RESUMO
The aim of the study is to evaluate the utility of a simple tongue blade bite test in predicting mandible fractures and use this test as an alternative screening tool for further workup. This is a retrospective chart review. An institutional review board approved the retrospective review of patients evaluated by the Department of Otolaryngology at a single institution for facial trauma performed from November 1, 2011, to February 27, 2014. Patients who had a bite test documented were included in the study. CT was performed in all cases and was used as the gold standard to diagnose mandible fractures. Variables analyzed included age, sex, fracture type/location on CT, bite test positivity, and operative intervention. A total of 86 patients met the inclusion criteria and of those 12 were pediatric patients. Majority of the patients were male (80.2%) and adult (86.0%; average age: 34.3 years). Fifty-seven patients had a negative bite test and on CT scans had no mandible fracture. Twenty-three patients had a positive bite test and a CT scan confirmed fracture. The bite test revealed a sensitivity of 88.5% (95% CI: 69.8-97.6%), specificity of 95.0% (95% CI:86.1-99%), positive predictive value [PPV] of 88.5% (95% CI: 69.8-97.6%), and negative predictive value [NPV] of 95.0% (95% CI: 86.1-99.0%). Among pediatric patients, the sensitivity was 100% (95% CI: 29.9-100%), specificity was 88.9% (95% CI: 68.4-100%), PPV was 75.0% (95% CI: 19.4-99.4%), and NPV was 100% (95% CI: 63.1-100%). The tongue blade bite test is a quick inexpensive diagnostic tool for the otolaryngologist with high sensitivity and specificity for predicting mandible fractures. In the pediatric population, where avoidance of unnecessary CT scans is of highest priority, a wider range of data collection should be undertaken to better assess its utility.
RESUMO
OBJECTIVES: To determine if monitoring weight growth curves is a sensitive objective parameter for evaluating operative outcomes after supraglottoplasty. STUDY DESIGN: Retrospective chart review. METHODS: An IRB approved retrospective review of patients who underwent supraglottoplasty from 2/28/2012 to 10/20/2014 by the otolaryngology department at a single institution was performed. Variables collected included age, race, sex, preoperative weight percentiles, and weight percentiles at 3 month, 12 month, and 3 year followup intervals. RESULTS: 20 patients met inclusion criteria. 15 (75%) patients were male and 5 (25%) were female. 9 (45%) patients were African American, 8 (40%) were Caucasian, and 3 (15%) were other. Average weight for age at surgery was 29.8 percentile. 6 (30%) had failure to thrive by weight. By 3 months postop average weight had increased by 7.67 percentile (p=0.09, 95% CI -1.62 to 17.0), by 12 months there was an observed increase of 19.1 percentile (p=0.06, 95% CI 0.47-37.8), and by 3 years the average weight had increased by 26.53 percentile (p=0.03, 95% CI 4.47-48.59). By three years postop the average weight had normalized (64.5 percentile). Among those who met preoperative failure to thrive criteria (average 0.11 percentile), weight gain was still dramatic with average weight percentile of 37.5 by 3 years postop. CONCLUSION: Patients undergoing supraglottoplasty are typically underweight for age. Statistically significant weight gain occurs in children after going supraglottoplasty. This intervention can normalize their growth chart growth patterns by 3 years postoperatively, even in children with failure to thrive.
