Depressor Reanimation After Facial Nerve Paralysis.

Facial expressions play a fundamental role in interpersonal communication and interaction; consequently, facial palsy has profound effects on the quality of life of patients. Reanimation of lower lip depressors is rarely addressed during facial reanimation but is as important as treating the eye sphincter and the lip levators. Depressors of lower lip are vital for full denture smile and the expression of facial emotions. Static and dynamic techniques are used to reanimate the lower lip depressors. Static techniques provide stationary results either by weakening the contralateral normal side to achieve symmetry using botulinum toxin injection, depressor labi inferioris myectomy and marginal mandibular nerve neurectomy, or by creating static slings and tightening procedures on the affected side. Dynamic techniques provide functional results by reanimating the affected depressor complex using nerve transfers, muscle transfers, and direct muscle neurotization. The purpose of this article is to present an overview of the literature on the applications of these techniques in lower lip reanimation. Furthermore, preoperative evaluation and indications are also discussed.

Resident fatigue in otolaryngology residents: a Web based survey.

IMPORTANCE: Resident fatigue has become a point of emphasis in medical education and its effects on otolaryngology residents and their patients require further study. OBJECTIVE: The purpose of our study was to evaluate the prevalence and nature of fatigue in otolaryngology residents, evaluate various quality of life measures, and investigate associations of increased fatigue with resident safety. STUDY DESIGN: Anonymous survey. SETTING: Internet based. PARTICIPANTS: United States allopathic otolaryngology residents. INTERVENTION: None. MAIN OUTCOME(S) AND MEASURES: The survey topics included demographics, residency structure, sleep habits and perceived stress. Responses were correlated with a concurrent Epworth Sleep Scale questionnaire to evaluate effects of fatigue on resident training and quality of life. RESULTS: 190 residents responded to the survey with 178 completing the Epworth Sleep Scale questionnaire. Results revealed a mean Epworth Sleep Scale score of 9.9±5.1 with a median of 10.0 indicating a significant number of otolaryngology residents are excessively sleepy. Statistically significant correlations between Epworth Sleep Scale and sex, region, hours of sleep, and work hours were found. Residents taking in-house call had significantly fewer hours of sleep compared to home call (p=0.01). Residents on "head and neck" (typically consisting of a large proportion of head and neck oncologic surgery) rotations tended to have higher Epworth Sleep Scale and had significantly fewer hours of sleep (p=.003) and greater work hours (p<.001). Additionally, residents who reported no needle stick type incidents or near motor vehicle accidents had significantly lower mean Epworth Sleep Scale scores. Only 37.6% of respondents approve of the most recent Accreditation Council for Graduate Medical Education work hour restrictions and 14% reported averaging greater than 80hours of work/week. CONCLUSION AND RELEVANCE: A substantial number of otolaryngology residents are excessively sleepy. Our data suggest that the effects of fatigue play a role in resident well-being and resident safety.

Analyzing complications of minimally invasive pediatric cochlear implantation: A review of 248 implantations.

PURPOSE: This study aims to report the postoperative complications and management of cochlear implantation in pediatric patients at our institution. All procedures were carried out by a single surgeon utilizing minimally invasive techniques. The impact of past surgical history of tympanostomy tubes was also reviewed to access association with postoperative complications. MATERIALS AND METHODS: All children receiving cochlear implants at our institution between April 2003 and October 2014 were reviewed. Complications were grouped into "major" and "minor" depending on degree of management and "immediate," "early," and "delayed" depending on time of presentation. RESULTS: In our series, 248 cochlear implants were placed into 141 children. The mean age at time of surgery was 4.8 years. The overall complication rate per ear was 16.5%, 5.2% being major and 11.3% being minor complications. Complications arose in the first 30 days following surgery in 8.4% of patients, with acute otitis media being the most common. A history of tympanostomy tubes did not impact complication rate. Excluding device failures, major complication rate was 2.4%. Hematoma was not encountered, and delayed seroma occurred in one patient. CONCLUSION: Minimally invasive cochlear implantation carries a low complication rate. The most common major complication was intrinsic device failure, and the most common minor complication was acute otitis media. Past medical history of chronic otitis media with tympanostomy tube placement prior to cochlear implantation did not have a statistically significant impact on postoperative complication rates. Given the rarity of hematomas and seromas, pressure dressings appear to be unnecessary with this approach.