Neck Surgery Service Research Articles

The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction.

Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.

CHONDROBLASTIC OSTEOSARCOMA OF THE MANDIBLE: A CASE REPORT

We report a case of chondroblastic osteosarcoma (OC) with an aggressive clinical course in the mandible of a 41-year-old female patient who presented with a painful swelling on the left side of the mandible, with rapid evolution. Imaging examinations revealed a mixed lesion with ill-defined boundaries, promoting expansion, thinning, and perforation of the mandibular cortical. An incisional biopsy was performed and the histopathological report was inconclusive and inconsistent with the clinical features presented by the patient. A case review was requested, which concluded the diagnosis as chondroblastic osteosarcoma. The patient was referred to a head and neck surgery service, where resection of the tumor was performed with a safety margin. The patient had a recurrence of the neoplasm before starting chemotherapy two months after surgery. The patient underwent another marginal resection procedure and is recovering and awaiting authorization to start chemotherapy. We report a case of chondroblastic osteosarcoma (OC) with an aggressive clinical course in the mandible of a 41-year-old female patient who presented with a painful swelling on the left side of the mandible, with rapid evolution. Imaging examinations revealed a mixed lesion with ill-defined boundaries, promoting expansion, thinning, and perforation of the mandibular cortical. An incisional biopsy was performed and the histopathological report was inconclusive and inconsistent with the clinical features presented by the patient. A case review was requested, which concluded the diagnosis as chondroblastic osteosarcoma. The patient was referred to a head and neck surgery service, where resection of the tumor was performed with a safety margin. The patient had a recurrence of the neoplasm before starting chemotherapy two months after surgery. The patient underwent another marginal resection procedure and is recovering and awaiting authorization to start chemotherapy.

SURGICAL MAPPING OF EXTENSIVE POTENTIALLY MALIGNANT ORAL DISORDER WITH TOLUIDINE BLUE STAIN: A CASE REPORT

A 66-year-old male patient who was an ex-smoker and ex-drinker presented with a main complaint of "tongue pain" for 6 months. Physical examination revealed an extensive heterogeneous plaque with mixed white and red patches, irregular borders, and with the largest diameter of 5 cm, located at the left lateral border of the tongue and floor of mouth. Based on the characteristics of the lesion, the clinical diagnosis was leukoplakia. The lesion was mapped using the toluidine blue stain; 4 areas were stained positive, and 2 areas were subjected to incisional biopsy. Histopathologic analysis revealed epithelial dysplasia and squamous cell carcinoma. The definite diagnosis was squamous cell carcinoma. The patient was referred to the head and neck surgery service, where he underwent partial glossectomy and is being followed up with no evidence of recurrence. Toluidine blue stain is important for selection of the incisional biopsy area in extensive heterogeneous lesions suspected of potentially malignant oral disorders and oral cancer.

AMELOBLASTIC CARCINOMA IN MANDIBLE - CASE REPORT

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits histologic characteristics of ameloblastoma. The term "ameloblastic carcinoma" is used to describe those ameloblastomas in which there is histologic evidence of malignancy. In this report, we describe a case of a 41-year-old female patient who sought dental care complaining about the mobility of the right lower second premolar tooth. On intraoral examination, firm swelling that extended from the ipsilateral lateral incisor to the molar was observed. A panoramic radiography showed an osteolytic lesion with irregular margins with a "moth-eaten" aspect in the mandible. Incisional biopsy was performed, and the material was sent for histopathologic analysis, which revealed ameloblastic carcinoma. The patient was referred to the head and neck surgery service where mandibulectomy with neck dissection was performed. The patient is under clinical follow-up for 9 years without recurrence.

VERRUCOUS CARCINOMA IN POSTTRANSPLANTED PATIENT WITH DECH

A male patient, 30 years old, diagnosed with severe aplastic anemia in 2005, underwent a hematopoietic stem cell transplantation in the same year. The patient developed graft-versus-host disease (GVHD), and underwent prolonged immunosuppression, which resulted in the development of nephrotic syndrome and immune thrombocytopenic purpura. The patient came to the dentistry clinic complaining of an oral lesion. We observed the presence of a 2 cm exophytic and ulcerated lesion with hardened edges, slightly bleeding to the touch, on the side of the tongue. In view of the suspicious aspect of the lesion, an incisional biopsy was performed and, after histopathologic analysis, the diagnosis of verrucous squamous cell carcinoma with ulceration was confirmed, and angiolymphatic and perineural invasions were not identified. The patient was referred to the head and neck surgery service for treatment. GVHD is a condition with the potential for malignant transformation, and such oral lesions must be monitored.

Otologic Surgery in a Tropical Environment: About 56 Cases were Operated on at the Yaounde General Hospital-Cameroon

Introduction and Aims : Ear surgery is a separate entity in the surgical activity of ENT department. In ENT services in developed countries, this activity has become routine. Several data on the activity of otologic surgery in Western teams are available. This surgery is performed in our tropical environment, characterized by under-equipment and poor access to care. But few data from the sub-Saharan African series are reported. To contribute to the understanding of this entity, we conducted this study in the ENT service of the Yaounde General Hospital (YGH), Cameroon. The general objective was to study the practice of ear surgery in our setting. Patients and Methods: This was a cross-sectional, descriptive, retrospective study. The study took place from June 2016 to June 2021, i.e. 5 years. The study was conducted in the ENT and Head and Neck Surgery service of the YGH. The sampling was consecutive. We included in this study all patients with an otological disease, treated surgically during the study period. Sociodemographic, clinical, paraclinical, therapeutic, and evolutionary data were collected. Results: Our sample consisted of 56 operated patients, out of a total of 330 surgeries performed during the study period. This represents a frequency of 16.96%. The distribution of patients according to sex was 33 women and 23 men, i.e. a sex ratio of 0.69 in favor of women. The distribution of the patients in the sample according to age showed an average age of 36.98 years, with extremes ranging from 3 years to 92 years. 55 patients, i.e. 98.2%, were undergoing their first otological surgery, and only one patient had already undergone a previous operation. 49 patients (87.5%) had a symptomatology that had been evolving for more than three months. And 7 (12.5%) had acute or sub-acute symptoms. The main pathologies found and operated on were: open non cholesteatoma chronic otitis with 19 patients (33.92%), otomastoiditis with 9 cases (16.01%), cholesteatoma chronic otitis with 8 cases (14.28%), followed by other pathologies such as otoscléroses, osteomas of the external auditory canal, etc. with 7 cases (12.5%). The most common surgical procedure was tympanoplasty with 19 cases (33.9%), mastoidectomy with 9 cases (16.1%), petro-mastoidectomy with 8 cases (14.3%), extraction of foreign bodies from the auditory canal with 5 cases (8.9%) and cochlear implantation with 4 cases (7.1%). 4 patients, i.e. 7.2%, presentedcomplications (4 infectious, 1 complaining of tinnitus). 55 patients, i.e. 98.2%, saw an improvement in their symptoms with a favorable evolution. Conclusion: The non-negligible frequency found in our practice at the YGH reflects the definite evolution of this surgery in our environement. The patients are young, chronic open otitis media without cholesteatoma are the main indication, and tympanoplasty is the most practiced surgical modality.

Prognostic analysis of lymph node ratio of patients with disease recurrence previously submitted to cervical dissection surgery for head and neck cancer.

the variable lymph node ratio has recently been studied as a possible influencer in the survival of patients diagnosed with head and neck cancer. to analyze the correlation between lymph node density and survival of recurred disease patients previously submitted to cervical dissection surgery due to head and neck squamous cell carcinoma. we retrospectively analyzed 71 medical records of patients treated at the Head and Neck Surgery Service of the Pontifícia Universidade Católica de Campinas who had undergone cervical dissection surgery and presented tumor recurrence between 2006 and 2019. Patient and tumor data such as age, gender, skin color, smoking, alcohol consumption, location of the primary tumor, anatomopathological characteristics and lymph node status were correlated with the survival time. we found a predominance of males and the mean age was 59.5 years. The most frequent primary site was the oral cavity followed by the larynx and oropharynx. The mortality rate was 53.52% and the mean lymph node ratio 0.28. We found influence on survival with statistical significance for the parameters: lymph node ratio, number of dissected and affected lymph nodes, T and N staging, type of treatment proposed (palliative or surgical), presence of compromited margins in the primary tumor and lymph node extravasation. the calculation of lymph node density in patients with recurred disease after cervical dissection surgery by head and neck squamous cell carcinoma should be taken into account during therapeutic planning and prognostic evaluation due to its direct influence on the survival.

EXTENSIVE MELANOMA IN THE PALATE: A CASE REPORT

A 63-year-old leucoderm man sought the dentistry service with a pigmented irregular lesion measuring approximately 4 × 4 cm in hard and soft palate and alveolar bone without symptoms . This lesion presented ABCDE signs of melanoma. The patient has diabetes mellitus type 2 and is an ex-smoker. The last dentistry visit was 40 years ago. The clinical hypothesis was oral melanoma, so a partial biopsy was performed in an anterior board site. Histopathologic diagnosis suggested malignant melanotic lesion, and immunohistochemistry analysis showed that the lesion was HMB45, KI-67, Melan A, and S100 positive, confirming oral melanoma diagnosis. Next, the patient was referred to head and neck surgery service. A palate device was performed after maxillectomy and partial pharyngectomy surgery to improve quality of life. The patient remains under clinical followed by the surgery service. Oral melanoma is most commonly on the palate and has approximate 20% survival rate over 5 years.

EPITHELIAL-MYOEPITHELIAL CARCINOMA OF MINOR SALIVARY GLANDS: A CASE REPORT

Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic low-grade malignant tumor accounting for less than 0.5% of all salivary gland tumors. We report a case of a 65-year-old Afrodescendant female presenting a painful nonulcerated nodular lesion on the mouth floor, with approximately 5.0 × 2.5 cm. An incisional biopsy was performed, and the specimen revealed proliferation of double-layered duct-like structures composed of clear myoepithelial and luminal cells within a hyalinized stromal, with a thin peripheral fibrous capsule. Immunohistochemical analysis showed outer ductal cells positive for α–smooth muscle actin and AE1/AE3 cytokeratin panel. The diagnosis was EMC. The patient was referred to a head and neck surgery service for proper management, and no recurrence or metastatic disease was observed so far. EMC histologic features frequently resemble other more aggressive salivary gland malignant tumors, such as adenoid cystic carcinoma. The correct diagnosis, based on morphologic and immunohistochemical criteria, is essential to assure the proper management of the tumor.

Rinoplastia estética y funcional, experiencia en la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello

Rinoplastia estética y funcional, experiencia en la Cátedra y Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello

Carcinoma de células escamosas em cisto do ducto tireoglosso: relato de caso

Objetivo: Descrever um caso de paciente com Cisto de Ducto Tireoglosso com malignização do tipo carcinoma de células escamosas. Relato de Caso: Paciente com 51 anos de idade, masculino, procurou o serviço de endocrinologia com queixa de massa cervical sem sintomas associados. Foi então solicitado ultrassom cervical, que revelou presença de formação cística de paredes finas, conteúdo homogêneo espesso, em aspecto de grão de areia, localizada na linha média. Aventou-se a hipótese de Cisto de Ducto Tireoglosso, sendo adotada conduta expectante, com ultrassonografias cervicais periódicas. Após aproximadamente dezoito meses, observou-se aumento das dimensões do cisto, sendo então encaminhado ao serviço de Cirurgia de Cabeça e Pescoço. Com base no exame físico e demais exames o diagnóstico de Cisto de Ducto Tireoglosso foi firmado e optado por realização de cirurgia de Sistrunk e envio de material para anatomopatológico. Após análise patológica foi elucidado o diagnóstico de Carcinoma de Células Escamosas de Cisto de Ducto Tireoglosso. Indicou-se então nova abordagem cirúrgica com laringectomia total. Considerações Finais: Sendo o Carcinoma de Células Escamosas de Cisto de Ducto Tireoglosso uma entidade que não apresenta inicialmente sinais clínicos de alarme, deve-se suspeitar de malignidade sempre que houver um caso de Cisto de Ducto Tireoglosso.

Advanced Stage Stuck Gland Adenocarcinoma: Case Report

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.

Facial Reconstruction According to Aesthetic Units.

Context:The facial subunit principle organizes the facial skin into subunits. Facial reconstruction for skin cancer based on aesthetic units consists of replacing the entire subunit when a large part of a subunit has been removed.Aims:To determine the prevalence of facial skin cancer, their location by facial aesthetic units, and the type of facial reconstruction used in each of them.Settings and Design:An observational cross-sectional study was conducted at the Head and Neck Surgery Service of a general hospital between 2017 and 2018.Materials and Methods:A population census was conducted during this period.Statistical Analysis Used:The categorical variables were expressed as frequencies (percentages). Continuous variables were described as the means and standard deviations or medians and interquartile ranges.Results:The most common skin cancer was basal cell skin cancer, followed by epithelial skin cancer and, at last, melanoma. In general, the most frequent localization of these cancers was the nose.Conclusions:In spite of primary closure being the most common form of reconstruction, a considerable number of patients required facial reconstruction based on aesthetic facial units, with satisfying results.

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology-Head and Neck Surgery?

(1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Retrospective case series. Tertiary academic hospital. The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology-head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

Impact of international classification of diseases, 10th revision, on head and neck surgery

Review changes in the number of International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes utilized in head and neck surgery service and associated changes in cost and charges of health services. A retrospective cross-sectional analysis was performed utilizing the Nationwide Readmissions Database, 2015. The study population included patients who were admitted for a primary head and neck procedure. Patients discharged in the third quarter (Q3), coding system ICD-9-CM, compared to patients discharged in the fourth quarter (Q4), coding system ICD-10-CM. A total of 11,456 and 10,431 patients discharged in Q3 and Q4, respectively. Comparing the top 90% billed disease codes demonstrated that the number of ICD-10-CM codes was more by a factor of 1.20. However, classifying codes by type of surgery, fewer codes were used in patients who had laryngeal surgeries or tonsillectomy/adenoidectomy by a factor of 0.8. Codes used to document the primary diagnoses for patients who underwent tracheostomy increased the most by a factor of 1.42. Controlling for multiple factors that would affect the cost of health services, there were no significant changes in the cost of management per case (Q3: $70,189.00 ± 1,546.39 vs. Q4: $70,502.00 ± 1,560.17, P = 0.68) or hospital charges (Q3: $273,411.00 ± 7,852.78 vs. Q4: 265,996 ± 7922.77, P = 0.05). The ICD-10-CM provides an expansion of codes. Initial indication is that utilization of ICD-10-CM codes for head and neck surgery is within expected parameters and appears not to affect the cost of management and hospital charges despite the overall increase in ICD codes in the newer version. NA Laryngoscope, 130:398-404, 2020.

Adenoid Cystic Carcinoma: Report of a Case

Adenoid cystic carcinoma (ACC) is a relatively rare tumor of the salivary glands with poor prognosis due to a high rate of recurrence and delayed onset of distant metastases. The most common symptom is a slow growing, painful mass due to perineural invasion. A 36-year-old woman presented with the chief complaint of a painful “small ball” in her lower lip for 2 years. Clinical examination showed a small submersed nodule with normal labial mucosa. Due to persistent pain and presence of the nodule, a surgery procedure was performed and the material was sent for histological evaluation. A diagnosis of ACC with a cribriform pattern was obtained and the patient was referred to a head and neck surgery service. Complementary examinations did not reveal nodal or distant metastases, and only surgical treatment was performed. After 5 years of follow-up, the patient has not shown any local or distant metastases.

Characterization of thyroid tissue using infrared spectroscopy

Introduction: In recent years, the number of surgical procedures involving the thyroid gland has increased worldwide; however, no increase in mortality rate has been observed. The Fourier Transform Infrared (FTIR) spectroscopy technique presents evidence in the characterization of multiple tissues, such as the thyroid gland, with the advantage of being rapid and preserving the tissue analyzed. Objectives: Characterize both healthy and pathological thyroid tissues by FTIR spectroscopy. Methods: Patients were selected at the Head and Neck Surgery Service of the Hospital das Clínicas, Ribeirão Preto Medical School, University of Sao Paulo - USP, Ribeirão Preto-SP, Brazil, from 2014 to 2015. The sample consisted of 44 patients with reference for thyroidectomy. The analysis was performed by defining the areas of each band using the OriginPro 8.6.0 software. The band was then normalized to 1240 cm-1. The mean area was calculated using the Student’s t-test with p<0.05. After calculation of the means, the second-order derivative of the spectrum was evaluated to show the positions of each absorption band. Results: The infrared spectrum of each piece was obtained and expressed as a function of absorbance and wave numbers in the mean IR (4000-900 cm-1). The present study demonstrated that, in the analysis of thyroid tissue by FTIR spectroscopy, it is possible to differentiate benign nodules from healthy tissue with significant difference in the area of the B-band between healthy tissue and goiter, which corresponds to 1452.90 cm-1 in healthy tissue (proteins and lipids) and 1069.80 cm-1 in goiter (DNA), as well as significant difference in width between normal thyroid tissue and carcinoma of the C band. Conclusions: FTIR spectroscopy is able to differentiate pathologically altered thyroid tissues from the thyroid gland compared with findings in healthy thyroid tissues. In patients with benign nodular disease of the thyroid gland, it is possible to differentiate healthy goiter tissue with statistical significance, as well as malignant nodules from healthy tissue through FTIR spectroscopy.

Multimodal Analgesia in Outpatient Head and Neck Surgery

Importance Perioperative analgesia strategies that rely solely on narcotics may contribute to adverse effects and concerns about opioid abuse or dependence. Multimodal analgesia protocols incorporating nonnarcotic agents may reduce the need for postoperative narcotic use. Objective To evaluate the feasibility and safety of a multimodal analgesia protocol for outpatient head and neck surgical procedures and to identify the association of the multimodal analgesia protocol with postoperative pain perception scores and patient satisfaction. Design, Setting, and Participants Retrospective evaluation of prospectively collected data on adults who underwent outpatient thyroid, parathyroid, and parotid surgery between July 2016 and February 2017 at the head and neck surgery service of a tertiary care hospital using a multimodal analgesia strategy with use of immediate preoperative acetaminophen and gabapentin, and intention to treat with a nonnarcotic postoperative outpatient analgesia strategy. Main Outcomes and Measures Overall patient satisfaction scores, Overall Benefit of Analgesia Score (OBAS), and median resting and peak pain scores were recorded. Incidence of reliance on a narcotic-based postoperative outpatient analgesia strategy and adverse events related to altered analgesia strategy were identified. Results Sixty-four patients (48 [75%] female; mean [SD] age, 54.6 [14.3] years) underwent outpatient thyroid, parathyroid, or parotid surgery with use of a multimodal analgesia protocol. On a 10-point rating scale, patients reported low resting pain perception scores (median, 2 [range, 0-8]) and peak pain scores (median, 4 [range, 0-9]). The OBAS assessment for composite effectiveness of analgesia indicated a favorable median score of 1 (range, 0-10; permissible range, 0-28, with lower scores better). Thirty-nine (61%) patients were able to avoid postoperative narcotic use on discharge. Fifty-six (88%) patients reported “high” or “very high” satisfaction with the multimodal analgesia strategy. No complications related to bleeding, hematoma, significant adverse events, or readmissions were observed. Conclusion and Relevance A multimodal analgesia strategy was feasible and safe in patients undergoing outpatient head and neck surgery and may reduce the need for narcotic use. It was associated with low pain perception scores, favorable OBAS, and overall satisfaction scores. The role of multimodal analgesia needs additional evaluation through comparative effectiveness assessment vs conventional pain management strategies.

Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center

ImportanceThe consultation patterns of an otolaryngology–head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown.ObjectiveTo assess trends in otolaryngology–head and neck surgery consultations conducted in emergency departments (EDs) and inpatient services.Design, Setting, and ParticipantsA retrospective analysis was conducted of the medical records of patients at a quaternary care center receiving inpatient otolaryngology consultations from January 1 to December 31, 2014.ExposureClinical evaluation and bedside and operative procedures performed by the otolaryngology–head and neck surgery service.Main Outcomes and MeasuresDemographics, reason for consultation, diagnosis, bedside procedures, operative interventions, and admission variables.ResultsA total of 1491 consultations were completed for adult (1091 [73.2%]; 854 men and 637 women; mean [SD] age 50.3 [19.3] years) and pediatric (400 [26.8%]; 232 boys and 168 girls; mean [SD] age, 4.0 [5.2] years) patients. Of the 1491 consultations, 766 (51.4%) originated from inpatient teams vs 725 (48.6%) from the ED. A total of 995 of all consultations (66.7%) resulted in a bedside procedure, and 243 (16.3%) required operative intervention. Consultations regarding airway evaluation (362 [47.3%] vs 143 [19.7%]), management of epistaxis (78 [10.2%] vs 33 [4.6%]), and rhinologic evaluation (79 [10.3%] vs 18 [2.5%]) were more frequent from inpatient teams than from the ED. Consultations regarding management of head and neck infections (162 [22.3%] vs 32 [4.2%]), facial trauma (235 [32.4%] vs 16 [2.1%]), and postoperative complications (73 [10.1%] vs 2 [0.3%]) were more frequent in the ED. Of the 725 consultations performed in the ED, 212 patients (29.2%) required hospitalization.Conclusions and RelevanceThe consultation volume of an otolaryngology–head and neck surgery service requires significant time and resources. Consultations are most often for rhinologic or laryngologic issues and are reflective of the clinical setting in which the patient is evaluated. Cost savings may be realized by increasing health care access points for nonurgent concerns that can be evaluated in an outpatient setting.

Predictors and costs of readmissions at an academic head and neck surgery service.

Health care metrics, such as readmission rates, are being scrutinized to improve quality and decrease cost of care. The purpose of this study was to determine the rate, predictors, and costs of 30-day unplanned readmissions (30dURs) in patients who undergo head and neck surgery. All patients undergoing head and neck surgery at the Ohio State University from July 1, 2011, to June 30, 2012, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for 30dURs. \Six hundred seven patients underwent 660 operations. Forty-eight cases (7.3%) had a 30dUR. Significant independent risk factors for readmissions included: coronary artery disease (odds ratio [OR] = 2.80; confidence interval [CI] = 1.3-5.9), chronic renal failure (OR = 3.56; CI = 1.5-8.5), not attending the preoperative clinic (OR = 2.74; CI = 1.2-6.3), length of stay (LOS) >5 days (OR = 3.19; CI = 1.6-6.5), and presence of a gastrostomy tube (OR = 2.75; CI = 1.3-5.8).The total cost of 30dURs was $1.68 million. The 30dURs in patients who undergo head and neck surgery can be low, but costly. Identifying patients at risk for 30dUR will help develop preventative strategies. © 2015 Wiley Periodicals, Inc. Head Neck 38: E502-E510, 2016.