<p>Supplementary Table S5 shows saliva, serum, and their combined miRNA levels from OSCC patients and healthy individuals (HC), and their fold-changes (OSCC/HC), in total patients, smokers, and non-smokers.</p>
Introduction: While there is extensive literature investigating surgical outcomes in free flaps for adults, there is a dearth of information on the efficacy of flap use in the pediatric population. This study is the first to measure complication rates following pediatric free flap reconstruction on a national level. Methods: All pediatric free flap cases between 2012 and 2018 were identified and stratified by type of flap using current procedural terminology codes assigned to the primary procedure in the National Surgical Quality Improvement Program database. Each entry included the recipient location of the flap, postoperative complications, and demographics. Chi-square analysis was used to compare complication rates across various flap groupings. In addition, univariate and multivariate analyses were used to identify independent predictors of flap complications or failure. Results: Multivariate regression analysis demonstrated that compared to bone flaps, there is increased risk of nonbleeding complications in skin (Odds Ratio (OR) =7.7, P = 0.029), muscle (OR = 10.6, P = 0.012), and osteocutaneous flaps (OR = 10.8, P = 0.018). Flap of the trunk (OR = 40.9, P = 0.003) and upper extremities (OR = 32.9, P = 0.041) had a higher odds of bleeding complications compared to head-and-neck flaps. Regression analysis also showed that older age is associated with bleeding complications, with patients aged 5–11 years (OR = 38.5, P = 0.027) and 12–17 years (OR = 30.6, P = 0.038) having greater rates compared to patients under the age of 2. The pediatric flap reoperation rate was found to be 3.6%–4.7%, with the highest flap anastomotic complication rate in the head-and-neck region (6.9%–8.0%). Conclusion: Free flap reconstruction across flap type, anatomic location, and age ranges are safe and efficacious in the pediatric population.
Objective The objective of this study is to evaluate the efficacy and outcomes of using a transmastoid approach with hydroxyapatite cement to repair lateral skull base cerebrospinal fluid (CSF) leaks. Study Design Retrospective cohort study. Setting Tertiary-level care hospital. Patients Surgical patients 18 years or older between 2013 and 2022 with spontaneous CSF leak. Interventions Trans-mastoid approach for skull base repair using hydroxyapatite cement. Main Outcome Measures Failure rate of repair; location and size of defect, patient demographic factors. Results Of the 60 total defects (55 patients, 5 bilateral repairs) that underwent CSF leak repair using hydroxyapatite cement, the success rate was 91.66% (55 successful repairs). The average defect size in unsuccessful repairs was 1.15 cm compared with 0.71 cm for successful repairs. In addition, 80% (4/5) of the failed repairs were in the tegmen tympani region. Higher failure rate was noted in women (3/5) and in former smokers (4/5). Average time to recurrent symptoms was 1.75 years in the failed repair cohort. Of the patients with failed repairs, 4/5 were prescribed acetazolamide before their second procedure with successful second repair. In addition, five patients experienced postoperative headaches, three (5.4%) of whom required placement of VP shunts to relieve increased intracranial pressure. Two patients (3.6%) had complications of either infection or hearing loss. Conclusions Transmastoid approach utilizing hydroxyapatite is a successful approach for CSF leak repair, with a low complication and failure rate. Women, prior smoking history, and larger defects in the tegmen tympani region may need alternative materials or approach for repair. Long follow-up is warranted as recurrence of symptoms might be delayed. In cases of benign intracranial hypertension, adjuvant treatment with either acetazolamide or VP shunt placement may prevent failures.
Introduction: Chronic refractory cough is defined as cough lasting greater than 8 weeks and with an unclear etiology. Blockade of the internal branch superior laryngeal nerve (iSLN) has been shown to be safe and effective in the treatment of chronic cough. It remains unknown, however, if underlying comorbidities impact patient response to iSLN blockade. Methods: A total of 44 patients aged 18 years and older were seen at our institution’s Laryngology clinics between 2019 and 2022 and treated with iSLN blockade. Patient demographics, comorbidities, and pre- and post-treatment cough severity index (CSI) scores were collected from electronic medical records. Two-tailed independent T tests were used to compare CSI scores between groups with and without 4 underlying comorbidities: GERD, pulmonary history, smoking history, and evidence of vocal fold paresis or asymmetry on stroboscopy. Results: Patients with a history of GERD or smoking and those with evidence of glottic insufficiency had similar improvements in CSI compared to those who did not (22.5 ± 26.4 vs 45.0 ± 47.1, P = .36; 32.7 ± 27.8 vs 29.0 ± 38, P = .85; 41.3 ± 18.8 vs 27.2 ± 37.7, P = .195). Patients with underlying pulmonary conditions had a significantly reduced response to iSLN blockade than did patients without underlying disease (9.85 ± 15.0 vs 47.4 ± 38.1, P = .028). Conclusion: Underlying lung pathology may contribute to decreased iSLN blockade efficacy in the treatment of chronic refractory cough from laryngeal hypersensitivity and its treatment is likely necessary for optimal symptom reduction. Characterizing patient comorbidity profiles can help guide patient counseling on expected treatment efficacy.
Objective While tobacco use is understood to negatively impact HPV+ oropharyngeal squamous cell carcinoma (OPSCC) outcomes, debate remains as to how this impact differs between cohorts. Multiple smoking metrics have been identified as having the greatest prognostic significance, and some recent works have found smoking to have no significant impact. Herein, we show through an analysis of four common smoking metrics that while smoking impacts overall survival (OS), it has a limited impact on recurrence‐free survival (RFS) in our cohort. Methods We conducted a retrospective review of patients treated for HPV+ OPSCC in our health system from 2012 to 2019. Patients with metastatic disease or concurrent second primaries were excluded. Four metrics of tobacco use were assessed: current/former/never smokers, ever/never smokers, and smokers with >10 or >20 pack‐year (PY) smoking histories. Our main outcomes were 3‐year RFS and OS. Results Three hundred and sixty‐seven patients met inclusion criteria. 37.3% of patients (137/367) were never‐smokers; 13.8% of patients (51/367) were currently smoking at diagnosis and 48.8% of patients (179/367) were former smokers. No tobacco‐use metric significantly impacted 3‐year RFS. On univariate analysis, all smoking metrics yielded inferior OS. On multivariate analysis, current and ever smoking status significantly impacted 3‐year OS. Conclusion The impact of tobacco use on HPV+ OPSCC outcomes is not universal, but may instead be modulated by other cohort‐specific factors. The impact of smoking may decrease as rates of tobacco use decline. Level of Evidence 3 (Cohort and case–control studies) Laryngoscope , 134:3158–3164, 2024
Background: Skull base fracture management depends on location, severity, and can range from observation to surgical intervention. A comparison between the different locations of skull base fractures, namely anterior versus lateral, with regards to hospital length of stay (LOS), need for intensive care, and surgery has not been studied. Methods: Patients with skull base fractures between 2012 and 2019 were reviewed. Demographics and inpatient events were collected. Multivariate logistic and linear regressions evaluated the association between fracture location, multiple traumas, loss of consciousness, and mechanism of injury with hospital course and sequalae. Results: There were 134 patients (74.6% male) with skull base fractures (67 anterior and 67 lateral), with an average age of 44.2 years. The mechanism of injury was more likely to be MVCs in anterior fractures and falls in lateral fractures (MVC: 56.7% vs 34.3%; falls: 28.4% vs 44.8%, P = .03). Patients with anterior fractures were more likely to undergo any surgery ( P < .002), and surgeries for facial fractures ( P < .005), but less likely to need ICU care ( P = .01). When admitted, patients with anterior skull base fractures had longer ICU stays ( P = .03). They were also more likely to experience vision difficulties whereas patients with lateral fractures were more likely to experience hearing loss ( P = .02). Conclusion: Patients with lateral skull base fractures are more likely to require an ICU admission compared to anterior fractures, but anterior fractures are more likely to need surgery and have longer ICU stays when admitted. A better understanding of the expected hospital course for patients based on skull base fracture location can improve care-coordination, hospital resource management and patient counseling.
Physicians-in-training in the United States work long hours for relatively low wages. In response to increased economic burden, the popularity of unionization in residency training programs has increased dramatically. In this study, we conducted a cross-sectional investigation of the association between unionization status and Internal Medicine PGY-1 compensation and benefits.
