Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database.

The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.

Aggressive surgical resection of anaplastic thyroid carcinoma may provide long-term survival in selected patients.

OBJECTIVE: In this study, we present our experience with aggressive surgical treatment in selected patients with anaplastic thyroid cancer with extrathyroidal extension. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care referral center. SUBJECTS AND METHODS: Retrospective chart review of all patients with anaplastic thyroid cancer surgically treated by the senior author from January 1998 to July 2012. RESULTS: A total of 38 cases of anaplastic thyroid cancer were treated (21 male and 17 female). The mean age was 64.5 years. Twenty-two patients were considered surgically unresectable (18 had distant metastases and 4 had extrathyroidal extension of cancer lateral to carotid arteries) and underwent biopsy with or without tracheostomy. The remaining 16 patients underwent surgical resection with curative intent. Fourteen of these patients underwent postoperative radiation therapy. None of these 16 patients developed local recurrence. Six developed distant metastasis at an average follow-up of 3.2 months, 1 died of an unrelated myocardial infarction at 3 months, 2 were lost to follow-up, and 7 remain disease free with an average follow-up of 4.8 years (range, 9 months to 8 years). Of those patients who underwent complete surgical resection followed by postoperative radiation, 7 of 14 (50%) are still alive, with a mean follow-up of 4.8 years. CONCLUSION: Selected patients with anaplastic thyroid cancer with extrathyroidal extension (stage IVB) who show no distant metastases by computed tomography or positron emission tomography scans and who do not have tumor extending lateral to the carotid arteries are candidates for complete surgical resection.

Residual hearing preservation after pediatric cochlear implantation.

OBJECTIVE: This study is designed to test the hypothesis that preservation of residual hearing in a pediatric population is possible using standard electrode arrays with full-length insertions. Surgical technique during implantation also is described. STUDY DESIGN: Retrospective review of patient medical records. SETTING: Academic tertiary care center. PATIENTS: Thirty-one severely to profoundly hearing impaired pediatric patients with some residual hearing precochlear implantation. INTERVENTION: Cochlear implantation using a modified "soft surgery" protocol. MAIN OUTCOME MEASURES: Preimplant and postimplant pure tone thresholds and pure-tone average were calculated from unaided preoperative and postoperative audiograms from 250, 500, and 1,000 Hz. Hearing preservation rates were determined to be complete (loss of ≤10 dB), moderate (loss of 11-20 dB), marginal (loss of 21-40 dB), or none (loss of >40 dB or no response at the limits of the audiometer). Functional residual hearing rates (defined in this study as at least 1 threshold better than or equal to 75 dB HL for 250, 500, or 1,000 Hz were calculated. RESULTS: Complete hearing preservation was achieved in 14 (45.2%) of 31 patients, whereas 28 (90.3%) of 31 had at least partial hearing preservation (loss of ≤40 dB). The preoperative to postoperative low-frequency pure-tone average had a mean change of 18.5 dB and median change of 20 dB. Of the patients who had preoperative functional hearing, 9 (50.0%) of 18 maintained functional residual hearing postoperatively for at least 1 pitch. CONCLUSION: Preservation of residual hearing is feasible in pediatric cochlear implant patients using standard-length electrode arrays with full insertions. These data have implications for cochlear implantation in pediatric patients who are at higher risk of progressive hearing loss than adults.