Dog-Bite-Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature.

Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite-related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1,069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study.

Early neurocognitive improvements following parathyroidectomy for primary hyperparathyroidism.

OBJECTIVES: To establish a time frame for postoperative improvements in neurocognitive function in patients who undergo parathyroidectomy for primary hyperparathyroidism by utilizing repeat neuropsychological assessment at multiple time points before and after surgery. STUDY DESIGN: Prospective cohort study. METHODS: A prospective study was conducted at a tertiary academic medical center between August 2014 and December 2015, including 50 patients with primary hyperparathyroidism who underwent parathyroidectomy. A panel of neurocognitive tests was administered at two separate time points: preoperative and 1-week postoperative. Validated neuropsychological assessment tools were utilized, including Rey Auditory-Verbal Learning Test, Trail Making Test A and B, Benton Controlled Oral Word Association, WAIS-IV Digit Span, Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and Insomnia Severity Index. Barona Information Sheet was used to collect demographic data. Paired t tests were to compare pre- and postoperative scores. RESULTS: Thirty-five patients completed the preoperative and 1-week postoperative testing. In cognitive testing, significant improvement was noted in immediate recall (P < 0.001), working memory (P = 0.011), and attention (P = 0.008) at 1-week postoperative. In mood testing, depression (P < 0.001), anxiety (P < 0.001), and negative affect (P = 0.001) scores were significantly improved at 1-week postoperative. Insomnia scores also were significantly improved at 1 week (P < 0.001). CONCLUSION: Objective improvements in neurocognitive function following parathyroidectomy for primary hyperparathyroidism were noted as early as 1 week after surgery, which is earlier than previously reported. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:775-780, 2018.

Current Management Practices in Ménière's Disease.

OBJECTIVE: To evaluate current trends in managing Ménière's disease (MD) by both general otolaryngologists and otologists/neurotologists and discuss treatment modalities. STUDY DESIGN: Cross-sectional study. SETTING: Survey of physicians. SUBJECTS AND METHODS: An electronic questionnaire was disseminated to all members of American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). RESULTS: Eight hundred and sixty members replied for a response rate of 14.5% for generalists and 35% for neurotologists. Thirty-nine percent of respondents think that diet and lifestyle changes are effective in controlling symptoms in more than 50% of their MD patients. Overall, 72.8% of respondents used hydrochlorothiazide/triamterene (HCTZ/TAT) "often" or "always" with neurotologists using HCTZ/TAT more often than generalists (p < 0.001). Half of neurotologists used IT steroids "often" or "always," compared with only 10% of generalists (p < 0.001). Endolymphatic sac procedures are the most common surgeries and are used more often by neurotologists than by generalists (p < 0.001). The Medtronic Meniett device is used more by neurotologists (p < 0.001) but it is not commonly used overall (69.2% "never" use). CONCLUSION: Many options are available for the treatment of MD. Neurotologists tend to use a wider variety of medications in their treatment protocols than generalists. Neurotologists tend to perform surgical interventions more frequently than generalists. Our evidence shows significant heterogeneity for treatment of Ménière's disease among otolaryngologists. A guideline that outlines appropriate therapeutic options, dosing, and treatment escalation is warranted.

Subcutaneous nasal angioleiomyoma: Case of a rare tumor and review of the literature.

We describe the case of a 46-year-old woman with a rare presentation of angioleiomyoma of the subcutaneous nasal tissue. The patient presented with pain and severe nasal obstruction. Her nasal deformity was sufficient to indicate an external rhinoplasty for both extirpation of the tumor and reconstruction of the defect with cartilage grafts. The procedure resulted in successful removal of the tumor and a satisfactory cosmetic outcome.

Pharyngeal Presentation of Goltz Syndrome: A Case Report with Review of the Literature.

Focal dermal hypoplasia (Goltz syndrome; GS) is an X-linked dominant disorder caused by a mutation in the porcupine homolog (PORCN) gene and is typically embryonically lethal for males. The presence of disease in males is usually the result of post-zygotic mutation, but may also be due to mosaicism. The presentation of this disorder is highly variable, but generally is characterized by cutaneous, skeletal, ocular, oral, dental, and aural defects. Cutaneous manifestations include foci of hypoplastic skin, abnormal pigmentation, and papillomatous growths. We present both the first case of a patient with GS related laryngeal obstruction due to papillary lymphoid hyperplasia in an adult, and the first case in a male patient. Clinical, histologic, and genetic features of the disease are discussed. Operative technique for management of the patient with pharyngeal lesions is detailed, and intraoperative photos are showcased. The challenge in airway evaluation and management is also highlighted as manifestations of GS are rarely encountered in the airway and can cause laryngeal obstruction.