Giancarlo Zuliani

Biofilm density in the pediatric nasopharynx: recurrent acute otitis media versus obstructive sleep apnea.

Objectives: We compared the biofilm surface density of adenoids removed from children with recurrent acute otitis media (RAOM) to that of adenoids removed from children with a diagnosis of obstructive sleep apnea (OSA). Methods: We performed a comparative microanatomic study of adenoid mucosa using scanning electron microscopy in patients with diagnoses of RAOM and OSA (27 female and 41 male; age range, 3 months to 15 years). Results: The adenoids removed from patients with RAOM had dense, mature biofilms covering nearly their entire mucosal surfaces. More specifically, the adenoids removed from patients with RAOM had an average of 93.53% of their mucosal surface covered, versus an average of 1.01% coverage on the adenoids removed from patients with OSA. These differences were statistically significant (p < 0.0001). Conclusions: The adenoids removed from patients with RAOM had almost their entire mucosal surface covered with biofilms, versus scant coverage for patients with OSA. Recurrent acute otitis media is notoriously resistant to antibiotic treatment, and aspirates of middle ear fluid repeatedly yield negative cultures. It is these properties that have led biofilms to become increasingly implicated in the pathogenesis of RAOM. Thus, the resistance of biofilms to antimicrobials, together with their planktonic shedding of organisms, may be an important mechanism in the development of RAOM.

Treatment compliance in patients lost to follow-up after polysomnography

Objectives Studies on positive airway pressure (PAP) compliance typically focus only on patients who returned for follow-up. In this study, we examined patients who failed to follow-up after their initial polysomnogram (PSG) and PAP titration to determine their treatment status in terms of PAP usage. Study Design On retrospective chart review, we identified 57 patients who, based on PSG findings and symptoms, required the use of PAP but failed to follow-up after titration. Twenty-five of these patients were successfully contacted and agreed to an interview. Results Only 7 (28%) patients were using PAP on a regular basis. The remaining 18 (72%) patients were noncompliant. Conclusions A significant proportion (24%) of OSA patients who required treatment with PAP were lost to follow-up after polysomnography. This group of patients has previously been ignored in the literature. We showed in this study that majority (72%) of these patients were not being treated adequately for OSA.

Single-Incision Transaxillary Robotic Thyroidectomy Challenges and Limitations in a North American Population

Objective We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population. Study Design Case series. Setting Academic institution. Subjects/Methods Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter. Results Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days). Conclusion Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region. Level of Evidence: 4

Burns in the head and neck: A national representative analysis of emergency department visits

Head and neck burns (HNBs) engender serious sequelae including airway edema, speech/swallowing dysfunction, sensory deficits, and scarring/disfigurement, often requiring significant reconstructive surgery. We used a nationally representative resource to estimate the number of visits to emergency departments (EDs), analyze burn types and demographic patterns, and identify specific consumer products involved.

Assault by battery: battery-related injury in the head and neck

To estimate nationwide incidence of emergency department (ED) visits for battery‐related injury (BRI) occurring in the head and neck, and analyze demographic and anatomic‐specific trends.

Hockey-related facial injuries: a population-based analysis.

Recognition of the potentially severe sequelae arising from inadequate facial protection has facilitated sustained efforts to increase the use of protective visors in recent decades. Our objective was to characterize nationwide trends among patients presenting to emergency departments (ED) for facial injuries sustained while playing ice hockey.

Scientific inquiry into rhinosinusitis: who is receiving funding from the National Institutes of Health?

To evaluate National Institutes of Health (NIH) support for rhinosinusitis research and characterize the proportion of funding awarded to otolaryngologists.

How did that get there? A population‐based analysis of nasal foreign bodies

The purpose of this study was to calculate nationwide incidence of emergency department (ED) visits for nasal foreign bodies, identify the most frequently encountered consumer products, and evaluate outcomes and demographic trends.

Craniofacial Surgery and Adverse Outcomes: An Inquiry Into Medical Negligence.

Objective: This study aimed to evaluate factors contributing to medical negligence relevant to craniofacial surgery. Methods: Retrospective analysis of verdict and settlement reports on the Westlaw legal database for outcome, awards, physician defendants, and other specific factors raised in malpractice litigation. Results: Of 42 verdicts and settlement reports included, 52.4% were resolved with either an out-of-court settlement or plaintiff verdict, with aggregate payments totaling

Salvage of Failed Local and Regional Flaps with Porcine Urinary Bladder Extracellular Matrix Aided Tissue Regeneration

50.1M (in 2013 dollars). Median settlements and jury-awarded damages were