Faculty Bibliography

PURPOSE/UNASSIGNED:While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York. METHODS/UNASSIGNED:A retrospective review of 79 patients was performed from January 2008 - December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann-Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution's statistician via a dedicated software package (vassarstats.net). RESULTS/UNASSIGNED:= .76). CONCLUSION/UNASSIGNED:Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.

Rhinoplasty is arguably one of the most challenging but rewarding procedures for the facial plastic surgeon. To adequately improve facial aesthetic parameters and preserve nasal function, the appropriate utilization of grafts is of utmost importance. While there is no best method, I found that in my hands, the endonasal approach allowed me to achieve greater control over my results by limiting dissection, utilizing less cartilage, and minimizing variables. In this manuscript, I outline the surgical pearls I have developed throughout my career that have helped me execute these grafts efficiently and effectively.

With a greater understanding of the aging process and relevant anatomy, the facial plastic surgeon has an expansive armamentarium of options for midface rejuvenation. Upon reflection, our practice has evolved over the years and only recently found a select number of interventions that have consistently produced excellent results. In this article, we discuss the steps needed to establish an effective patient relationship, present an algorithm on how to approach midface rejuvenation, describe our surgical technique, and review the attributes and liabilities of each procedure.

Chimeric antigen receptor T-cell therapy (CAR-T) is a novel immunotherapy used for the treatment of refractory B-cell leukemias and lymphoma. As clinical trials continue to expand, multiple treatment toxicities have been documented. Treatment-associated toxicities are typically systemic, however, focal manifestations have been described. We present a unique case of a 55-year-old female who developed oropharyngeal and laryngeal dystonia following CAR-T therapy. This case points to a possible association between CAR-T therapy and focal head and neck dystonia. Laryngoscope, 2020.

BACKGROUND:Postoperative cerebrospinal fluid leak after endoscopic pituitary surgery ranges from 1.9% to 10% in different series. Vascularized flaps have reduced the incidence of leak; however, this carries nasal morbidity. This study presents a technique for sellar reconstruction with free mucosal graft from the nasal cavity floor including inferior meatus mucosa. This technique aims to standardize sellar reconstruction without the use of the nasoseptal flap and to keep the advantage of mucosal coverage of the defect in all cases. METHODS:Fifty consecutive patients who had endoscopic surgery for pituitary tumors and reconstruction with nasal cavity floor free mucosal graft were retrospectively reviewed. There were a total of 50 patients with postoperative follow-up from 3 to 16 months. Collagen dural graft was used inlay and free mucosal graft overlay to cover the sellar defect. No fat grafts or lumbar drains were used. A Sinonasal Outcome Test-22 (SNOT-22) was performed before, 1 and 3 months after surgery. RESULTS:There were 40% detected intraoperative leaks and no postoperative leaks. Nasal endoscopy performed at 1 month follow-up showed complete healing of the graft to the skull base and near total or complete mucosalization of the donor site. No significant difference was found in the SNOT-22 comparing the total preoperative and 1-month scores. CONCLUSIONS:The nasal cavity floor free mucosal graft is an easy and safe technique, with minimal nasal morbidity. There were no postoperative cerebrospinal fluid leaks, despite aggressive tumor resection. No lumbar drains or fat graft were used. The harvest of mucosal graft does not worsen the quality of life measured with the SNOT-22 test.

OBJECTIVE:Endoscopic endonasal transsphenoidal surgery (EETS) is a widely accepted technique for sellar tumors. Common findings during preoperative assessment include septal deviations and turbinate hypertrophy. This study evaluated quality of life changes after concurrent septoplasty and/or inferior turbinoplasty during EETS. METHODS:A retrospective review was performed of a prospectively collected database including all patients undergoing EETS at our institution during a 10-month period between 2015 and 2016. Patients were divided into a septoplasty/inferior turbinoplasty group and a no septoplasty/inferior turbinoplasty group. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate quality of life. Mean preoperative scores were compared with 1- and 3-month postoperative scores within each cohort. The SNOT-22 was also reorganized into 5 distinct subdomains. Average subdomain scores were calculated, and preoperative and 1- and 3-month postoperative subdomain scores were compared within each cohort. A paired Student t test was used. P values < 0.05 were considered statistically significant. RESULTS:All 24 patients met inclusion criteria by completing preoperative and postoperative SNOT-22 surveys. In the septoplasty/inferior turbinoplasty group, preoperative and 3-month postoperative scores showed a clinically significant difference (P = 0.047). The septoplasty/inferior turbinoplasty group specifically showed a significant difference in the psychiatric and sleep SNOT-22 subdomains when comparing preoperative with 3-month postoperative scores (P = 0.03, P = 0.01). CONCLUSIONS:Patients who underwent concurrent septoplasty and/or turbinoplasty with EETS had a significantly improved quality of life compared with preoperative assessment, specifically regarding psychological and sleep symptoms.

OBJECTIVE:A significant proportion of children with congenital hearing loss who are candidates for cochlear implants (CIs) may have inner ear malformations (IEMs). Surgical and speech outcomes following CI in these children have not been widely reported. METHODS:The charts of children who were evaluated for a CI between 1/1/1986 and 12/31/2014 at a university-based tertiary level pediatric cochlear implant center were reviewed. Principal inclusion criteria included (i) age 1-18 years, (ii) history of bilateral severe to profound sensorineural hearing loss, and (iii) limited benefit from binaural amplification. Exclusion criteria included (i) underlying diagnosis of neurodevelopmental disorder and (ii) lack of follow up for speech assessment if a CI was performed. The following outcome measures were reviewed: (i) imaging findings with magnetic resonance imaging or high resolution computed tomography, (ii) intraoperative complications, and (iii) speech perception categorized as the ability to perceive closed set, open set, or none. RESULTS:The prevalence of IEMs was 27% (102 of 381), of which 79% were bilateral. Cochlear dysplasia accounted for 30% (40 of 136) of the anomalies. Seventy-eight of the 102 patients received a CI (78%). Surgery was noted to be challenging in 24% (19 of 78), with a perilymphatic gusher being the most common intraoperative finding. Cochlear dysplasia, vestibular dysplasia and cochlear nerve hypoplasia were associated with poor speech perception (open OR closed set speech recognition scores, 0-23%), although the outcomes in children with enlarged vestibular aqueduct were similar to those of children with normal inner ear anatomy (65%). CONCLUSIONS:Cochlear implantation is safe in children with IEMs. However, the speech perception outcomes are notably below those of patients with normal anatomy, with the exception of when an enlarged vestibular aqueduct is present.

The osteotemporoparietal fascia flap (OTPFF) has been used for bony defects, especially on the maxilla and orbital floor. However, there are limited reports about the reconstruction of the zygoma. We report the use of composite OTPFF for reconstruction of zygomaticomaxillary complex. The patient had undergone zygomaticomaxillary complex reconstruction with composite OTPFF because of the resection of recurrent postradiation tumor. Extratemporoparietal fascia was harvested and rotated to cover the medullary surface of the bone flap. Flap was successfully transferred with complete bone integration. There were no surgical complications and excellent cosmetic result. The patient is free of disease 12 months post surgery. The OTPFF seems to be a good option in zygomatic reconstruction, even in previously irradiated fields. Utilization of extratemporoparietal fascia to cover the medullary surface of the bone flap has potential to be an advantageous technique to minimize bone exposure and improve flap integration.