Considering the Interaction between Surgical Approach and Timing on Complication Rates of Complex Orbital Fracture Repair.

OBJECTIVE: The optimal approach and timing of complex orbital fracture repair is an unresolved issue that is complicated by unique clinical presentations and patient-specific considerations. Early surgical repair in less than 14 days is associated with fewer complications; however, there are no guidelines addressing the optimal timing for surgical repair. This study assesses the time of surgical repair and surgical outcomes of complex orbital fractures. METHODS: Retrospective chart review from 2010 to 2022. Adult patients with orbital fractures are treated with surgical repair. RESULTS: In all, 94 patients presented with orbital fractures and were treated with 108 surgeries. Postoperative complications: vision disturbance 33/108 (30.6%), gaze restriction 12/108 (11.1%), lid malposition 10/108 (9.3%), globe complication 13/108 (12.0%), and hardware issues 14/108 (13.0%). Postoperative complications were not significantly associated with the surgical approach used for fracture repair or the time of surgical repair. CONCLUSION: Postoperative complications following surgical repair of orbital fractures are not associated with surgical approach or time of repair following the initial injury.

Evaluating Geographic Access to Interdisciplinary Laryngology and Speech-Language Pathology Clinic Models in the Southeast Region of the United States.

OBJECTIVE: An interdisciplinary model of care for the evaluation and treatment of voice, swallowing, and upper airway disorders with laryngologists and specialized speech-language pathologists is known to increase revenue, attendance to visits, patient adherence, and most importantly, improve patient outcomes. Individuals who live outside of areas with high population density often have reduced geographic access to this specialized care. The primary aim of this study is to identify the percentage of the population that has an "extended drive time" to access an interdisciplinary clinic in the Southeast region of the United States. STUDY DESIGN: NA. METHODS: Interdisciplinary laryngology and speech-language pathology clinics were identified via publicly accessible information including an internet search and state department of public health databases. Included clinics had at least one full-time fellowship-trained laryngologist and at least one full-time speech-language pathologist on staff. Descriptive statistics and visual representation of the results were achieved with the use of Smappen, a location intelligence online platform, to identify the percent of the population with a drive time greater than 1 hour. RESULTS: 47.24% of the Southeast population of the United States must drive over 1 hour to access an interdisciplinary clinic. Visual representations of these data are included and generated by Smappen. CONCLUSIONS: While close geographic proximity does not ensure access to care, it can increase the likelihood that healthcare services will be used. This study identified the population in the Southeast region of the United States with extended drive time to interdisciplinary voice and swallowing centers due to their geographic distance from these centers. The results from this study support the need for increased geographic access to specialty care clinics, specifically voice, swallowing, and upper airway care, and provide insight into potential sites for interdisciplinary centers based on population density in areas that are underserved.

Advanced age has dissociable effects on hippocampal CA1 ripples and CA3 high frequency events in male rats.

Sharp wave/ripples/high frequency events (HFEs) are transient bursts of depolarization in hippocampal subregions CA3 and CA1 that occur during rest and pauses in behavior. Previous studies have reported that CA1 ripples in aged rats have lower frequency than those detected in young animals. While CA1 ripples are thought to be driven by CA3, HFEs in CA3 have not been examined in aged animals. The current study obtained simultaneous recordings from CA1 and CA3 in young and aged rats to examine sharp wave/ripples/HFEs in relation to age. While CA1 ripple frequency was reduced with age, there were no age differences in the frequency of CA3 HFEs, although power and length were lower in old animals. While there was a proportion of CA1 ripples that co-occurred with a CA3 HFE, none of the age-related differences in CA1 ripples could be explained by alterations in CA3 HFE characteristics. These findings suggest that age differences in CA1 are not due to altered CA3 activity, but instead reflect distinct mechanisms of ripple generation with age.