ABSTRACT
PURPOSE: Hypothyroidism is a known possibility after hemithyroidectomy, with a highly variable incidence in the literature ranging from 8 to 60Ā %. Incidence of hypothyroidism after hemithyroidectomy was evaluated with a secondary aim to assess incidence in patients with Hashimoto's disease. MATERIALS & METHODS: A retrospective study using the TriNetX global federated research network was performed. We included patients within the last 15Ā years that were ≥18Ā years of age and had Current Procedural Terminology codes for hemithyroidectomy. Patients were excluded if they had a total or completion thyroidectomy at any time, a history of thyroid cancer, were preoperatively either on levothyroxine, diagnosed with hypothyroidism, or had a Thyroid Stimulating HormoneĀ ≥Ā 4Ā m[IU]/L. We assessed the 3Ā month incidence of hypothyroidism postoperatively based on the International Classification of Diseases code, TSHĀ ≥Ā 4Ā m[IU]/L, or taking levothyroxine after surgery. RESULTS: 6845 patients met the inclusion criteria. Most of the cohort was female (67Ā %) and white (63Ā %). The mean age at surgery for this population was 54Ā Ā±Ā 14.8Ā years. During the 15Ā years of data, we found the 3-month incidence of hypothyroidism following hemithyroidectomy to be 23.58Ā %. The median time to develop the disease was 41.8Ā months. A subgroup analysis of those with Hashimoto's revealed a 3-month incidence of 31.1Ā % of patients developing hypothyroidism after surgery. CONCLUSIONS: This population-based study gives additional insight into the incidence of hypothyroidism after hemithyroidectomy. This will help improve perioperative patient counseling and management.
Subject(s)
Hashimoto Disease , Hypothyroidism , Postoperative Complications , Thyroidectomy , Humans , Thyroidectomy/adverse effects , Thyroidectomy/methods , Female , Male , Hypothyroidism/etiology , Hypothyroidism/epidemiology , Middle Aged , Retrospective Studies , Incidence , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Adult , Hashimoto Disease/surgery , Aged , Thyroxine/therapeutic use , Time FactorsABSTRACT
Soft-tissue calcifications in the head and neck are relatively common and are the result of a wide variety of benign and malignant pathologies. They can present a diagnostic challenge given the broad range of underlying etiologies. Uremic tumoral calcinosis (UTC) is a rare complication of end-stage renal disease (ESRD) resulting from metastatic soft tissue calcification. Common sites include periarticular soft tissues of the shoulders, elbows, and hands (Pan and Chen, 2016). UTC can also affect the cervical spine and mimic osteosarcomas (Zhou et al., 2018). We present the case of a 71-year-old female with hypertension, left carotid artery stenosis, mitral valve prolapse, and ESRD secondary to diabetes mellitus type II (DMII) on peritoneal dialysis who was found to have large, heterogeneous, bilateral calcified neck masses. Given her clinical history, laboratory results, and imaging findings, she was diagnosed with UTC. In addition to this case, we provide an overview of tumoral calcinosis (TC) and a differential diagnosis for calcified lesions of the head and neck.
Subject(s)
Calcinosis , Kidney Failure, Chronic , Humans , Female , Aged , Calcinosis/complications , Calcinosis/diagnostic imaging , Neck , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Cervical Vertebrae , HeadABSTRACT
BACKGROUND: While the etiology of Bell's palsy (BP) is largely unknown, current evidence shows it may occur secondary to the immune response following a viral infection. Recently, BP has been reported as a clinical manifestation of coronavirus disease (COVID-19). OBJECTIVES: To investigate an association between COVID-19 infection and BP. Additionally, to evaluate the need for COVID-19 testing in patients who present with BP. METHODS: Hospital records of patients who presented to a single tertiary care center with BP in 2020 and 2021 were reviewed for presenting symptoms, demographics, COVID-19 infection and vaccination status. RESULTS: There was no statistically significant difference between patients with BP who had a positive or negative COVID test in terms of sex, BMI, age, race, smoking history or alcohol use. All 7 patients with BP and a positive COVID test were unvaccinated. Of the total cohort of 94 patients, 82Ā % were unvaccinated at the time of the study. None of the 17 patients who were vaccinated had a positive COVID test. A history of BP showed no statistical significance (10.3Ā % vs 14.3Ā %, p-value 0.73). CONCLUSION: We discovered a limited cohort of patients who underwent COVID-19 testing at the time of presentation for BP. Though there have been recent studies suggesting a COVID-19 and BP, we were unable to clearly identify a relationship between COVID-19 and BP. Interestingly, all patients with facial paralysis and COVID-19 were unvaccinated. To further study this relationship, we recommend consideration of a COVID-19 test for any patient that presents with facial paralysis.
Subject(s)
Bell Palsy , COVID-19 , Facial Paralysis , Humans , Bell Palsy/epidemiology , Bell Palsy/etiology , Bell Palsy/diagnosis , Tertiary Care Centers , COVID-19 Testing , COVID-19/complications , COVID-19/epidemiologyABSTRACT
PURPOSE: To analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). STUDY DESIGN: Retrospective chart review. MATERIALS AND METHODS: Medical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. RESULTS: 381 patients met eligibility criteria. Median TTI was 35.0Ā days (IQR: 25.0-49.0). Only 10.8Ā % of all patients reported any treatment delay, with TTI exceeding 90Ā days found in 3.7Ā % of patients. TTI increased with African American race (pĀ =Ā 0.02), ED referrals (pĀ =Ā 0.02), and direct admission status (pĀ =Ā 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (pĀ =Ā 0.02), adjuvant chemoradiation (pĀ =Ā 0.04), and salvage surgery (pĀ =Ā 0.04). Univariate Cox-regressions found smoking (pĀ =Ā 0.01), direct admission status (pĀ =Ā 0.02), increased duration of symptoms (pĀ =Ā 0.02), placement of PEG tubes (pĀ <Ā 0.01) and tracheostomies (pĀ <Ā 0.01), combination treatment (pĀ <Ā 0.01), and surgery with adjuvant chemoradiation treatment (pĀ =Ā 0.01) to increase mortality risk. Disease characteristics, including tumor size (pĀ <Ā 0.01), presence of nodal disease (pĀ =Ā 0.02), and late-stage disease (pĀ <Ā 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. CONCLUSIONS: Our analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Humans , Squamous Cell Carcinoma of Head and Neck/therapy , Prognosis , Carcinoma, Squamous Cell/pathology , Retrospective Studies , Head and Neck Neoplasms/therapyABSTRACT
OBJECTIVES: To investigate the incidence of synchronous malignancies identified during triple endoscopy in patients with head and neck squamous cell carcinoma. METHODS: A retrospective chart review of patients from a tertiary academic medical center was performed. Patients with a primary head and neck squamous cell carcinoma who underwent triple endoscopy were included. Operative, radiographic, and pathology reports were reviewed to evaluate for the presence of synchronous malignancies in the aerodigestive tract diagnosed through endoscopy. Demographics, relevant medical history, including tobacco and alcohol use, and tumor characteristics were recorded. Univariate and multivariate regression analyses were conducted to assess for associations with synchronous malignancy on triple endoscopy. RESULTS: 215 patients were reviewed, 164 of which had a biopsy-positive head and neck squamous cell carcinoma and underwent triple endoscopy. Synchronous lesions were found in 8 patients (4.9%). Of the synchronous lesions, only two were identified on esophagoscopy and bronchoscopy; the remaining six were found on direct laryngoscopy. Clinical comorbidities including smoking and alcohol history, tumor p16 status, and tumor stage were not associated with presence of synchronous lesions. A positive synchronous lesion on positron emission tomography was significantly correlated with finding a synchronous lesion on triple endoscopy (pĀ =Ā 0.006). CONCLUSION: This study shows the incidence of synchronous lesions on triple endoscopy to be closer to 5%. While endoscopic examination can be useful in the anatomic characterization of head and neck malignancies, the low incidence of synchronous malignancies suggests that the need for triple endoscopy may be considered on a case-by-case basis.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Neoplasms, Multiple Primary , Carcinoma, Squamous Cell/pathology , Endoscopy/methods , Esophagoscopy , Head and Neck Neoplasms/epidemiology , Humans , Incidence , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/epidemiology , Retrospective StudiesABSTRACT
OBJECTIVE: To analyze the prognostic significance of microscopic vs macroscopic extranodal extension and to assess the impact of chemoradiation on overall survival among patients with oral cavity squamous cell carcinoma and varying degrees of extranodal extension. METHODS: Utilizing the National Cancer Database, we performed a retrospective cohort study of 7975 patients with oral cavity squamous cell carcinoma and varying degrees of extranodal extension who underwent primary surgical intervention. Propensity-score matched models following Cox regression analyses allowed us to assess the impact of adjuvant radiation alone vs adjuvant chemoradiation on overall survival in patients with microscopic extranodal extension and macroscopic extranodal extension. RESULTS: 7975 patients with oral cavity squamous cell carcinoma were included in the final analysis. Within this cohort, 25.4% had microscopic extranodal extension and 5.2% had macroscopic extranodal extension. On univariate analysis, we found that microscopic and macroscopic extranodal extension were associated with decreased overall survival when compared to those with positive nodes without extranodal extension (HRĀ =Ā 1.67; 95% CI 1.56, 1.79 and HRĀ =Ā 1.88; 95% CI 1.66, 2.14, respectively). On multivariate analysis after propensity-score matching, we found no significant difference in overall survival in patients who received adjuvant radiation alone vs. adjuvant chemoradiation for both microscopic and macroscopic extranodal extension. CONCLUSION: Our data suggest that microscopic extranodal extension in oral cavity squamous cell carcinoma is associated with worse overall survival than patients without extranodal extension following primary surgical intervention with neck dissection. The results of this study also suggest that the addition of chemotherapy to adjuvant radiation may not provide a significant survival benefit in patients with oral cavity squamous cell carcinoma with microscopic and macroscopic extranodal extension. Comprehensive assessment of the benefits of adjuvant chemoradiation in the setting of microscopic vs macroscopic extranodal extension would need to be studied in a randomized controlled trial.
Subject(s)
Carcinoma, Squamous Cell , Head and Neck Neoplasms , Mouth Neoplasms , Carcinoma, Squamous Cell/pathology , Extranodal Extension , Head and Neck Neoplasms/pathology , Humans , Mouth Neoplasms/pathology , Neoplasm Staging , Prognosis , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck/pathology , Squamous Cell Carcinoma of Head and Neck/therapyABSTRACT
BACKGROUND: To evaluate the relationship between intraoperative ischemia time with acute microvascular free tissue transfer (MFTT) complications in head and neck reconstruction. METHODS: A systematic review using PRISMA guidelines was performed. Inclusion encompassed all available studies published and indexed using PubMed, Medline, and Embase. Meta-analyses were performed using the Cochrane Review Manager tool. Methodological Index for Non-Randomized Studies (MINORS), the Revised Cochrane risk-of-bias tool for randomized trials, and the NIH Study Quality Assessment Tool for non-randomized prospective studies. RESULTS: A total of 430 citations were reviewed. 25 were included in our overall qualitative analysis, and 14 for meta-analysis. When comparing ischemia times for flaps with and without complications, no significant difference was observed (pĀ =Ā 0.98). Additionally, in a separate cohort, no significant effect was realized when correlating ischemia time to overall rates and total complications. CONCLUSION: Ischemia time was not significantly different between those with and without acute flap complications.
Subject(s)
Free Tissue Flaps , Head and Neck Neoplasms , Plastic Surgery Procedures , Free Tissue Flaps/blood supply , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/surgery , Humans , Ischemia/complications , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Plastic Surgery Procedures/adverse effects , Retrospective StudiesABSTRACT
PURPOSE: Head and neck paragangliomas are slow growing tumors where observation has become more widely accepted. Tumor growth rate as well as predictors of increased tumor growth were analyzed with the goal to identify factors to better predict disease progression and counsel patients. MATERIALS AND METHODS: Multi-institutional retrospective cohort study from 2011 to 2020. RESULTS: 130 head and neck paragangliomas in 125 patients were analyzed. 38 were observed (30.4%), 16 radiated (12.8%), and 71 underwent surgery (56.8%). Surgical patients were significantly younger (pĀ =Ā 0.038) and with more genetically mediated paragangliomas (pĀ =Ā 0.026). Significantly more patients were asymptomatic in the observation group (pĀ =Ā 0.005). Of the 39 observed tumors, 43.6% (nĀ =Ā 17) grew with a tumor doubling time of 5.67Ā years. More than half of the observed paragangliomas had no growth. When examining symptoms postoperatively and at follow-up, the surgical cohort had significantly more worsening symptoms (pĀ =Ā 0.007) and new cranial neuropathies (pĀ =Ā 0.031). CONCLUSIONS: Head and neck paragangliomas have slow growth rates if they grow at all. Patients in the surgical cohort had more clinical symptoms at presentation and worsening postoperative symptoms.
Subject(s)
Cranial Nerve Diseases , Head and Neck Neoplasms , Paraganglioma , Disease Progression , Head and Neck Neoplasms/surgery , Humans , Paraganglioma/surgery , Retrospective StudiesABSTRACT
OBJECTIVE: Recent years have seen increase in individuals pursuing postgraduate fellowships in head and neck (HN) surgery. This has presented concerns about insufficient jobs where graduates can apply their scope of specialized training. METHODS: Data was collected in two manners- a survey and a manual online search of American Head and Neck Society (AHNS) fellowship graduates. A 25-question survey was sent in 2021 to approximately 400 HN fellows who graduated between 2010 and 2020. The AHNS list of graduates from the same years were searched online to collect information including gender, graduation year, fellowship training, and current job practice. RESULTS: Of the 78 survey responses, 64.1Ā % were male and 34.6Ā % female. 96.2Ā % reported ablative, 84.6Ā % microvascular, and 82.1Ā % TORS training. Mean number of interviews was 4 with most interviewing during the 3rd quarter (January to March). Majority reported being in academic and university-based practices (79.6Ā %). Online search was done on 393 graduates. Since 2010 the number of graduates almost doubled. There was a statistically significant increase in females by year (pĀ =Ā 0.022). There was a significant decrease (pĀ =Ā 0.022) in graduates with additional fellowship training from that of their AHNS fellowship. There was also a statistically significant increase in graduates being in academic practices (pĀ =Ā 0.022). CONCLUSION: Despite growing numbers, there appears to be more graduates entering an academic practice, although the definition of an academic HN practice may be evolving. These results provide guidance on how to approach the job search in a select market. LEVEL OF EVIDENCE: II.
Subject(s)
Fellowships and Scholarships , Internship and Residency , Female , Humans , Male , Surveys and Questionnaires , United StatesABSTRACT
Hyperbaric oxygen (HBO) is a treatment modality with the primary mechanism of therapy being the delivery of oxygen to hypoxic tissues. A review of HBO applications in the field of head and neck reconstruction and facial cosmetic surgery is provided. HBO can be useful in the management of radiation sequelae and treatment of compromised flaps and grafts. It may also have application in tissue compromise following cosmetic surgery and dermal fillers. We provide evidence from the available literature as well as highlight our experience in using HBO in head and neck reconstruction.
Subject(s)
Head and Neck Neoplasms , Hyperbaric Oxygenation , Surgery, Plastic , Head and Neck Neoplasms/surgery , Humans , Oxygen , Surgical FlapsABSTRACT
PURPOSE: Deficiencies in airway management knowledge can result in harm, especially in tracheostomy patients. Our objective is to assess the degree of knowledge in different medical specialties, before and after targeted airway education. MATERIALS AND METHODS: A lecture on tracheostomy management was prepared for Otolaryngology, Anesthesia, Emergency Medicine, General Surgery, Oral and Maxillofacial Surgery (OMFS), Internal Medicine (IM), and Family Medicine (FM). Before the lecture, a 12-question quiz on surgical airway knowledge was administered, and demographics from participants collected. Immediately following the lecture, participants were asked to retake the quiz. Performance was assessed. Population baseline characteristics included, specialty, years of practice, and previous education. RESULTS: A paired t-test evaluating pre- and post-lecture results showed a 34.2% improvement for all participants (nĆ¢ĀĀÆ=Ć¢ĀĀÆ168) overall (2.7 points, pĆ¢ĀĀÆ<Ć¢ĀĀÆ0.001). Providers with more years of practice performed better. Otolaryngology and OMFS performed the highest on the baseline test while FM and IM performed the lowest. The providers who reported previous standardized training from the hospital system, informal instruction on the ward, or had the topic covered in their degree program performed better compared to those without previous education (ANOVA, 3.5 points, pĆ¢ĀĀÆ<Ć¢ĀĀÆ0.01). Providers who underwent formal training in their degree program performed the best. A Likert scale with self-assessment of comfort with surgical airway correlated positively with the performance on the quiz. CONCLUSION: Variability in tracheostomy knowledge based on specialty and years of training exists. We demonstrate that formal education on tracheostomy and surgical airways improved quantitative measures of knowledge.
Subject(s)
Clinical Competence , Curriculum , Internship and Residency , Specialties, Surgical , Tracheostomy/education , HumansABSTRACT
Plasmacytoid squamous cell carcinoma is an especially aggressive variant of squamous cell carcinoma that has previously been described in the literature as a variant of oral cancers and most extensively, in vulvular [3], transitional cell, and urothelial carcinomas [2,13,15-20]. In this case report, we present a 36-year-old man with 6 to 8Ć¢ĀĀÆweeks of a progressively enlarging mass over the lateral third of his clavicle, acromion process, and deltoid. The mass was resected, and the supraclavicular defect was reconstructed using an anterolateral thigh free flap. Final pathology determined the specimen was an invasive poorly differentiated squamous cell carcinoma with spindle cell and plasmacytoid features of cutaneous origin. Plasmacytoid squamous cell carcinomas have previously been described in the oral cavity, but in no other subsite of the head and neck. This article describes the patient's case and provides a literature review of the available reports related to plasmacytoid variant of squamous cell carcinoma.
Subject(s)
Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Skin Neoplasms/pathology , Skin Neoplasms/therapy , Adult , Humans , MaleABSTRACT
Laryngeal sarcoma is a rare and potentially aggressive malignancy. In this case report, we present a 23year-old-male with four-years of progressive hoarseness who was found to have a large left paraglottic mass. A partial laryngectomy was successful at completely excising the lesion. Final pathology returned as alveolar soft part sarcoma. Alveolar soft part sarcomas of the larynx are extremely rare with only five cases published in the current literature. This article provides a case presentation with literature review of alveolar soft part sarcoma of the head and neck.
Subject(s)
Laryngeal Neoplasms/surgery , Laryngectomy/methods , Sarcoma, Alveolar Soft Part/surgery , Diagnosis, Differential , Humans , Laryngeal Neoplasms/pathology , Male , Sarcoma, Alveolar Soft Part/pathology , Young AdultABSTRACT
Steroid-releasing sinus stents have emerged as a safe and effective tool in endoscopic sinus surgery. In this case report, we present two patients with recurrent cystic sellar masses. Transsphenoidal approach was used to access the sella. Following resection and drainage of the cystic pathology, a Propel (Menlo Park, CA) stent was placed through the corridor of the resection site to stent the cavity open. This is the first report where a steroid-releasing sinus stent was used in the treatment of a sellar lesion. It supports that this technology is safe and effective for use in skull base surgery.
Subject(s)
Central Nervous System Cysts/surgery , Craniopharyngioma/surgery , Paranasal Sinuses/surgery , Sella Turcica , Stents , Adult , Central Nervous System Cysts/diagnostic imaging , Central Nervous System Cysts/pathology , Craniopharyngioma/diagnostic imaging , Craniopharyngioma/pathology , Female , Humans , Male , Middle AgedABSTRACT
Vascular tumors of the nasal cavity can represent a variety of pathologies. In this case report, we discuss two patients presenting with a large vascular lesion occupying the nasal cavity. Significant bleeding was encountered during the initial attempts for endoscopic surgical resection. One lesion was successfully excised following preoperative embolization while a second following sphenopalatine artery vascular ligation. In both cases, final pathology showed lobular capillary hemangioma (LCH). We present a literature review and discussion of LCH and other vascular tumors that present in the nasal cavity. In addition, we discuss the utility of pre-resection vascular control of these tumors.
Subject(s)
Hemangioma, Capillary/diagnosis , Nose Neoplasms/diagnosis , Otorhinolaryngologic Surgical Procedures/methods , Diagnosis, Differential , Endoscopy , Hemangioma, Capillary/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nasal Cavity , Nose Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Biallelic inactivation of cancer susceptibility gene BRCA1 leads to breast and ovarian carcinogenesis. Paradoxically, BRCA1 deficiency in mice results in early embryonic lethality, and similarly, lack of BRCA1 in human cells is thought to result in cellular lethality in view of BRCA1's essential function. To survive homozygous BRCA1 inactivation during tumorigenesis, precancerous cells must accumulate additional genetic alterations, such as p53 mutations, but this requirement for an extra genetic "hit" contradicts the two-hit theory for the accelerated carcinogenesis associated with familial cancer syndromes. Here, we show that heterozygous BRCA1 inactivation results in genomic instability in nontumorigenic human breast epithelial cells in vitro and in vivo. Using somatic cell gene targeting, we demonstrated that a heterozygous BRCA1 185delAG mutation confers impaired homology-mediated DNA repair and hypersensitivity to genotoxic stress. Heterozygous mutant BRCA1 cell clones also showed a higher degree of gene copy number loss and loss of heterozygosity in SNP array analyses. In BRCA1 heterozygous clones and nontumorigenic breast epithelial tissues from BRCA mutation carriers, FISH revealed elevated genomic instability when compared with their respective controls. Thus, BRCA1 haploinsufficiency may accelerate hereditary breast carcinogenesis by facilitating additional genetic alterations.
Subject(s)
Breast/cytology , Epithelial Cells/physiology , Genes, BRCA1 , Genomic Instability/genetics , Haploinsufficiency/genetics , Female , Gene Silencing , Genomic Instability/physiology , Heterozygote , Humans , In Situ Hybridization, Fluorescence , Polymorphism, Single Nucleotide , Sequence Deletion/geneticsSubject(s)
Electric Stimulation Therapy/methods , Hypoglossal Nerve , Implantable Neurostimulators , Prosthesis Implantation/methods , Sleep Apnea, Obstructive/surgery , Adult , Aged , Electric Stimulation Therapy/instrumentation , Female , Humans , Male , Middle Aged , Retrospective Studies , Sleep Apnea, Obstructive/physiopathologyABSTRACT
OBJECTIVES: To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees' confidence. METHODS: The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin's palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants' confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included. RESULTS: Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores (P < .001). CONCLUSIONS: Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.
Subject(s)
Clinical Competence , Drainage , Internship and Residency , Otolaryngology , Peritonsillar Abscess , Humans , Peritonsillar Abscess/surgery , Internship and Residency/methods , Drainage/methods , Otolaryngology/education , Simulation Training/methods , Manikins , Models, Anatomic , Education, Medical, Graduate/methodsABSTRACT
Background: Coronavirus disease 2019 (COVID-19) has been linked to Bell's palsy and facial paralysis. Studies have also shown increased risk of Bell's palsy in unvaccinated COVID-19 patients. Objective: To compare the relationship between Bell's palsy and COVID-19 infection and vaccination. Design: This is a retrospective longitudinal study. Methods: The COVID-19 research network was used to identify patients with facial palsy presenting to 70 health care organizations in the United States. The incidence of Bell's palsy was measured within an 8-week window after COVID-19 test or vaccination event in identified patients. Results: Incidence of facial palsy diagnosis (0.99%) was higher than the background rate within 2 months of COVID-19 infection. When compared with their negative counterparts, patients with COVID-19 infection had significantly higher risk of Bell's palsy (risk ratio [RR] = 1.77, p < 0.01) and facial weakness (RR = 2.28, p < 0.01). Risk ratio was also amplified when evaluating Bell's palsy (RR = 12.57, p < 0.01) and facial palsy (RR = 44.43; p < 0.01) in COVID-19-infected patients against patients who received COVID-19 vaccination. Conclusion: In our patient population, there is a higher risk of developing facial palsy within 2 months of COVID-19 infection versus vaccination. Vaccinated patients are not at higher risk of developing facial palsy.
Subject(s)
Bell Palsy , COVID-19 , Facial Paralysis , Humans , United States/epidemiology , Bell Palsy/epidemiology , Bell Palsy/etiology , Bell Palsy/diagnosis , Facial Paralysis/etiology , Facial Paralysis/complications , Longitudinal Studies , Retrospective Studies , COVID-19 VaccinesABSTRACT
BACKGROUND: We aim to describe the management and outcomes of patients with persistent lymphadenopathy (LAD) after primary chemoradiation for head and neck squamous cell carcinoma (HNSCC) based on post-treatment PET/CT results. METHODS: Retrospective chart review was conducted of all patients who underwent primary concurrent chemoradiation for HNSCC at a tertiary care center from 2010 to 2022 and had persistent post-treatment LAD. RESULTS: Nearly 62% of patients were managed conservatively, and 27.0% underwent neck dissection. PET-positive patients were more likely to undergo neck dissection than PET-negative patients (p = 0.042). Positive predictive value (PPV) and negative predictive values (NPV) of PET/CT in detecting residual disease in the neck were 48.0% and 73.7%, respectively. CONCLUSIONS: PPV and NPV of PET/CT for detecting residual neck disease in patients with post-treatment LAD was lower than those of HNSCC patients with and without persistent LAD reported in other studies.