Outcomes of Two-Stage Interpolated Flaps Versus Single-Stage Techniques for Reconstruction of Intermediate Nasal Defects.

Objective: This study compares the results of patients undergoing reconstruction of intermediate nasal defects, measuring 1.5-2.5 cm, with single-staged techniques as opposed to the traditionally recommended staged interpolated flap reconstruction. Design: This is a retrospective review of patients who underwent reconstruction of a nasal defect by a single surgeon between 2010 and 2016. Methods: Postoperative results including revision surgery, treating persistent edema with Kenalog (triamcinolone acetonide), and perioperative complications were analyzed. Aesthetic outcomes were analyzed by a panel of experts and nonexperts, and compared using a 5-point Likert scale. Results: In total, 51 single-stage and 26 two-stage patients underwent evaluation, and of these, 40 single-stage and 15 two-stage patients underwent panel analysis of aesthetic outcomes. The odds of requiring a revision procedure were 6.69 times higher and odds of using Kenalog postoperatively were 29.67 times higher in the two-stage group than in the single-stage group. Aesthetic scores were consistently better for the single-stage group for both panels. Conclusion: Patients undergoing single-stage techniques for reconstruction of intermediate nasal defects showed improved appearance and reduced number of additional procedures relative to patients undergoing two-stage techniques with short-term follow-up.

Effectiveness of a standardized education process for tracheostomy care.

OBJECTIVES/HYPOTHESIS: Evaluate the effectiveness of an educational curriculum on general tracheostomy care principles and determine the effect of this educational curriculum on the level of provider comfort with tracheostomy care. STUDY DESIGN: Cross-sectional questionnaire in an academic medical center. MATERIALS AND METHODS: A 25-question multiple choice and true/false quiz was given to nonotolaryngology health care providers (nurses and physicians) who routinely provide tracheostomy care. This was followed by an education module, and the quiz was repeated. Participants were also asked to rate their level of comfort (0-100 point scale) managing a tracheostomy before and after the module. A 6-month follow-up assessment was also obtained. RESULTS: A total of 94 health care providers participated in the education module (50 physicians, 37 nurses, 7 fourth-year medical students). The average number of correct answers increased by 3.1 (P < 0.001). The level of confidence in tracheostomy care improved by 18.8 points (P < 0.001). At the 6-month assessment, there was still a significant improvement in the number of correct questions and level of confidence when compared to preeducation values (P < 0.02 for both). There was no significant change in the 6-month values when compared to the posteducation values. CONCLUSIONS: A standardized education module for tracheostomy care teaching resulted in significant increases in provider knowledge and confidence. Standardization of tracheostomy education and care is essential in academic hospital medical centers where multiple specialties may be performing tracheostomies and health care providers frequently change. LEVEL OF EVIDENCE: N/A.

The anterior olfactory nucleus: quantitative study of dendritic morphology.

The anterior olfactory nucleus (AON) occupies a crucial position within the olfactory circuit, as it is able to influence function in nearly every major synaptic processing stage of both the ipsilateral and the contralateral pathways. Nevertheless, very little is known about the region's internal organization and circuitry. The present study provides basic quantitative and qualitative data on the morphology of several cell types within the two major regions of the AON, pars externa and pars principalis. In pars externa two types of cells are analyzed, the "classical" cell (type I), containing only apically directed dendrites with large spines, and a previously unreported cell with basilar dendrites and complex, spiny apical processes (type II). In pars principalis the characteristic pyramidal cell is described both on the basis of the depth of the cell bodies in the cell layer comprising the structure and on the basis of their radial location. Several other nonpyramidal neurons are also described. The findings provide useful basic information necessary for understanding and modeling the circuitry of the AON.