Practicing functional nasal surgery in the non-urban setting: experience from a single center.

Nasal airway obstruction is a prevalent chief complaint in the contemporary facial plastic surgery practice. Studies report an asymmetric distribution of plastic surgeons across the United States with a disproportionately high concentration of surgeons practicing in urban areas. The lack of elective specialist care creates unique challenges for these patients who may need to travel and dedicate time to reach a nasal surgery expert. We conducted a retrospective chart review to report our experience from practicing functional nasal surgery in such a non-urban setting in the United States. A total of 103 patients underwent functional nasal surgery (FNS) between May 2015 and August 2021 including septoplasty, inferior turbinate reduction, septorhinoplasty and nasal valve procedures. We present the epidemiological characteristics, surgical techniques used and postoperative complications and illuminate the unique characteristics of practicing FNS in the non-urban setting.

Trichofolliculoma of the external auditory canal: a case report and review of the literature.

Trichofolliculoma is a rare tumor that arises from immature hair follicular tissue. In this report, we present the case of a 51-year-old man with a trichofolliculoma in the left external auditory canal. Uniquely, there was no prior trauma in this patient, despite previous trauma being hypothesized in the etiology of this tumor. The lesion was excised using microsurgical instruments and the tumor was closely adherent to the cartilage of the external auditory canal. Histopathology following excisional biopsy confirmed the diagnosis.

Idiopathic parotid pain: a rare clinical presentation of first bite syndrome without history of head and neck surgery or underlying malignancies.

First bite syndrome (FBS) has been previously characterised as a surgical complication, following head and neck surgical procedures. There are also rare reports in the literature associating FBS with malignancies of the head and neck. The term 'idiopathic parotid pain' (IPP) has been used recently to describe an exceedingly rare clinical presentation similar to FBS, but without history of head and neck surgery or malignancy. We present the rare case of a 65-year-old male diagnosed with IPP, our work-up and management.

Functional Considerations in Reconstruction of the Nasal Ala.

We present the case of a 33-year-old female referred with a 13x10 mm surgical defect immediately after Mohs micrographic surgery for excision of basal cell carcinoma. Functional considerations for the external nasal valve were accounted for using free alar rim cartilage graft, soft tissue tunnels, and pre-auricular full-thickness skin grafts. Our post-operative experience demonstrates excellent nasal valve integrity and acceptable aesthetic outcomes for the patient by providing structural support for the nasal ala. Our management has minimal additional morbidity and minimizes the risk of external nasal valve compromise in the long-term.

External jugular vein aneurysm presenting as submandibular neck mass.

External jugular vein aneurysms presenting as neck masses is very rare in the literature. This case report presents an 80-year-old female, who was referred to the office due to an incidental finding of a left submandibular neck mass. The patient presented to her primary care physician initially complaining of bilateral intermittent ear pain that was present for several years. After extensive workup, the patient was diagnosed with a left external jugular vein aneurysm. When asymptomatic, this rare condition can be followed safely on an outpatient basis. Vascular surgery consultation should also be considered.

Sentinel Lymph Node Biopsy Versus Elective Node Dissection in Stage cT1-2N0 Oral Cavity Cancer.

OBJECTIVE: To compare overall survival (OS) and disease-free survival (DFS) between sentinel lymph node biopsy (SNB) and elective neck dissection (END) in the surgical management of cT1-2N0 oral cavity squamous cell carcinoma (OCSCC). METHODS: English full-text articles were searched in PubMed and Embase on May 9, 2021. Articles had to compare SNB with END in cT1-T2N0 OCSCC patients; report hazard ratios (HRs), Kaplan-Meier curves, or P-values with total number of events for survival outcomes; be from a clinical trial, cohort, or case-control study. Two reviewers reviewed articles and a third settled disagreements. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Risk of Bias in Non-randomized Studies of Interventions tool and revised Cochrane risk-of-bias tool for randomized trials were used. The generic inverse variance method with a random-effect model was used for meta-analysis. RESULTS: Ten studies, five retrospective, three prospective, and two randomized controlled trials, were included (total number of patients [n] = 10,498, END n = 9102, SNB n = 1396). No significant differences were found in OS (HR = 0.92; 95% confidence interval [CI]: 0.65-1.31) or DFS (HR = 0.70; 95% CI: 0.41-1.20). Heterogeneity was not detected in pooled OS analysis (P = .18; I2  = 30%), but was in pooled DFS analysis (P = .003; I2  = 66%). CONCLUSIONS: No statistically significant differences in OS or DFS were observed between SNB and END in cT1-2N0 OCSCC, suggesting that SNB might be an alternative to END in the management of early-stage, clinically node-negative OCSCC. Laryngoscope, 132:989-998, 2022.

Management of Extruded Porous High-density Polyethylene Implant in the Internal Nasal Valve.

Porous high-density polyethylene (PHDPE) has been used since the 1990s as an alternative to autologous grafts. Implant extrusion is a rare but well-known complication of PHDPE and other alloplastic implants. This article discusses the case of PHDPE implant extrusion in a 69-year-old man with unsuccessful previous alar batten graft placement for internal nasal valve insufficiency. We detail the surgical techniques engaged in removing the implant from the internal nasal valve, postoperative results, and care, and present a histologic study of the removed implants.

Connecting the connectome: A bibliometric investigation of the 50 most cited articles.

OBJECTIVE: Connectomics is an emerging and novel research area in neuroscience. We performed a bibliometric analysis to characterize the most impactful articles regarding connectomics, in hopes of evaluating the current state of the field and guiding future research. METHODS: The Web of Science ™ database was queried to identify the 50 most cited articles regarding brain connectomics. Publication meta-data, including country of origin, journal of publication, citation count, and year of publication were extracted and analyzed. Studies were qualitatively analyzed to characterize the goals and area of research. RESULTS: The top 50 cited articles were published between 2005 and 2018, with a majority revolving around MRI acquisition and down-stream processing (n = 24, 48%). Articles were published in journals with an average impact factor of 16.5 and averaged a citation count of 1019 (+ 627.2). Most articles originated from the United States (n = 27, 54%) displayed level II (n = 18, 36%) or level V (n = 20, 40%) evidence. CONCLUSION: The Human Connectome Project in 2009 spurred widespread research on functional brain connectivity, and the effort to understand the functional networks and connections of the nervous system remains an area of exciting potential. Despite much work done to understand image acquisition and analysis, a renewed appreciation for the wide clinical application of connectomics is warranted. Our analysis helps contextualize the most relevant scientific work on brain connectomics, providing insights for the future for connectomics research.

Menstrual Effluent Provides a Novel Diagnostic Window on the Pathogenesis of Endometriosis.

Endometriosis is a chronic inflammatory disorder characterized by the presence of endometrial-like tissue growing outside of the uterus. Although the cause is unknown, retrograde menstruation leads to deposition of endometrial cells into the peritoneal cavity. Lack of disease recognition and long diagnostic delays (6-10 years) lead to substantial personal, social and financial burdens, as well as delayed treatment. A non-invasive diagnostic for endometriosis is a major unmet clinical need. Here, we assessed whether differences in menstrual effluent-derived stromal fibroblast cells (ME-SFCs) from women with and without endometriosis provide the basis for a non-invasive diagnostic for endometriosis. In addition, we investigated whether treatment of control ME-SFCs with inflammatory cytokines (TNF and IL-1ß) could induce an endometriosis-like phenotype. ME-SFCs from laparoscopically diagnosed endometriosis patients exhibit reduced decidualization capacity, measured by IGFBP1 production after exposure to cAMP. A receiver operating characteristic (ROC) curve developed using decidualization data from controls and endometriosis subjects yielded an area under the curve of 0.92. In addition, a significant reduction in ALDH1A1 gene expression and increased podoplanin surface expression were also observed in endometriosis ME-SFCs when compared to control ME-SFCs. These endometriosis-like phenotypes can be reproduced in control ME-SFCs by exposure to inflammatory cytokines (TNF and IL-1ß) and are associated with increased cell migration. These results are consistent with the hypothesis that chronic intrauterine inflammation influences the development of endometriosis lesions following retrograde menstruation. In conclusion, the analysis of ME-SFCs can provide an accurate, rapid, and non-invasive diagnostic for endometriosis and insight into disease pathogenesis.