1
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Nasrollahi T, Borrelli M, Lin HW, Djalilian HR. Cogan Syndrome: A Case Study and Review of the Literature. Ear Nose Throat J 2023; 102:35S-39S. [PMID: 37551701 DOI: 10.1177/01455613231187765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Cogan syndrome is an autoimmune disease characterized by vestibular symptoms, bilateral sensorineural hearing loss, and inflammatory ocular manifestations, which may be accompanied by systemic vasculitis. We herein present the case of a patient with bilateral sensorineural hearing loss who presented with pain over her cochlear implantation incision site. She was later found to have evidence of ocular disease and underlying vasculitis leading to a diagnosis of Cogan syndrome.
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Affiliation(s)
- Tasha Nasrollahi
- Cedars-Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- Cedars-Sinai Department of Otolaryngology, Los Angeles, CA, USA
| | - Michela Borrelli
- Cedars-Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- Cedars-Sinai Department of Otolaryngology, Los Angeles, CA, USA
| | - Harrison W Lin
- Departments of Otolaryngology-Head and Neck Surgery, and Neurological Surgery, University of California, Irvine, CA, USA
| | - Hamid R Djalilian
- Departments of Otolaryngology-Head and Neck Surgery, and Neurological Surgery, University of California, Irvine, CA, USA
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2
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Shahrestani S, Sayed S, Nasrollahi T, Nasrollahi T, Huang L, McGillivray E, Chour W, Foong A, Dowlatshahi S. Association between frailty status and complications in patients undergoing surgical excision of malignant esophageal neoplasms. Ann Gastroenterol 2023; 36:517-523. [PMID: 37664228 PMCID: PMC10433248 DOI: 10.20524/aog.2023.0825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 09/05/2023] Open
Abstract
Background Research within the last decade highlights the patients' frailty status as an important predictor of esophageal cancer outcomes, but the literature evaluating frailty's role in these patients remains limited. We evaluated the role of frailty in patients undergoing resection of malignant esophageal neoplasms. Methods We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients who underwent excision of a malignant esophageal neoplasm. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Propensity score matching identified 289 frail patients and 281 non-frail patients. Mann-Whitney U testing was performed and receiver operating characteristic (ROC) curves were created, following the creation of logistic regression models for predicting discharge disposition. The area under the curve (AUC) served as a proxy for model performance. Results Frail patients had significantly more nonroutine discharges, longer inpatient lengths of stay, higher costs, more acute infections, posthemorrhagic anemia and deep vein thrombosis, and greater mortality (P<0.05). No significant differences were found between the 2 cohorts with respect to readmission rates, pulmonary embolism or dysphagia. Predictive models for patient discharge disposition demonstrated that frailty status in combination with age resulted in better ROC curves (AUC: 0.652) compared to models using age alone (AUC: 0.601). Conclusions Frailty was found to be significantly correlated with higher rates of inpatient medical complications following esophagectomy. The inclusion of patient frailty status in predictive models for discharge disposition resulted in a better predictive capacity compared to those using age alone.
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Affiliation(s)
- Shane Shahrestani
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
- Department of Medical Engineering, California Institute of Technology, Pasadena (Shane Shahrestani)
| | - Sammy Sayed
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
| | - Tania Nasrollahi
- California Northstate University College of Medicine, Elk Grove (Tania Nasrollahi, Tasha Nasrollahi), CA, USA
| | - Tasha Nasrollahi
- California Northstate University College of Medicine, Elk Grove (Tania Nasrollahi, Tasha Nasrollahi), CA, USA
| | - Linda Huang
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
| | - Erin McGillivray
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
| | - William Chour
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
| | - Andrew Foong
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
| | - Shadi Dowlatshahi
- Department of Internal Medicine, Keck School of Medicine, University of Southern California, Los Angeles (Shane Shahrestani, Sammy Sayed, Linda Huang, Erin McGillivray, William Chour, Andrew Foong, Shadi Dowlatshahi)
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3
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Shahrestani S, Silverstein M, Nasrollahi T, Nasrollahi T, Maas M, Ugarte C, Kulkarni S, Lenz HJ, Genyk Y. The influence of frailty on perioperative outcomes in patients undergoing surgical resection of liver metastases: a nationwide readmissions database study. Ann Gastroenterol 2023; 36:333-339. [PMID: 37144016 PMCID: PMC10152815 DOI: 10.20524/aog.2023.0787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/15/2023] [Indexed: 05/06/2023] Open
Abstract
Background Liver metastases arise frequently from primary colorectal, pancreatic, and breast cancers. Research has highlighted the patient's frailty status as an important predictor of outcomes, but the literature evaluating the role of frailty in patients with secondary metastatic disease of the liver remains limited. Using predictive analytics, we evaluated the role of frailty in patients who underwent hepatectomy for liver metastases. Methods We used the Nationwide Readmissions Database from 2016-2017 to identify patients who underwent resection of a secondary malignant neoplasm of the liver. Patient frailty was evaluated using the Johns Hopkins Adjusted Clinical Groups (JHACG) frailty-defining diagnosis indicator. Propensity score matching was performed and Mann-Whitney U testing was used to analyze complication rates. Receiver operating characteristic (ROC) curves were created following creation of logistic regression models for predicting discharge disposition. Results Frail patients reported significantly higher rates of nonroutine discharges, longer inpatient stays, greater costs, higher rates of acute infection, posthemorrhagic anemia, urinary tract infection (UTI), deep vein thrombosis (DVT), wound dehiscence and readmission, and greater mortality (P<0.05). Predictive models for patient discharge disposition, DVT and UTI demonstrated that the use of frailty status and age improved the area under the ROC curves significantly compared to models using age alone. Conclusions Frailty was found to be significantly correlated with higher rates of medical complications during inpatient stay following hepatectomy in patients with liver metastasis. The inclusion of patient frailty status in predictive models improved their predictive capacity compared to those using age alone.
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Affiliation(s)
- Shane Shahrestani
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA (Shane Shahrestani)
| | - Madeleine Silverstein
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
| | - Tania Nasrollahi
- California Northstate University College of Medicine, Elk Grove, CA (Tania Nasrollahi, Tasha Nasrollahi)
| | - Tasha Nasrollahi
- California Northstate University College of Medicine, Elk Grove, CA (Tania Nasrollahi, Tasha Nasrollahi)
| | - Marissa Maas
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
| | - Chaiss Ugarte
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
| | - Sujit Kulkarni
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
| | - Heinz-Josef Lenz
- Department of Preventative Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, California (Heinz-Josef Lenz); USA
| | - Yuri Genyk
- Department of Hepatobiliary Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA (Shane Shahrestani, Madeleine Silverstein, Marissa Maas, Chaiss Ugarte, Sujit Kulkarni, Yuri Genyk)
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4
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Borrelli M, Nasrollahi T, Raskin J, Khan S, Alexander RE. Laryngotracheal Recurrent Papillomatosis: A Case Study and Survey of Surgical and Systemic Management. Ear Nose Throat J 2022; 101:47S-51S. [PMID: 36173000 DOI: 10.1177/01455613221128714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This case report presents a 72-year-old man with longstanding recurrent respiratory papillomatosis (RRP). He has undergone multiple procedures for the condition, including an apparent urgent surgical airway followed by tracheoplasty repair. Modern management of complicated RRP should include both local debulking and systemic approaches. Systemic bevacizumab (Avastin) has shown some initial success as an effective treatment option, in addition to other medications such as pembrolizumab. Other future care strategies may include an HPV vaccination and other adjuvants; vaccination has been reported to have the possibility of drastically reducing the incidence of RRP.
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Affiliation(s)
- Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,6918Oakland University William Beaumont School of Medicine, Detroit, MI, USA
| | - Sana Khan
- 43986American University of Antigua College of Medicine, Osbourn, AN, USA
| | - Ronda E Alexander
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,2013Montefiore Medical Center, Bronx, NY, USA
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5
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Borrelli M, Nasrollahi T, Raskin J, Khan S, Mehdizadeh OB. Severe Airway Edema Following Calcium Hydroxylapatite (CaHA) Injection Augmentation. Ear Nose Throat J 2022; 101:52S-55S. [PMID: 36172821 DOI: 10.1177/01455613221127584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case study presents an abnormal complication after routine injection augmentation using calcium hydroxylapatite (CaHA) vocal fold filler in-office on a 73-year-old female. The patient presented initially with severe dysphonia, hypophonia, and a past surgical history of total thyroidectomy, bilateral neck dissection, and a right lateral neck dissection for history of metastatic papillary thyroid carcinoma. She also had a past medical history of hypothyroidism. Post-injection of CaHA, the patient developed severe laryngeal edema, limited vocal cord mobility, obliteration of the pyriform, and a significantly reduced airway aperture requiring intensive care monitoring. Although uncommon, injectable fillers can result in complications which can be severe. Careful technique, the volume of injectate, and hypersensitivity should be considered in reducing complications following injection augmentation. There are multiple injection techniques to consider. The most direct approach is with direct laryngoscopy to allow for visualization of glottic incompetence. A smaller slotted laryngoscope can be considered for vocal fold injection as an alternative and without endotracheal intubation. Although these techniques allow for injection, real-time assessment of vocal fold closure is done in an awake patient. Therefore, laryngeal injection can be considered via percutaneous, per-oral, and trans-nasal approaches.
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Affiliation(s)
- Michela Borrelli
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,6918Oakland University William Beaumont School of Medicine, Detroit, MI, USA
| | - Sana Khan
- 43986American University of Antigua College of Medicine, Saint Johns, AG, USA
| | - Omid B Mehdizadeh
- Pacific Head and Neck, Pacific Neuroscience Institute, Santa Monica, CA, USA
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6
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Nasrollahi T, Borrelli M, Raskin J, Wrobel BB. A Case of Mediastinal Emphysema Following Functional Endoscopic Sinus Surgery. Ear Nose Throat J 2022; 101:44S-46S. [PMID: 36148716 DOI: 10.1177/01455613221121492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediastinal emphysema is an extremely rare and potentially fatal complication of endoscopic sinus surgery. The case presented involves a 73-year-old man who developed mediastinal emphysema following endoscopic sinus surgery for severe sinonasal polyposis. We describe the multiple etiologies that may have contributed to his condition including possible microtrauma at the time of intubation or during intubation, microfracture of the orbital wall/lamina papyracea, and severe hiccups.
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Affiliation(s)
- Tasha Nasrollahi
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Michela Borrelli
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Jonathan Raskin
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Bozena B Wrobel
- Sinus Center of Excellence, 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA.,Sinus Center of Excellence, Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,USC Caruso Department of Otolaryngology Head and Neck Surgery, 5116University of Southern California, Los Angeles, CA, USA
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7
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Shohet JA, Borrelli M, Nasrollahi T, Raskin J. Penetration of the Vestibule Following a History of Stapedectomy. Ear Nose Throat J 2022; 101:33S-36S. [PMID: 36062376 DOI: 10.1177/01455613221121501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case study describes a 72-year-old female with a history of stapedectomy 40 years prior. She presented experiencing vertigo, fogginess, and imbalance for 9 months. Computed tomography (CT) imaging revealed that the prosthesis was displaced into the vestibule by approximately 2.1 to 2.4 mm. The patient was presented with treatment options, including observation, removal, replacement of the prosthesis, and an oval window patch. The patient opted for observation as the symptoms she was experiencing did not significantly impact her quality of life. Although a stapedectomy may fail for a multitude of reasons, some of the most common causes are prosthesis displacement, especially out of the oval window into the middle ear or away from the incus. Incus necrosis may also play a substantial role in failure.
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Affiliation(s)
- Jack A Shohet
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,Shohet Ear Associates, Orange County, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,472525California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA
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8
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Raskin J, Nasrollahi T, Borrelli M, Birkeland A. Facial Paresis After Mandibular Reconstruction. Ear Nose Throat J 2022; 101:37S-39S. [PMID: 36053551 DOI: 10.1177/01455613221121497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Condylar neck fractures are common injuries that occur in the facial and mandibular regions. The proximity of this area to the vital neurovasculature creates the increased importance of proper surgical intervention to limit damage to the underlying structures. Here, we report a case of a condylar neck fracture that resulted in temporary paresis of the facial nerve. In addition, a review of the literature regarding condylar fracture treatment and its complications was conducted.
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Affiliation(s)
- Jonathan Raskin
- William Beaumont School of Medicine, 6918Oakland University, Rochester, MI, USA.,22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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9
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Raskin J, Nasrollahi T, Borrelli M, Nasseri S. Acute Variceal Hemorrhage and Airway Obstruction in a Patient With Reinke's Edema. Ear Nose Throat J 2022; 101:30S-32S. [PMID: 36052403 DOI: 10.1177/01455613221123825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental stressors, such as smoking and vocal cord usage, thus, treatment involves their corresponding cessation.1 Here, we report a case of a patient with severe Reinke's edema and bilateral chronic vocal cord varices. The patient had a 30-pack-year history of cigarette smoking and was obstructed with intubation due to acute variceal hemorrhage and severe swelling of Reinke's edema. Moreover, a review of the literature regarding Reinke's edema and variceal hemorrhage treatment and their complications was performed.
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Affiliation(s)
- Jonathan Raskin
- William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA.,22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,472525California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
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10
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Miller JE, McCormick JP, Raskin J, Borrelli M, Nasrollahi T, Suh JD. Endoscopic Management of a Post-Traumatic Internal Maxillary Artery Pseudoaneurysm: Case Report and Review of the Literature. Ear Nose Throat J 2022; 101:40S-43S. [PMID: 36047445 DOI: 10.1177/01455613221121443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Internal maxillary artery (IMA) pseudoaneurysms are rare, and typically occur following trauma or orthognathic surgery. Pseudoaneurysms are life-threatening conditions, and expeditious workup and treatment is critical. Endoscopic treatment of an IMA pseudoaneurysm is a feasible option and should be considered when IR embolization is not available. The objective of this study is to review the literature on IMA pseudoaneurysms and present the first reported case of an IMA pseudoaneurysm successfully treated endoscopically.
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Affiliation(s)
- Jessa E Miller
- Department of Head and Neck Surgery, 8783University of California, Los Angeles, CA, USA
| | - Justin P McCormick
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Health, Newark, NJ, USA
| | - Jonathan Raskin
- William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA.,Sinus Center of Excellence, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Michela Borrelli
- Sinus Center of Excellence, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA.,Division of Otolaryngology, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- Sinus Center of Excellence, 22494Cedars Sinai Medical Center, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, 8783University of California, Los Angeles, CA, USA
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11
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Nasrollahi T, Michela Borrelli, Raskin J, Tawk K, Djalilian HR. Cholesteatoma With Cochlear Fistula and Carotid Dehiscence. Ear Nose Throat J 2022; 101:19S-22S. [PMID: 36045486 DOI: 10.1177/01455613221123823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cholesteatomas are non-neoplastic, invasive lesions created by the accumulation of keratinized squamous epithelium in the temporal bone. If left untreated, its expansion may cause local destruction of the surrounding structures, eventually leading to inner ear fistula, dehiscence of tegmen and possible intracranial pathology, and facial nerve paralysis. Surgical resection is the mainstay of curative treatment. We hereby present a case of a giant cholesteatoma in a 62-year-old patient who presented with a right-sided hemifacial spasm with later paralysis who was treated with botulinum toxin injection by a neurologist. CT scan imaging showed a very large cholesteatoma with involvement of the carotid canal, cochlea, and geniculate ganglion. The patient underwent transmastoid and subarcuate approach for resection which led to marked improvement of her symptoms.
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Affiliation(s)
- Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Jonathan Raskin
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,22494Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Karen Tawk
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, 8788University of California Irvine, Irvine, CA, USA
| | - Hamid R Djalilian
- Division of Neurotology and Skull Base Surgery, Department of Otolaryngology - Head & Neck Surgery, 8788University of California Irvine, Irvine, CA, USA
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12
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Raskin J, Borrelli M, Nasrollahi T, Chen H. Rhinoplasty Complication Requiring Multiple Revisions. Ear Nose Throat J 2022; 101:23S-25S. [DOI: 10.1177/01455613221123826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cosmetic rhinoplasties are complex surgical procedures that can present with serious complications requiring revision surgeries. Septal graft difficulties are common complications in rhinoplasties, requiring surgeon awareness of the potential future need for corrective surgery. Here, we report a case of multiple revision cosmetic rhinoplasties due to recurrent complications. Additionally, a review of the literature regarding cosmetic rhinoplasty complications and risk factors was performed.
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Affiliation(s)
- Jonathan Raskin
- William Beaumont School of Medicine, Oakland University, Detroit, MI, USA
- Sinus Center of Excellence, Cedars Sinai, Los Angeles, CA, USA
| | - Michela Borrelli
- Sinus Center of Excellence, Cedars Sinai, Los Angeles, CA, USA
- Division of Otolaryngology, Cedars-Sinai, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- Sinus Center of Excellence, Cedars Sinai, Los Angeles, CA, USA
- College of Medicine, California Northstate University, Elk Grove, CA, USA
| | - Henry Chen
- Division of Otolaryngology, Cedars-Sinai, Los Angeles, CA, USA
- Division of Facial Plastic and Reconstructive Surgery, Cedars-Sinai, Los Angeles, CA, USA
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13
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Raskin J, Borrelli M, Nasrollahi T, Heaton C. Tracheal Rupture After Tracheostomy Tube Exchange in a Patient With Recurrent Oral Cavity Spindle Cell Carcinoma. Ear Nose Throat J 2022; 101:15S-18S. [PMID: 36017599 DOI: 10.1177/01455613221123854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Oral Cavity Spindle Cell Carcinoma (OCSCC) is a rare variant of squamous cell carcinoma involving the nasopharynx and oral mucosa. This tumor has a high propensity to invade local structures of the head and neck region, making surgical removal challenging and potentially morbid for the patient. Here, we report a case of OCSCC and the complications that were confronted during its surgical resection. Additionally, a review of the literature regarding OCSCC complications and their treatments was performed.
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Affiliation(s)
- Jonathan Raskin
- William Beaumont School of Medicine, 6918Oakland University, Detroit MI, USA
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Chase Heaton
- 8785University of California San Francisco, San Francisco, CA, USA
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14
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Liu D, Jang S, Suh JD, Borrelli M, Nasrollahi T, Raskin J, Ference EH. Retained Dental Implant in the Maxillary Sinus. Ear Nose Throat J 2022; 101:6S-11S. [PMID: 35968734 DOI: 10.1177/01455613221121043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Implant dentistry has become a popularized means of replacing damaged or missing teeth. Although it has become common practice, there are accounts of implants displacing into surrounding structures, commonly the maxillary sinus. We present the case of a 54-year-old man who presented with chronic left sided pain and pressure found to be secondary to a displaced implant obstructing the left maxillary outflow sinus tract. A systematic review was conducted to assess the current management and treatment options for dental implants displaced into the maxillary sinus. Functional endoscopic sinus surgery (FESS) and the lateral window approach were both found to be safe techniques with minimal postoperative complications.
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Affiliation(s)
- Derek Liu
- Department of Otolaryngology-Head and Neck Surgery, 8788University of California Irvine, Irvine, CA, USA
| | - Sophie Jang
- Department of Otolaryngology-Head and Neck Surgery, 8784University of California San Diego, San Diego, CA, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, 12222David Geffen School of Medicine of the University of California Los Angeles, Los Angeles, CA, USA
| | - Michela Borrelli
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- 22494Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA.,Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Jonathan Raskin
- Cedars-Sinai Division of Otolaryngology, Los Angeles, CA, USA.,California Northstate University College of Medicine, Elk Grove, CA, USA.,William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA
| | - Elisabeth H Ference
- Caruso Department of Otolaryngology-Head and Neck Surgery, 12223Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
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15
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Borrelli M, Nasrollahi T, Ulloa R, Raskin J, Ference E, Tang DM. Invasive Fungal Sinusitis During Active COVID-19 Infection. Ear Nose Throat J 2022; 101:12S-14S. [PMID: 35770808 PMCID: PMC9247627 DOI: 10.1177/01455613221112337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case study demonstrates a 58-year-old female who contracted COVID-19 post-vaccination presenting with severe left-sided facial pain, headaches, and dyspnea. A computed tomography was ordered and showed acute sinusitis, and upon bedside endoscopy, the patient was shown to have necrosis of the left-sided middle turbinate with no discoloration, palate necrosis, or facial changes. All samples of the necrotic tissue were reported to be invasive fungal sinusitis. The entire turbinate was resected in the operating room and ethmoid, frontal, and maxillary sinuses were healthy. Chest x-rays post-operatively showed pulmonary effusions and edema although the patient was not stable enough for a lung examination to rule out a pulmonary fungal infection. A bedside endoscopy showed no further necrosis post-operatively although a repeat endoscopy showed duskiness at the lateral attachment of the basal lamella right at the most posterior resection of the middle turbinate. The patient was placed on multiple antifungal agents. The patient remained in hypoxemic respiratory failure and septic shock while on pressors and 2 weeks following this, expired. Post-COVID-19 patients have been shown in the literature to have an increased risk of developing invasive fungal sinusitis (IFS) and all IFS cases during active COVID-19 infection have had a 100% mortality rate.
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Affiliation(s)
- Michela Borrelli
- Sinus Center of Excellence, 22494Cedars Sinai, Los Angeles, CA, USA.,Division of Otolaryngology, 12223Cedars-Sinai, Los Angeles, CA, USA
| | - Tasha Nasrollahi
- Sinus Center of Excellence, 22494Cedars Sinai, Los Angeles, CA, USA.,Division of Otolaryngology, 12223Cedars-Sinai, Los Angeles, CA, USA.,6918California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Ruben Ulloa
- Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Jonathan Raskin
- Sinus Center of Excellence, 22494Cedars Sinai, Los Angeles, CA, USA.,Division of Otolaryngology, 12223Cedars-Sinai, Los Angeles, CA, USA.,William Beaumont School of Medicine, 6918Oakland University, Detroit, MI, USA
| | - Elisabeth Ference
- Caruso Department of Otolaryngology-Head & Neck Surgery, 12223Keck Medicine of University of Southern California, Los Angeles, CA, USA
| | - Dennis M Tang
- Sinus Center of Excellence, 22494Cedars Sinai, Los Angeles, CA, USA.,Division of Otolaryngology, 12223Cedars-Sinai, Los Angeles, CA, USA
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16
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Shahrestani S, Brown NJ, Singh R, Kurtz JS, Patel NA, Himstead AS, Nasrollahi T, Borrelli M, Pierzchajlo N, Ransom SC, Gendreau J. Evaluating the incidence and predictors of anti-NMDAR encephalitis in a contemporary cohort of patients diagnosed with dermoid tumors: A national inpatient sample analysis. J Clin Neurosci 2022; 102:109-113. [PMID: 35777113 DOI: 10.1016/j.jocn.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/24/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a form of encephalitis previously associated with dermoid tumors. However, most studies in the literature evaluating the disease are case reports and small patient cohorts, limiting robust statistical analysis. Here, we demonstrate predictors of anti-NMDAR encephalitis in a large cohort of US patients. METHODS We used the 2016 National Inpatient Sample (NIS) to identify a cohort of 24,270 admitted for an ovarian dermoid tumor. Of these patients, 50 (0.21%) were diagnosed with anti-NMDAR encephalitis. Patient demographics, hospital characteristics, length of stay (LOS), and complications were collected. Statistical analysis consisted of odds ratios with chi-square testing to compare categorical variables. RESULTS The mean age of all patients with dermoid tumors was 45.5 ± 18.0 years, and the mean age of patients with diagnosed anti-NMDAR encephalitis was 27.4 ± 4.9 years. The mean LOS in the dermoid tumor cohort was 3.5 ± 4.9 days, while the mean LOS in the anti-NMDAR encephalitis cohort was 31.9 ± 25.9 days (p < 0.001). The mean cost in the dermoid tumor cohort was $44,813.18±$54,305.90, while the mean cost in the anti-NMDAR encephalitis cohort was $445,628.60±$665,423.40 (p < 0.001). Patients with age above 30 years with dermoid tumors had significantly lower odds of developing anti-NMDAR encephalitis compared to patients younger than 30 years (OR: 0.19; 95%CI: 0.045-0.67; p-value: 0.003). White patients had significantly lower odds of developing anti-NMDAR encephalitis (OR: 0.19; 95%CI: 0.026-0.77; p-value: 0.013), and Black patients had significantly higher odds of developing anti-NMDAR encephalitis (OR: 3.45; 95%CI: 1.00-12.46; p-value: 0.044). CONCLUSION Patient predictors of developing anti-NMDAR encephalitis include age, race, ethnicity and patients who go on to develop anti-NMDAR encephalitis have a significantly increased hospital LOS and cost compared to those who do not. Future research, including multi-center clinical trials and longitudinal data, is necessary to fully cement the findings of this manuscript.
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Affiliation(s)
- Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA.
| | - Nolan J Brown
- School of Medicine, University of California, Irvine, CA, USA
| | - Rohin Singh
- School of Medicine, University of California, Irvine, CA, USA
| | - Joshua S Kurtz
- School of Medicine, University of California, Irvine, CA, USA
| | - Neal A Patel
- Mercer University School of Medicine, Macon, GA, USA
| | | | - Tasha Nasrollahi
- Department of Otolaryngology, Head and Neck Surgery, Cedars Sinai School of Medicine, Los Angeles, CA, USA
| | - Michela Borrelli
- Department of Otolaryngology, Head and Neck Surgery, Cedars Sinai School of Medicine, Los Angeles, CA, USA
| | | | - Seth C Ransom
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
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17
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Shahrestani S, Brown NJ, Strickland BA, Bakhsheshian J, Ghodsi SM, Nasrollahi T, Borrelli M, Gendreau J, Ruzevick JJ, Zada G. The role of frailty in the clinical management of neurofibromatosis type 1: a mixed-effects modeling study using the Nationwide Readmissions Database. Neurosurg Focus 2022; 52:E3. [DOI: 10.3171/2022.2.focus21782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Frailty embodies a state of increased medical vulnerability that is most often secondary to age-associated decline. Recent literature has highlighted the role of frailty and its association with significantly higher rates of morbidity and mortality in patients with CNS neoplasms. There is a paucity of research regarding the effects of frailty as it relates to neurocutaneous disorders, namely, neurofibromatosis type 1 (NF1). In this study, the authors evaluated the role of frailty in patients with NF1 and compared its predictive usefulness against the Elixhauser Comorbidity Index (ECI).
METHODS
Publicly available 2016–2017 data from the Nationwide Readmissions Database was used to identify patients with a diagnosis of NF1 who underwent neurosurgical resection of an intracranial tumor. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining indicator. ECI scores were collected in patients for quantitative measurement of comorbidities. Propensity score matching was performed for age, sex, ECI, insurance type, and median income by zip code, which yielded 60 frail and 60 nonfrail patients. Receiver operating characteristic (ROC) curves were created for complications, including mortality, nonroutine discharge, financial costs, length of stay (LOS), and readmissions while using comorbidity indices as predictor values. The area under the curve (AUC) of each ROC served as a proxy for model performance.
RESULTS
After propensity matching of the groups, frail patients had an increased mean ± SD hospital cost ($85,441.67 ± $59,201.09) compared with nonfrail patients ($49,321.77 ± $50,705.80) (p = 0.010). Similar trends were also found in LOS between frail (23.1 ± 14.2 days) and nonfrail (10.7 ± 10.5 days) patients (p = 0.0020). For each complication of interest, ROC curves revealed that frailty scores, ECI scores, and a combination of frailty+ECI were similarly accurate predictors of variables (p > 0.05). Frailty+ECI (AUC 0.929) outperformed using only ECI for the variable of increased LOS (AUC 0.833) (p = 0.013). When considering 1-year readmission, frailty (AUC 0.642) was outperformed by both models using ECI (AUC 0.725, p = 0.039) and frailty+ECI (AUC 0.734, p = 0.038).
CONCLUSIONS
These findings suggest that frailty and ECI are useful in predicting key complications, including mortality, nonroutine discharge, readmission, LOS, and higher costs in NF1 patients undergoing intracranial tumor resection. Consideration of a patient’s frailty status is pertinent to guide appropriate inpatient management as well as resource allocation and discharge planning.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurosurgery, University of Southern California, Los Angeles, California
- Department of Medical Engineering, California Institute of Technology, Pasadena, California
| | - Nolan J. Brown
- Department of Neurosurgery, UCI Medical Center, Irvine, California
| | - Ben A. Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Joshua Bakhsheshian
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | | | - Tasha Nasrollahi
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Michela Borrelli
- Cedars-Sinai Sinus Center of Excellence, Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California; and
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland
| | - Jacob J. Ruzevick
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California
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18
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Nasrollahi T, Borrelli M, Salehi K, Hopp ML, Alessi D. Trapezius fasciocutaneous flap for burn reconstruction. Ear Nose Throat J 2021:1455613211066659. [PMID: 34961347 DOI: 10.1177/01455613211066659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.
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Affiliation(s)
- Tasha Nasrollahi
- 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA
- 22494Cedars-Sinai Division of Otolaryngology, Los Angeles CA, USA
| | - Michela Borrelli
- 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA
- 22494Cedars-Sinai Division of Otolaryngology, Los Angeles CA, USA
| | | | - Martin L Hopp
- 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA
- 22494Cedars-Sinai Division of Otolaryngology, Los Angeles CA, USA
| | - David Alessi
- 22494Cedars-Sinai Sinus Center, Los Angeles, CA, USA
- 22494Cedars-Sinai Division of Otolaryngology, Los Angeles CA, USA
- Alessi Institute, Los Angeles, CA, USA
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