Christina H. Fang

Internal carotid artery injury in endoscopic endonasal surgery: A systematic review

Internal carotid artery (ICA) injury during endoscopic endonasal surgery (EES) is a known and feared complication of paranasal sinus and skull base procedures. These ICA injuries can result in stroke, cranial nerve palsies, and death. This review examines the setting of injury along with the treatment approaches, and patient outcomes.

Assessment of Online Patient Education Materials From Major Ophthalmologic Associations

IMPORTANCE Patients are increasingly using the Internet to supplement finding medical information, which can be complex and requires a high level of reading comprehension. Online ophthalmologic materials from major ophthalmologic associations should be written at an appropriate reading level. OBJECTIVES To assess ophthalmologic online patient education materials (PEMs) on ophthalmologic association websites and to determine whether they are above the reading level recommended by the American Medical Association and National Institutes of Health. DESIGN, SETTING, AND PARTICIPANTS Descriptive and correlational design. Patient education materials from major ophthalmology websites were downloaded from June 1, 2014, through June 30, 2014, and assessed for level of readability using 10 scales. The Flesch Reading Ease test, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook test, Coleman-Liau Index, Gunning Fog Index, New Fog Count, New Dale-Chall Readability Formula, FORCAST scale, Raygor Readability Estimate Graph, and Fry Readability Graph were used. Text from each article was pasted into Microsoft Word and analyzed using the software Readability Studio professional edition version 2012.1 for Windows. MAIN OUTCOMES AND MEASURES Flesch Reading Ease score, Flesch-Kincaid Grade Level, Simple Measure of Gobbledygook grade, Coleman-Liau Index score, Gunning Fog Index score, New Fog Count, New Dale-Chall Readability Formula score, FORCAST score, Raygor Readability Estimate Graph score, and Fry Readability Graph score. RESULTS Three hundred thirty-nine online PEMs were assessed. The mean Flesch Reading Ease score was 40.7 (range, 17.0-51.0), which correlates with a difficult level of reading. The mean readability grade levels ranged as follows: 10.4 to 12.6 for the Flesch-Kincaid Grade Level; 12.9 to 17.7 for the Simple Measure of Gobbledygook test; 11.4 to 15.8 for the Coleman-Liau Index; 12.4 to 18.7 for the Gunning Fog Index; 8.2 to 16.0 for the New Fog Count; 11.2 to 16.0 for the New Dale-Chall Readability Formula; 10.9 to 12.5 for the FORCAST scale; 11.0 to 17.0 for the Raygor Readability Estimate Graph; and 12.0 to 17.0 for the Fry Readability Graph. Analysis of variance demonstrated a significant difference (P < .001) between the websites for each reading scale. CONCLUSIONS AND RELEVANCE Online PEMs on major ophthalmologic association websites are written well above the recommended reading level. Consideration should be given to revision of these materials to allow greater comprehension among a wider audience.

Impact of Diabetes Mellitus on Head and Neck Cancer Patients Undergoing Surgery.

Objective The impact of diabetes mellitus (DM) on surgical outcomes and cost of care for patients undergoing surgery for head and neck cancer (HNCA) is not well established. We used the Nationwide Inpatient Sample to analyze the postoperative impact of DM on HNCA patients. Study Design Population-based inpatient registry analysis. Setting Academic medical center. Subjects and Methods Discharge data from the Nationwide Inpatient Sample were analyzed for patients undergoing HNCA surgery from 2002 to 2010. Patient demographics, comorbidities, length of stay, hospital charges, and postoperative complications were compared between HNCA patients with and without DM. Results Of 31,075 patients, 4029 patients (13.0%) had a DM diagnosis. DM patients were older (65.7 ± 10.8 vs 61.1 ± 14.1 years old; P < .001), had more preexisting comorbidities, had longer hospitalizations, and incurred greater hospital charges. Compared with the non-DM cohort, DM patients experienced significantly higher rates of postoperative infections (2.6% vs 2.1%, P = .025), cardiac events (9.0% vs 4.3%, P < .001), pulmonary edema/failure (6.6% vs 5.7%, P = .023), acute renal failure (3.3% vs 1.5%, P < .001), and urinary tract infections (2.8 % vs 2.1%, P = .005). No differences in surgical wound healing rates were observed (0.1 vs 0.1, P = .794). On multivariate logistic regression corrected for age and race, DM patients had greater odds of postoperative infections (1.382, P = .007), cardiac events (1.893, P < .001), and acute renal failure (2.023, P < .001). Conclusions DM is associated with greater length of stay and hospital charges among HNCA patients. DM patients have significantly greater rates of postoperative complications, including postoperative infections, cardiac events, and acute renal failure.

Nasolabial cysts: A systematic review of 311 cases

Nasolabial cysts are rare nonodontogenic cysts arising commonly in the nasal alar region. Intraoral sublabial resection of nasolabial cysts is considered the standard treatment modality. In the past 16 years, transnasal endoscopic marsupialization has emerged as an alternative approach for these lesions. A systematic review on this entity was performed to evaluate management and outcomes.

Emergent Awake tracheostomy—The five‐year experience at an urban tertiary care center

There are few studies that discuss the issues surrounding emergent awake tracheostomy. We aim to review the indications, anesthesia used, complications, and outcomes of patients undergoing urgent awake tracheostomy.

Prevalence of Cochlear-Facial Dehiscence in a Study of 1,020 Temporal Bone Specimens.

Objective: To determine the prevalence of cochlear-facial dehiscence (CFD) and to examine the influence of otic capsule area, age, sex, and race on CFD. Study Design: Descriptive study of archived temporal bone specimens. Materials and Methods: Targeted sections from 1,020 temporal bone specimens were scanned and examined for CFD. Cochlear-facial partition width (CFPW) and otic capsule area (OCA), a marker of bone thickness, were measured using image analysis software. Demographic data were analyzed using multiple linear regression analysis. Results: The mean CFPW was 0.23 mm (range, 0–0.92 mm; SD, 0.15 mm). Six patients were completely dehiscent (0.59%). Fallopian canal width, age, sex, race, and OCA were found to be significant predictors of CFPW. Age was found to be negatively correlated with CFPW (&bgr; = −0.001) (p < 0.005). Thicker CFPW was associated with males (&bgr; = 0.024) and non-Caucasian individuals (&bgr; = 0.031). The mean OCA for dehiscent specimens (mean, 9.48 mm2; range, 6.65–11.58 mm2; SD 3.21 mm2) was significantly smaller than the mean OCA for nondehiscent specimens, (mean, 12.88 mm2; range, 6.63–21.92 mm2; SD, 2.47 mm2) (p < 0.01). Conclusion: CFD occurred in nearly 0.6% of specimens in this temporal bone collection. Close to 35% of patients were sufficiently thin (<0.1 mm) to appear dehiscent on computed tomography scanning. Smaller OCA correlated with thinner CFPW, suggesting a developmental factor. Older, female, and Caucasian patients may have a greater risk for CFD and its associated symptoms.

Purely endoscopic endonasal surgery of the craniovertebral junction: A systematic review

Endoscopic endonasal surgery (EES) is a relatively novel approach to the craniovertebral junction (CVJ). The purpose of this analysis is to determine the surgical outcomes of patients who undergo purely EES of the CVJ.

Treatment of Chronic, Noninfectious, Nonnecrotizing Scleritis with Tumor Necrosis Factor Alpha Inhibitors

Abstract Purpose: To evaluate the use of TNF-alpha inhibitors for non-infectious, non-necrotizing scleritis. Methods: We conducted a retrospective chart review of patients with non-infectious, non-necrotizing scleritis treated at our institutions from 2002 to 2012. Results: Seventeen patients (26 eyes) were included. Ten patients were started on infliximab and seven on adalimumab; five patients were treated with both TNF-alpha inhibitors on separate occasions. All patients had an associated autoimmune disease. Control of active inflammation for at least 2 months was achieved in 15 (88%) of 17 patients. Seven out of eight patients successfully tapered concurrent corticosteroid use. Only one patient discontinued TNF-alpha inhibitor use due to an allergic reaction. Conclusions: TNF-alpha inhibitors appear to have a role in managing non-infectious, non-necrotizing scleritis refractory to initial therapy, mainly by reducing inflammation and decreasing concurrent CS use.

Sinonasal and ventral skull base inflammatory pseudotumor: a systematic review.

Inflammatory pseudotumor is a benign idiopathic inflammatory process often misdiagnosed as an infection or neoplasm. This review analyzes all reported cases of sinonasal and ventral skull base inflammatory pseudotumor to date, and provides a framework for evaluation and management of this uncommon condition.

Sinonasal eosinophilic angiocentric fibrosis: a systematic review.

Eosinophilic angiocentric fibrosis (EAF) is a benign rare lesion of the upper respiratory mucosa. EAF most commonly presents with an obstructive nasal mass. Due to the rarity of EAF, case reports and case studies have predominated the literature. This systematic review discusses the demographics, clinical presentation, associated findings, management, and outcomes of this uncommon entity.