Systematic review of the free thoracodorsal artery perforator flap for head and neck reconstruction.

BACKGROUND: The thoracodorsal artery perforator (TDAP) flap has gained interest as a option for reconstruction of head and neck defects while minimizing donor site morbidity as compared to traditional workhorse flaps. The primary aim of this systematic review is to assess the postoperative outcomes and efficacy of this flap. METHODS: Several databases were screened for relevant citations. The quality of studies and risk of bias were evaluated using the MINORS scoring system. RESULTS: Twenty articles containing 168 patients undergoing at least one TDAP flap reconstruction met the inclusion criteria. There were no incidences of total flap failure and only 10 incidences of partial flap failure (5.95 %). Flap complications and donor site morbidity was low. The average MINORS score of the studies suggested a moderately high amount of bias. CONCLUSIONS: Based on limited quality evidence, this review suggests that TDAP flap is a safe and feasible option for head and neck reconstruction with comparable success rates as other commonly used flaps, with low complication rate and donor site morbidity. Further large-scale studies are warranted.

Predictors of Facial Pain and Headache Associated With Cryotherapy Ablation of the Posterior Nasal Nerve for the Treatment of Chronic Rhinitis.

OBJECTIVE: Cryotherapy ablation of the posterior nasal nerve (PNN) for treatment of patients with refractory chronic rhinitis (CR) is associated with postoperative facial pain and headache. This study sought to understand factors that may contribute to the development of this adverse effect. METHODS: Patients undergoing PNN cryotherapy ablation for refractory CR at a single institution from January 2018 to August 2023 were included. Demographics and clinical characteristics were collected via chart review and interview. Student's T-test and Chi-square tests were used to assess the significance of quantitative and categorical data, respectively (alpha = 0.05). RESULTS:  Forty-eight patients underwent cryotherapy ablation. Twenty-eight patients (58%) reported having facial pain and headache (adverse effect group) immediately post-procedurally. The average age of the adverse effect group was 54.9 years (SD: 17.8 years) which was significantly lower (p=0.002) than the asymptomatic group (69.7 years, SD: 8.7 years). Female patients were significantly more likely to experience this adverse event than males (p=0.04). Moreover, Caucasian females were significantly more likely to experience this adverse effect when compared to all patients experiencing the adverse effect (n=15, p=0.04). Previous diagnosis of migraine disorder was more common in the adverse effect group (28%) compared to the asymptomatic group (15%) but not statistically significant (p=0.26). Previous migraine, trigeminal neuralgia, or headache disorder diagnoses were not significantly correlated with adverse effect prevalence (p = 0.26, 0.24, 0.15, respectively). CONCLUSION: Given the relative immediacy and severity of this adverse effect, physicians should strongly consider these factors when counseling and selecting certain patient groups for this procedure.

Postnasal drip and chronic cough in patients with chronic rhinitis treated with temperature-controlled radiofrequency neurolysis.

OBJECTIVE: To evaluate the contribution of postnasal drip (PND) and chronic cough (CC) to symptoms of patients with chronic rhinitis treated with temperature-controlled radiofrequency (TCRF) neurolysis of the posterior nasal nerve (PNN), and correlate PND and CC scores with components of the reflective total nasal symptom score (rTNSS). METHODS: Pooled data from three prospective studies: two single-arm studies and the index active treatment arm of a randomized controlled trial. Adult patients with baseline rTNSS ≥6 were treated with TCRF neurolysis at nonoverlapping regions of the PNN. PND and CC symptoms were evaluated on a 0 (none) to 3 (severe) scale. RESULTS: Data from 228 patients (57.9% women, 42.1% men) were included. The mean baseline rTNSS was 8.1 (95% confidence interval [CI], 7.8-8.3), which decreased to 3.2 (95% CI, 2.9-3.5) at 6 months. At baseline, 97.4% of patients had PND and 80.3% had CC. Median baseline PND and CC symptom scores were 3 (interquartile range [IQR], 2-3) and 2 (IQR, 1-2), respectively. At 6 months, this decreased to 1 (IQR, 0-2) and 0 (IQR, 0-1), respectively, showing significant improvement from baseline (both p < 0.001). Spearman correlation coefficients with components of rTNSS (rhinorrhea, congestion, itching, sneezing) were 0.16 to 0.22 for CC and 0.19 to 0.46 for PND, indicating only a weak to moderate correlation. CONCLUSION: PND and CC contribute to the symptomatology of chronic rhinitis and are significantly improved after TCRF neurolysis of the PNN. The inclusion of PND and CC symptoms in a chronic rhinitis assessment instrument could provide important additional information for the characterization of the disease state and outcomes after any therapeutic treatment.

Patient Questions Surrounding Posterior Nasal Nerve Ablation for Chronic Rhinitis.

Objective: In-office ablation of the posterior nasal nerve (PNN) has emerged as an effective treatment option for chronic rhinitis patients. This study explored questions patients commonly search online regarding this therapy and the quality of content available. Study Design: A retrospective analysis of online search criteria and sources was performed with subsequent analysis of results. Setting: Search and data acquisition was in September of 2023. Methods: Most common search terms related to cryotherapy and radiofrequency neurolysis of the PNN were identified with associated People Also Ask (PAA) questions. Questions were categorized and organized into subtopics and sources evaluated using readability and quality metrics. Results: A total of 255 unique PAA questions and 175 unique websites were identified. The most common subtopics were related to facts about chronic rhinitis (26.7%) and rhinitis treatment options (25.1%). Nearly a quarter (24.3%) of websites were from commercial sources. Quality metrics indicate difficult-to-read and low-quality materials. Conclusion: Existing online resources need improvement to provide patients material that is easier to read. Physicians counseling patients should be aware of these areas for adequate shared decision making.

What Questions Do Patients Ask About Biologic Therapies for Chronic Sinusitis With Nasal Polyps?

Objective: The objective of this study is to explore the questions commonly asked online about biologic therapies for use in treatment of chronic sinusitis with nasal polyps (CRSwNP) and the quality of the available content. Methods: Most common search terms were identified via Google Trends. People Also Ask (PAA) questions were identified and extracted with their associated website using an online data-scraping program [Search Engine Optimization (SEO) Minion, Keywords Everywhere]. Sources were evaluated using Flesch Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE, higher number = better) score for readability; Journal of American Medical Association (JAMA) Benchmark criteria for quality assessment (0-4, 4 = all criteria met). Results: A total of 143 unique PAA questions and unique websites were identified. Questions were organized into 3 categories: questions about biologic therapies overall (38.46%), about CRSwNP (37.76%), and about treatment options for CRSwNP (23.78%). Websites answering PAA questions were from commercial (60.14%), medical practice (13.99%), academic (13.29%), and government (12.59%) sources. FKGL scores found the average reading level to be at approximately a 12th grade level (SD = 3.297) alongside a low reading ease FRE score of 37.6 (SD = 16.77). Mean JAMA criteria scores were 0.9895 (SD = 0.848), indicating largely low-quality materials. Conclusion: Biologic therapies are a novel treatment option for CRSwNP, and participants are seeking more information about these treatments and disease state. Online resources regarding biologics should be presented at a lower reading level. Sources with evidence-based information are needed. Physicians should be aware of these limitations in online material and counsel accordingly by curating and directing patients to good sources.Level of Evidence: Step 4.

Large mandibular mass with several floating teeth: granular cell ameloblastoma.

Ameloblastomas are benign, locally aggressive, odontogenic epithelial neoplasms. We present a patient with a rare granular cell ameloblastoma. This is a case report and literature review conducted from July 2022 to the present. Our 52-year-old male patient presented to the clinic with a several month history of right lower lateral lip swelling and dental complaints. On imaging and physical exam, we noticed a large heterogenous, multiloculated, expansile lesion of the right mandible with several floating teeth. After incisional biopsy confirmed multicystic granular cell ameloblastoma, the patient underwent successful surgical resection and osteocutaneous fibula free-flap reconstruction. At the time of writing this report, 7 years after resection, the patient is alive with no evidence of recurrence. The recognition and treatment of mandibular lesions can represent significant clinical challenges, especially for rarely seen subtypes such as the granular cell ameloblastoma. Special consideration must be given for the identification and treatment of these neoplasms.

Beyond Hypoglossal Hype: Social Media Perspectives on the Inspire Upper Airway Stimulation System.

In the landscape of sleep surgery, the Inspire® Upper Airway Stimulation (UAS) device has gained prominence as an increasingly popular treatment option for obstructive sleep apnea, prompting significant discourse across social media platforms. This study explores the social media narrative of the UAS device, particularly the nature of multimedia content, author demographics, and audience engagement on Instagram, Facebook, and TikTok. Our analysis encompassed 423 public posts, revealing images (67.4%) and videos (28.1%) as the dominant content types, with over a third of posts authored by physicians. A notable 40% of posts were advertisements, whereas patient experiences comprised 34.5%. TikTok, although presenting a smaller sample size, showed a substantially higher engagement rate, with posts averaging 152.9 likes, compared with Instagram and Facebook at 32.7 and 41.2 likes, respectively. The findings underscore the need for otolaryngologists and healthcare professionals to provide clear, evidence-based information on digital platforms. Given social media's expanding role in healthcare, medical professionals must foster digital literacy and safeguard the accuracy of health information online. In this study, we concluded that maintaining an evidence-based, transparent digital dialogue for medical innovations such as the UAS device necessitates collaborative efforts among physicians, health institutions, and technology companies.

Multifocal Paraganglioma Including the Cervical Sympathetic Chain.

Multifocal head and neck paragangliomas are exceptionally rare. We present a patient with 4 synchronous tumors including a sympathetic chain lesion. This is a case report and literature review conducted from September 2021 to the present. Our 69-year-old male patient presented to the clinic with multifocal paraganglioma involving the right carotid body, right cervical sympathetic trunk, right glomus jugulare, and left glomus tympanicum. After preoperative embolization, successful surgical resection was performed for the right sympathetic trunk and right carotid body tumor. Postoperatively, the patient had a right Horner's syndrome but a strong voice and intact recurrent laryngeal nerve function. He also had first-bite syndrome and right cranial nerve XII weakness which resolved. Of interest, patient also has a strong family history of paragangliomas: his sister has malignant paragangliomas with lymph node involvement and his mother and nephew have non-malignant paragangliomas. To our knowledge, multifocal tumors including synchronous carotid body, sympathetic chain, glomus jugulare, and glomus tympanicum lesions occurring in 1 person have not been reported until now. As a result of this study, there is new light shed on the treatment and evaluation of patients who present with multifocal paraganglioma involving the sympathetic chain.

Finite Element Modeling of Quantitative Ultrasound Analysis of the Surgical Margin of Breast Tumor.

Ultrasound is commonly used as an imaging tool in the medical sector. Compared to standard ultrasound imaging, quantitative ultrasound analysis can provide more details about a material microstructure. In this study, quantitative ultrasound analysis was conducted through computational modeling to detect various breast duct pathologies in the surgical margin tissue. Both pulse-echo and pitch-catch methods were evaluated for a high-frequency (22-41 MHz) ultrasound analysis. The computational surgical margin modeling was based on various conditions of breast ducts, such as normal duct, ductal hyperplasia, DCIS, and calcification. In each model, ultrasound pressure magnitude variation in the frequency spectrum was analyzed through peak density and mean-peak-to-valley distance (MPVD) values. Furthermore, the spectral patterns of all the margin models were compared to extract more pathology-based information. For the pitch-catch mode, only peak density provided a trend in relation to different duct pathologies. For the pulse-echo mode, only the MPVD was able to do that. From the spectral comparison, it was found that overall pressure magnitude, spectral variation, peak pressure magnitude, and corresponding frequency level provided helpful information to differentiate various pathologies in the surgical margin.