Jeremy D. Meier

SURGICAL MARGIN DETERMINATION IN HEAD AND NECK ONCOLOGY: CURRENT CLINICAL PRACTICE. THE RESULTS OF AN INTERNATIONAL AMERICAN HEAD AND NECK SOCIETY MEMBER SURVEY

Our aim was to investigate the ways in which surgeons who perform head and neck ablative procedures on a regular basis define margins, how they use frozen sections to evaluate margins, and the effect of chemoradiation on determining tumor margins.

Pediatric facial trauma.

Purpose of reviewTo review the epidemiology, evaluation, and treatment of pediatric facial trauma, with emphasis on the unique challenges encountered in the pediatric patient. Current controversies in management will be discussed. Recent findingsMuch of the current literature relating to pediatric facial trauma focuses on the etiology and epidemiology of these injuries, with few studies concentrating on the management. In general, treatment of pediatric maxillofacial fractures is more conservative than in adults. When open reduction and internal fixation is necessary, either temporary placement of permanent titanium plating systems or absorbable plating is recommended. Increasing use of resorbable plating systems in rigid fixation of pediatric fractures is noted; however, these have not become the standard of care. ConclusionPediatric facial fractures are relatively uncommon, but can cause significant short-term and long-term morbidity. A thorough understanding of the unique characteristics in the growing maxillofacial skeleton is a requisite for surgeons encountering these injuries.

Shared Decision Making and Choice for Elective Surgical Care: A Systematic Review.

Objective Shared decision making (SDM), an integrative patient-provider communication process emphasizing discussion of scientific evidence and patient/family values, may improve quality care delivery, promote evidence-based practice, and reduce overuse of surgical care. Little is known, however, regarding SDM in elective surgical practice. The purpose of this systematic review is to synthesize findings of studies evaluating use and outcomes of SDM in elective surgery. Data Sources PubMed, Cochrane CENTRAL, EMBASE, CINAHL, and SCOPUS electronic databases. Review Methods We searched for English-language studies (January 1, 1990, to August 9, 2015) evaluating use of SDM in elective surgical care where choice for surgery could be ascertained. Identified studies were independently screened by 2 reviewers in stages of title/abstract and full-text review. We abstracted data related to population, study design, clinical dilemma, use of SDM, outcomes, treatment choice, and bias. Results Of 10,929 identified articles, 24 met inclusion criteria. The most common area studied was spine (7 of 24), followed by joint (5 of 24) and gynecologic surgery (4 of 24). Twenty studies used decision aids or support tools, including modalities that were multimedia/video (13 of 20), written (3 of 20), or personal coaching (4 of 20). Effect of SDM on preference for surgery was mixed across studies, showing a decrease in surgery (9 of 24), no difference (8 of 24), or an increase (1 of 24). SDM tended to improve decision quality (3 of 3) as well as knowledge or preparation (4 of 6) while decreasing decision conflict (4 of 6). Conclusion SDM reduces decision conflict and improves decision quality for patients making choices about elective surgery. While net findings show that SDM may influence patients to choose surgery less often, the impact of SDM on surgical utilization cannot be clearly ascertained.

Endoscopic fluorescence lifetime imaging for in vivo intraoperative diagnosis of oral carcinoma.

A clinically compatible fluorescence lifetime imaging microscopy (FLIM) system was developed. The system was applied to intraoperative in vivo imaging of head and neck squamous cell carcinoma (HNSCC). The endoscopic FLIM prototype integrates a gated (down to 0.2 ns) intensifier imaging system and a fiber-bundle endoscope (0.5-mm-diameter, 10,000 fibers with a gradient index lens objective 0.5 NA, 4-mm field of view), which provides intraoperative access to the surgical field. Tissue autofluorescence was induced by a pulsed laser (337 nm, 700 ps pulse width) and collected in the 460 ± 25 nm spectral band. FLIM experiments were conducted at 26 anatomic sites in ten patients during head and neck cancer surgery. HNSCC exhibited a weaker florescence intensity (~50% less) when compared with healthy tissue and a shorter average lifetime (τ(HNSCC) = 1.21 ± 0.04 ns) than the surrounding normal tissue (τN = 1.49 ± 0.06 ns). This work demonstrates the potential of FLIM for label-free head and neck tumor demarcation during intraoperative surgical procedures.

Causes and costs for ED visits after pediatric adenotonsillectomy.

Objective (1) Review the reasons, timing, and costs for children presenting to the emergency department (ED) after adenotonsillectomy (T&A). Study Design Case series with chart review. Setting Tertiary care children’s hospital. Subjects and Methods A standardized activity-based hospital accounting system was used to identify 437 children from an academic pediatric otolaryngology practice presenting to the ED after T&A from 2009 to 2012. The reason for presentation, timing after surgery, and facility costs were recorded. Results The study cohort represented 13.3% of the 3198 patients who underwent T&A during that time period. Overall, 133 (4.2%) presented for dehydration, 106 (3.3%) presented for post-tonsillectomy hemorrhage, 65 (2.0%) for poorly controlled pain, 42 (1.3%) for fever, 29 (1.0%) for vomiting/nausea/GI discomfort, 22 (0.7%) for respiratory complications, and 12 (0.4%) for miscellaneous reasons related to the operation; 28 (0.8%) were unrelated to the T&A and excluded. Mean postoperative day at the time of ED presentation was 4.4 (95% CI, 4.1-4.7). The mean cost per patient presenting to the ED was

Time-resolved laser-induced fluorescence spectroscopy as a diagnostic instrument in head and neck carcinoma

1420 (95% CI,

Surgeon Dependent Variation in Adenotonsillectomy Costs in Children

1104-

Risk Factors for Supraglottoplasty Failure

1737), the most costly subgroups being those presenting with respiratory complications (

Time-Resolved Fluorescence Spectroscopy as a Diagnostic Technique of Oral Carcinoma: Validation in the Hamster Buccal Pouch Model

2855; 95% CI,

Variation in pediatric outpatient adenotonsillectomy costs in a multihospital network

1434-