Gitanjali M. Fleischman

University of North Carolina at Chapel Hill

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Trends

Author Order

Document Type

Co-Authors

Charles S. Ebert

University of North Carolina at Chapel Hill

Adam M. Zanation

University of North Carolina at Chapel Hill

Brent A. Senior

University of North Carolina at Chapel Hill

Brian D. Thorp

University of North Carolina at Chapel Hill

Vishal H. Dhandha

University of North Carolina at Chapel Hill

Dennis O. Frank‐Ito

Duke University

Kibwei A. McKinney

University of Oklahoma Health Sciences Center

Megan J. DiFurio

University of North Carolina at Chapel Hill

Julia S. Kimbell

University of North Carolina at Chapel Hill

Trevor Hackman

University of North Carolina at Chapel Hill

Cooperative Institutions

University of North Carolina at Chapel Hill

University of North Carolina Hospitals

University of North Carolina Health Care

Communities In Schools of Orange County

Indiana University School of Medicine

Triological Society

Case Western Reserve University

Memorial Hospital

University Hospitals of Cleveland

UNC Lineberger Comprehensive Cancer Center

Author Statistics

Papers

Citation

H-Index

i-10 index

Research Field

Treatment of Chronic Frontal Sinusitis with Difficult Anatomy: A Hybrid Balloon Technique in Four Cases

Allergy & Rhinology (2014)

Gitanjali M. Fleischman Justin D. Miller Grace G. Kim Adam M. Zanation Charles S. Ebert

The presence of frontal cells poses unique challenges when using endoscopic approaches. This study describes the use of a balloon dilation system as an aid for functional endoscopic sinus surgery (FESS) to access the frontal sinus in cases that would traditionally require open approaches. We present a case series of four patients with chronic rhinosinusitis refractive to medical management who underwent FESS with the aid of a balloon dilation system at a tertiary referral center. All patients had variant forms of frontal sinus anatomy. Surgical techniques will be described and use of the balloon system will be reviewed. All patients (aged 13–68 years) successfully underwent fontal sinusotomies with the assistance of a balloon dilation system, which was used in a variety of ways: to dilate the narrow infundibulum of a high intersinus septal cell, to remove an anteriorly located type III frontal sinus cell, to expand the natural frontal ostium in the presence of excessive agger nasi pneumatization, and to remove a type IV frontal sinus cell. All patients were spared an osteoplastic flap or trephination, and there were no intraoperative complications. No postoperative bleeding, infection, or cerebral spinal fluid leaks were reported. Balloon dilation in combination with standard frontal sinus dissection techniques may be beneficial for a select group of patients with complex frontal anatomy. In this series of patients, the balloon dilation system was used as a tool during FESS and eliminated the need for open approaches.

Frontal sinus

Ostium

Balloon dilation

Sinus (botany)

Chronic Rhinosinusitis

10.2500/ar.2014.5.0096

Cite

Citations (2)

The Bipedicled Orbicularis Oculi Myocutaneous Flap for the Repair of Paralytic Ectropion

JAMA Facial Plastic Surgery (2018)

Gitanjali M. Fleischman Brian D. Thorp W. Shockley J. Madison Clark

Entropion

Chapel

Ectropion

10.1001/jamafacial.2018.1704

Cite

Citations (3)

Accuracy of Ultrasonography-Guided Fine-Needle Aspiration in Detecting Persistent Nodal Disease After Chemoradiotherapy

Carolina Digital Repository (University of North Carolina at Chapel Hill) (2016)

Gitanjali M. Fleischman Brian D. Thorp Megan J. DiFurio Trevor G. Hackman

Chemoradiotherapy

10.17615/4t4p-6q26

Cite

Citations (0)

Obstructive sleep apnea in patients undergoing endoscopic surgical repair of cerebrospinal fluid rhinorrhea

The Laryngoscope (2014)

Gitanjali M. Fleischman Emily Ambrose Rounak B. Rawal Benjamin Huang Charles S. Ebert

To examine the relationship between cerebrospinal fluid (CSF) rhinorrhea and obstructive sleep apnea (OSA).Retrospective chart review of patients who underwent surgical repair of encephaloceles and/or CSF rhinorrhea at a tertiary medical center over a 12-year period.Pertinent demographic, clinical, and surgical data including age, sex, and medical and surgical history were obtained. Patients were classified by etiology of CSF leak into a spontaneous leak group and a nonspontaneous leak group, which included patients with documented trauma, malignancy, or known iatrogenic injury.We retrospectively identified 126 patients who underwent repair of encephalocele or CSF rhinorrhea. Of these, 70 (55.5%) were found to have a spontaneous etiology, whereas 56 (44.4%) had a nonspontaneous cause. Patients with spontaneous CSF rhinorrhea were more likely than their nonspontaneous counterparts to have a diagnosis of OSA (30.0% vs. 14.3%, P = .0294) and radiographic evidence of an empty sella on magnetic resonance imaging MRI (55.4% vs. 24.3%, P = .0027). Overall, patients in the spontaneous CSF rhinorrhea group were more likely to be female compared to the nonspontaneous group (84.3% vs. 41.1% female, P = .0001).Our study shows that patients with spontaneous CSF rhinorrhea are significantly more likely to have a diagnosis of OSA compared to those with nonspontaneous causes of CSF leaks, or to the general population (incidence of 1%-5% in various population studies). Given the known association between OSA and intracranial hypertension (ICH), it may be prudent to screen all patients with spontaneous CSF rhinorrhea for symptoms of OSA as well as for ICH, and vice versa.4

Cerebrospinal Fluid Rhinorrhea

Etiology

Encephalocele

Cerebrospinal fluid leak

10.1002/lary.24661

Cite

Citations (37)

Accuracy of Ultrasonography-Guided Fine-Needle Aspiration in Detecting Persistent Nodal Disease After Chemoradiotherapy

JAMA Otolaryngology–Head & Neck Surgery (2016)

Gitanjali M. Fleischman Brian D. Thorp Megan J. DiFurio Trevor Hackman

Importance

Few patients with persistent adenopathy following chemoradiotherapy (CRT) for head and neck squamous cell carcinoma harbor viable disease. Improved selectivity for surgical salvage is needed to prevent unnecessary salvage neck dissection.

Objective

To determine whether ultrasonography-guided fine-needle aspiration (FNA) can be used to identify viable cancer cells in the lymph nodes of patients with persistent radiographic adenopathy following CRT.

Design, Setting, and Participants

A pilot study included patients undergoing preoperative ultrasonography-guided FNA of lymph nodes considered suspicious on radiography prior to planned neck dissection at a quaternary care facility from February 28, 2011, to March 18, 2013. Data analysis was performed from April 28 to December 24, 2013. Patients treated for head and neck squamous cell carcinoma with CRT who were determined to have persistent neck disease on a 6-week posttreatment computed tomographic scan of the neck and scheduled for salvage neck dissection were considered candidates for this pilot study. All patients enrolled in the study underwent ultrasonography-guided FNA of the suspicious lymph nodes within 2 weeks of the planned neck dissection. The cytopathologist reading the samples was blinded to the patient's identity.

Exposures

Fine-needle aspiration with a 23- to 25-gauge needle following CRT.

Main Outcomes and Measures

The accuracy of ultrasonography-guided FNA cytologic results was compared with the standard of surgical pathologic examination of neck dissection specimens.

Results

Fourteen patients (11 [79%] men; mean [SD] age, 57.8 [11.2] years) were enrolled in this pilot study; data were collected on 17 lymph nodes. Among these 14 patients with incomplete radiographic clinical response, 17 lymph node aspirations were performed. Ultrasonography-guided FNA identified squamous cell carcinoma in the aspirates of 4 (80%) of the 5 nodes with squamous cell carcinoma identified on pathologic testing and confirmed the absence of disease in the remaining 12 (71%) lymph nodes. The statistical analysis of these results revealed a sensitivity of 80%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 92.3%. The diagnostic accuracy of ultrasonography-guided FNA at detecting residual persistent cancer was 88%.

Conclusions and Relevance

This pilot study suggests that ultrasonography-guided FNA may be a feasible ancillary diagnostic imaging tool to imaging to assess patients with radiographic persistent disease prior to consideration of salvage neck dissection.

Chemoradiotherapy

10.1001/jamaoto.2015.3934

Cite

Citations (19)

Obstructive Sleep Apnea in Patients Undergoing Endoscopic Surgical Repair of Cerebrospinal Fluid Rhinorrhea

Journal of Neurological Surgery Part B Skull Base (2013)

Gitanjali M. Fleischman Adam M. Zanation Emily Cohn Charles S. Ebert Brent A. Senior

Objective: To examine the relationship between cerebrospinal fluid (CSF) rhinorrhea and obstructive sleep apnea (OSA).

Cerebrospinal Fluid Rhinorrhea

10.1055/s-0033-1336266

Cite

Citations (1)

A computational study of functional endoscopic sinus surgery and maxillary sinus drug delivery

Rhinology Journal (2015)

Matthew Wofford Julia S. Kimbell Dennis O. Frank‐Ito Vishal H. Dhandha Kibwei A. McKinney

Background: Topical medication is increasingly used following functional endoscopic sinus surgery (FESS).Information on particle sizes that maximise maxillary sinus (MS) delivery is conflicting, and the effect of antrostomy size on delivery is unclear.The purpose of this study was to estimate antrostomy and particle size effects on topical MS drug delivery.Methodology: Sinonasal reconstructions were created from a pre-and a post-FESS CT scan in each of four chronic rhinosinusitis patients.Additional models were created from each post-FESS reconstruction representing four alternative antrostomy sizes.Airflow and particle deposition were simulated in each reconstruction using computational fluid dynamics for nebulised and sprayed delivery.Results: MS ventilation and drug delivery increased following FESS, the largest virtual antrostomy led to greatest delivery, and MS delivery was sensitive to particle size.Particles within a 5-18 µm and 5-20 µm size range led to peak MS deposition for nebulised and sprayed particles, respectively.Post-FESS increases in drug delivery varied across individuals and within individuals by the type of antrostomy created. Conclusion:Our findings suggest that FESS, particularly with larger antrostomies, improves topical drug delivery, and that certain particle sizes improve this delivery.Further research is needed to contextualise these findings with other post-surgical effects.

Chronic Rhinosinusitis

Endoscopic sinus surgery

Sinus (botany)

10.4193/rhin13.065

Cite

Citations (33)

Quantification of airflow into the maxillary sinuses before and after functional endoscopic sinus surgery

International Forum of Allergy & Rhinology (2013)

Dennis O. Frank‐Ito Adam M. Zanation Vishal H. Dhandha Kibwei A. McKinney Gitanjali M. Fleischman

The effects of increases in maxillary sinus (MS) airflow following functional endoscopic sinus surgery (FESS) are unknown. The goal of this study was to quantify the effects of FESS on airflow into the MS in a cohort of patients with chronic rhinosinusitis, and compare MS flow rate with patient-reported outcome measures.A pilot study was conducted in which preoperative and postoperative computed tomography scans of 4 patients undergoing bilateral or unilateral FESS were used to create 3-dimensional (3D) reconstructions of the nasal airway and paranasal sinuses using Mimics™ (Materialise, Inc.). The size of the maxillary antrostomies post-FESS ranged from 107 to 160 mm(2). Computational meshes were generated from the 3D reconstructions, and steady-state, laminar, inspiratory airflow was simulated in each mesh using the computational fluid dynamics (CFD) software Fluent™ (ANSYS, Inc.) under physiologic, pressure-driven conditions. Airflow into the MS was estimated from the simulations and was compared preoperatively and postoperatively. In addition, patients completed preoperative and postoperative Rhinosinusitis Outcome Measure-31 (RSOM-31) questionnaires and scores were compared with MS airflow rates.CFD simulations predicted that average airflow rate into post-FESS MS increased by 18.5 mL/second, and that average flow velocity into the MS more than quadrupled. Simulation results also showed that MS flow rate trended with total RSOM-31 and all domain scores.CFD simulations showed that the healed maxillary antrostomy after FESS can greatly enhance airflow into the MS. Our pilot study suggests that to some extent, increasing airflow into the MS may potentially improve chronic rhinosinusitis patients' quality of life pre-FESS and post-FESS.

Sinus (botany)

10.1002/alr.21203

Cite

Citations (46)