteotomy, and percutaneous osteotomy. No visible droplet contamination was observed for any rhinoplasty techniques investigated. Compared with the negative control of anterior rhinoscopy, total 0.300-10.000 μm aerosols were increased after monopolar electrocautery ( < 0.001) and endonasal rasp ( = 0.003). Opening the skin-soft tissue envelope, endonasal osteotomies, and percutaneous osteotomies did not generate a detectable increase in aerosols ( > 0.15). In this investigation, droplets were not observed under ultraviolet light, and aerosol generation was noted only with cautery and endonasal rasping.
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http://dx.doi.org/10.1089/fpsam.2021.0157DOI Listing
December 2021

Wraparound nylon foil implant for isolated orbital floor fractures.

Am J Otolaryngol 2022 Jan-Feb;43(1):103229. Epub 2021 Sep 15.

Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA; Ascension St. Vincent Hospital, Indianapolis, IN, USA; Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. Electronic address:

Purpose: There are a variety of implant materials available for orbital floor fracture repair. Implant selection is guided by surgeon experience, availability, and patient specific needs. The purpose of this study is to describe a "wraparound" technique for nylon foil implant placement for large, isolated floor fractures that provides excellent results with low incidence of enophthalmos or other complications.

Materials And Methods: A retrospective chart review from 2012 to 2020 was conducted in patients who underwent isolated orbital floor fracture repair with the use of the "wraparound" nylon foil implant. The surgical technique is described. Preoperative CT scans were assessed, and the patients were divided into groups based on the size of the floor fracture. Postoperative data was collected including Hertel measurements and complications related to the implant.

Results: There were eighty patients who underwent orbital floor fracture repair with the described technique and had adequate follow-up. There were 18 (22.5%) small-sized fractures, 32 (40%) medium-sized fractures, and 30 (37.5%) large-sized fractures in the study group. One patient (3.33%) in the large fracture group had clinically significant enophthalmos of 2 mm postoperatively. There were no other patients with clinically significant enophthalmos. There were no instances of any complications related to the implant, and no patients required implant removal.

Conclusions: The "wraparound" technique for a nylon foil implant provides excellent results for isolated orbital floor fractures. It provides more support and stability than traditional nylon implants for larger fractures and has minimal complication rates.
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http://dx.doi.org/10.1016/j.amjoto.2021.103229DOI Listing
January 2022

Eyelid Coupling Using a Modified Tarsoconjunctival Flap in Facial Paralysis.

Facial Plast Surg Clin North Am 2021 Aug;29(3):447-451

Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, 2521 Stockton Boulevard, Suite 7200, Sacramento, CA, USA. Electronic address:

Eyelid coupling using the modified tarsoconjunctival flap is an effective treatment for paralytic ectropion. Eyelid position and quality of life can be improved in patients with flaccid facial paralysis using these eyelid coupling procedures. The modified tarsoconjunctival flap can obscure the lateral visual field by coupling the eyelids, but without distortion of the canthal angle and eyelid margin. The procedure is often coupled with a lateral canthoplasty or canthopexy to address horizontal laxity of the lower eyelid. Collecting standardized outcome measures will help establish the ideal treatment paradigm of paralytic eyelid malposition.
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http://dx.doi.org/10.1016/j.fsc.2021.03.007DOI Listing
August 2021

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 generation during routine rhinologic surgeries and in-office procedures.

Laryngoscope Investig Otolaryngol 2021 Feb 14;6(1):49-57. Epub 2021 Jan 14.

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

Objective: Cadaveric simulations have shown endonasal drilling and cautery generate aerosols, which is a significant concern for otolaryngologists during the COVID-19 era. This study quantifies aerosol generation during routine rhinologic surgeries and in-office procedures in live patients.

Methods: Aerosols ranging from 0.30 to 10.0 μm were measured in real-time using an optical particle sizer during surgeries and in-office procedures. Various mask conditions were tested during rigid nasal endoscopy (RNE) and postoperative debridement (POD).

Results: Higher aerosol concentrations (AC) ranging from 2.69 to 10.0 μm were measured during RNE ( = 9) with no mask vs two mask conditions ( = .002 and = .017). Mean AC (0.30-10.0 μm) were significantly higher during POD (n = 9) for no mask vs a mask covering the patient's mouth condition (mean difference = 0.16 ± 0.03 particles/cm, 95% CI 0.10-0.22,  < .001). There were no discernible spikes in aerosol levels during endoscopic septoplasty (n = 3). Aerosol spikes were measured in two of three functional endoscopic sinus surgeries (FESS) with microdebrider. Using suction mitigation, there were no discernible spikes during powered drilling in two anterior skull base surgeries (ASBS).

Conclusion: Use of a surgical mask over the patient's mouth during in-office procedures or a mask with a slit for an endoscope during RNE significantly diminished aerosol generation. However, whether this reduction in aerosol generation is sufficient to prevent transmission of communicable diseases via aerosols was beyond the scope of this study. There were several spikes in aerosols during FESS and ASBS, though none were associated with endonasal drilling with the use of suction mitigation.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.520DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883622PMC
February 2021

Ocular motility and diplopia measurements following orbital floor fracture repair.

Am J Otolaryngol 2021 Mar-Apr;42(2):102879. Epub 2021 Jan 5.

Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA; Ascension St. Vincent Hospital, Indianapolis, IN, USA; Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology-Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.

Purpose: Diplopia and ocular motility restriction following orbital fracture repair are common complications. The reported rates in the literature differ greatly, in part due to varying definitions of diplopia and methods of measurement. The purpose of this study is to describe a practical and efficient in-office method for examining ocular motility and diplopia in orbital trauma patients and to report the outcomes in a series of patients who underwent orbital floor fracture repair.

Materials And Methods: A retrospective chart review from 2012 to 2019 was conducted in patients who underwent isolated orbital floor fracture repair within 3 weeks of trauma. All patients had examinations to assess extraocular motility and subjective diplopia using the described techniques.

Results: Ninety-three patients underwent orbital floor fracture repair and had adequate follow-up. Preoperatively, 71 (76%) patients had some restriction in motility and 59 (63%) patients complained of diplopia. Postoperatively, only 1 patient (1.09%) had clinically significant diplopia. Five (5.4%) additional patients demonstrated mild restriction in supraduction upon detailed ophthalmic examination that was not discovered upon subjective history. No patients had worsening of diplopia or motility after surgery.

Conclusions: Diplopia and motility restriction following orbital fracture repair can be a persistent problem for some patients. It is important to perform a careful ophthalmic examination to detect motility deficits and diplopia that can be significant to the patient. The true rate of restriction and diplopia may be higher using detailed ophthalmic diagnostic techniques compared to subjective patient history.
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http://dx.doi.org/10.1016/j.amjoto.2020.102879DOI Listing
September 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

The association of weather, temperature, and holidays on pediatric maxillofacial trauma.

Laryngoscope Investig Otolaryngol 2020 Oct 22;5(5):846-852. Epub 2020 Sep 22.

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

Objective: To evaluate the association of weather, seasons, months and holidays on the frequency and pattern of pediatric facial fractures.

Methods: Retrospective review of pediatric patients treated for facial fractures at two Level I trauma centers in a midsize Midwestern US city over a 5-year period. Patients were included only if presentation was within 3 hours of inciting trauma, transfers from other facilities were excluded. Demographic characteristics, fracture patterns, operative interventions, weather data, and local public school schedules were acquired and associations were analyzed with unpaired tests, χ, multivariate and binomial regression model analyses.

Results: Two hundred and sixty patients were included. The average age (SD) was 11.8 (5.0) years, with 173 males and 87 females. The highest distribution of presentations occurred in the summer season (35.0%), on weekends and holidays (58.1%), and when the weather was described as clear (48.5%). The most common mechanisms of injury were motor vehicle collisions (25.8%), followed by sports-(21.5%) and assault-(16.5%) related injuries. Mechanisms were significantly associated with certain fracture patterns. Older age was associated with fewer orbital fractures ( < .01). Seventy-five patients (28.8%) required operative intervention. Age was found to impact the likelihood of operative intervention (Exp() = 1.081, = .03) while weather, temperature, and mechanism did not.

Conclusion: Pediatric facial fractures are linked to warmer weather with clear skies and warmer season. Age predicts some fracture patterns and need for operative intervention. These results can be used to inform public health interventions, policymaking, and trauma staffing.Level of Evidence: Level 2b (retrospective cohort).
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http://dx.doi.org/10.1002/lio2.457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585244PMC
October 2020

Mitigation of Aerosols Generated During Rhinologic Surgery: A Pandemic-Era Cadaveric Simulation.

Otolaryngol Head Neck Surg 2021 02 11;164(2):433-442. Epub 2020 Aug 11.

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

Objective: After significant restrictions initially due to the COVID-19 pandemic, otolaryngologists have begun resuming normal clinical practice. However, the risk of SARS-CoV-2 transmission to health care workers through aerosolization and airborne transmission during rhinologic surgery remains incompletely characterized. The objective of this study was to quantify the number concentrations of aerosols generated during rhinologic surgery with and without interventions involving 3 passive suction devices.

Study Design: Cadaver simulation.

Setting: Dedicated surgical laboratory.

Subjects And Methods: In a simulation of rhinologic procedures with and without different passive suction interventions, the concentrations of generated aerosols in the particle size range of 0.30 to 10.0 µm were quantified with an optical particle sizer.

Results: Functional endoscopic sinus surgery with and without microdebrider, high-speed powered drilling, use of an ultrasonic aspirator, and electrocautery all produced statistically significant increases in concentrations of aerosols of various sizes ( < .05). Powered drilling, ultrasonic aspirator, and electrocautery generated the highest concentration of aerosols, predominantly submicroparticles <1 µm. All interventions with a suction device were effective in reducing aerosols, though the surgical smoke evacuation system was the most effective passive suction method in 2 of the 5 surgical conditions with statistical significance ( < .05).

Conclusion: Significant aerosol concentrations were produced in the range of 0.30 to 10.0 µm during all rhinologic procedures in this cadaver simulation. Rhinologic surgery with a passive suction device results in significant mitigation of generated aerosols.
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http://dx.doi.org/10.1177/0194599820951169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424621PMC
February 2021

Reverse-Surge Planning During the COVID-19 Pandemic: A Cautionary Ramp-up for the Otolaryngologist.

Otolaryngol Head Neck Surg 2020 12 30;163(6):1137-1139. Epub 2020 Jun 30.

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

As the coronavirus disease 2019 (COVID-19) pandemic continues to evolve through the United States and other countries, differing rates of progression and decline are occurring based on varied population densities. While some health systems are reaching a steady state of new patient cases, others are seeing a leveling off or decline, allowing for restoration of normal practices. This "reverse-surge" planning and implementation process is a colossal undertaking for health systems trying to reacquire patient access and financial stability while preserving necessary resources and maintaining precautions for another potential surge. For the otolaryngologist, reverse-surge planning involves additional workflow adjustments in the outpatient and operating room settings given the abundance of COVID-19 virus in the upper aerodigestive tract. As the reverse-surge best practices are still under development, open communication between otolaryngology colleagues and health system leadership is paramount to optimize efficiency and maintain an adequate measure of safety for patients and our health care teams.
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http://dx.doi.org/10.1177/0194599820938045DOI Listing
December 2020

Facial nerve repair utilizing intraoperative repair strategies.

Laryngoscope Investig Otolaryngol 2020 Jun 28;5(3):552-559. Epub 2020 May 28.

Department of Anatomy, Cell Biology and Physiology Indiana University School of Medicine Indianapolis Indiana USA.

Objectives: To determine whether functional and anatomical outcomes following suture neurorrhaphy are improved by the addition of electrical stimulation with or without the addition of polyethylene glycol (PEG).

Methods: In a rat model of facial nerve injury, complete facial nerve transection and repair was performed via (a) suture neurorrhaphy alone, (b) neurorrhaphy with the addition of brief (30 minutes) intraoperative electrical stimulation, or (c) neurorrhaphy with the addition electrical stimulation and PEG. Functional recovery was assessed weekly for 16 weeks. At 16 weeks postoperatively, motoneuron survival, amount of regrowth, and specificity of regrowth were assessed by branch labeling and tissue analysis.

Results: The addition of brief intraoperative electrical stimulation improved all functional outcomes compared to suturing alone. The addition of PEG to electrical stimulation impaired this benefit. Motoneuron survival, amount of regrowth, and specificity of regrowth were unaltered at 16 weeks postoperative in all treatment groups.

Conclusion: The addition of brief intraoperative electrical stimulation to neurorrhaphy in this rodent model shows promising neurological benefit in the surgical repair of facial nerve injury.

Level Of Evidence: Animal study.
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http://dx.doi.org/10.1002/lio2.411DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314485PMC
June 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

Hair-bearing human skin generated entirely from pluripotent stem cells.

Nature 2020 06 3;582(7812):399-404. Epub 2020 Jun 3.

Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA.

The skin is a multilayered organ, equipped with appendages (that is, follicles and glands), that is critical for regulating body temperature and the retention of bodily fluids, guarding against external stresses and mediating the sensation of touch and pain. Reconstructing appendage-bearing skin in cultures and in bioengineered grafts is a biomedical challenge that has yet to be met. Here we report an organoid culture system that generates complex skin from human pluripotent stem cells. We use stepwise modulation of the transforming growth factor β (TGFβ) and fibroblast growth factor (FGF) signalling pathways to co-induce cranial epithelial cells and neural crest cells within a spherical cell aggregate. During an incubation period of 4-5 months, we observe the emergence of a cyst-like skin organoid composed of stratified epidermis, fat-rich dermis and pigmented hair follicles that are equipped with sebaceous glands. A network of sensory neurons and Schwann cells form nerve-like bundles that target Merkel cells in organoid hair follicles, mimicking the neural circuitry associated with human touch. Single-cell RNA sequencing and direct comparison to fetal specimens suggest that the skin organoids are equivalent to the facial skin of human fetuses in the second trimester of development. Moreover, we show that skin organoids form planar hair-bearing skin when grafted onto nude mice. Together, our results demonstrate that nearly complete skin can self-assemble in vitro and be used to reconstitute skin in vivo. We anticipate that our skin organoids will provide a foundation for future studies of human skin development, disease modelling and reconstructive surgery.
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http://dx.doi.org/10.1038/s41586-020-2352-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593871PMC
June 2020

Readability of Printed Online Education Materials on Pituitary Tumors: Untangling a Web of Complexity.

Am J Rhinol Allergy 2020 Nov 27;34(6):759-766. Epub 2020 May 27.

Indiana University School of Medicine, Indianapolis, Indiana.

Background: Patients are increasingly turning to the internet for health education. Due to the complex pathophysiology, clinic-diagnostic profile, and management spectrum of pituitary tumors, an evaluation of the readability of printed online education materials (POEMs) regarding this entity is warranted.

Objective: (1) To apply established readability assessment tools to internet search results on the topic of pituitary tumors. (2) To identify sources of complexity in order to guide the creation POEMs that are in line with the reading level of the target audience. After independent, neutral internet search for the phrase "pituitary tumor," the first 100 results were subjected to inclusion criteria matching. Analysis was performed using 5 readability assessment tools including Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning-Fog Score (GFS), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG).

Results: A total of 82 websites met inclusion criteria. All websites were found to be at a higher reading level ( < .01) than the United States Department of Health and Human Services (USDHHS) recommended sixth-grade level. Mean readability scores were as follows: FRE, 38.79; FKGL, 11.27; GFS, 12.83; CLI, 17.31; SMOG, 12.12. Intergroup comparison between FKGL, GFS, CLI, and SMOG yielded that CLI was significantly higher ( < .03). No significant differences in readability were noted between academic and other websites.

Conclusion: There is a significant misalignment between the reading level of patients and the readability of pituitary tumor POEMs. This may lead patients to misconceive their diagnoses, management options, and prognosis.
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http://dx.doi.org/10.1177/1945892420927288DOI Listing
November 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

Cadaveric Simulation of Endoscopic Endonasal Procedures: Analysis of Droplet Splatter Patterns During the COVID-19 Pandemic.

Otolaryngol Head Neck Surg 2020 07 19;163(1):145-150. Epub 2020 May 19.

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

Objective: The primary mode of viral transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is thought to occur through the spread of respiratory droplets. The objective of this study was to investigate droplet and splatter patterns resulting from common endoscopic endonasal procedures.

Study Design: Cadaver simulation series.

Setting: Dedicated surgical laboratory.

Subjects And Methods: After instilling cadaver head specimens (n = 2) with fluorescein solution, endoscopic endonasal procedures were systematically performed to evaluate the quantity, size, and distance of droplets and splatter following each experimental condition.

Results: There were no observable fluorescein droplets or splatter noted in the measured surgical field in any direction after nasal endoscopy, septoplasty with microdebrider-assisted turbinoplasty, cold-steel functional endoscopic sinus surgery (FESS), and all experimental conditions using an ultrasonic aspirator. Limited droplet spread was noted with microdebrider FESS (2 droplets, <1 mm in size, within 10 cm), drilling of the sphenoid rostrum with a diamond burr (8, <1 mm, 12 cm), and drilling of the frontal beak with a cutting burr (5, <1 mm, 9 cm); however, the use of concurrent suction while drilling resulted in no droplets or splatter. The control condition of external activation of the drill resulted in gross contamination (11, 2 cm, 13 cm).

Conclusion: Our results indicate that there is very little droplet generation from routine rhinologic procedures. The droplet generation from drilling was mitigated with the use of concurrent suction. Extreme caution should be used to avoid activating powered instrumentation outside of the nasal cavity, which was found to cause droplet contamination.
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http://dx.doi.org/10.1177/0194599820929274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240308PMC
July 2020

Otolaryngologists' Role in Redeployment During the COVID-19 Pandemic: A Commentary.

Otolaryngol Head Neck Surg 2020 07 5;163(1):94-95. Epub 2020 May 5.

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

As otolaryngologists, we identify as subspecialists and fellowship-trained surgeons and may even identify as "super-subspecialists." The likelihood of being redeployed and drawing from knowledge learned during our postgraduate year 1 training seemed exceedingly unlikely until physician resources became scarce in some health care systems during the COVID-19 pandemic. More now than ever, it is evident that our broad training is valuable in helping patients and allowing the otolaryngologist to meaningfully contribute to the larger health care community, especially while the majority (70%-95%) of elective care is delayed. With our skill set, otolaryngologists are poised to support various aspects of hospital wards, intensive care units, emergency departments, and beyond.
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http://dx.doi.org/10.1177/0194599820926982DOI Listing
July 2020

Evaluation of the Quality of Printed Online Education Materials in Cosmetic Facial Plastic Surgery.

Facial Plast Surg Aesthet Med 2020 Jul/Aug;22(4):255-261. Epub 2020 Apr 8.

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

In the modern-day health care environment, it is expected that a large proportion of patients will utilize the Internet to gather health care-related information. However, online sources are often not subjected to adequate quality control measures. To evaluate the quality of printed online education materials (POEMs) pertaining to elective facial cosmetic surgery. This is a descriptive correlational study. Independent Internet searches for the terms "rhinoplasty," "rhytidectomy," "blepharoplasty," and "browlift" were carried out using the Google search engine. The top 20 web resources for each term were analyzed. All web resources were analyzed for HONcode certification. The DISCERN instrument was then used to determine reliability and specificity of information, whereas readability was assessed using the Flesch Reading Ease (FRE) score and the Flesch-Kincaid Grade Level (FKGL). Of the resulting 80 web resources, 30% ( = 24) were HONcode certified. None of the surgical society web resources ( = 12) were HONcode certified, and only 42% ( = 8) of web resources associated with academic institutions were HONcode certified. Out of a maximum DISCERN score of 80, the mean (standard deviation [SD]) scores were 48 (11) for rhinoplasty, 50 (11) for rhytidectomy, 47 (11) for blepharoplasty, and 45 (10) for browlift. The mean DISCERN scores of the HONcode-certified web resources did not differ significantly from scores of uncertified web resources ( = 0.069). There was no significant difference in overall mean DISCERN scores for the different web resource categories. The mean (SD) FRE score was 45.7 (11.9), whereas the mean FKGL score was 10.7 (1.9). HONcode-certified web resources had significantly higher FRE scores ( = 0.028) and significantly lower FKGL scores ( = 0.0003). A significant proportion of POEMs regarding elective cosmetic facial plastic surgery remains uncertified and of inadequate quality. This can negatively impact the informed decision-making process and increase the risk of poor outcomes and lower satisfaction rates.
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http://dx.doi.org/10.1089/fpsam.2019.0013DOI Listing
November 2020

Understandability and actionability of audiovisual patient education materials on sinusitis.

Int Forum Allergy Rhinol 2020 04 12;10(4):564-571. Epub 2020 Jan 12.

Indiana University School of Medicine, Indianapolis, IN.

Background: Acute and chronic rhinosinusitis are debilitating diseases that affect from 5% to 16% of the population. YouTube is the second most commonly used search engine and is often utilized by patients to garner health information regarding various disease processes and their respective management options. An evaluation of these information resources for quality and reliability is warranted, especially in an era in which patients are increasingly turning to audiovisual (A/V) media to educate themselves regarding their ailments.

Methods: The YouTube video database was searched using the term "sinusitis" from its inception through to November 2018. The first 50 videos populated under the relevance-based ranking option were collected and parsed by time and language. Of the 50 videos, 10 were eliminated either for length (≤1 minute or ≥20 minutes), language (any language other than English), and/or for later being removed by YouTube for copyright violations. The videos were then assessed using the Patient Education Materials Assessment Tool-Audio/Visual (PEMAT-A/V) by 2 independent reviewers for understandability and actionability.

Results: A total of 40 videos were examined using the PEMAT-A/V tool. The average understandability score was 57.7%, whereas the average actionability score was 46.3%. Eleven videos (28%) had actionability scores of 0%. Videos most commonly addressed disease management options (38%). The second largest category was case presentations regarding surgical techniques (30%). There were only 6 videos focused primarily on education about the definition and common traits of sinusitis (15%).

Conclusion: Our results show a paucity of high-quality online A/V educational material pertaining to sinusitis, with a majority of videos being neither understandable nor actionable. As patients increasingly turn to internet video databases like YouTube for medical information, it is critical that physicians and institutions create A/V material that is accurate, understandable, and actionable.
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http://dx.doi.org/10.1002/alr.22518DOI Listing
April 2020

Pediatric Midface Fractures: Outcomes and Complications of 218 Patients.

Laryngoscope Investig Otolaryngol 2019 Dec 6;4(6):597-601. Epub 2019 Nov 6.

Department of Otolaryngology-Head and Neck Surgery Indiana University School of Medicine Indianapolis Indiana U.S.A.

Objective: To analyze management, outcomes, and complications of pediatric midface fractures.

Methods: Retrospective cohort study at an urban, single-institution, multispecialty surgical teams, at two level 1 pediatric trauma centers. Query included subjects aged 0-17 diagnosed with midface fractures between 2012 and 2016.

Results: A total of 218 pediatric patients presented with 410 total midface fractures. The most common etiologies included motor vehicle collisions (MVC) (n = 56, 25.7%), sport-related (n = 35, 16.1%), and assault/battery (n = 32, 14.7%). Fracture site distribution included: 125 maxillary (34 with exclusively the nasal/frontal process), 109 nasal, 47 ethmoid, 40 sphenoid, 33 zygoma, 29 frontal sinus, 21 lacrimal, and 6 palatal. Among these, there were 105 orbital, 17 naso-orbito-ethmoid, and 12 Le Fort fractures. One-quarter of patients received at least one midface-related operation during the initial encounter. Operative intervention rates for specific midface fracture subsites were not significantly different ( = 6.827, = .234). One hundred thirty-five patients (63.4%) attended follow-up, thus known complication rate was 14.6% (n = 31). Complication rates between midface fracture subsites were not significantly different ( = 5.629, = .229). Complications included facial deformity (n = 18), nasal airway obstruction (n = 8), diplopia (n = 4), hardware-related pain (n = 3), and paresthesias (n = 3).

Conclusions: The most common sites of pediatric midface fractures involved the maxilla, and nasal bones. Three quarters of pediatric midface fractures were treated conservatively, with low rates of complications. Facial deformity was the most common complication; as such, proper management and follow-up are important to ensure normal growth and development of the pediatric facial skeleton.

Level Of Evidence: 4.
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http://dx.doi.org/10.1002/lio2.315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929601PMC
December 2019

Multicenter study on the effect of nonsteroidal anti-inflammatory drugs on postoperative pain after endoscopic sinus and nasal surgery.

Int Forum Allergy Rhinol 2020 04 13;10(4):489-495. Epub 2019 Dec 13.

Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose, & Throat, Department of Otolaryngology-Head & Neck Surgery, University of Louisville, Louisville, KY.

Background: The taboo of avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) after functional endoscopic sinus surgery (FESS) has been waning. The impetus to reduce opioid prescriptions in view of the opioid epidemic led the authors to change their practices to include NSAIDs after sinus surgery. This study's aim was to analyze the differences between patients before and after we began recommending NSAIDs after FESS.

Methods: A prospective cohort study was performed on patients undergoing FESS or other endoscopic nasal surgeries at 3 institutions, by 5 rhinologists and 1 facial plastic surgeon. Before introducing NSAIDs, all patients were given a prescription for hydrocodone-acetaminophen 5/325 mg and also recommended preferentially to use acetaminophen 325 mg. After the addition of NSAIDs, ibuprofen 200 mg and acetaminophen 325 mg were recommended preferentially, using the narcotic as a rescue medication. Patients kept a pain diary and medication log, and gave a visual analog scale (VAS) score for overall pain. Demographics, surgical variables, and comorbidities were also analyzed.

Results: One hundred sixty-six total patients were recruited and had data that could be analyzed (65 without NSAIDs, 101 with NSAIDs). Overall, mean pain VAS score was 3.12 ± 1.95 for the non-NSAID group and 2.33 ± 2.30 for the NSAID group (p value = 0.006). The day with the highest mean pain was the first postoperative day. The mean number of total opioid pills taken was 6.94 ± 6.85 without NSAIDs vs 3.77 ± 4.56 with NSAIDs (p = 0.018). Age and gender were found to be the only consistently significant patient variables to affect pain. There were no bleeding complications.

Conclusion: NSAID use was introduced into the practices of 5 practicing rhinologists and 1 facial plastic surgeon. No bleeding complications were seen. Both pain and overall opioid usage were reduced significantly.
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http://dx.doi.org/10.1002/alr.22506DOI Listing
April 2020

Validity testing of a three-dimensionally printed endoscopic sinonasal surgery simulator.

Laryngoscope 2020 12 12;130(12):2748-2753. Epub 2019 Nov 12.

Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.

Objectives/hypothesis: To assess the face, content, construct, and concurrent validity of the PHACON Sinonasal Surgery Simulator (SNSS).

Study Design: Prospective cohort study.

Methods: A total of 12 otolaryngology residents were recruited to perform sinonasal surgery on the simulator followed by cadaveric heads. Resident performances were recorded and de-identified. Face and content validities were evaluated based on 5-point Likert scale questionnaires. The recordings were evaluated by extramural expert rhinologists based on a validated Global Rating Scale (GRS). These results were analyzed and compared to assess construct and concurrent validity.

Results: The appearance of anatomic structures was rated as realistic by 75% of all participants, while only 30% and 41.7% rated the mucosal and bony tissues as realistic, respectively. A total of 91.7% of participants found the model useful for teaching anatomy, while 66.7% said it was useful for teaching operative technique. Construct validity was confirmed by showing significant differences in performance between the novice and experienced groups. Concurrent validity was confirmed by showing significant correlation between performance on the model and gold standard (i.e. cadaver head).

Conclusions: This study demonstrates the face, content, concurrent, and construct validity of a 3D-printed SNSS. Although this model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents, improvements are required with respect to the quality of simulated mucosal tissue as well as the simulated anatomy of the fronto-ethmoid compartment Level of Evidence: NA Laryngoscope, 2019.
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http://dx.doi.org/10.1002/lary.28356DOI Listing
December 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

Management of Mandible Fracture in 150 Children Across 7 Years in a US Tertiary Care Hospital.

JAMA Facial Plast Surg 2019 Sep;21(5):414-418

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

Importance: Pediatric mandible fractures are the most common pediatric facial fracture requiring hospitalization, but data are lacking on management methods, outcomes, and complications.

Objective: To analyze management methods, outcomes, and complications of pediatric mandible fractures at an urban academic tertiary care center.

Design, Setting, And Participants: Single-institution cohort study conducted at 2 urban level 1 pediatric trauma centers including all patients aged 0 to 17 years diagnosed with mandible fractures between January 1, 2010, and December 31, 2016. Fractures were treated by multispecialty surgical teams. Data were analyzed between January 1, 2018, and March 1, 2018.

Main Outcomes And Measures: Fracture distributions, mechanisms, treatment methods, complications, and follow-up.

Results: Of 150 patients with 310 total mandible fractures, the mean (SD) age was 12.8 (4.6) years; 108 (72.0%) were male; 107 (71.3%) were white; and 109 (72.7%) had 2 or more mandible fractures. There were 78 condylar or subcondylar fractures (60 patients), 75 ramus or angle fractures (69 patients), 69 body fractures (62 patients), 78 symphyseal or parasymphyseal fractures (76 patients), and 10 coronoid fractures (10 patients). The most common mechanisms of injury were assault and battery, motor vehicle collisions, falls or play, and sports-related mechanisms. Thirty-eight (25%) patients were treated with observation and a soft diet. Children 12 years and older were more likely to receive open reduction internal fixation (ORIF) (P = .02). Of 112 patients treated with surgery, 63 (56.2%) were treated with maxillomandibular fixation (MMF), 24 (21.4%) received ORIF, and 20 (17.9%) received both MMF and ORIF. Nonabsorbable plating was used in all but 1 of the ORIF procedures. Five of 44 (11.4%) patients receiving ORIF or ORIF and MMF had follow-up beyond 6 months, and 8 of the 44 (18.2%) had documented plating hardware removal; hardware was in place for a mean (SD) 180 (167) days. Sixty of the 150 patients (40.0%) had some form of follow-up, a mean (SD) 90 (113) days total after initial presentation. Thirteen patients experienced complications, for a total complication rate of 8.7%.

Conclusions And Relevance: Conservative management, using MMF and a soft diet, was favored for most operative pediatric mandible fractures. Open reduction internal fixation with titanium plating was less commonly used. Outcomes were favorable despite a lack of consistent follow-up.

Level Of Evidence: 4.
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http://dx.doi.org/10.1001/jamafacial.2019.0312DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555477PMC
September 2019

Post-operative epiphora following the transcutaneous medial canthal incision.

Am J Otolaryngol 2019 Jul - Aug;40(4):564-566. Epub 2019 May 14.

Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA.

Purpose: The safety profile of the transcutaneous medial canthal incision for access to the medial orbit is assessed with a focus on the risk of post-operative iatrogenic epiphora.

Methods: A retrospective chart review of patients undergoing medial orbitotomy via the transcutaneous medial canthal incision was performed. Patients with a minimum of 3 months of follow-up were included and post-operative complications were assessed and characterized.

Results: One-hundred-fifty patients were included in the study. A total of 4 complications were identified, including one each of the following: nasolacrimal duct obstruction, hypertrophic scar, suture granuloma and soft tissue infection. Only the nasolacrimal duct obstruction required surgical intervention.

Discussion: Access to the medial orbit has been achieved through a variety of approaches, each with their own benefits and risk profile. The transcaruncular approach has increased in usage as a means to avoid a visible cutaneous scar and decrease the risk of iatrogenic epiphora, however, there are specific patients who may have relative contraindications to this approach. The current study demonstrates the low risk profile of the transcutaneous medial canthal incision, specifically the minimal risk of iatrogenic damage to the nasolacrimal outflow system. This approach is another useful tool which orbit surgeons should be familiar with to offer as an option to patients requiring medial orbitotomy.
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http://dx.doi.org/10.1016/j.amjoto.2019.05.005DOI Listing
December 2019

Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management.

Am J Otolaryngol 2019 Jul - Aug;40(4):509-511. Epub 2019 Apr 9.

Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA; Department of Ophthalmology, Indiana University, Indianapolis, IN, USA; Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA; St. Vincent Hospital, Indianapolis, IN, USA. Electronic address:

Purpose: To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants.

Methods: A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants.

Results: Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years.

Conclusions: To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported. PRéCIS: A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.
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http://dx.doi.org/10.1016/j.amjoto.2019.04.008DOI Listing
December 2019

In-office Functional Nasal Surgery.

Otolaryngol Clin North Am 2019 Jun 22;52(3):485-495. Epub 2019 Mar 22.

Division of Facial Plastic, Aesthetic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, 1130 W. Michigan Street, Suite 400, Indianapolis, IN 46202, USA. Electronic address:

Nasal airway obstruction is a common complaint encountered by the otolaryngologist. In-office nasal procedures are becoming increasingly popular and should be considered for patients desiring immediate treatment without the adverse effects of general anesthesia, operating room costs, or scheduling delays. This article discusses the factors in patient selection, room setup, and other considerations. The options available for in-office treatment of nasal valve repair are discussed, including turbinoplasty, septoplasty, and nasal valve repair/functional rhinoplasty-type techniques described in the literature.
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http://dx.doi.org/10.1016/j.otc.2019.02.010DOI Listing
June 2019

Three-Dimensional Printing of Nasal Prosthetics: Overcoming the Hump.

JAMA Otolaryngol Head Neck Surg 2018 07;144(7):564-565

Division of Facial Plastic and 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.2018.0371DOI Listing
July 2018

Functional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model.

JAMA Facial Plast Surg 2019 Jan;21(1):61-68

Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.

Importance: Functional and anatomical outcomes after surgical repair of facial nerve injury may be improved with the addition of polyethylene glycol (PEG) to direct suture neurorrhaphy. The application of PEG has shown promise in treating spinal nerve injuries, but its efficacy has not been evaluated in treatment of cranial nerve injuries.

Objective: To determine whether PEG in addition to neurorrhaphy can improve functional outcomes and synkinesis after facial nerve injury.

Design, Setting, And Subjects: In this animal experiment, 36 rats underwent right facial nerve transection and neurorrhaphy with addition of PEG. Weekly behavioral scoring was done for 10 rats for 6 weeks and 14 rats for 16 weeks after the operations. In the 16-week study, the buccal branches were labeled and tissue analysis was performed. In the 6-week study, the mandibular and buccal branches were labeled and tissue analysis was performed. Histologic analysis was performed for 10 rats in a 1-week study to assess the association of PEG with axonal continuity and Wallerian degeneration. Six rats served as the uninjured control group. Data were collected from February 8, 2016, through July 10, 2017.

Intervention: Polyethylene glycol applied to the facial nerve after neurorrhaphy.

Main Outcomes And Measures: Functional recovery was assessed weekly for the 16- and 6-week studies, as well as motoneuron survival, amount of regrowth, specificity of regrowth, and aberrant branching. Short-term effects of PEG were assessed in the 1-week study.

Results: Among the 40 male rats included in the study, PEG addition to neurorrhaphy showed no functional benefit in eye blink reflex (mean [SEM], 3.57 [0.88] weeks; 95% CI, -2.8 to 1.9 weeks; P = .70) or whisking function (mean [SEM], 4.00 [0.72] weeks; 95% CI, -3.6 to 2.4 weeks; P = .69) compared with suturing alone at 16 weeks. Motoneuron survival was not changed by PEG in the 16-week (mean, 132.1 motoneurons per tissue section; 95% CI, -21.0 to 8.4; P = .13) or 6-week (mean, 131.1 motoneurons per tissue section; 95% CI, -11.0 to 10.0; P = .06) studies. Compared with controls, neither surgical group showed differences in buccal branch regrowth at 16 (36.9 motoneurons per tissue section; 95% CI, -14.5 to 22.0; P = .28) or 6 (36.7 motoneurons per tissue section; 95% CI, -7.8 to 18.5; P = .48) weeks or in the mandibular branch at 6 weeks (25.2 motoneurons per tissue section; 95% CI, -14.5 to 15.5; P = .99). Addition of PEG had no advantage in regrowth specificity compared with suturing alone at 16 weeks (15.3% buccal branch motoneurons with misguided projections; 95% CI, -7.2% to 11.0%; P = .84). After 6 weeks, the number of motoneurons with misguided projections to the mandibular branch showed no advantage of PEG treatment compared with suturing alone (12.1% buccal branch motoneurons with misguided projections; 95% CI, -8.2% to 9.2%; P = .98). In the 1-week study, improved axonal continuity and muscular innervation were not observed in PEG-treated rats.

Conclusions And Relevance: Although PEG has shown efficacy in treating other nervous system injuries, PEG in addition to neurorraphy was not beneficial in a rat model of facial nerve injury. The addition of PEG to suturing may not be warranted in the surgical repair of facial nerve injury.

Level Of Evidence: NA.
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http://dx.doi.org/10.1001/jamafacial.2018.0308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439742PMC
January 2019

A hybrid technique to address exposure keratopathy secondary to facial nerve paresis: A combination of a lateral tarsorrhaphy and lateral wedge resection.

Am J Otolaryngol 2018 Sep - Oct;39(5):472-475. Epub 2018 May 9.

Department of Ophthalmology and Visual Sciences, University of Louisville, 301 E. Muhammad Ali Blvd, Louisville, KY 40202, United States; Department of Ophthalmology, Indiana University, 1160 W. Michigan St, Indianapolis, IN 46202, United States; Oculofacial Plastic and Orbital Surgery LLC, 201 Pennsylvania Parkway Ste 225, Indianapolis, IN 46280, United States. Electronic address:

Purpose: To present the results of treating combined lower eyelid laxity, retraction and midface descent secondary to facial nerve weakness with a hybrid surgical procedure.

Materials And Methods: A retrospective analysis of patients from January 2015 to January 2017 who underwent a hybrid surgical technique for the treatment of corneal exposure secondary to facial nerve paresis with a single surgeon was performed. Age, gender, and presence of exposure symptoms were recorded pre-operatively. Outcomes assessed included improvement of lower eyelid laxity and position, operative complications, and post-operative symptomatic relief.

Results: A total of 11 patients underwent unilateral eyelid surgery. All patients had symptomatic relief and good functional outcomes defined as improvement in eyelid laxity, lower eyelid position, and objective corneal exposure. No cases required reoperation during an average follow up of 174.5 days.

Conclusions: Combining portions of a tarsorrhaphy and lateral wedge resection technique is a simple and effective procedure to improve lower eyelid position and limit corneal exposure secondary to facial nerve paresis.
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http://dx.doi.org/10.1016/j.amjoto.2018.05.001DOI Listing
December 2018
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