Frank G. Garritano

Incidence of Venous Thromboembolism in Otolaryngology–Head and Neck Surgery

OBJECTIVE To examine the incidence of venous thromboembolic disease in the otolaryngology-head and neck surgery (OTO-HNS) patient population. DESIGN, SETTING, AND PATIENTS Review of medical records for all patients undergoing a surgical procedure during fiscal years 2008 to 2011 (July 1, 2008, through June 30, 2011) at an academic tertiary care medical center. INTERVENTION A total of 59 884 total surgical procedures among all the surgical services. MAIN OUTCOME MEASURES The incidence of deep venous thrombosis and pulmonary embolism. RESULTS There were 5616 otolaryngology procedures performed during the study period. Clinically evident deep venous thrombosis developed in 3 patients; 2 of these patients also developed a pulmonary embolism. The overall incidence of deep venous thrombosis and pulmonary embolism in OTO-HNS was 0.05% and 0.035%, respectively. All patients who developed deep venous thrombosis or a pulmonary embolism in the OTO-HNS population were inpatients being treated for cancer. There were no deep venous thromboses or pulmonary emboli in patients undergoing same-day or overnight surgery or in patients without an active cancer. The OTO-HNS service had significantly lower rates of venous thromboembolism than did most other surgical specialties despite lower rates of adherence to venous thromboembolism prophylaxis guidelines. CONCLUSIONS The incidence of deep venous thrombosis and pulmonary embolism among the OTO-HNS patient population at our academic center is lower than the incidence reported in previous studies (range, 0.1%-0.3%) and is significantly lower than the incidence observed in other surgical specialties. It is likely that patient- and specialty-specific factors as well as the more aggressive use of venous thromboembolism prophylaxis during recent years are at least partially responsible for the decreased incidence in our population.

Current practices in venous thromboembolism prophylaxis in otolaryngology–head and neck surgery

There has been recent investigation into the incidence of venous thromboembolism in otolaryngology, but the current utilization of venous thromboembolic (VTE) prophylaxis among practicing otolaryngologists remains largely unknown.

Characteristics of patients undergoing supraglottoplasty for laryngomalacia.

OBJECTIVE To examine the characteristics of patients undergoing supraglottoplasty for the treatment of laryngomalacia and to better understand the features of laryngomalacia that may predispose patients to the need for supraglottoplasty. METHODS Review of patients who underwent supraglottoplasty for laryngomalacia at our academic tertiary care childrens hospital between 2005 and 2012 examining demographic information, medical comorbidities, symptoms, indications for surgery, operative findings and procedure, site of laryngeal obstruction, operative techniques, and surgical success rates. RESULTS Seventeen patients with laryngomalacia underwent nineteen procedures. The most common indications for supraglottoplasty were persistent stridor beyond 18 months of age (64.7%), difficulty feeding (47%), and failure to thrive (29.4%). The most common comorbidities were gastroesophageal reflux (88.2%) and cardiopulmonary disease (35.3%). Operative findings included shortened aryepiglottic folds in sixteen patients (94.1%), retropositioned epiglottis in sixteen (94.1%), and prolapsed arytenoid mucosa in five (29.4%). Fifteen patients (88.2%) underwent division of the aryepiglottic folds and four underwent ablation of arytenoid mucosa (23.5%). Of the seventeen patients who had followed up at the time of study conclusion, sixteen (94.1%) had symptom improvement and twelve (70.6%) had complete resolution of their symptoms. CONCLUSIONS Supraglottoplasty is an effective treatment for laryngomalacia. Outcomes in our patients are similar to those reported in prior literature. The findings of shortened aryepiglottic folds and a retropositioned epiglottis appear to be disproportionately represented in our cohort of patients undergoing supraglottoplasty.

Successful Telemedicine Programs in Otolaryngology

This article discusses the types of telemedicine technologies that are currently in place and being used successfully in otolaryngology. It examines how these technologies have been applied in several different otolaryngology telemedicine programs and discusses their relative merits and successes.

Pathologic fracture of the mandible secondary to traumatic bone cyst.

The traumatic bone cyst (TBC) is an uncommon and poorly understood lesion. First described in 1929, TBCs lack an epithelial lining, typically occur during the second decade of life, and are most frequently located in the jaw. Although the majority of TBCs are asymptomatic, rarely a TBC can cause a pathologic fracture of the mandible. We present a case of an adolescent suffering a sports-related pathologic mandible fracture secondary to a traumatic bone cyst.

The difficult neck in facelifting.

The management of the neck often presents the most challenging aspect of the facelift procedure. The aesthetic neck has a well-defined jaw line, a pleasing and adequate cervicomental angle, and visible definitions of the deeper lateral and midline structures, such as the sternocleidomastoid muscles and trachea. Several unfavorable anatomic characteristics will present that will compound the challenge. These characteristics are contrasted with ideal features and include the following: an excess of adipose tissue, an excess of either thin or thick inelastic skin, marked relaxation of the suspension structures of the neck with resultant platysma banding and jowling, and unfavorable skeletal features such as microgenia and hyoid malposition. These patients present for rhytidectomy with inadequate chin projection, an obtuse cervicomental angle, sagging skin, and a heavy neck. To maximize rhytidectomy results in these patients with difficult neck anatomy, special attention to the anatomy and application of recognized techniques in an individualized manner is recommended. This article reviews the issues encountered in the management of the difficult neck in facelifting, with special attention given to patients with a heavy neck.

Surgical Anatomy of the Upper Face and Forehead

&NA; Aesthetic ideals regarding proportion and balance of the face have existed for centuries. The upper third of the face, including the brow, forehead, and temple, provides an important contribution to the overall facial aesthetic. This is especially true given how the brow frames the eyes, and the eyes serve as the key focal point in our interactions with others. There exists a variety of surgical and nonsurgical procedures aimed at improving the aesthetic of the upper portion of the face, and a thorough knowledge of the surgical anatomy of the upper face and forehead is critical to their successful execution.

Collaborating to increase access to clinical and educational resources for surgery: a case study.

A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institutions electronic medical record.

Characteristics of Patients Undergoing Supraglottoplasty

Objective: 1) To examine the characteristics of patients undergoing supraglottoplasty for the treatment of laryngomalacia. 2) To better understand the features of laryngomalacia that may predispose patients to the need for future supraglottoplasty. Method: Retrospective case series evaluating patients who underwent supraglottoplasty for laryngomalacia at our academic tertiary care children’s hospital between 2005 and 2012 and examining their demographic information, medical comorbidities, symptoms, indications for surgery, operative findings and procedure, site of laryngeal obstruction, operative techniques, and surgical success rates. Results: Fifteen patients with laryngomalacia underwent seventeen procedures. The most common indications for supraglottoplasty were persistent stridor (93.3%), difficulty feeding (53.3%), and failure to thrive (33.3%). The most common comorbidities were gastroesophageal reflux (86.7%) and cardiopulmonary disease (40%). Operative findings included shortened aryepiglottic folds in 14 patients (93.3%), retropositioned epiglottis in 14 (93.3%), and prolapsed arytenoids in 4 (26.7%). Thirteen patients (86.7%) underwent division of the aryepiglottic folds and 4 underwent ablation of arytenoid mucosa (26.7%). Of the 14 patients who had followed up at the study conclusion, 13 (92.9%) had symptom improvement and 9 (64.3%) had complete resolution of their symptoms. Conclusion: Supraglottoplasty is an effective treatment for laryngomalacia. Outcomes in our patients are similar to those reported in prior literature. The findings of shortened aryepiglottic folds and a retropositioned epiglottis appear to be disproportionately represented in our cohort of patients undergoing supraglottoplasty.