International Medical Graduates in Otolaryngology Education: The Overlooked Path to Diversity and Inclusivity.

"International Medical Graduates" (IMGs) make up a large percentage of "underrepresented in medicine" physicians and comprise 25% of the US physician workforce. The American Academy of Otolaryngology-Head and Neck Surgery, in its "Statement on Diversity," has expressed its enduring commitment to inclusion and diversity in all its forms. However, unlike various other specialties, a discussion about integration of IMGs in Otolaryngology has not been raised in our community. This commentary reviews the data on the recruitment of IMGs in Otolaryngology residency programs and highlights the need for a strategic effort to increase their participation in the US residency programs. Strong benefits may be derived from this effort such as promoting inclusivity and diversity of the workforce and increasing the support of the nation's underserved communities.

Medial Canthal Reconstruction - Scar Restricting Vision in Only Seeing Eye of a 75-year-old Female.

Scarring is a common post-injury outcome that can precipitate functional impairment. We present the case of a 75-year-old female who presented with diminished upper eyelid excursion in her right (only seeing) eye due to scarring associated with a facial laceration. She had a history of right eye corneal transplantation and necessitated urgent excision of the scar to release upper eyelid motion. The scar was excised, and a full-thickness skin graft (FTSG) was used, harvested from the skin of the right supraclavicular neck. Post-operative recovery was excellent, and the patient was relieved of restriction of her right upper eyelid opening.

Diagnosis and Management of Common Presentations of Posttraumatic Nasal Deformity: A Narrative Review.

Posttraumatic nasal deformity (PTND) is a surgical challenge for the otolaryngologist and plastic surgeon. Various classifications and management algorithms have been proposed without reaching much consensus in terms of definition and management. Methods: We present a narrative review aimed to define PTND and consolidate current knowledge regarding its diagnosis, subtypes, and treatment options. Results: This report is a clinical overview of PTND. We also review recent studies that characterize different osteotomy approaches and techniques used for patients with PTND. Conclusions: By providing a summary of the main challenges for PTND, we aim to add context to its variable presentation. We hope this broad overview will reinforce more effective communication between providers and promote patient understanding in order to ensure favorable long-term outcomes.

Benign osteonecrosis of the external ear canal: case series.

Benign osteonecrosis of the external ear canal is a rare pathology that commonly gets misdiagnosed as cholesteatoma of the external ear canal, keratosis obturans and malignant otitis externa. Each pathology has characteristics that allow for differentiation between them. Careful analysis is required to diagnose properly and determine the best modality of management. This case series presents two patients that were diagnosed with benign osteonecrosis of the external ear canal and is being managed conservatively with serial debridement. Response to conservative treatment has resulted in adequate control of symptoms in both patients.

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.

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.

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.

A case of an air gun bullet paranasal sinuses injury in an 11-year-old male.

Non-powder firearms, such as BB guns, are considered safer than traditional firearms and are often marketed toward younger demographics as children's toys. Recent advances in compressed-gas technology have drastically increased the firing power of these types of firearms, which has caused them to be more dangerous and capable of causing severe injury. We report the case of an 11-year-old male admitted for nasal injury caused by a BB gun pellet. The projectile had an unpredictable course: it pierced the skin of his left nasal sidewall, traversed through the soft tissues of the nose to the right nasal cavity violating the posterior septum, and lodged in the right posterior ethmoids adjacent to the posterior attachment of the middle turbinate. The metallic foreign object was successfully retrieved from the right nasal cavity via an endoscopic approach after minimal endoscopic dissection, guided by the preoperative radiologic imaging.

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.

Saddle nose deformity: a rare complication of COVID-19 infection.

Introduction: Although the effects of SARS-CoV-2 (COVID-19) infection in olfaction have been well established, there is relative paucity of information on possible other complications of COVID-19 in the nasal cavities and nasal function. Case report: We report the unique case of a young female patient, with a remote history of septoplasty and functional endoscopic sinus surgery who developed severe nasal airway obstruction (NAO) and saddle nose deformity two to three weeks after her recovery from COVID-19. Conclusion: This case report illustrates a late septoplasty complication that may be associated with COVID-19. This unusual clinical presentation indicates that structural destabilization of the nose may ensue as a complication of the COVID-19, and requires further investigation of the SARS-CoV-2 effects in vascularity and wound healing in the nasal cavity.

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.

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.

Clinical Outcomes in Dorsal Preservation Rhinoplasty: A Meta-Analysis.

Background: Dorsal preservation rhinoplasty (PR-D) attempts to preserve as much of the native nasal anatomy as possible when performing a hump reduction, but clinical outcomes are unclear. Objective: In patients undergoing PR-D rhinoplasty, this article investigates the rates of complications and revisions. Methods: This meta-analysis was prospectively registered on the PROSPERO database. The Pubmed, Embase, and Scopus databases were searched. Pooled incidence was calculated in a meta-analysis within a random-effects model. Results: Twenty-two studies representing a cohort of 5660 patients were included in this study. Postoperative hump recurrence rates (4.18%, 95% confidence interval [CI]: 2.41-6.40%), rates of revision rhinoplasty (3.48%, 95% CI: 1.77-5.74%), rates of postoperative nasal deviation (1.13%, 95% CI 0.37-2.28%), and rates of infection (1.89%, 95% CI: 0.35-4.62%) were all found to be low. Conclusion: PR-D has low rates of revision surgery, residual or recurrent hump, postoperative nasal deviation, and postoperative infection.

Techniques to Enhance Survival of Auricular Composite Graft in Reconstruction of Skin Defects of the Nasal Ala and Nasal Sidewall: A Case Report.

The auricular composite graft consists of a free tissue graft containing part of the auricular cartilage attached to its overlying skin. The survival of the auricular composite graft depends primarily on its size, and a graft diameter of 1- 2 cm has been previously reported as the critical cut-off size. The auricular composite graft is a reliable option for the reconstruction of skin defects of the nasal sidewall and the nasal ala, and its survival rates can be enhanced with the utilization of specific surgical techniques. These include increasing the contact surface with skin de-epithelization/ perichondrial underlay in the surgical bed, injection of autologous platelet-rich plasma, and non-strangulating nasal sidewall splinting. Here, we report a 64-year-old man with a skin lesion in the right nasal ala who underwent Mohs micrographic surgery. The lesion was reconstructed with the use of composite auricular skin graft.

Recurrent, oral cavity tumor-like exophytic lesions mimicking neoplastic disease in a patient with history of human papillomavirus-mediated squamous cell carcinoma.

Reactive hyperplasia is a phenomenon responsible for exophytic lesions in the oral cavity, and may appear to be suspicious, especially in patients who have a significant history of malignancy. Here, we present a case of reactive hyperplasia mimicking recurrence in a patient who was previously treated for tonsillar carcinoma. Physicians who commonly see patients with oral lesions, particularly oral surgeons and otolaryngologists, should be cognizant of the unusual presentation of these lesions as they may mimic the physical characteristics of recurrence.

Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review.

OBJECTIVES: To present our experience with head and neck squamous cell carcinoma (HNSCC) seeding of percutaneous endoscopic gastrostomy (PEG) sites and to review all reported cases to identify risk factors and develop strategies for complication avoidance. MATERIALS AND METHODS: The records of 4 patients with PEG site metastasis from HNSCC were identified from the authors' institution. Thirty-eight further cases were reviewed following a PubMed search and evaluation of references in pertinent articles. RESULTS: Review of 42 cases revealed the average time from PEG to diagnosis of metastatic disease to be 8 months. Average time to death from detection of PEG disease was 5.9 months. One-year survival following PEG metastasis was 35.5% with an overall mortality of 87.1%. CONCLUSION: PEG site metastatic disease portends a poor prognosis. Early detection and aggressive therapy may provide a chance of cure. Changes in PEG technique or in timing of adjunctive therapies are possible avenues in further research to prevent this complication.

Etiology of unilateral hearing loss in a national hereditary deafness repository.

PURPOSE: The aim of this study was to characterize the genetic, audiologic, and epidemiologic characteristics of unilateral hearing loss (HL) in a national hereditary deafness repository. MATERIALS AND METHODS: This is a prospective clinical study involving 34 subjects identified in a national hereditary deafness repository. Clinical data and family history of HL were obtained on enrollment. Candidate deafness genes were screened by single-stranded conformation polymorphism, and mutations were confirmed with sequencing. RESULTS: Thirty-four subjects (19 males, 15 females) with unilateral HL were identified, ranging in age from 2 months to 36 years. The mean age at diagnosis was 7 years, and the left ear was affected in 62% of the cases. The racial distribution of our sample was 62% white, 23% African American, and 15% Hispanic. Imaging results were available in 47%, and most (69%) were considered normal. Nineteen percent had enlarged vestibular aqueducts, 2 had ipsilateral Mondini dysplasia, and 1 had a common cavity deformity. Twenty subjects (59%) had a family history of HL, with 26% specifically reporting familial unilateral HL. Mutational screening revealed sequence variants in the GJB2 (connexin 26), GJB3 (connexin 31), TECTA, and COCH genes. Two novel mutations were detected in COCH and TECTA. CONCLUSIONS: Sequence variants in known deafness genes were detected in more than one-third of our study population, suggesting that gene/gene or gene/environmental interactions may indeed play a role in the etiology of some cases of unilateral deafness. Further prospective studies including congenital cytomegalovirus screening at birth and molecular screening of deafness genes in children with congenital unilateral HL will be required to establish the etiology of unilateral deafness with certainty.

Role of the recently identified dysadherin in E-cadherin adhesion molecule downregulation in head and neck cancer.

Dysadherin is a cancer-related cell membrane glycoprotein, recently identified, playing an important role in tumor progression and metastasis. In the present minireview article, we are focusing on the role of dysadherin in E-cadherin downregulation, the various expression patterns of the molecule in head and neck cancer as well as its potential role as a molecular target for future applications in diagnosis, clinical routine and prognosis of the disease.