Presentation, Management, and Outcomes of Pathologic Scars Within a Pediatric Otolaryngology Practice.

OBJECTIVES: This study aims to review the spectrum of scarring that may present to an urban, pediatric otolaryngology practice and determine if associations exist between race, scar location, treatment modality, and outcomes following interventions for scarring. METHODS: Retrospective cohort study among 115 pediatric patients with 138 unique keloids or hypertrophic scars (HTS), and 141 children presenting for tonsillectomy at Tufts Medical Center. Age at presentation and sex assigned at birth were collected for both populations. For those presenting for pathologic scars, income quintile, self-identified race/ethnicity, anatomical location, treatment number and type, and clinical outcome were also analyzed. Multivariate analyses calculated adjusted odds ratios (aORs) and 95% confidence intervals to assess associations between scar subsite, intervention type, and persistence after treatment. RESULTS: Compared to individuals presenting for tonsillectomy, a disproportionate percentage of patients presenting for scarring identified as Black (26.6% vs. 13.5%) or Asian (17.4% vs. 7.1%, p = 0.016) or were male (61.7% vs. 49.7%, p = 0.053). Individuals identifying as Black or Asian were more likely to present with ear lobe and neck scars, respectively (50.0% vs. 45.5%, p = <0.001). Ear scars were significantly more likely to receive excision at initial treatment (aOR = 5.86 [1.43-23.96]) compared to other subsites, and were more likely to require >1 treatment (aOR = 5.91 [1.53-22.75]). CONCLUSION: Among pediatric patients presenting with keloids or HTS, children who identified as Black or Asian were more likely to present with ear and neck scars, respectively. Ear scars were frequently treated with excision and appear more likely to require adjuvant treatments and multiple interventions. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3127-3135, 2024.

The Role of the Cross Face Nerve Graft in Facial Reanimation and Endoscopic Harvest of the Sural Nerve.

Cross-face nerve grafting (CFNG) allows for spontaneous, involuntary facial movement for patients with irreversible hemifacial paralysis. This technique uses an intact contralateral facial nucleus and nerve as an input and axon source, allowing donor neural input to be routed through a nerve graft across the face. The sural nerve is well equipped for use as a nerve graft due to its length and minimal donor site morbidity. Endoscopic nerve harvest techniques allow for efficient, minimally invasive dissection that improves the integrity of the harvested nerve.

Point-of-care ultrasound scan as the primary modality for evaluating parotid tumors.

Objectives: This study aimed to explore ultrasonography as a single imaging modality for the initial assessment of parotid lesions compared to computed tomography (CT) and magnetic resonance imaging (MRI). Methods: A retrospective cross-sectional study was performed on 264 parotid gland lesions evaluated in a dedicated point-of-care ultrasound (POCUS) clinic with concurrent fine needle biopsy (FNB). Two hundred and nine of these lesions also underwent CT or MRI imaging. Histopathology results, when available, were recorded and compared to imaging impressions. Results: Surgeon-performed POCUS classified parotid masses accurately when compared to final histopathology (90/96, 94%). Using predefined criteria, POCUS determined the nature of parotid lesions more definitively than the descriptive CT or MRI radiology reports (p <.001). Sub-analysis showed that ultrasonography was able to distinguish between benign pathologies with high degree of accuracy (Warthin tumor-82%, pleomorphic adenoma-64%). Conclusions: POCUS can accurately distinguish between benign and malignant parotid lesions. POCUS may suffice as the only imaging study for benign lesions, obviating the need for additional cross-sectional imaging. This can be combined with fine needle or core biopsy in the same visit, resulting in expedient diagnosis, low cost, and lack of radiation exposure. Level of Evidence: 2b, individual cross-sectional cohort study.

Milan system for reporting salivary gland cytopathology: Adoption and outcomes in a community setting.

BACKGROUND: Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to standardize reporting of salivary gland cytopathology. METHODS: A retrospective review of ultrasound-guided fine needle biopsy of salivary gland lesions was performed between January 2018 and May 2021 at a community otolaryngology practice. Diagnostic accuracy and rate of diagnostic sialoadenectomy were calculated. RESULTS: A total of 203 FNAs (fine needle aspiration) were performed in 184 patients. MSRSGC was utilized in 87/203 cytopathology reports, with a diagnostic accuracy of 84%. Descriptive reporting was used in 115 FNAs, with a diagnostic accuracy of 89% (p = 0.68). Sialoadenectomy rate was 41% for MSRSGC compared to 36% in descriptive cytopathology (p = 0.48). CONCLUSIONS: MSRSGC is as accurate as descriptive cytopathology and the rate of diagnostic sialoadenectomy between both groups is similar in our community. The MSRSGC brings uniformity and standardization to the FNA reporting process.

Race, Income, and the Timeliness of Cleft Palate Repair in the United States.

Objective To determine if differences exist in the timing of cleft palate repair with respect to sex, race, income, and geographical location within the United States. Design Retrospective cross-sectional study using the Kids' Inpatient Database (KID) from 1997 to 2009. Setting Inpatient. Patients Children with cleft palate with or without cleft lip undergoing inpatient cleft palate repair. Main outcome measures Age at the time of palatoplasty (in months) by sex, race, income quartile, and geographic location. Results A total of 7,218 children with cleft palate underwent repair at a mean age of 12.1 months (95% CI 12.0-12.3). Females underwent palatoplasty at an older age (13.6 months) than males (13.2 months), a difference of 0.47 months (SE: 0.19, p=0.015). White children underwent surgery at an earlier age (12.1 months) than Black (12.9 months) (difference: 0.73 months, SE: 0.37, p=0.045), Hispanic (12.7 months) (difference: 0.57 months, SE 0.25, p=0.025), and Asian children (15.7 months) (difference: 3.60 months, SE 0.49, p<0.0001). Asian children were also found to undergo repair later than Hispanic (difference 3.03 months, SE 0.51, p<0.0001) and Black (difference: 2.87 months, SE 0.59, p<0.0001) children. Patients born into the highest income brackets were repaired 0.75 months earlier than those in the lowest bracket (SE: 0.26, p=0.005). Patients in the Midwest underwent palatoplasty later (14.3 months) than in the Northeast (12.9 months) (difference: 1.36 months, SE: 0.31, p<0.0001), South (13.2 months) (difference: 1.05 months, SE: 0.36, p=0.004), and West (13.2 months) (difference: 1.09 months, SE: 0.32, p=0.0007). Conclusions After controlling for confounding factors, our results suggest that in recent history, Black, Hispanic, and Asian children with cleft palate were repaired later than their White counterparts. In addition, children of affluent families were repaired earliest, and economically disadvantaged children were repaired later than their peers.

Neonatal tooth infection resulting in subperiosteal orbital abscess: A case report.

Neonatal orbital infections are quite rare, and are most often attributed to ethmoid sinusitis. This report describes a case of subperiosteal orbital abscess in a neonate secondary to an infected neonatal tooth. Although there have been two cases reported in the literature describing odontogenic infection resulting in orbital abscess in neonates, these cases were due to infected tooth buds rather than an infected neonatal tooth. We discuss workup and surgical management of this patient, including tooth extraction and intraoral approach to the orbit for abscess drainage.

Diagnostic Accuracy of Fine-Needle Biopsy for Salivary Gland Neoplasms in a Community Otolaryngology Practice.

OBJECTIVE: To assess the diagnostic accuracy of fine-needle biopsy (FNB) of salivary gland neoplasms via ultrasound (US) or palpation guidance by an otolaryngologist in a community practice. STUDY DESIGN: Retrospective chart review. SETTING: Community otolaryngology practice. METHODS: Retrospective analysis was conducted for all office-based salivary gland FNBs from a community practice from 2005 through 2018. There were 433 FNBs performed among 370 patients. The likelihood of achieving a diagnostic result based on method (US vs palpation guidance) was calculated. Of this cohort, 196 cases had surgical follow-up (parotid gland, n = 168; submandibular gland, n = 28). Correlation of preoperative FNB results to final surgical pathology was performed and measures of diagnostic accuracy computed. RESULTS: US-guided FNBs were more likely to achieve a diagnostic result than FNBs obtained via palpation guidance (P = .00002). Parotid gland FNBs demonstrated a sensitivity and specificity of 78.57% and 92.44%, respectively. Submandibular FNBs demonstrated a sensitivity and specificity of 57.14% and 93.74%. CONCLUSION: FNBs performed under US guidance are more likely to achieve a diagnostic specimen than those performed under palpation guidance. FNBs of parotid gland tumors may be assessed with diagnostic accuracy in the community setting that is similar to that achieved at tertiary care centers. Further research is needed to ascertain whether this finding extends to FNBs of submandibular gland tumors. Offering this procedure at point of care in the community may improve compliance and reduce wait time.

Breast Cancer Metastases to the Paranasal Sinuses Mimicking Inflammatory Sinus Disease.

INTRODUCTION: Breast cancer is one of the most common cancers in women. Metastatic disease is a leading cause of morbidity and mortality. It frequently metastasizes to bone, lungs, regional lymph nodes, liver and brain. Metastasis to the orbit and paranasal sinuses is uncommon. Patients presenting with sinus pain, nasal congestion, or visual disturbance can be misdiagnosed with an infectious process. METHODS: The authors describe 2 patients with metastatic breast cancer to the paranasal sinuses presenting with signs and symptoms of sinusitis and orbit pathology unresponsive to antibiotics. The authors discuss diagnostic strategy and perform a literature review. Both patients had biopsy-proven metastatic breast adenocarcinoma lesions, and subsequently underwent various treatment options. RESULTS: A literature review reveals that metastatic breast adenocarcinoma lesions to the paranasal sinuses are a rare entity that commonly denotes a very poor prognosis. These lesions can significantly affect one's quality of life, and can cause blurry vision, diplopia, proptosis, sinus pressure and pain, nasal congestion, mandibular misalignment or difficulty with mastication. However, early diagnosis and treatment of these lesions can lead to prolonged survival and improved quality of life. If the lesion is surgically resectable, endoscopic sinus surgery is generally considered to be the optimal treatment. However, radiotherapy, chemotherapy, and immunotherapy can potentially play a role in controlling the symptomatology. CONCLUSION: Metastatic lesions to the paranasal sinuses are a rare entity that should be considered in the appropriate clinical setting in order to expedite the proper treatment modality for improved morbidity and mortality.