Amar C. Suryadevara

Day Float: An Alternative to the Night Float Coverage System for Residency Programs†

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) has mandated an 80‐hour work week that has resulted in changes to many residency programs. In otolaryngology, most programs have switched to either home call or night float systems. Our department covers all of the maxillofacial trauma and backup airway calls, which has made it difficult to employ a home call system. Instead of a night float coverage system, our program implemented a day float coverage system that allows the residents to participate in a 24‐hour call period. After call and sign‐out, the residents go home; however, their clinical duties are covered by the day float resident.

The use of fibrin glue for fixation of acellular human dermal allograft in septal perforation repair

OBJECTIVES Acellular human dermal allograft used as an interpositional graft between mucoperichondrial flaps has been shown to be effective in the repair of septal perforations. The material is typically sutured to the septum, but this can be technically difficult. We describe a technique in which fibrin glue is used to secure the acellular human dermal allograft for septal perforation repair. STUDY DESIGN A retrospective case series of 5 patients who underwent this procedure are reviewed. METHODS Five patients with preexisting septal perforations underwent septal repair using fibrin glue to secure the interpositional acellular human dermal allograft. The graft was first placed between the mucoperichondrial flaps, and 1/3 cm(3) of fibrin glue was applied to both sides. One side was then covered with a bipedicled mucosal flap and compressed for 5 minutes to allow for fixation. RESULTS The use of fibrin glue compared with conventional suturing decreased the length of the procedure by approximately 30 minutes. At the 3-month postoperative examination, all 5 patients were found to have successful outcomes. CONCLUSION The use of fibrin glue for fixation of the acellular human dermal allograft in septal perforation repair is technically less difficult and reduces the length of the procedure, and we believe it reduces graft migration when compared with conventional suturing techniques.

Upper lateral strut graft: a technique to improve the internal nasal valve.

Background Internal nasal valve (INV) collapse can contribute significantly to nasal obstruction and may be caused by upper lateral cartilage (ULC) collapse medially or laterally. Surgical techniques addressing INV collapse have focused more on treating the narrowed INV angle, with less consideration of the lateral INV area. This article describes a technique to improve INV patency both medially and laterally. This study analyzes the changes in minimal cross-sectional area (MCA) at the INV after graft placement and determines whether these changes are significantly different for normal versus narrow INVs. Methods Noses of six fixed cadavers were dissected by open rhinoplasty to release the ULCs from the septum. Upper lateral strut grafts were placed through subperichondrial pockets along the ULC undersurfaces and out over the piriform apertures into subperiosteal pockets. Grafts were secured to the dorsal septum. Acoustic rhinometry and nasal endoscopy were used to classify INVs before graft placement as narrow or normal and to assess changes at the INV after graft placement. Results Mean pregraft MCA was 0.58 cm2. Mean MCA percent increase after graft placement was 22%. By INV type, percent increases were 51% for narrow INVs and 1% for normal INVs. Mean increases in MCA after graft placement were statistically significant for the entire group and for narrow INVs, with increases of 0.10 cm2 (p = 0.03) and 0.22 cm2 (p = 0.004), respectively. Conclusion The upper lateral strut graft improved patency of cadaveric INVs, with statistically significant increases in the MCA most notable when placed for narrow INVs.

Anatomy of the upper lateral cartilage along the lateral pyriform aperture.

Background: The upper lateral cartilages underlie the nasal bones cephalically, and articulate with the nasal septum medially. The authors studied the histologic and anatomical relationships between the lateral aspect of the upper lateral cartilages and the frontal process of the maxilla. Methods: Six cadaver noses were dissected by open rhinoplasty to expose the upper lateral cartilages bilaterally. Subperiosteal dissection was performed over the medial maxillae and nasal bones to expose the perimeter of the pyriform aperture. Twelve sides were analyzed anatomically. Three cadavers were used to create six tissue specimens for histologic analysis, by resecting the tissue of the upper lateral cartilage–maxillary bone articulation en bloc. Results: Grossly in all specimens, the upper lateral cartilage articulated with the frontal process of the maxilla laterally, lying deep to the coronal plane of the maxillary bone. In four histologic specimens, the upper lateral cartilage was found to underlie the frontal process of the maxilla laterally, displaying an overlapping relationship. In the other two histologic specimens, the upper lateral cartilage ended medial to the maxilla. In all specimens, the ends of the upper lateral cartilage and maxilla articulated by way of a pyriform ligament. Conclusions: The upper lateral cartilage articulates laterally with the frontal process of the maxilla by means of the pyriform ligament, with a variable amount of overlap between the upper lateral cartilage and maxilla. Relationships among the upper lateral cartilage, maxilla, and pyriform ligament affect the configuration of the lateral internal nasal valve area, and should be considered when planning internal nasal valve reconstruction.

Tissue conservation using circular defect with dog-ear deformities excision technique†‡§

Compare circular defect with dog‐ear deformities excision (CDDE) technique to 3:1 fusiform excision technique when removing facial lesions to analyze which technique provides superior wound closure.

Incision and drainage of a retropharyngeal abscess located adjacent to C1 with InstaTrak image guidance.

INTRODUCTION Abscess formation in the deep neck spaces may occur because of spread of infection from a contiguous area, such as nasal, oral, otitic, or bony structures or direct inoculation secondary to penetrating trauma.1,2 Abscesses of the deep neck spaces have many potential complications including arterial erosion, venous thrombosis, caudal extension leading to mediastinitis, pharyngeal rupture with subsequent aspiration and pulmonary abscess, and intracranial spread.2 The widespread use of antimicrobials has helped to curtail these lethal complications but has not eliminated them. Abscesses in the deep neck spaces continue to present clinical challenges, particularly when surgical incision and drainage is required after antibiotics fail. In this setting, incision and drainage allows for faster recovery and fewer complications by both evacuation of pus and identification of the infectious organism for better antibiotic coverage.3 Depending on the location of the deep neck abscess, different surgical approaches have been used for incision and drainage, and each approach carries its own benefits and risks. An external approach, for example, allows for greater visualization and identification of vital structures, but it requires a longer recovery period and has the potential for hematoma formation, nerve injury, and cutaneous scarring.4 A transoral approach, which bypasses some of these complications, is typically used for retropharyngeal abscesses in more convenient to reach locations. A retropharyngeal abscess that is located more superiorly or laterally, however, has traditionally been incised and drained by way of an external approach secondary to poor intraoral visualization and the proximity of the great vessels. In this paper, we describe how a superolateral-based retropharyngeal abscess pocket was incised and drained by way of a transoral approach using InstaTrak image guidance. The InstaTrak System uses the patient’s preoperative computed tomography (CT) scan and electromagnetic tracking technology to provide positional feedback of instrument location within the patient’s skull in three different planes. A CT scan of the head and neck is performed while the patient wears a special headset. Before starting the surgical procedure, the headset is again placed on the patient with an attached electromagnetic transmitter, and the system is calibrated. When a specially designed surgical instrument containing a related electromagnetic receiver is placed within the head and neck region, the relationship in space of the instrument can be computed by the transmitter/receiver interaction and coordinates calculated. These coordinates are mapped to the preoperative CT images on a computer screen, which allows the surgeon to see the precise location of the instrument relative to the patient’s head and neck structures while the operation is being performed.

Decade review of mandible fractures and arch bar impact on outcomes of nonsubcondylar fractures.

Review trends in mandible fracture management and outcomes in patients treated with and without intraoperative arch bar use.

Audiovestibular symptoms as predictors of prolonged sports-related concussion among NCAA athletes

We looked to determine the rates of audiovestibular symptoms following sports‐related concussions among collegiate athletes. Further, we assessed the correlation between these symptoms and the time to return to participation in athletic activity.

Maxillofacial injuries among National Collegiate Athletic Association (NCAA) athletes: 2004 to 2014

Participation in National Collegiate Athletic Association (NCAA) sports increases annually, yet the risk of maxillofacial injuries among these athletes is unknown. We report the incidence and trends in maxillofacial injuries among NCAA athletes.

Outcomes of Manual Reduction vs Arch Bars for Mandibular Angle Fractures

Objective: To compare post-operative complications of mandibular angle fractures treated with manual reduction, arch bar maxillomandibular fixation (MMF), and non-arch bar MMF.