Management of Skull Base Defects After Surgical Resection of Sinonasal and Ventral Skull Base Malignancies.

Over the past 2 decades, there has been a significant increase in the resection of larger and more complex ventral skull base malignancies. The resection of these lesions has resulted in the creation of larger and more difficult to repair skull base defects. There are many available options for ventral skull base reconstruction. Despite the variety of reconstructive options, the key objective is to eliminate any communication between the intracranial space and the sinonasal cavity. This article discusses some of the more common techniques currently used for repair of these skull base defects.

Squamous cell carcinoma of the parotid gland: a population-based analysis of 2545 cases.

PURPOSE: Squamous cell carcinoma (SCC) of the parotid gland is an uncommon tumor, which generally affects older patients. In this study, we explore various aspects of this entity using a national population-based database. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was used to extract data on frequency, incidence, and disease-specific survival (DSS) from 1973 to 2009. Variables analyzed included age, gender, race, histologic grade, stage and treatment. Cox proportional hazards analysis was conducted. RESULTS: A total of 2545 cases were identified. Parotid SCC was most common in males (79.8%), whites (92.9%), and patients aged ≥75 years (51.4%). Incidence increased slightly over the past three decades (annual percent change 1.90%, p<0.05). Overall 5-year DSS was 54.4%. Statistically significant poor prognostic factors included black race, age ≥75 years, tumor T3 or greater, and higher clinical stage at diagnosis. Elective neck dissection (END) in patients staged N0 was associated with higher DSS (78.3% versus 51.1%, p<0.0001). The omission of END was associated with a three-fold greater hazard of death (hazard ratio 3.19, 95% confidence interval 1.53-7.26, p=0.0016), regardless of whether or not radiotherapy was given. CONCLUSION: Parotid SCC is uncommon, and data on treatment decisions are limited. Our study profiles the demographic, clinicopathologic, incidence, and survival features of this entity. Perhaps most notably, our results support the practice of END of the N0 neck.

Teaching and assessing endoscopic sinus surgery skills on a validated low-cost task trainer.

OBJECTIVES/HYPOTHESIS: To evaluate a previously validated low-cost sinus surgery task trainer as a means of acquiring basic endoscopic sinus surgery skills and as an objective structured assessment of technical skills (OSATS) to determine procedural competency. STUDY DESIGN: Prospective blinded study. METHODS: Medical students (N = 52) with no sinus surgery experience learned to perform nasal endoscopy and five specific sinus surgery tasks using the validated task trainer. Training included regimented expert instruction, peer instruction/observation, and experienced-based learning. Pre- and post-training video recordings of nasal endoscopy and five sinus surgery skills were obtained. Two blinded expert otolaryngologists compared pre- and post-training performance using a checklist and global rating scale. RESULTS: Medical student post-training performance was significantly better than pre-training performance for each checklist item and global rating scale as calculated by paired t test (P < .001). Interrater reliability and internal consistency were confirmed by Kendall's coefficient of concordance and Cronbach's α calculations, respectively. CONCLUSIONS: The sinus surgery task trainer provides an effective means of teaching and evaluating nasal endoscopy and basic sinus surgery skills for novice surgeons. With repeated practice, there was significant improvement in performance. An OSATS using the sinus surgery task trainer suggests that we can effectively measure endoscopic sinus surgery ability with the potential to reliably determine competency outside the operating room.

Face, content, and construct validity of a low-cost sinus surgery task trainer.

OBJECTIVE: To assess the face, content, and construct validities of a low-cost sinus surgery task trainer in acquisition of skills for endoscopic sinus surgery. STUDY DESIGN: Prospective validation study. SETTING: Tertiary academic center. SUBJECTS AND METHODS: Attending otolaryngologists, otolaryngology residents at various levels of training, and medical students performed nasal endoscopy and 5 specific tasks using this model. Face and content validities were assessed based on the attendings' responses to a questionnaire evaluating the task trainer. Construct validity was determined by comparing novice to experienced performance using a validated checklist and globalized rating scale. RESULTS: A total of 77 subjects participated in the study. Attending otolaryngologists responded to a survey after completing the tasks. Eighty percent of evaluators rated the trainer as realistic and agreed that this model correlates with the essential skills needed for endoscopic sinus surgery, 90% felt this model provided adequate training and would increase resident competency, and 90% were interested in using the model to train residents. On the task trainer, experienced otolaryngologists and senior residents scored significantly higher than junior residents and medical students using the objective measures of the globalized rating scale and checklist. CONCLUSION: This study demonstrates face, content, and construct validity of the low-cost sinus surgery task trainer. This model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents.

A novel low-cost sinus surgery task trainer.

Sinus surgery simulation has proven to be a valuable teaching tool, yet the cost of many simulators limits the incorporation of this technology into training programs. The authors developed an inexpensive endoscopic sinus surgery task trainer and evaluated its value as a means of developing basic endoscopy and sinus surgery skills. For less than 5 US dollars, the training model was constructed using gelatin and embedded with reusable, recyclable, and readily available materials. Ten attending otolaryngologists performed nasal endoscopy and 5 specific tasks using this model, followed by completion of a survey evaluating the value of the model as a teaching tool. The model scored very well in promoting camera skills, instrumentation, and hand-eye coordination. This easily reproducible, highly rated sinus surgery task trainer can serve as an alternative to more expensive simulators. Studies are under way to determine its validity and effectiveness as both a teaching and assessment tool.