Faculty Bibliography

OBJECTIVE:Pediatric data regarding treatment via an auditory brainstem implant (ABI) remains sparse. The authors aimed to describe their experience at their institution and to delineate associated demographic data, audiometric outcomes, and surgical parameters. METHODS:An IRB-approved, retrospective chart review was conducted among the authors' pediatric patients who had undergone auditory brainstem implantation between 2012 and 2021. Demographic information including sex, age, race, coexisting syndrome(s), history of cochlear implant placement, average duration of implant use, and follow-up outcomes were collected. Surgical parameters collected included approach, intraoperative findings, number of electrodes activated, and complications. RESULTS:A total of 19 pediatric patients had an ABI placed at the authors' institution, with a mean age at surgery of 4.7 years (range 1.5-17.8 years). A total of 17 patients (89.5%) had bilateral cochlear nerve aplasia/dysplasia, 1 (5.3%) had unilateral cochlear nerve aplasia/dysplasia, and 1 (5.3%) had a hypoplastic cochlea with ossification. A total of 11 patients (57.9%) had a history of cochlear implants that were ineffective and required removal. The mean length of implant use was 5.31 years (0.25-10 years). Two patients (10.5%) experienced CSF-related complications requiring further surgical intervention. The most recent audiometric outcomes demonstrated that 15 patients (78.9%) showed improvement in their hearing ability: 5 with sound/speech awareness, 5 able to discriminate among speech and environmental sounds, and 5 able to understand common phrases/conversation without lip reading. Nine patients (47.4%) are in a school for the deaf and 7 (36.8%) are in a mainstream school with support. CONCLUSIONS:The authors' surgical experience with a multidisciplinary team demonstrates that the retrosigmoid approach for ABI placement in children with inner ear pathologies and severe sensorineural hearing loss is a safe and effective treatment modality. Audiometric outcome data showed that nearly 79% of these patients had an improvement in their environmental and speech awareness. Further multicenter collaborations are necessary to improve these outcomes and potentially standardize/enhance electrode placement.

Turn-taking is a central feature of conversation across languages and cultures.¹

BACKGROUND: Microgenia resulting from congenital deficiency or aging can significantly affect the facial profile and render it less attractive. This study assessed the effectiveness of treatment with incobotulinumtoxinA (Inco) and calcium hydroxylapatite with integral lidocaine (CaHA[+]) for improving chin profile. METHODS: Subjects with a hyperactive mentalis and at least moderate chin retrusion according to the Asian Chin Projection Scale (ACPS) were recruited. At Visit 1, subjects received Inco injection into the mentalis, followed by deep, pre-periosteal injections of CaHA(+) into the pogonion. The primary endpoint was an ACPS improvement of one point at one and six months. Photographs at baseline and each follow-up visit were rated by physicians using the Global Aesthetic Improvement Scale (GAIS). All subjects completed a satisfaction questionnaire. RESULTS: Ten female subjects were recruited. Mean age was 42.5 years and all had moderate-to-severe chin retrusion at baseline (ACPS score ≥2). All subjects demonstrated at least a one-point improvement in ACPS compared with baseline at both the one-month and six-month posttreatment visits. Physician GAIS ratings of subject appearance confirmed that 100 percent of subjects experienced improved chin projection at each follow-up visit compared to baseline. All 10 subjects were pleased with their chin profile after treatment, with 90 percent noting that it was still "very much improved" at six months. CONCLUSION: Based on our results, combined treatment with CaHA and Inco appears to be effective and well tolerated for improving the facial profile of subjects with chin retrusion. Treatment was associated with a high degree of patient satisfaction and was well tolerated.

PURPOSE/OBJECTIVE:Although ongoing studies are assessing the efficacy of new systemic therapies for patients with triple negative breast cancer (TNBC), the overwhelming majority have excluded patients with brain metastases (BM). Therefore, we aim to characterize systemic therapies and outcomes in a cohort of patients with TNBC and BM managed with stereotactic radiosurgery (SRS) and delineate predictors of increased survival. METHODS:We used our prospective patient registry to evaluate data from 2012 to 2023. We included patients who received SRS for TNBC-BM. A competing risk analysis was conducted to assess local and distant control. RESULTS:Forty-three patients with 262 tumors were included. The median overall survival (OS) was 16 months (95% CI 13-19 months). Predictors of increased OS after initial SRS include Breast GPA score > 1 (p < 0.001) and use of immunotherapy such as pembrolizumab (p = 0.011). The median time on immunotherapy was 8 months (IQR 4.4, 11.2). The median time to new CNS lesions after the first SRS treatment was 17 months (95% CI 12-22). The cumulative rate for development of new CNS metastases after initial SRS at 6 months, 1 year, and 2 years was 23%, 40%, and 70%, respectively. Thirty patients (70%) underwent multiple SRS treatments, with a median time of 5 months (95% CI 0.59-9.4 months) for the appearance of new CNS metastases after second SRS treatment. CONCLUSIONS:TNBC patients with BM can achieve longer survival than might have been previously anticipated with median survival now surpassing one year. The use of immunotherapy is associated with increased median OS of 23 months.

OBJECTIVE:To describe outcomes of patients with sporadic vestibular schwannoma (VS) who underwent repeat stereotactic radiosurgery (SRS) after primary SRS failure. STUDY DESIGN/METHODS:Multi-institutional historical cohort study. SETTING/METHODS:Five tertiary care referral centers. PATIENTS/METHODS:Adults ≥18 years old with sporadic VS. INTERVENTION/METHODS:Primary and repeat treatment with SRS. MAIN OUTCOME MEASURE/METHODS:Microsurgery-free survival after repeat SRS. RESULTS:Across institutions, 32 patients underwent repeat SRS after primary SRS. Most patients (74%) had tumors with cerebellopontine angle extension at primary SRS (median size, 13.5 mm [interquartile range, 7.5-18.8] mm). After primary SRS, patients underwent repeat SRS at a median of 4.8 years (interquartile range, 3.2-5.7 yr). For treatment modality, 30 (94%) patients received gamma knife for primary treatment and 31 (97%) patients received gamma knife as their repeat treatment. Median tumor volume increased from 0.970 cm3 at primary SRS to 2.200 cm3 at repeat SRS. Facial nerve function worsened in two patients after primary SRS and in two patients after repeat SRS. There were no instances of intracranial complications after repeat SRS. Microsurgery-free survival rates (95% confidence interval; number still at risk) at 1, 3, and 5 years after repeat SRS were 97% (90-100%, 24), 84% (71-100%, 13), and 68% (48-96%, 6), respectively. There was one occurrence of malignancy diagnosed after repeat radiosurgery. CONCLUSION/CONCLUSIONS:Overall, repeat SRS for sporadic VS has comparable risk profile, but lower rates of tumor control, compared with primary SRS.

Endotracheal Tubes (ETTs) maintain and secure a patent airway; however, prolonged intubation often results in unintended injury to the mucosal epithelium and inflammatory sequelae which complicate recovery. ETT design and materials used have yet to adapt to address intubation associated complications. In this study, a composite coating of electrospun polycaprolactone (PCL) fibers embedded in a four-arm polyethylene glycol acrylate matrix (4APEGA) is developed to transform the ETT from a mechanical device to a dual-purpose device capable of delivering multiple therapeutics while preserving coating integrity. Further, the composite coating system (PCL-4APEGA) is capable of sustained delivery of dexamethasone from the PCL phase and small interfering RNA (siRNA) containing polyplexes from the 4APEGA phase. The siRNA is released rapidly and targets smad3 for immediate reduction in pro-fibrotic transforming growth factor-beta 1 (TGFϐ1) signaling in the upper airway mucosa as well as suppressing long-term sequelae in inflammation from prolonged intubation. A bioreactor was used to study mucosal adhesion to the composite PCL-4APEGA coated ETTs and investigate continued mucus secretory function in ex vivo epithelial samples. The addition of the 4APEGA coating and siRNA delivery to the dexamethasone delivery was then evaluated in a swine model of intubation injury and observed to restore mechanical function of the vocal folds and maintain epithelial thickness when observed over 14 days of intubation. This study demonstrated that increase in surface lubrication paired with surface stiffness reduction significantly decreased fibrotic behavior while reducing epithelial adhesion and abrasion.

Mature vertebrates maintain posture using vestibulospinal neurons that transform sensed in-stability into reflexive commands to spinal motor circuits. Postural stability improves across development. However, due to the complexity of terrestrial locomotion, vestibulospinal con-tributions to postural refinement in early life remain unexplored. Here we leveraged the relative simplicity of underwater locomotion to quantify the postural consequences of losing vestibulospinal neurons during development in larval zebrafish of undifferentiated sex. By comparing posture at two timepoints, we discovered that later lesions of vestibulospinal neu-rons led to greater instability. Analysis of thousands of individual swim bouts revealed that lesions disrupted movement timing and corrective reflexes without impacting swim kinemat-ics, and that this effect was particularly strong in older larvae. Using a generative model of swimming, we showed how these disruptions could account for the increased postural variability at both timepoints. Finally, late lesions disrupted the fin/trunk coordination observed in older larvae, linking vestibulospinal neurons to postural control schemes used to navigate in depth. Since later lesions were considerably more disruptive to postural sta-bility, we conclude that vestibulospinal contributions to balance increase as larvae mature. Vestibulospinal neurons are highly conserved across vertebrates; we therefore propose that they are a substrate for developmental improvements to postural control.Significance Statement Many animals experience balance improvements during early life. Mature vertebrates use vestibulospinal neurons to transform sensed instability into postural corrections. To under-stand if/how these neurons shape postural development, we ablated them at two develop-mentally important timepoints in larval zebrafish. Loss of vestibulospinal neurons disrupted specific stabilizing behaviors (swim timing, tilt correction, and fin/body coordination) more profoundly in older fish. We conclude that postural development happens in part by changes to vestibulospinal neurons - a significant step towards understanding how developing brains gain the ability to balance.

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.