Using Machine Learning for Endoscopic Detection of Low-Grade Subglottic Stenosis: A Proof of Principle.

The current study trains, tests, and evaluates a deep learning algorithm to detect subglottic stenosis (SGS) on endoscopy. A retrospective review of patients undergoing microlaryngoscopy-bronchoscopy was performed. A pretrained image classifier (Resnet50) was retrained and tested on 159 images of airways taken at the glottis, 106 normal-sized airways, and 122 with SGS. Data augmentation was performed given the small sample size to prevent overfitting. Overall model accuracy was 73.3% (SD: 3.8). Precision and recall for stenosis were 77.3% (SD: 4.0) and 72.7 (SD: 4.0). F1 score for the detection of stenosis was 0.75 (SD: 0.04). Precision and recall for normal-sized images were lower at 69% (SD: 4.35) and 74% (SD: 4), with an F1 score of 0.71 (SD: 0.04). This study demonstrates that an image classification algorithm can identify SGS on endoscopic images. Work is needed to improve diagnostic accuracy for eventual deployment of the algorithm into clinical care.

Endoscopic posterior cricoid split with costal cartilage graft placement in patients under one year of age.

Endoscopic posterior cricoid split and costal rib graft placement (EPCSCG) is an important tool in enlarging the glottic and subglottic airway, both of which can be disproportionally affected in the small airways of neonates and early infants. We present a series of 8 patients under the age of one who successfully underwent EPCSCG, with 7/8 patients avoiding tracheostomy entirely. Of these patients, the indication for EPCSCG was isolated bilateral vocal fold immobility (6/8), bilateral vocal fold immobility with subglottic stenosis (1/8), and isolated subglottic stenosis (1/8). EPCSCG can be safely applied to select patients less than one year of age.

Tracheal Stenosis in Open Versus Percutaneous Tracheostomy.

OBJECTIVE: This study aims to investigate if there is an increased risk of developing tracheal stenosis after tracheostomy with an open versus percutaneous tracheostomy. METHODS: The patient cohort included patients receiving open or percutaneous tracheostomies at Catholic Health Initiatives Midwest facilities from January 2017 to June 2023. The primary aim was to compare the differences in the risk of developing tracheal stenosis between open and percutaneous tracheostomy techniques. Between-technique differences in the risk of developing tracheal stenosis were assessed via a Cox proportional hazard model. To account for death precluding patients from developing tracheal stenosis, death was considered a competing risk. RESULTS: A total of 828 patients met inclusion criteria (61.7% open, 38.3% percutaneous); 2.5% (N = 21) developed tracheal stenosis. The median number of days to develop tracheal stenosis was 84 (interquartile range: 60 to 243, range: 6 to 739). Tracheal stenosis was more frequent in patients who received a percutaneous tracheostomy (percutaneous: 3.5% vs. open: 2.0%); however, the risk of developing tracheal stenosis was statistically similar between open and percutaneous techniques (HR: 2.05, 95% CI: 0.86-4.94, p = 0.108). CONCLUSIONS: This study demonstrates no significant difference in the development of tracheal stenosis when performing an open versus a percutaneous tracheostomy. Tracheal stenosis is a long-term complication of tracheostomy and should not influence the decision about the surgical technique used.

From Nasolabial Folds to Pan-facial Rejuvenation-The Evolution of Fillers in my Career.

This is a comprehensive review of facial fillers including landmark studies and expert commentary spanning the years from 2003 (when the first hyaluronic acid [HA] dermal filler underwent Food and Drug Administration approval in United States) to present.

Actinomyces: An Under Appreciated Cause of Postoperative Infection in Rhinoplasty.

OBJECTIVE: To discuss a case series of Actinomyces infection post-rhinoplasty and review the literature for correct diagnosis and management. STUDY DESIGN: Case series with chart review. METHODS: Three cases are presented of patients with a history of recurrent infectious symptoms post revision rhinoplasty later being diagnosed as Actinomyces. RESULTS: Three patients were identified having undergone revision rhinoplasty and later being diagnosed with Actinomyces infection. They initially presented with underwhelming physical exams, mild erythema, slight swelling, yet extreme pain. They also had periods of recurrent infection once antibiotics were stopped. Aerobic, anaerobic, fungal, and Actinomyces cultures were sent to pathology and returned positive for Actinomyces. Treatment typically involved a combination of prolonged antibiotics, incision and drainage, and/or surgical debridement. CONCLUSIONS: Awareness of Actinomyces as a possible cause of infection post-rhinoplasty is significant as this pathogen can lead to extensive tissue destruction and fistula formation which could be detrimental for a rhinoplasty. Duration of treatment is beyond typical lengths for other infections and a specific culture for Actinomyces is required to be sent as it isn't captured in standard aerobic/anaerobic cultures. Therefore, a high index of suspicion is required by physicians to ensure that patients are evaluated thoroughly. Laryngoscope, 133:2948-2950, 2023.

A Comparison of Quadriceps-to-Hamstrings Ratios During Isokinetic Testing, Cutting, and Drop Landings in Male Soccer Players.

Collegiate soccer is not an unusual place to suffer a knee injury. The sport has many dynamic movements, such as cutting, jumping and shooting. Many professionals use quadriceps-to-hamstring (Q/H) ratios as a tool to determine when an injured player can to return to game play or use the ratio to investigate how predisposed a certain player is to sustaining a knee injury. However, many of these ratios are taken in isokinetic testing in a controlled environment and to our knowledge it is unknown if these ratios are similar to those measured during dynamic activity. Therefore, this study investigated if there was a relationship between Q/H ratios measured during isokinetic testing and drop landings and cutting. Fifteen Division 2 collegiate male soccer players (age: 19.79 ± 1.25 years; height: 176.74 ± 6.22 cm; weight: 77.24 ± 11.01 kg). Wearing Athlos© compression shorts participants performed isokinetic testing, drop landings and cutting drills while muscle activity was measured. A significant difference was found between the bilateral Q/H ratios during the drop landings (p = 0.04; η = 0.49). There were no significant bilateral differences measured during the cutting drills in either direction and isokinetic testing (p > 0.05). Additionally, there was so significant relationship in Q/H ratios between isokinetic testing and the dynamic movements (p > 0.05). This suggests that clinicians should use Q/H ratios during dynamic movements rather than isokinetic testing in a controlled environment to better assess player risk disposition and return-to-play criteria.