Search

Objective: Facial selective neurectomy (SN) improves facial function by denervation of muscles antagonistic to the smile in nonflaccid facial paralysis (NFFP) patients. This study aims to assess whether and which objective facial function metrics affect favorable SN outcome in NFFP patients, as perceived by facial nerve (FN) practitioners. Study Design: Retrospective cohort study. Setting: NFFP patients who underwent SN at the facial nerve center. Methods: Standardized preoperative and postoperative facial photographs of patients undergoing SN were analyzed using clinician‐graded measures (eFACE) and automated facial measurement (Emotrics). Favorable outcome was ranked subjectively by 3 independent FN practitioners. Correlations between objective metrics and favorable subjective outcome were examined. Results: Fifty‐eight SN cases were included. Oral commissure excursion with smile, interlabial distance, and lower lip movement were all considered statistically significantly important for favorable outcome perception. Each +1 mm of smile excursion increases the odds of a favorable outcome by 75.4% (odds ratio [OR]: 1.754). Each +1 mm of interlabial distance asymmetry decreases the odds of a favorable outcome by 24.7% (OR: 0.753). Each +1‐point change in lower lip movement eFACE score increases the odds of a favorable outcome by 2.7% (OR: 1.027). Conclusion: Several smile metrics contribute to favorable SN outcome perception among FN practitioners. Smile excursion, interlabial distance, and lower lip movement were significant predictors of success. These observations may be extrapolated to other facial reanimation interventions and serve surgeons and patients during counseling and expectation management, and during surgery. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses a rare case of a solitary fibrous tumor in the nasal cavity. Solitary fibrous tumors are uncommon neoplasms that can arise in various parts of the body, including the head and neck region. Although these tumors are slow-growing, they can potentially spread and invade nearby structures, leading to life-threatening complications. The article highlights the importance of early identification and surgical resection in managing these tumors. The case presented in the article describes the successful removal of the tumor through endoscopic surgical resection after embolization. The article emphasizes the need for prompt diagnosis and treatment due to the potential risks associated with these tumors. [Extracted from the article]

Objective: Little is known about pricing for reconstructive procedures of the head and neck. As of January 2021, the Centers for Medicare and Medicaid Services requires hospitals to disclose payer‐negotiated prices for services, offering new insight into prices for privately insured patients. Study Design: Cross‐sectional analysis. Setting: Turquoise database. Methods: Payer‐negotiated facility fees for 41 reconstructive surgeries were grouped by procedure type: primary closure, skin grafts, tissue rearrangement, locoregional flaps, or free flaps. Prices were normalized to account for local labor costs, then calculated as percent markup in excess of Medicare reimbursement. The mean percent markup between procedure groups was compared by the Kruskal‐Wallis test. Subset analyses were performed to compare mean percent markup using a Student's t test. We also assessed price variation by calculating the ratio of 90th/10th percentile mean prices both across and within hospitals. Results: In total, 1324 hospitals (85% urban, 81% nonprofit, 49% teaching) were included. Median payer‐negotiated fees showed an increasing trend with more complex procedures, ranging from $379.54 (interquartile range [IQR], $230.87‐$656.96) for Current Procedural Terminology (CPT) code 12001 ("simple repair of superficial wounds ≤2.5 cm") to $5422.60 ($3983.55‐$8169.41) for CPT code 20969 ("free osteocutaneous flap with microvascular anastomosis"). Median percent markup was highest for primary closure procedures (576.17% [IQR, 326.28%‐1089.34%]) and lowest for free flaps (99.56% [37.86%‐194.02%]). Higher mean percent markups were observed for rural, for‐profit, non‐Northeast, nonteaching, and smaller hospitals. Conclusion: Wide variation in private payer‐negotiated facility fees exists for head/neck reconstruction surgeries. Further research is necessary to better understand how pricing variation may correlate with out‐of‐pocket costs and quality of care. [ABSTRACT FROM AUTHOR]

Access to cochlear implantation can be restricted by financial burden, and little is known about the extent to which cochlear implant (CI) devices prices may vary between hospitals or manufacturers. We performed a cross‐sectional analysis of private payer‐negotiated prices for CI devices. In total, 161 hospitals were analyzed. Prices varied widely across hospitals and between payers. Despite clinical equipoise between manufacturers with regards to CI user outcomes, significant differences in prices were identified, with higher prices for MED‐EL ($38,478 ± 2633) than for Cochlear Ltd. ($34,150 ± 2418, p <.001). Markup analysis for Cochlear Ltd. devices revealed a mean 58.5% ± 7.4% markup in excess of the company's average sales price ($24,649). Negotiated prices were also at least $5000 lower when all 3 brands were offered at the same center (p <.05). Further research examining the influence of patient outcomes and hospital volume on prices are needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION In the United States, a person may apply for asylum if the person meets the statutory definition of a "refugee." (1) Asylum status grants "withholding of removal" (2) from [...]

Objectives: Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures. Methods: We performed a cross‐sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer‐specific prices for M&T and T&A. We additionally characterized the extent of variation in payer‐specific prices both across and within hospitals. Results: Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across‐center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.82 versus 90th percentile: $9,209.88). Median within‐center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure. Conclusion: The majority of hospitals serving pediatric patients were non‐compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer‐specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions. Level of Evidence: 3 Laryngoscope, 133:948–955, 2023 [ABSTRACT FROM AUTHOR]

Health care costs can present a significant strain on patients with head and neck cancer. It remains unclear how much prices may vary among hospitals providing care and what factors lead to differences in prices of surgical procedures. A cross‐sectional analysis of private payer–negotiated prices was performed for 10 commonly performed head and neck surgical oncology procedures. In total, 896 hospitals disclosed prices for at least 1 common head and neck surgical oncology procedure. Wide variation in negotiated surgical prices was identified. Across‐center ratios ranged from 6.2 (partial glossectomy without primary closure) to 22.8 (excision of tongue lesion without closure). For‐profit hospital ownership structure and geographic region outside of the northeast United States were associated with increased prices. For example, private payer–negotiated prices for direct laryngoscopy with biopsy were on average $2083 greater at for‐profit hospitals when compared with nonprofit hospitals ($5215 vs $3132, P <.001). Further research comparing prices and outcomes is needed. [ABSTRACT FROM AUTHOR]