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ObjectivesA subset of patients who require revision rhinoplasty will change surgeons for their second procedure. We sought to investigate the rate of surgeon change and identify associated predictors using a population-based, ambulatory surgery database.Methods/study designIn this retrospective review, 9172 rhinoplasty procedures over a 5-year period were analyzed using the Healthcare Cost and Utilization Project (HCUP) Florida State Ambulatory Surgery and Services Database (SASD). We identified 380 patients who had at least two rhinoplasty procedures between 2009 and 2014. Logistic regression analysis was used to identify predictors of patients changing surgeons for their second documented rhinoplasty.ResultsAmong the 380/8531 (4.4%) patients who underwent a revision rhinoplasty, 117/380 (30.8%) patients changed surgeons for their subsequent procedure within a 5-year period. Multivariable logistic regression identified a lower likelihood of surgeon change in patients undergoing functional or cosmetic cartilage grafting procedures (OR 0.342, 95%CI 0.155-0.714, P = .006) and in patients who self-paid for their procedure (OR 0.476, 95%CI 0.225-0.984, P = .048). One hundred twenty-four patients underwent a cosmetic revision rhinoplasty and were twice as likely to change surgeons as those who underwent functional revision rhinoplasty (OR 2.042 95%CI 1.046-4.050, P = .038). Time elapsed (>2 years) was positively correlated with likelihood of surgeon change (OR 1.236, 95%CI 1.153-1.333, P

We describe reconstruction of the orbital floor following suprastructure maxillectomy for resection of maxillary squamous cell carcinoma utilizing an osteocutaneous radial forearm free flap and palmaris longus tendon. [ABSTRACT FROM AUTHOR]

Objective: Fluorescence‐guided surgery (FGS) is a rapidly developing intraoperative technology, and many contrast agents are currently under investigation. We sought to provide a review of the current state of FGS clinical trials in Otolaryngology, emphasizing its oncologic applications. Methods: According to the preferred reporting Items for systematic reviews and meta‐analyses (PRISMA) workflow for scoping reviews, a clinical trial search was performed across multiple international clinical trials registries, searching for permutations of "fluorescence," "tumor," "surgery," and "nerve" to identify all relevant studies. Studies that were active, enrolling, or soon to be enrolling patients undergoing head and neck surgery were included. Results: Nineteen studies were eligible for inclusion. Seventeen studies are focused on FGS for oncologic resection and lymph node detection. One study assesses peripheral nerve fluorescence, and one evaluates normal parathyroid function after thyroidectomy. Contrast agents under development are conjugated to fluorophores that excite in the 800 nm (indocyanine green), 410 nm (5‐aminolevulinic acid), 700 nm (Cyanine 5.5), and 525 nm ranges (fluorescein derivatives). Conclusion: Presently, there are 19 ongoing trials investigating novel FGS contrast agents for their safety, efficacy, and utility in Otolaryngology—Head and Neck Surgery. These agents rely on unique fluorophores and absorption ranges in the near‐infrared and visible light spectra. FGS studies are expanding within Otolaryngology—Head and Neck Surgery with profound implications in oncologic surgery, lymph node detection, and anatomic and functional assessment. Laryngoscope, 132:36–44, 2022 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: A subset of patients will undergo revision endoscopic sinus surgery (ESS) with a different otolaryngologist than the one who performed their primary surgery. The purpose of this study is to report the incidence of and clinicodemographic factors associated with a change in surgeon for revision ESS. Study Design: Retrospective cohort study. Methods: Adult patients who underwent at least two outpatient ESS procedures between 2009 and 2014 using the State Ambulatory Surgery Database for Florida were included in the study. Change in surgeon was defined by a change in a unique provider identifier for the revision procedure. Multivariable regression analysis was used to determine characteristics associated with a change in surgeon. Results: A total of 2,963 patients were included. For the revision procedure, 47.7% of patients changed their surgeon. On multivariable logistic regression, a medium‐ (odds ratio [OR]: 0.64; 95% confidence interval [CI]: 0.53‐0.77) or high‐volume (OR: 0.50; 95% CI: 0.42‐0.61) surgeon performing the index surgery and advanced age (≥65 years) (OR: 0.79; 95% CI: 0.63‐0.99) were associated with decreased odds of surgeon change for revision ESS. Longer time elapsed between index and revision surgery (OR: 1.15; 95% CI: 1.13‐1.17) was associated with increased odds of surgeon change. Conclusions: Nearly half of patients who undergo revision ESS select a surgeon other than the one who performed their primary procedure. Surgeon volume, age, and time between surgeries affect the likelihood of a change in surgeon for revision ESS. These findings may provide introductory insights into patient preferences and decision making in the surgical management of recalcitrant chronic rhinosinusitis. Level of Evidence: 4 Laryngoscope, 131:E1049–E1053, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Prophylactic flexible bronchoscopy immediately following open airway reconstruction allows for directed clearance of the distal airways, potentially reducing the rate of certain postoperative respiratory complications. In this investigation, we sought to determine if prophylactic flexible bronchoscopy at the conclusion of pediatric open airway reconstruction has any benefit over blind flexible suctioning of the trachea. Methods: A retrospective, single-center study at an urban tertiary care hospital was completed. From January 2010 to April 2013, patients underwent open airway reconstruction, immediately followed by blind flexible suctioning of the trachea for distal airway clearance. From May 2013 through December 2016, sequential patients underwent prophylactic flexible bronchoscopy immediately following airway reconstruction. Results: A total of 29 patients (age: 3.6 months-6.2 years) met inclusion criteria. Sixteen sequential patients underwent simple blind flexible suctioning and 13 sequential patients underwent directed, prophylactic flexible bronchoscopy. Demographics and comorbidities between the groups were equivalent other than slightly older age in the prophylactic bronchoscopy group. All clinical outcomes analyzed were equivalent other than faster time to room air (P <.002) and a decrease in the number of chest physical therapy sessions (P <.02) in a subset of patients who did not undergo prophylactic bronchoscopy. Conclusion: This investigation suggests that the use of prophylactic flexible bronchoscopy immediately following open airway reconstruction may not be superior to blind flexible suctioning of the trachea in limiting postoperative pulmonary complications. Further studies of greater power are needed to better elucidate any small differences that may exist between these two interventions. [ABSTRACT FROM AUTHOR]