The Laryngoscope
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The endoscopic endonasal transcribriform approach (EETA) is a viable alternative option for resection of selected anterior skull base (ASB) tumors. However, this technique results in the creation of large cribriform defects. Some have reported the use of a rigid substitute for ASB reconstruction to prevent postoperative frontal lobe sagging. We evaluate the degree of frontal lobe sagging using our triple-layer technique [fascia lata, acellular dermal allograft, and pedicled nasoseptal flap (PNSF)] without the use of rigid structural reconstruction for large cribriform defects. ⋯ Rigid structural repair may not be necessary for ASB defect repair after endoscopic endonasal resection of the cribriform plate. Our technique for multilayer cranial base reconstruction appears to be satisfactory in preventing delayed frontal lobe sagging.
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Comparative Study
Impact of fellowship training on research productivity in academic otolaryngology.
Assessment of scholarly productivity as measured by research output is a key component of decisions regarding appointment and advancement in academic otolaryngology. An increasing number of graduating residents are pursuing postresidency fellowships, and evaluation of research productivity among these subspecialists is important in determining their role in academic otolaryngology departments. The h-index is a reliable indicator of research productivity, as it takes into account both quantity and relevance of research contributions. Our objective was to evaluate and compare trends in research productivity among the various otolaryngology subspecialties. ⋯ Fellowship-trained otolaryngologists had higher h-indices, and faculty members trained in the subspecialties with the highest research productivity were disproportionately represented in positions of leadership within academic otolaryngology, probably reflecting the importance of research contributions in the academic advancement process, although other factors, such as educational contributions and clinical performance, may also be important factors.
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Comparative Study
Retrospective evaluation of laboratory-based diagnostic tools for cervical necrotizing fasciitis.
Cervical necrotizing fasciitis (CNF) is challenging to diagnose and associated with high morbidity and mortality. The objective of this study is to evaluate the utility of two laboratory-based diagnostic tools for distinguishing necrotizing from non-necrotizing infection when specifically applied to neck infection. ⋯ Neither the LRINEC score nor the use of admission white blood cell count and sodium level were useful for distinguishing cervical necrotizing fasciitis from non-necrotizing neck infection.
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Randomized Controlled Trial
Preoperative topical antimicrobial decolonization in head and neck surgery.
Surgical site infections (SSIs) are an important cause of morbidity and mortality after head and neck surgery. Our primary objective was to determine the efficacy of preoperative topical antimicrobial decolonization before head and neck surgery. ⋯ Preoperative antimicrobial decolonization did not significantly decrease the incidence of SSIs after head and neck surgery, but might be considered for high-risk groups despite the lack of conclusive evidence confirming efficacy. Risk factors for SSIs after head and neck surgery are identified for the first time in a prospective study.
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Two million new users will abuse prescription narcotics this year, most commonly hydrocodone. The most commonly prescribed form is hydrocodone-acetaminophen (HA). Many individuals crush the tablets and snort the product to take advantage of the rapid transmucosal delivery of narcotics. The resultant pathology of intranasal hydrocodone acetaminophen abuse (INHAA) has been described only in a few case studies. ⋯ The vast majority of cases presented with characteristic physical findings that included acute necrosis of soft tissue, which can progress to destroy oronasal structures. In the absence of invasive fungal disease, the condition is self-limited after cessation of INHAA and performance of local nasal debridement and nasal hygiene.