The timing of drain removal in parotidectomies: outcomes of removal at 4 h post-operatively and a Canadian survey of practice patterns.

BACKGROUND: The post-operative management of parotidectomies is highly provider dependent. No guidelines are currently available for timing of parotid drain removal. This study aimed to assess: (1) outcomes and complications after early drain removal (< 4 h, post-operative day [POD] 0) versus late drain removal (POD ≥ 1); (2) current Canadian provider practices. METHODS: A single surgeons ten-year parotidectomy practice was reviewed, spanning his practice change from routine POD ≥ 1 drain removal to POD 0 removal, with extraction of patient demographic, disease, and complication variables. An anonymous, cross-sectional survey on parotid drain practices was distributed to Canadian Society of Otolaryngology-Head and Neck Surgery members. Descriptive statistics, Wilcoxon Rank Sum, and unpaired student's t-tests were calculated. RESULTS: In total, 526 patients were included and 44.7% (235/526) had drains removed POD 0. There was no significant difference in hematoma or seroma rates between the POD 0 and POD ≥ 1 drain removal cohorts. The national survey on parotid drain management had 176 responses. The majority (67.9%) reported routinely using drains after parotidectomy and 62.8% reported using a drain output based criteria for removal. The most common cut-off output was 30 ml in 24 h (range 5-70 ml). CONCLUSION: There was no difference in hematoma or seroma rates for patients with parotid drains removed on POD 0 versus POD ≥ 1. Our national survey found significant variation in Canadian parotidectomy drain removal practices, which may be an area that can be further assessed to minimize hospital resources and improve patient care.

Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy.

Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.

Supportive Care and Survivorship Strategies in Management of Squamous Cell Carcinoma of the Head and Neck.

Supportive care and survivorship strategies in the management of head and neck squamous cell carcinoma (HNSCC) revolve around continued collaborative efforts aimed at early identification and intervention for locoregional disease recurrence, second primary malignancy, management of treatment-related side effects, and provision for psychosocial support. Development of evidence-based guidelines and optimization of these strategies is increasingly important in the setting of improved survival of patients with HNSCC because of a variety of diagnostic and therapeutic advances and evolving demographics of HNSCC patient population, specifically, p16-associated oropharyngeal squamous cell carcinoma.

Current incidence of duplicate publication in otolaryngology.

OBJECTIVES/HYPOTHESIS: Duplicate publication--deemed highly unethical--is the reproduction of substantial content in another article by the same authors. In 1999, Rosenthal et al. identified an 8.5% incidence of duplicate articles in two otolaryngology journals. We explored the current incidence in three otolaryngology journals in North America and Europe. STUDY DESIGN: Retrospective literature review. METHODS: Index articles in 2008 in Archives of Otolaryngology-Head and Neck Surgery, Laryngoscope, and Clinical Otolaryngology were searched using MEDLINE. Potential duplicate publications in 2006 through 2010 were identified using the first, second, and last authors' names. Three authors independently investigated suspected duplicate publications--classifying them by degree of duplication. RESULTS: Of 358 index articles screened, 75 (20.9%) had 119 potential duplicates from 2006 to 2010. Full review of these 119 potential duplicates revealed a total of 40 articles with some form of redundancy (33.6% of the potential duplicates) involving 27 index articles (7.5% of 358 index articles); one (0.8%) "dual" publication (identical or nearly identical data and conclusions to the index article); three (2.5%) "suspected" dual publications (less than 50% new data and same conclusions); and 36 (30.3%) publications with "salami-slicing" (portion of the index article data repeated) were obtained. Further analysis compared the likelihood of duplicate publication by study source and subspecialty within otolaryngology. CONCLUSIONS: The incidence of duplicate publication has not significantly changed over 10 years. "Salami-slicing" was a concerning practice, with no cross-referencing in 61% of these cases. Detecting and eliminating redundant publications is a laborious task, but it is essential in upholding the journal quality and research integrity.

An unusual instance of stridor: airway obstruction from a nasogastric tube knot in a 1-month old infant.

We report a 1 month old infant with a spontaneously knotted nasogastric tube. Attempted removal of the nasogastric tube was unsuccessful, prompting further investigation. Plain radiographs revealed a large, multi-looped knot impacted in the nasopharynx and oropharynx. The tube was subsequently removed through the mouth under general anesthesia without complication, revealing a large, impressive knot of the distal end of the nasogastric tube.

Cartilage on the floor: how effective is antibiotic sterilization?

OBJECTIVE: To determine the incidence of positive cultures from contaminated nasal cartilage and to demonstrate the effectiveness of antibiotic irrigation as a means of sterilization. DESIGN: A prospective study. SETTING: Tertiary referral centre. METHODS: Nasal septal cartilage was harvested during routine endoscopic septoplasties. The harvested cartilage was then dropped on the floor for 60 seconds. The cartilage was then divided into four equal portions, which were then divided into four experimental groups: (1) untreated, (2) normal saline soak for 60 seconds, (3) 40 mg/mL gentamicin solution soak for 60 seconds, and (4) 300 seconds. All specimens were sent for bacterial culture and sensitivity, along with nasal swabs and floor swabs. The incidence of bacterial contamination in the different groups was analyzed using the McNemar hypothesis. MAIN OUTCOME MEASURES: Correlation between bacterial culture results and treatments of contaminated nasal septal cartilages. RESULTS: Thirty-two patients were enrolled in this study. Thirty-one percent of the untreated specimens had bacterial contamination. Thirty-one percent of the saline-soaked specimens had significant bacterial growth. Bacterial growth was not observed in any of the specimens treated with gentamicin irrigation for 60 seconds (absolute reduction of 31%); one specimen (3%) in the 300 seconds gentamicin group had a positive culture. A correlation of 70% was observed in the bacterial growth observed in the swab of the operating room floor and the untreated cartilage. CONCLUSIONS: When no other options are available, this study demonstrates that cartilage dropped on the floor can be decontaminated by washing with gentamicin.

Cat scratch disease presenting as acute mastoiditis.

OBJECTIVE: To present the first published case of Cat Scratch Disease presenting as acute mastoiditis and review the relevant literature to discuss the Otolaryngologic manifestations of this disease and its treatment. DESIGN: A case report and literature review of the Otolaryngologic manifestations of Cat Scratch Disease. METHODS: A case report of a clinical scenario followed by a standard literature review. PubMed, EMBASE, and Cochrane database were used to find articles related to the Otolaryngologic manifestations of Cat Scratch Disease. RESULTS: A 6 year-old female presented to the Otolaryngologist with the typical appearance of acute mastoiditis. CT Scan confirmed breakdown of the osseous septae of the mastoid and mastoidectomy was undertaken. Granulation tissue and infected lymph nodes adjacent to the mastoid cortex were positive for Cat Scratch Disease. The patient was treated expectantly and recovered uneventfully. CONCLUSION: This is the first literature report of Cat Scratch Disease presenting as an acute mastoiditis.