Approach to Major Nasal Reconstruction: Benefits of Staged Surgery and Use of Technology.

This article reviews special considerations in complex nasal defects including treatment of adjacent subunit defects, timing of repair with radiation, reconstruction in patients with prior repairs or recurrent disease, and the role of prosthetics. The role of technological advances including virtual surgical planning, 3 dimensional printing, biocompatible materials, and tissue engineering is discussed.

Childhood Hearing Loss in Patients With Sickle Cell Disease in the United States.

This study sought to examine if modern medical evaluations including newborn screening and early diagnosis along with better methods of disease control have improved rates of hearing loss in children with sickle cell disease (SCD). Audiometric and medical data for patients with SCD was obtained from the AudGen Database and analyzed for the presence of hearing loss, type of hearing loss, severity of hearing loss, and correlation with comorbid conditions. Children with sickle cell trait (SCT) were used as a comparison group. A total of 189 patients with SCD and 244 patients with SCT had sufficient audiologic data available. Hearing loss was present in 62% of children with SCD and 50% of children with SCT in the study population. Patients with SCD were significantly more likely than those with SCT to have a sensorineural component to their hearing loss (P<0.001, odds ratio: 2.41 [1.53 to 3.79]) and to have severe or profound hearing loss (P=0.02, odds ratio: 4.00 [1.14 to 14.04]). The true prevalence of hearing loss in children with SCD has not been established as routine screening is not being performed. Routine auditory testing should be done for these children to detect this loss before it impacts development.

Hearing loss in children with primary ciliary dyskinesia.

OBJECTIVES: To evaluate the type and severity of hearing impairment in pediatric patients with primary ciliary dyskinesia (PCD) and relate these measures to patient demographics, treatment options, and other otologic factors. METHODS: A retrospective analysis of children with a diagnosis of PCD, Kartagener's syndrome, or situs inversus in the AudGen Database was conducted. Audiograms were analyzed for type of hearing loss (HL), severity, laterality, and progression. Medical charts were reviewed to identify factors that influence severity and progression of hearing loss. RESULTS: 56 patients met inclusion criteria and 42 patients had HL. 66.6% had bilateral and 33.3% had unilateral loss (70 total ears with HL). Conductive hearing loss (CHL) was the most common type of HL, though 30% of children had some sensorineural component to their hearing loss. 92.9% of children with HL received at least one diagnosis of otitis media, but HL did not improve in the majority (77.8%) of ears in our study regardless of ear tube placement. CONCLUSIONS: Slight to mild CHL and all types of otitis media are prevalent among patients with PCD, and some of these children have sensorineural hearing loss (SNHL). All patients diagnosed with situs inversus at birth should be evaluated by an otolaryngologist.

Propionibacterium acnes as an emerging pathogen in skull base osteomyelitis: A case series.

Skull base osteomyelitis (SBO) is recognized as a potentially life-threatening infection that has been classically attributed to Pseudomonas aeruginosa. However, growing data shows that the bacteriology of SBO is changing. Traditionally thought of as commensal bacterium, P. acnes has been implicated as a serious pathogen in other specialties. Building on a previous case report from our institution, we have identified three patients with SBO who are culture-positive for Propionibacterium acnes as a single isolate. Herein, we describe the clinical history of the three patients, along with treatment, present outcome, and review of the literature. Laryngoscope, 128:332-335, 2018.

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer.

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

Lost in translation: Cultural divides in communication skills teaching identified in the ICCH 2016 student symposium.

OBJECTIVE: To provide a platform for learners' voices at an international conference on communication in healthcare. METHODS: A group of medical students were invited to explore their experiences with communication skills learning at a symposium at the 2016 International Conference on Communication in Healthcare in Heidelberg, DE. RESULTS: Students from the US, Denmark, Germany, and Russia discussed their experiences with communication skills curriculum at their institutions. We identified divides that have challenged our ability to develop and maintain strong communication skills: 1) valuation of communication skills vs. other topics, 2) curricular theory vs. practice, 3) evaluation vs. feedback, 4) preclinical vs. clinical learning, and 5) the medical student vs. practicing clinician role. CONCLUSION: The points of transition we identified on the road of communication skills teaching highlight opportunities to strengthen the educational experience for students. Without an effort to address these divides, however, our communication skills may be lost in translation. PRACTICE IMPLICATIONS: Students value communication skills teaching during their medical education and there are opportunities to translate this to countries that currently lack robust curricula and to the real-life post-graduate setting. Support is necessary from students, teachers, and administrators, and focus on translation of skills during role transitions is needed.

Single thyroid tumour showing multiple differentiated morphological patterns and intramorphological molecular genetic heterogeneity.

AIMS: A 49-year-old man presented with a single thyroid tumour that showed a combination of conventional papillary carcinoma, follicular variant of papillary carcinoma, clear cell papillary carcinoma, columnar cell carcinoma and poorly differentiated carcinoma. As all of the morphologies have been associated with papillary carcinoma in the literature, we wished to determine if they contained identical or different molecular abnormalities. METHODS: Targeted next generation sequencing (NGS) of each morphological component and metastases was performed. RESULTS: NGS revealed a BRAF p.K601E mutation in both the clear cell papillary carcinoma and poorly differentiated carcinoma and a KRAS p.G12R mutation in the papillary carcinoma, follicular variant. Two different areas of columnar cell variant were tested, with one showing a KRAS p.G12D mutation but no mutation in the other area. A KRAS p.G12R mutation was seen in the metastatic clear cell variant. Two different lymph nodes had metastatic columnar cell carcinoma, one negative for mutations but the other with a compound KRAS p.G12R and KRAS p.G12V mutation on different alleles. No mutations including BRAF and KRAS were seen in the conventional papillary carcinoma. CONCLUSIONS: Although all of the morphological patterns in this tumour have been reported as having aetiological or other association with one another, there was only partial concordance with their molecular signatures. There was significant molecular discordance, however, even with identical morphologies.