Brian C. Lobo

Endoscopic Skull Base Reconstruction: An Evolution of Materials and Methods

Endoscopic skull base surgery has developed rapidly over the last decade, in large part because of the expanding armamentarium of endoscopic repair techniques. This article reviews the available technologies and techniques, including vascularized and nonvascularized flaps, synthetic grafts, sealants and glues, and multilayer reconstruction. Understanding which of these repair methods is appropriate and under what circumstances is paramount to achieving success in this challenging but rewarding field. A graduated approach to skull base reconstruction is presented to provide a systematic framework to guide selection of repair technique to ensure a successful outcome while minimizing morbidity for the patient.

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base.

Outcomes of Sinonasal Squamous Cell Carcinoma with and without Association of Inverted Papilloma: A Multi-Institutional Analysis

Introduction Sinonasal squamous cell carcinoma (SCC) accounts for <1% of all malignancies but represents 70% of sinonasal cancer. Up to 10% of SCCs are associated with inverted papilloma (IPSCC). Studies that compare patients, treatment, and outcomes of SCC and IPSCC are absent in the literature. Methods A retrospective review of patients with SCC and those with IPSCC at Cleveland Clinic and Indiana University from 1995 to 2015. The records were analyzed for demographics, tumor characteristics, treatment, and outcomes. Results The study comprised 117 patients with SCC, of whom, 29 had IPSCC. The mean age at diagnosis was similar: 63 and 64 years for patients with SCC and patients with IPSCC, respectively; with female patients representing 36% and 34%, respectively (p > 0.99). Smokers represented 64% of the patients with SCC and 55% of patients with IPSCC (p = 0.3); excessive alcohol intake was noted in 16% of the patients with SCC and 21% of the patients with IPSCC (p = 0.56). The maxillary sinus was most commonly involved, followed by the nasal cavity (51% versus 35% SCC, 45% versus 38% IPSCC). Frontal ethmoid and sphenoid sinuses contained primary tumors only in patients with SCC. Upfront treatment was surgery in 84% of patients with SCC and 97% of patients with IPSCC (p = 0.18); 68 and 55% received radiation, respectively, and 25 and 21% received chemotherapy, respectively. Overall survival averaged 5.5 and 3.4 years for patients with SCC and patients with IPSCC, respectively (p = 0.12); disease-free survival was 4.8 and 2.9 years, respectively (p = 0.18). Nodal metastasis was more likely in patients with SCC (18 versus 0%; p = 0.02). When divided into high- and low-stage disease: more common nodal metastases were demonstrated in high-stage SCC than in low-stage disease (p = 0.03). Overall survival was decreased between high- and low-grade disease but not when subdivided between SCC and IPSCC. Conclusion Although SCC with and without IP association are considered different diseases, their demographics and outcomes seem similar. Nodal metastasis was noted to be higher in the SCC cohort, which may indicate different tumor biology. Further study is warranted.

Perioperative management in endoscopic endonasal skull-base surgery: a survey of the North American Skull Base Society: NASBS ESBS survey

The objective of this work was to better understand variations in perioperative management in endoscopic endonasal skull‐base surgery (EESBS) and to identify trends in management based upon the practice patterns of North American Skull Base Society (NASBS) members.

Advances in Microdebrider Technology: Improving Functionality and Expanding Utility

Since its application in nasal surgery, the microdebrider has revolutionized the practice of endoscopic sinus surgery. As the demands and breadth of procedures performed endoscopically have increased, so has the need for improvement in the microdebrider and related technologies. This article addresses how use of the microdebrider has impacted endonasal surgery and discusses current advances, which include creation of specialty hand pieces and blades, increases in instrument rotational speed, incorporation of navigation and energy, adaptation for intracranial use, and disposable instrumentation designed for in office use. Advances in microdebrider technology have improved functionality and expanded the utility of these devices.

Aspiration of Aluminum Beverage Can Tab: Case Report and Literature Review

We describe the case of a 16-year-old male who aspirated a beverage can tab resulting in significant functional impairment. Since the introduction of beverage can opening tabs (“pop-tops” or “pull-tabs”) nearly 50 years ago, five cases of their aspiration have been reported in the literature and this is the first case to report tracheal lodgment. We describe the clinical course for this patient including the inadequacy of radiographic evaluation and a significant delay in diagnosis. We highlight unique features of small aluminum foreign bodies that require consideration and mention a potential change in epidemiology associated with evolving product design. Our primary objective is increased awareness among otolaryngologists that radiography is unreliable for diagnosis or localization of small aluminum foreign bodies. The patient history must therefore be incorporated with other imaging modalities and/or endoscopic evaluation. Also, given the marked prevalence of aluminum beverage cans, we suspect that the inadvertent aspiration of can tabs is more common than indicated by the paucity of published reports.

Lean Belt Certification Pathway for Student, Resident, and Faculty Development and Scholarship

Since July 2013, 20 trainee participants have completed the quality improvement curriculum within the Indiana University Department of Otolaryngology–Head & Neck Surgery, including 7 otolaryngology residents, 6 otolaryngology-bound medical students, and 7 psychiatry residents. Nine faculty and staff attended. Participants were highly satisfied with the quality and effectiveness of the program. Following program implementation, 2 otolaryngology residents and 2 medical students initiated their own quality improvement projects. Lean training directly resulted in oral and poster presentations at national conferences, journal publications, and institutional research and quality awards. Students completing the program established a local affiliate group of an international health care quality organization. Quality improvement training can be successfully incorporated into residency training with overwhelming program satisfaction and results in greater scholarly and professional development for motivated participants. The skillset acquired by participants leads to projects that improve patient care, increase value, and justify equipment and personnel retention and expansion.

Vibratory stimulus reduces in vitro biofilm formation on tracheoesophageal voice prostheses

Demonstrate that biofilm formation will be reduced on tracheoesophageal prostheses when vibratory stimulus is applied, compared to controls receiving no vibratory stimulus, in a dynamic in vitro model of biofilm accumulation simulating the interface across the tracheoesophageal puncture site.

Application of Ultrasonic Aspirators in Rhinology and Skull Base Surgery

Ultrasonic aspirators (UAs) are increasingly being used in rhinology and skull base surgery. The use of ultrasonic vibration for the removal of bony tissue transfers minimal heat to surrounding tissues and is relatively atraumatic to nearby soft tissue structures. This article details the development and application of this technology in septoturbinoplasty, endoscopic dacryocystorhinostomy (DCR), and skull base surgery. The benefits and limitations of UAs compared with conventionally powered instruments are discussed.

Incorporating Lean Six Sigma Training within an Otolaryngology Residency Program

Objectives: (1) Describe the implementation of Lean Six Sigma (LSS) training within an otolaryngology residency program. (2) Illustrate the challenges and opportunities of project execution. (3) Address the institutional considerations for a successful LSS program. Methods: (1) From July 2013, LSS training and Lean Belt Certification were offered through the IUSM Department of Otolaryngology in collaboration with VA Systems Redesign. (2) The curriculum and training were designed to maximize participant learning and engagement. (3) Resident and faculty initiated LSS projects were reviewed. (4) Participant feedback survey results were collected. Results: (1) The Lean Belt curriculum and training were completed by some of the residents and faculty to date. (2) Two medical students completed Yellow Belt Certification. (3) Salivary and thyroid gland ultrasound projects and a sterile supply project translate quality improvement and cost savings to patients and the organization. (4) Participant survey results have been overwhelmingly positive. The medical students identified the added value of LSS certification in their residency application process. Conclusions: (1) Lean Belt Certification can be successfully incorporated into residency training. (2) Projects serve to improve patient care, increase value, and justify equipment and personnel retention and expansion. (3) Most academic centers have the necessary training available either internally or often from affiliated VAMC or Business Schools. (4) The Lean Belt curriculum and training program has since been used by other subspecialty departments. (5) The additional skill sets acquired by LSS trainees increase their confidence in identifying opportunities for improvement in their immediate health care environment.