The impact of a head and neck microvascular fellowship program on otolaryngology resident training

Objective

To assess the impact of a microvascular head and neck (H&N) fellowship on senior residents' surgical experience.

Study Design

Retrospective review of Accreditation Council for Graduate Medical Education-generated operative case log reports, retrospective chart review, and electronic survey.

Methods

A retrospective review of one institution's residents' H&N operative case logs and free flap operative reports was performed to determine changes in key indicator cases (KICs) after the addition of a H&N fellowship. An electronic survey was distributed to senior residents at all U.S. otolaryngology residency programs to determine residents' perceptions of a H&N fellow's impact on their surgical experience. An electronic survey was distributed to senior medical students applying to surgical residencies to explore the perceived impact that a fellowship has on the desirability of a residency program.

Results

The average number of each postgraduate year (PGY)5's H&N KIC before and after the addition of the fellowship were: parotidectomy, 19 versus 17.8; neck dissection, 33.2 versus 40.6; oral cavity resection, 15.3 versus 12.6; thyroid/parathyroid, 45.5 versus 45.6; and flaps/grafts, 56.7 versus 42. PGY5 participation as first assistant in free flaps dropped from 78% to 17%; however, residents still participated in some aspect of 45% of the cases. Seventy percent of senior residents reported a positive perception of the H&N fellow on their H&N operative experience. Eighty-nine percent of senior medical student respondents reported a nonnegative perception of a fellowship in their applied field.

Conclusion

The addition of a H&N fellowship did not decrease senior residents' H&N KIC, and most senior residents at programs with fellowships report that the fellow has a positive impact on their H&N operative experience.

Level of Evidence

4. Laryngoscope, 2017

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Clinical evaluations of complete autologous fibrin glue, produced by the CryoSeal® FS System, and polyglycolic acid sheets as wound coverings after oral surgery

Publication date: Available online 10 June 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Atsumu Kouketsu, Shinnosuke Nogami, Minami Yamada-Fujiwara, Hirokazu Nagai, Kensuke Yamauchi, Shiro Mori, Hitoshi Miyashita, Tadashi Kawai, Aritsune Matsui, Yoshihiro Kataoka, Norihisa Satomi, Yushi Ezoe, Satoko Abe, Yuri Takeda, Takeshi Tone, Bunnichi Hirayama, Tsuyoshi Kurobane, Kazuki Tashiro, Yuta Yanagisawa, Tetsu Takahashi




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Effect of pre-emptive analgesia on clinical parameters and tissue levels of TNF-α and IL-1β in third molar surgery: a triple-blind, randomized, placebo-controlled study

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A.F.M. Albuquerque, C.S.R. Fonteles, D.R. do Val, H.V. Chaves, M.M. Bezerra, K.M.A. Pereira, P.G. de Barros Silva, B.B. de Lima, E.C.S. Soares, T.R. Ribeiro, F.W.G. Costa
This study aimed to evaluate whether pre-emptive analgesia modifies the tissue expression of tumour necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β), and whether there is an association with postoperative surgical outcomes. A triple-blind, randomized, placebo-controlled study of patients undergoing mandibular third molar removal was performed. Volunteers were allocated randomly to receive etoricoxib 120 mg, ibuprofen 400 mg, or placebo 1h before surgery. Twenty-four surgical sites per group were required (95% confidence level and 80% statistical power). Pain scores differed significantly between groups (P<0.001). Etoricoxib and ibuprofen reduced pain scores compared to placebo (P<0.05). Pain scores peaked at 4h postoperative in the experimental groups, but at 2h postoperative in the placebo group (P<0.05). A significant reduction in TNF-α concentration from time 0′ to time 30′ was seen for ibuprofen (P=0.001) and etoricoxib (P=0.016). The ibuprofen group showed a significant reduction in IL-1β levels from time 0′ to time 30′ (P=0.038). In conclusion, TNF-α and IL-1β levels and the inflammatory events in third molar surgery were inversely associated with the degree of cyclooxygenase 2 selectivity of the non-steroidal anti-inflammatory drugs used pre-emptively. Patients given pre-emptive analgesia showed significant reductions in the clinical parameters pain, trismus, and oedema when compared to the placebo group.



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Superolateral dislocation of the intact mandibular condyle: report of a rare case with a review

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): N. Srinath, D.N. Umashankar, C. Naik, J. Biradar
Dislocation of the temporomandibular joint, which represents 3% of all dislocated joints reported in the body, occurs when the mandibular condyle is displaced anteriorly beyond the articular eminence. Although anterior dislocation of the mandibular condyle is well documented in the literature, superior, lateral, and posterior dislocation of the condyle is rare. Only a few reports documenting superolateral dislocation with anterior mandible fractures have been published in the past. However such dislocations without any associated fractures are even rarer. This report documents a case of superolateral dislocation of an intact mandible in a 48-year-old woman following a traumatic incident. This paper also reviews previously documented case reports and focuses on the causative mechanism, dynamics, and management of such dislocations.



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Mandibular symphyseal midline distraction osteogenesis for micrognathia associated with aglossia and situs inversus totalis

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): X.C. Ren, Y.F. Li, Y. Liu, S.S. Zhu
Aglossia is a rare congenital abnormality, often associated with micrognathia and limb defects. Situs inversus totalis is also a rare congenital abnormality, defined as a mirror-image reversal of all the asymmetric organs of the thorax and abdomen. The concurrence of these two abnormalities has only been reported in eight similar cases in the literature. Although micrognathia and malocclusion were observed in all of these cases, few treatments were performed for the patients' dentofacial deformities. This report describes the case of a 7-year-old boy suffering from micrognathia, aglossia, and situs inversus totalis simultaneously, and the treatment for his micrognathia by mandibular symphyseal midline distraction osteogenesis, guided by virtual surgical planning and a three-dimensional printed surgical template. In a review of the literature, this is the first case of micrognathia associated with aglossia and situs inversus totalis that has been treated by mandibular symphyseal midline distraction osteogenesis for the dentofacial deformity.



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Simulation of three surgical techniques combined with two different bone-borne forces for surgically assisted rapid palatal expansion of the maxillofacial complex: a finite element analysis

Publication date: Available online 10 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): S.C. Möhlhenrich, A. Modabber, K. Kniha, F. Peters, T. Steiner, F. Hölzle, U. Fritz, S. Raith
Surgically assisted rapid palatal expansion (SARPE) is a common treatment to correct transverse maxillary deficiencies. Finite element analysis was simulated for six designs of SARPE based on a computed tomography scan of a human skull: median osteotomy with palatal (type A) or alveolar ridge (type B) bone-borne force, additional lateral osteotomy with palatal (type C) or alveolar ridge (type D) bone-borne force, and additional pterygomaxillary separation with palatal (type E) or alveolar ridge (type F) bone-borne force. The transverse expansion was about 1.0mm. The distribution of von Mises stress and the displacement were evaluated. The largest stress distribution was after types A and B, followed by types C and D, and finally types E and F. Displacement increased simultaneously. Palatal bone-borne forces (types A, C, and E) led to higher stress distributions in the midface and maxilla, but to a more parallel expansion compared with alveolar ridge-borne forces (types B, D, and F). The largest bony displacements at the midpalatal suture were anterior in all models. Increased weakening of the bony pillar of the facial skeleton and the use of palatal bone-borne forces leads to a decrease in stress distribution in the midface and to a more parallel transverse expansion of the maxilla.



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Ischemic stroke complicating thrombolytic therapy with tenecteplase for ST elevation myocardial infarction: two case reports

Hemorrhagic complications are quite common in the rare cases where thrombolysis is performed. Ischemic stroke in the aftermath of thrombolysis for a ST elevation myocardial infarction is a very rare and parado...

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