Cost and value of office-based facial plastic and reconstructive surgery procedures.

Introduction: This chapter will provide an overview of factors affecting the cost of office-based procedures in Facial Plastics and Reconstructive Surgery (FPRS), and will discuss the value of office-based interventions. Material and Methods: An in-depth literature review was conducted using multiple primary and secondary sources. Literature from multiple disciplines was included in the review, including otolaryngology, anesthesiology, surgery, public health, and economics. Discussion/Conclusions: A wide variety of procedures can be performed in an FPRS office. Large upfront costs to the office include laser, electrocautery and surgical equipment. These investments will yield an initial negative cost margin until sufficient case volume is achieved. It is often in the best interest of the patient to perform a procedure in-office and avoid the facility and anesthesia fees associated with a surgical center or hospital. Costs and reimbursements vary greatly across regions and facilities. Additionally, overall cost depends on payer mix, procedures performed, and productivity of the practice. The scarcity of literature on this topic as it applies specifically to FPRS indicates that further research is needed to elucidate the value of common facial plastics procedures in an office-based setting.

A Case of HPV+ Squamous Cell Carcinoma of the Perigeniculate Area and Middle Fossa.

Herein we present an unusual case of a primary HPV+ perigeniculate, extra-axial middle fossa skull base tumor and our management thereof. Laryngoscope, 133:3158-3160, 2023.

Racial Disparities in Pediatric Endoscopic Sinus Surgery.

OBJECTIVE: To determine the impact of race and ethnicity on 30-day complications following pediatric endoscopic sinus surgery (ESS). STUDY DESIGN: Cross-sectional cohort study. SUBJECTS AND METHODS: Patients ≤ 18 years of age undergoing ESS from 2015 to 2017 were identified in the Pediatric National Surgical Improvement Program-Pediatric database. Patient demographics, comorbidities, surgical indication, and postoperative complications were extracted. Patient race/ethnicity included non-Hispanic black, non-Hispanic white, Hispanic, and other. Multivariable logistic regression was performed to determine if race/ethnicity was a predictor of postoperative complications after ESS. RESULTS: A total of 4,337 patients were included in the study. The median age was 10.9 (interquartile range: 14.5-6.7) years. The cohort was comprised of 68.3% non-Hispanic white, 13.9% non-Hispanic black, 9.7% Hispanic, and 2.1% other. The 30-day complication rate was 3.2%, and the mortality rate was 0.3%. The rate of reoperation was 3.8%, and readmission was 4.1%. Black and Hispanic patients had higher rates of urgent operations (P = .003 and P < .001, respectively), and black patients had a higher incidence of emergent operations (P < .001) compared to their white peers. For elective ESS cases, multivariable analysis adjusting for sex, age, comorbidities, and surgical indication indicated that children of Hispanic ethnicity had increased postoperative complications (odds ratio: 1.57, 95% confidence interval: 1.04-2.37). CONCLUSION: This analysis demonstrated that black and Hispanic children disproportionately undergo more urgent and emergent ESS. Hispanic ethnicity was associated with increased 30-day complications following elective pediatric ESS. Further studies are needed to elucidate potential causes of these disparities and identify areas for improvement. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1369-E1374, 2021.

Duplication of the oral cavity and mandible: a rare congenital craniofacial anomaly.

A newborn girl was referred to the otolaryngology service after prenatal imaging showed a right mandibular mass. Physical examination revealed a 1-2 cm mass along the right mandible with the appearance of a vestigial oral cavity. Tissue resembling the vermillion and primitive tongue appeared innervated and moved in conjunction with oral movements. MRI and CT of the mandible after birth confirmed a partially ossified soft tissue mass of the right mandibular body, containing unerupted teeth. She was taken to the operating room at 6 months of age for mass excision and reconstruction. Postoperatively, she healed well and was feeding without difficulty. Craniofacial duplication, including duplication of stomatodeal structures or diprosopus, is a rare condition with a variety of phenotypes. In the case of suspected craniofacial duplication, associated syndromes should be ruled out and appropriate imaging employed to determine the extent of involvement of adjacent structures, which will ultimately guide surgical planning.