Skin Grafts vs Local Flaps for Reconstruction of Nasal Defects: A Retrospective Cohort Study.

IMPORTANCE: Nasal defects commonly are a result of removal of skin lesions, and reconstruction presents a cosmetic challenge to surgeons. Conventional thought and study results have held that cosmetic outcomes of local flap reconstructions may be superior to those of skin grafts. However, local flap reconstructions require more adjunctive procedures. We propose that in select cases, skin grafts can provide aesthetic outcomes equal to those of local flaps with fewer adjunctive procedures. OBJECTIVE: To evaluate the cosmetic outcomes of skin grafts vs local flaps in the reconstruction of nasal defects. DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective review of medical records for 103 patients who underwent nasal reconstruction with either skin graft (n=39) or local flap (n=64) between 2005 and 2013. All patients were treated by a single surgeon at an academic medical institution. Patients who had defects larger than 30 × 35 mm or a history of adjacent reconstruction that would detract from the cosmetic outcome of the procedure under analysis were excluded. MAIN OUTCOMES AND MEASURES: Cosmetic outcome was graded using a visual analog scale (VAS) score based on an ordinal 5-point Likert scale (1, excellent; 5, poor) by 4 independent raters blinded to reconstruction technique. Information was collected regarding patient demographics, defect size, pathology, type of reconstruction, and any postoperative procedures performed. RESULTS: The mean VAS score for the skin graft group was 2.18, while the mean score for the flap group was 2.12 (P = .43). The 39 patients with graft reconstruction had a total of 11 triamcinolone acetonide injections and 8 dermabrasion sessions postoperatively. The 64 patients with local flap reconstruction had a total of 259 triamcinolone acetonide injections and 13 dermabrasion sessions postoperatively plus 39 additional staged surgical procedures. CONCLUSIONS AND RELEVANCE: Skin grafts are a valuable reconstructive option that provide aesthetic outcomes comparable to those of local flap procedures and with less need for additional postoperative interventions in properly selected nasal defects. LEVEL OF EVIDENCE: 3.

Plummer-Vinson syndrome following gastric bypass surgery.

Plummer-Vinson syndrome (PVS) is the combination of dysphagia, angular cheilitis, atrophic glossitis, and esophageal webbing in the setting of iron deficiency anemia. Although it is relatively uncommon, this condition is important to recognize because it is a source of dysphagia and it confers an increased risk for hypopharyngeal cancer. Cases of PVS associated with gastrointestinal conditions such as celiac disease and gastric cancer have been previously reported in the literature, but as far as we know, no case of PVS associated with bariatric surgery has been previously reported. We describe the case of a 39-year-old woman who developed PVS following gastric bypass surgery, and we briefly discuss the current knowledge of this syndrome.

Functional endoscopic analysis of beatbox performers.

OBJECTIVES: Beatboxing is a form of vocal percussion in which performers imitate drum sounds, interspersed with vocalization and other sounds, using their vocal tracts. Although similarities between beatboxing and singing are expected because of the anatomy involved, the medical literature has a wealth of information on singing and minimal studies on beatboxing. The objective of our study was to report on a case series of functional endoscopic evaluation of the anatomy involved in beatboxing and determine whether beatboxing may be a risk factor for phonotrauma or if this form of vocalization might be protective of the vocal folds. METHODS: We reviewed the flexible fiberoptic data collected from four beatbox artists who were evaluated at an outpatient Laryngology clinic. These records included videos of a standard flexible laryngoscopic evaluation during which the beatboxers performed beatbox sounds in isolation and in various combinations ("beats"), both standardized and improvised. RESULTS: All four participants were males aged 22-32 years. We found that voicing during beatboxing was not the same as full voice to have sustained phonation interlaced with percussive sounds. Performers overall demonstrated similarities in delivery of the same beatbox sounds, although subtle differences were noted between performers. CONCLUSIONS: Beatboxing is a complex form of vocal percussion using the entire vocal tract. Although similarities with singing in the anatomical structures and positioning are noted in beatboxing, there are several unique and interesting anatomical processes occurring. Use of the entire vocal tract, including the pharyngeal constrictors, may actually protect against glottic injury.

A comparison of revision adenoidectomy rates based on techniques.

OBJECTIVE: No studies are available specifically comparing revision rates between suction coagulator and microdebrider-performed adenoidectomies. Our objective was to compare revision adenoidectomy rates between these instrument groups. STUDY DESIGN: Historical cohort study. SETTING: Patients included in this study had surgery at the Ann and Robert H. Lurie Children's Hospital in Chicago, Illinois, from June 2007 through December 2011. SUBJECTS AND METHODS: The patients were divided into 2 groups based on technique of adenoidectomy used at the time of initial surgery and the regrowth rate analyzed. RESULTS: During the 4.5-year study period, the microdebrider was used in 4071 adenoidectomies, and 3328 cases were performed with suction coagulation. There was a revision rate of 0.84% (34 patients) for the microdebrider group. The rate was 1.50% (50 patients) for suction coagulation. This difference was found to be statistically significant on univariate analysis. The suction coagulator group had a younger mean age at initial surgery and a higher incidence of gastroesophageal reflux disease. No difference in revision rates between the 2 groups was noted on multivariate analysis. CONCLUSION: Symptomatic regrowth of adenoid tissue occurs infrequently. Both suction coagulation and microdebrider methods are commonly used when performing adenoidectomies due to more consistent ease of use in removal of tissue. The incidence of regrowth likely relates to variables other than the technique used, as there was no difference in the regrowth rate between the 2 groups.

Pseudo-sudden deafness.

OBJECTIVES: We describe the symptom complex and management of a clinical entity we refer to as "pseudo-sudden deafness," which is an episode of acute otitis media that leads to sensorineural hearing loss with reduced speech discrimination. METHODS: We included 8 adult patients with audiometrically confirmed, asymmetric sensorineural hearing loss with decreased speech discrimination that presented after an episode of acute otitis media. Magnetic resonance imaging ruled out retrocochlear disease. Both physical examination and myringotomy helped confirm the diagnosis of serous otitis media (SOM). Myringotomy, tympanostomy tubes, oral antibiotics, and otic antibiotic-steroid drops were used to treat the SOM. Oral steroids were used to treat the sensorineural component. RESULTS: Pretreatment and posttreatment audiograms showed an improvement in speech discrimination score, pure tone thresholds, or both after treatment for underlying SOM and sensorineural hearing loss in 6 of the 8 patients. CONCLUSIONS: Patients who present with an acute onset of unilateral sensorineural hearing loss with decreased speech discrimination may be mistakenly thought to have idiopathic sudden sensorineural hearing loss when, in fact, they may have an SOM-induced phenomenon that is potentially reversible. The distinguishing feature is a preexisting otitis media, which must be treated first, before the administration of steroids.