Faculty Bibliography

BACKGROUND:Predictors of outcomes in pediatric microtia surgery are not well understood within the current literature. A multi-institutional database study may reveal insights into these predictors. OBJECTIVES/OBJECTIVE:To explore the predictors of 30-day complications, 30-day readmission, and postoperative length of stay (PLOS) in pediatric microtia patients undergoing autologous rib grafting. METHODS:The Pediatric National Surgical Quality Improvement Program was queried for details on patients with microtia (ICD-9/10 744.23/Q17.2) who underwent autologous rib grafting (CPT 21230) between 2012-2021. Demographics, comorbidities, inpatient status, 30-day complications, PLOS, and 30-day readmissions were analyzed. Statistical analyses were performed to compare the preoperative characteristics with postoperative outcomes. RESULTS:Overall, 667 patients met the inclusion criteria. Sixty-three (9.4%) had at least one complication, and 19 (2.9%) were readmitted. Univariate analysis showed that inpatient status (p = 0.011) and race (p = 0.023) were associated with higher complication rates. Multivariate analysis revealed that outpatient status was associated with significantly lower odds of complications (OR: 0.49, 95% CI [0.27, 0.87], p = 0.018), and developmental delay was associated with higher odds of 30-day readmission (OR: 2.80, 95% CI [1.05, 7.17], p = 0.036). Longer operative time was associated with older age (13.9% increase per five-year age increase, p < 0.001) and inpatient status (35.3% increase, p < 0.001). PLOS was shorter for outpatients (45.45% shorter, p < 0.001) and cases performed by plastic surgeons (14.2% shorter, p < 0.001). CONCLUSION/CONCLUSIONS:Microtia reconstruction using autologous cartilage is a relatively safe procedure with low complication and readmission rates. Significant predictors of postoperative outcomes include inpatient status, race, developmental delay, and age. These findings highlight the importance of considering these factors in surgical planning and patient counseling.

PURPOSE/UNASSIGNED:Patient-reported outcome measures (PROMs) are an important tool both in clinical practice and research involving patients with swallowing disorders. There are several challenges to be overcome and methodological details to be adequately reported to ensure rigor and transparency in studies utilizing PROMs in dysphagia research. For this reason, the Framework for RigOr aNd Transparency In REseaRch on Swallowing (FRONTIERS), a critical appraisal tool developed to ensure rigor and transparency in dysphagia research, has devoted a domain to PROMs. The aim of this current article, as part of a larger forum of articles, is to present the PROM section of FRONTIERS and describe its development. METHOD/UNASSIGNED:A literature review was carried out on PROMs in the field of dysphagia by three members of the FRONTIERS collaborative to identify items that were necessary for the rigorous application and transparent reporting of PROMs utilized in research of swallowing disorders in human subjects. Framework items were then subjected to an iterative process of feedback and consensus among the three members of the working group as well as all members of the FRONTIERS collaborative. Items were flagged for review and revised as needed until consensus was achieved on the final list. The final item list was compared to existing critical appraisal tools for PROMs. RESULTS/UNASSIGNED:The final checklist for the PROMs domain included 20 "Yes/No" questions that can be broadly divided into three categories: (a) development and validation, (b) patient population, and (c) PROM administration method. Each item is presented with a rationale for its inclusion. CONCLUSIONS/UNASSIGNED:The use of the FRONTIERS Framework will serve researchers and those appraising quality of research involving PROMs. More broadly, the FRONTIERS Framework will facilitate improved rigor and transparency across dysphagia research. Special considerations and future goals are discussed.

PURPOSE/OBJECTIVE:DNA methylation profiling stratifies isocitrate dehydrogenase (IDH)-mutant astrocytomas into methylation low-grade and high-grade groups. We investigated the utility of the T2-FLAIR mismatch sign for predicting DNA methylation grade and cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) homozygous deletion, a molecular biomarker for grade 4 IDH-mutant astrocytomas, according to the 2021 World Health Organization (WHO) classification. EXPERIMENTAL DESIGN/METHODS:Preoperative MRI scans of IDH-mutant astrocytomas subclassified by DNA methylation profiling (n=71) were independently evaluated by two radiologists for the T2-FLAIR mismatch sign. The diagnostic utility of T2-FLAIR mismatch in predicting methylation grade, CDKN2A/B status, copy number variation, and survival was analyzed. RESULTS:The T2-FLAIR mismatch sign was present in 21 of 45 (46.7%) methylation low-grade and 1 of 26 (3.9%) methylation high-grade cases (p<0.001), resulting in 96.2% specificity, 95.5% positive predictive value, and 51.0% negative predictive value for predicting low methylation grade. The T2-FLAIR mismatch sign was also significantly associated with intact CDKN2A/B status (p=0.028) with 87.5% specificity, 86.4% positive predictive value, and 42.9% negative predictive value. Overall multivariable Cox analysis showed that retained CDKN2A/B status remained significant for PFS (p=0.01). Multivariable Cox analysis of the histologic grade 3 subset, which was nearly evenly divided by CDKN2A/B status, CNV, and methylation grade, showed trends toward significance for DNA methylation grade with OS (p=0.045) and CDKN2A/B status with PFS (p=0.052). CONCLUSIONS:The T2-FLAIR mismatch sign is highly specific for low methylation grade and intact CDKN2A/B in IDH-mutant astrocytomas.

Adolescents and young adults (ie, individuals aged 15-39 years, known as AYAs) with cancer face unique vulnerabilities yet remain underrepresented in clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8%-12%). We used the Pediatric Oncology COVID-19 Case Report to examine the clinical course of COVID-19 among AYAs with cancer. The Pediatric Oncology COVID-19 Case Report collects deidentified clinical and sociodemographic data regarding individuals aged from birth to 39 years with cancer (37%) and COVID-19 from more than 100 institutions. Between April 1, 2020, and November 28, 2023, 191 older AYAs (individuals 22-39 years of age) and 640 younger AYAs (individuals 15-21 years of age) were captured. Older AYAs were less often hospitalized (P < .001), admitted to the intensive care unit (P = .02), and required respiratory support (P = .057). In multivariable analyses, older AYAs faced 80% lower odds of intensive care unit admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of intensive care unit admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform oncology teams directing COVID-19 management and prevention in AYA patients with cancer.

OBJECTIVE:This study utilized bibliometric methodologies to explore the body of research presented at the World Workshop on Oral Medicine (WWOM) over the past 35 years. METHODS:A systematic tracking of articles across 8 editions of WWOM was conducted using databases such as Web of Science, Scopus, and PubMed. Comprehensive bibliographic analysis and data visualization were executed through Bibliometrix, Rstudio, and VOSviewer, facilitating an in-depth examination of citation metrics and collaborative networks. RESULTS:The investigation revealed that WWOM, held in 6 cities spanning four countries and addressing 33 distinct topics, demonstrated an annual citation growth rate of 8.29%, with an average of 49.31 citations per article. Notably, WWOM IV garnered the highest number of citations (1,342), reaching its peak in 2021 with 365 citations. Key contributors to the most-cited articles include Al-Hashimi, Dawes, and Syrjänen et al. Since its inception, the workshops have engaged 505 faculty members from 37 nations, with significant participation from the Americas and Europe, notably the United States and the United Kingdom, which also led in terms of publications. Network analysis delineated 6 country clusters, underscoring robust connections between the US and the UK. Co-authorship analysis revealed 18 clusters involving 267 authors. CONCLUSION/CONCLUSIONS:The influence of the WWOM on the field of oral medicine is clearly demonstrated by the outcomes of its publications, reflecting a collaborative effort to enhance comprehension and treatment modalities for patients with oral diseases. The study's findings provide insights into future research directions within the WWOM legacy.

Thyroid carcinoma of follicular cell origin exists on a histopathologic and clinical spectrum. The authors focus on the category of tumors that fall between the very favorable well-differentiated thyroid carcinomas and the very unfavorable anaplastic thyroid carcinomas. These intermediately aggressive tumors include poorly differentiated thyroid carcinoma and the newly defined differentiated high-grade thyroid carcinoma. Both diagnoses require certain histopathologic requirements be met in order to accurately identify these tumors post-operatively. Management remains primarily surgical though adjunctive treatments such as molecular targeted therapies (eg, tyrosine kinase inhibitors) and differentiation therapy (to restore tumor response to radioactive iodine) are also becoming available.

Evidence on facial rehabilitation therapy (FRT) for acute facial paralysis (FP) remains limited. We present a retrospective review of patients with acute FP who have received FRT with physical therapists within 1 year of FP onset as determined by Sunnybrook Facial Grading Scale (SFGS) composite scores. A total of 702 patients with a clinical diagnosis of FP were referred to a university rehabilitation program between January 1, 2015 and January 1, 2022. Seventy-six patients met the criteria, defined as FP diagnosis <12 months before FRT initiation, ≥3 therapy sessions, and sufficient follow-up data. Average number of treatment sessions between SFGS scores was 7.7. History of cancer, sex, number of treatment sessions, and initial SFGS score were correlated with change in SFGS. Time to treatment was not correlated with change in SFGS score. SFGS improved with each additional treatment session (p < 0.01). Each additional point in the initial SFGS was correlated with less change in the final SFGS score (p < 0.01). FRT can provide meaningful improvement in functionality for patients with acute FP, regardless of time to treatment. Furthermore, patients who present with poorer functionality at baseline and those who undergo more treatment are most likely to see SFGS improvement. Research comparing the effect of facial rehabilitation with other treatment modalities and to a control cohort is warranted.

OBJECTIVE/UNASSIGNED:To assess differences in otorrhea, tympanic membrane perforation, and time to extrusion in children receiving one of four commonly used, short-term ventilation tubes for the first time. METHODS/UNASSIGNED:Retrospective chart review of 2 years of postoperative follow-up to analyze patient outcomes after insertion of either a Paparella type-I Activent, Armstrong Beveled, Modified Armstrong, or Armstrong Microgel ventilation tube. Incidence of complications was determined by reviewing provider notes. Adjusted multivariate logistic regression models were used to determine odds ratios of complications among the four tube types. RESULTS/UNASSIGNED:A total of 387 patients were reviewed. The mean age was 2.4 years and 35.9% were female. Armstrong beveled tubes had the highest odds of otorrhea. Paparella type-I tube had the shortest time to extrusion of about 9 months, while Armstrong Beveled had the longest, at almost 19 months. When evaluating episodes of otorrhea each child experienced on average, per month, Armstrong beveled tubes had the highest monthly rate of otorrhea and Paparella type-I the least. No significant differences were found regarding tympanic membrane perforation. CONCLUSIONS/UNASSIGNED:This retrospective chart review showed that no tube was clinically superior across all complications. The findings from this study may give otolaryngologists an opportunity to consider choosing a specific type of tube according to the clinical situation. The large variations in extrusion times should be considered in terms of patient age, seasonality, and desired duration of tube placement. LEVEL OF EVIDENCE/UNASSIGNED:4.

This aim of this study is to characterize the nature and pathophysiology of dysphagia after ACDF surgery by precisely and comprehensively capturing within-subject changes on videofluoroscopy between preoperative and postoperative time points. 21 adults undergoing planned primary ACDF procedures were prospectively recruited and enrolled. Participants underwent standardized preoperative and six-week postoperative videofluoroscopic swallow studies. Videos were blindly rated using the Penetration-Aspiration Scale (PAS) and analysis of total pharyngeal residue (%C2-4²), swallowing timing, kinematics, and anatomic change was completed. Linear mixed-effects modeling was used to explore the relationships between possible predictor variables and functional outcomes of interest that changed across timepoints. There was no change in PAS scores across timepoints. Total pharyngeal residue (%C2-C4²) was increased postoperatively (p < 0.001). Our statistical model revealed significant main effects for timepoint (p = 0.002), maximum pharyngeal constriction area (MPCA_N) (p < 0.001), and maximum thickness of posterior pharyngeal (PPWT_MAX) (p = 0.004) on the expression of total pharyngeal residue. There were significant two-way interactions for timepoint and MPCA_N (p = 0.028), timepoint and PPWT_MAX (p = 0.005), and MPCA_N and PPWT_MAX (p = 0.010). Unsurprisingly, we found a significant three-way interaction between these three predictors (p = 0.027). Our findings suggest that in planned ACDF procedures without known complications, swallowing efficiency is more likely to be impaired than airway protection six weeks after surgery. The manifestation of impaired swallowing efficiency at this timepoint appears to be driven by a complex relationship between reduced pharyngeal constriction and increased prevertebral edema.