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Honorary Editor-in-Chief of AOHNS: Dr. Murray Grossan

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Improvement in Pediatric Recurrent Respiratory Papillomatosis With Systemic Bevacizumab: Case Report and Review of the Literature

Improvement in Pediatric Recurrent Respiratory Papillomatosis With Systemic Bevacizumab: Case Report and Review of the Literature

The authors describe their experience in treating severe recurrent respiratory papillomatosis with systemic bevacizumab in two young children with intractable papillomatosis requiring multiple surgical debridements. This is the first report to describe the successful management of recurrent respiratory papillomatosis with systemic bevacizumab in young children. The findings illustrate that systemic bevacizumab can have a dramatic effect on patient outcomes, eliminating the need for repeat surgical interventions. Furthermore, the findings suggest that this novel antiangiogenic agent can safely be used in young children using the same dosing recommendations used in the adolescent and adult populations.
A Rare Cause of Airway Collapse: Spontaneous Hemorrhage and Rupture of a Parathyroid Adenoma

A Rare Cause of Airway Collapse: Spontaneous Hemorrhage and Rupture of a Parathyroid Adenoma

The authors report the first published case of a patient presenting with stridor from an acute, near complete, airway obstruction with normal biochemical markers, as the initial presentation of a parathyroid adenoma, which required immediate surgical intervention. The learning point from this case is to ensure a broad differential is placed forward when dealing with acute neck swelling. Routine Head and Neck pathology can present in an unusual fashion, with resultant challenging presentations.
The Thin Profunda Artery Perforator Flap: Customized Design and Harvest

The Thin Profunda Artery Perforator Flap: Customized Design and Harvest

A thin profunda artery perforator flap harvested from the left thigh is shown in this video. Preoperative computed tomographic angiography is used to assess morphology of the perforators and its branches, pedicle length and vertical location of the two branches from the ischial tuberosity. These measurements are translated on to the patient. Locations of both branches are confirmed with a handheld doppler. The authors concluded that preoperative computed tomographic angiography is a useful technique to provide detailed anatomic information on morphology of perforators, course through the septum or muscle above the deep fascia and skin thickness. Computed tomographic angiography allows quick and easy assessment of the whole vascular anatomy of the leg and helps to arrive at the decision about selection of the best flaps based on the characteristics of the defect and on the individual anatomy of the patient.
Indocyanine Green Angiography in Salvage Planning: From Pedicled Supraclavicular Flap to Free Supraclavicular Flap

Indocyanine Green Angiography in Salvage Planning: From Pedicled Supraclavicular Flap to Free Supraclavicular Flap

The supraclavicular flap has gained popularity in recent years as a reliable and easily harvested flap with occasional anatomical variations in the course of the pedicle. The study shows how the determination of the dominant pedicle may be aided with indocyanine green angiography. Additionally, the authors demonstrate how they convert a supraclavicular flap to a free flap if the dominant pedicle is unfavorable to a pedicled flap design.
Comparable Specimens for Lipid-Laden Macrophage Index: Pediatric Tracheal Aspirate Versus Bronchoalveolar Lavage Fluid

Comparable Specimens for Lipid-Laden Macrophage Index: Pediatric Tracheal Aspirate Versus Bronchoalveolar Lavage Fluid

The study assesses the correlation between lipid-laden macrophage index in tracheal secretions (tLLMI) acquired at the time of direct laryngobronchoscopy (DLB) with the bronchoalveolar LLMI (aLLMI) collected via flexible bronchoscopy. Assessment of lipid-laden macrophages within bronchoalveolar lavage fluid has been proposed to be diagnostically helpful in evaluation of tracheobronchial inflammation. However, measurement requires flexible bronchoscopy with bronchoalveolar lavage, which can be associated with oxygen desaturation and post-operative fever. Quantification of lipid-laden macrophages in tracheal material has not been explored. The study demonstrates that the LLMI in tracheal aspirates collected at the time of DLB correlates with that of aspirates measured directly from the lower airways.
Digital Vessel Thrombosis After Early Cessation of Heparin Therapy Following Reimplantation: Two Case Reports

Digital Vessel Thrombosis After Early Cessation of Heparin Therapy Following Reimplantation: Two Case Reports

The implications of rebound heparin hypercoagulability following cessation of therapy in microsurgery is unreported. In this article the authors report two cases of late digit circulatory compromise shortly after withdrawal of heparin therapy. The authors also propose potential consideration for changes in perioperative anticoagulation practice to reduce this risk.
A Full Waiver of Any Submission of Original or Review Article to International Microsurgery Journal (IMJ) from Sep. 4, 2021 to Oct. 31, 2018!

A Full Waiver of Any Submission of Original or Review Article to International Microsurgery Journal (IMJ) from Sep. 4, 2021 to Oct. 31, 2018!

To celebrate nearly 5 years of partnership with International Microsurgery Club, we are waiving the publication fee (USD 790) for any submission of original article or review article to International Microsurgery Journal. This offer ends on Oct. 31, 2021. Join us today!
Effective Management of Epistaxis

Effective Management of Epistaxis

There have been several developments in the management of epistaxis. In this article, the author has reviewed the literature on epistaxis, its anatomy, etiology, and the current developments in its treatment. The stepwise treatment algorithms and flow diagram provided in the article will guide the clinicians to produce better results in epistaxis management.

Muscle Relaxant Administration to Manage Severe Tracheomalacia

Muscle Relaxant Administration to Manage Severe Tracheomalacia

Tracheomalacia is a rare congenital abnormality of the tracheobronchial cartilage causing the collapse of the airway and obstruction of expiratory flow. It is very difficult to manage infants with severe tracheomalacia. Severe cases lead to worse respiratory conditions and may become life-threatening, and necessitate immediate surgical treatment. Takeshi Yano of the University of Miyazaki, Japan has published an article in the Annals of Case Reports and Images Journal, in which a method to manage severe tracheomalacia patients using muscle relaxant has been discussed.

Relationship between Depression and Cholesteatoma

Relationship between Depression and Cholesteatoma

The study by Dr. Chin-Lung Kuo provided strong evidence, which was unrecognized earlier, to establish the potential link between cholesteatoma and depression. It is necessary to conduct routine psychiatric screening and monitoring of cholesteatoma patients for detection and treatment at the beginning stage itself. Despite the accuracy and acceptability of this population-based study, more prospective studies need to be carried out for additional confirmation.

Safety Science Principles for Administration of Oxytocin and Magnesium Sulfate in Labor & Delivery Units

Safety Science Principles for Administration of Oxytocin and Magnesium Sulfate in Labor & Delivery Units

The Institute of Safe Medication Practices has listed Oxytocin and Magnesium sulfate as high-alert medications causing significant harm to patients when used in error. Since these medications are frequently used in Labor & Delivery (L&D) units, safe administration to prevent medication errors is necessary for these units. As a part of the Safety Program for Perinatal Care (SPPC) of the Agency for Healthcare Research and Quality (AHRQ), several L&D units opted for implementing safety science principles for the safe administration of oxytocin and magnesium sulfate. The research team led by Kayla B Gray has published a qualitative research article in the Research on Women’s Health Journal, which describes the experiences of 25 L&D units, which have opted to implement the safety science principles for the safe administration of these medications.

Otolaryngology Simulation to Manage Oropharyngeal Hemorrhage

Otolaryngology Simulation to Manage Oropharyngeal Hemorrhage

Oropharyngeal hemorrhage is a serious complication of oropharyngeal tumor that occurs instantly without any warning and may result in airway obstruction and respiratory distress. The bleeding, if not controlled effectively, can be life-threatening. The management of such cases without prior experience can make the situation too complex. Considering the critical nature of such bleeding, a simulation scenario was created where the junior Otolaryngology residents (interns) could learn to manage the patients with oropharyngeal hemorrhage safely and properly interact with the fellow healthcare providers. This simulation scenario was designed and developed by a team of senior medical professionals from New York, led by Joshua Feintuch. A detailed article of the simulation program is published in the Archives of Otorhinolaryngology-Head & Neck Surgery Journal.

Vascularized Lymph Vessel Transfer - Lymph Node Transfer 2.0?

Lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established lymphedema treatments. However, LVA is only effective for early disease and VLNT can cause donor-site lymphedema and contour deformity. Vascularized lymph vessel transfer (VLVT) is free of these limitations. In the video, the authors described their experience of a new VLVT technique.

Laryngoscopic examination for signs of laryngeal irritation associated with reflux

This video shows a laryngoscopic examination for signs of laryngeal irritation associated with laryngopharyngeal reflux. Large bilateral granulomas are identified on the surface of bilateral arytenoids

Role of Trapezius Transfer for Shoulder Reconstruction in Adult Traumatic Brachial Plexus Injuries: Literature Review

This is a video abstract regarding the article on the role of trapezius transfer for shoulder reconstruction in adult traumatic brachial plexus injuries.

Immediate Limb Compression Following Supermicrosurgical Lymphaticovenular Anastomosis – Is It Helpful or Harmful?

In this video, the authors describe how they set out to assess the effect of external limb compression on the lymphaticovenular anastomosis.

An Unusual Nasal Mass: The Sinonasal Teratocarcinosarcoma

In this video, the author discusses an unusual nasal mass (i.e., teratocarcinosarcoma) in the the sinonasal cavity.

Strategic Incision Placement to Facilitate Successful Supermicrosurgical LVA

In this video, the author describes their guided approach to incision placement to increase the likelihood of creating a successful lymphaticovenular anastomosis at each incision for an effective treatment for lymphedema.

Editor's Choice

Articles
News
Videos
Illness Perceptions, Psychological Distress and Coping Strategies as Predictors of Quality of Life After Radiotherapy in Head and Neck Cancer Patients

Illness Perceptions, Psychological Distress and Coping Strategies as Predictors of Quality of Life After Radiotherapy in Head and Neck Cancer Patients

The study aims to assess the predictive values of certain psychological factors on the quality of life in patients with Head and Neck Cancer after radiotherapy. The authors conclude that the identification and the understanding of the depressive symptoms of patients, their beliefs about their illness as well as their coping strategies may provide the basis for timely implementation of appropriate intervention that may improve the quality of life in patients.
Dangers of a False Sense of Security in a Huge Mastoid Cholesteatoma With Skull Base Erosion and Cerebrospinal Fluid Leakage

Dangers of a False Sense of Security in a Huge Mastoid Cholesteatoma With Skull Base Erosion and Cerebrospinal Fluid Leakage

The author reports a case involving a 59-year-old man with delayed presentation of a huge mastoid cholesteatoma complicated by skull base erosion and cerebrospinal fluid leakage. Delayed presentation of this disease entity can have negative health consequences for patients. Regular otologic examinations, audiologic follow-up, and imaging examinations are viewed as the most effective strategies for the prevention of this type of situation. Early recognition of cholesteatomas is essential, as appropriate and timely treatment can prevent this rare comorbid condition from becoming fatal.
Voice, Cough, and Diurnal Breathing Problems and Quality of Life in Obstructive Sleep Apnea

Voice, Cough, and Diurnal Breathing Problems and Quality of Life in Obstructive Sleep Apnea

The study identifies how current voice, cough, and daytime breathing problems affect mental and physical quality of life in obstructive sleep apnea patients, as well as how the combination of voice, cough, and diurnal dyspnea impacts quality of life.
Neuroplastic Effect of Constraint-Induced Music Therapy on Hearing Recovery in Patients with Sudden Sensorineural Hearing Loss

Neuroplastic Effect of Constraint-Induced Music Therapy on Hearing Recovery in Patients with Sudden Sensorineural Hearing Loss

Constraint-induced music therapy has been shown to enhance hearing recovery in patients with sudden sensorineural hearing loss by preventing maladaptive reorganization of the auditory cortex. This study was the second research to provide scientific evidence related to the neuroplasticity of the central auditory nervous system in response to constraint-induced acoustic rehabilitation.
Current State of Surgical Simulation Training in Otolaryngology: Systematic Review of  Simulation Training Models

Current State of Surgical Simulation Training in Otolaryngology: Systematic Review of Simulation Training Models

The review article presents an expansive list of otolaryngology-specific surgical simulation training models as described in Otolaryngology literature as well as evaluates recent advances in simulation training in Otolaryngology.
The ‘Orochi’ Flap Concept: Multi-Stage Combined Flap Using Sequential Flaps

The ‘Orochi’ Flap Concept: Multi-Stage Combined Flap Using Sequential Flaps

Prof. Koushima, president of World Society for Reconstructive Microsurgery, proposes an innovative concept and technique of the multi-stage ‘Orochi’ combined flaps (sequential flaps in parallel). The technique opens a new vista in reconstructive microsurgery.
Head and Neck Juxtacortical Chondrosarcoma

Head and Neck Juxtacortical Chondrosarcoma

The incidence of Head and Neck Juxtacortical Chondrosarcoma (HNJCS) is extremely rare. Among a large database, the authors could identify only nine cases of HNJCS that have been amply described. It has been observed that irrespective of the location of the body, HNJCS has a consistent clinical and diagnostic profile. HNJCS is generally a low or intermediate grade malignancy with a low rate of recurrence and metastases. Primary surgical excision with negative margins was found to be the therapeutic modality of choice.  Radiotherapy and chemotherapy have limited roles in the management of HNJCS.

Assessment and Management of Laryngopharyngeal Reflux

Assessment and Management of Laryngopharyngeal Reflux

In this article, the author reviews the manifestations, diagnosis, and treatments of LPR and suggests adopting a multidisciplinary approach for a reliable and conclusive diagnosis of LPR. Based on the previous research and latest findings, an algorithm is put forth to streamline the assessment and management of reflux disorders. Highlighting the significance of correct diagnosis and effective treatment of LPR, the author suggests that in case the diagnosis is doubtful, and the therapeutic response is unsatisfactory, the patient should be referred to a specialist.

A Comparison of Hematology and Cytology Laboratories in Detection of Body Fluid Malignancy

A Comparison of Hematology and Cytology Laboratories in Detection of Body Fluid Malignancy

Based on the comparison between the hematology and cytology, the authors concluded that by improving the skills of the technologists of the hematology laboratory in identifying cell morphology, the diagnostic values in body fluid malignancy could be improved, and the hematology laboratory would achieve comparable competency similar to the cytology laboratory.

Can the Cervical Length Predict Procedure-Related Miscarriage?

Can the Cervical Length Predict Procedure-Related Miscarriage?

Procedure-related miscarriage is the most crucial complication of the prenatal invasive tests which are being used for the diagnosis of fetal aneuploidies. Even though several risk factors like operator experience, gestational age, sampling route, and the number of tapping have been suggested for the procedure-related miscarriage, the cause of this complication remains unknown. The results of the study confirmed that the cervical lengths in the patients complicated with miscarriages were within normal limits.

The Brain Functions Mathematically!

The Brain Functions Mathematically!

The brain can process information, store them, and retrieve them as and when required; however, we hardly know much about the physiological mechanisms behind such fundamental functions of the brain. The efforts by psychologists, scientists, engineers, physicists, and mathematicians over the past decades have given some significant insight on the brain functions and have been helpful for carrying out further research on the subject.

Welcome Prof. Isao Koushima as Honorary Editor-in-Chief in International Microsurgery Journal

Welcome Prof. Isao Koushima as Honorary Editor-in-Chief in International Microsurgery Journal

It is our pleasure to invite Prof. Isao Koushima to be Editor-in-Chief in International Microsurgery Journal!

Experience with Robotic-assisted Microsurgery

Over the past decade, Da Vinci Surgical System has made great strides in surgery. It has been widely applied in urology, gynecology, bariatric surgery, hepatobiliary surgery, thoracoscopic surgery, cardiac surgery, neurological surgery, and transoral otolaryngologic neoplasm resection. However, its application in plastic and reconstructive surgery still in the preliminary stages of development. I went to Hong Kong in April 2013 for the robotic surgical system training program and was awarded console surgeon certificate.

Chang's Technique of Sequential End-to-Side Microvascular Anastomosis

This novel technique of sequential ETS micro-venous anastomosis is a modified technique from its classical form. The unique use of vessel loops provides protection to the vessel, while it achieves equisegmental IJV occlusion for sequential (proximal to distal) venous anastomosis. This method not only saves precious operating time from repetitive positioning of instruments and recipient vessel (IJV), but also creates a safer operating field for the microsurgeons. Utilizing a second single vascular clamp over the anastomosis junction provides an anchoring point for self-retraction by revealing and maintaining an accessible position to the posterior wall, once it is turned at 180 degrees laterally. This maneuver allows the surgeon to have full control of the surgical field and perform ETS micro-venous anastomosis confidently and independently.

Lateral Plantar Artery as Recipient Vessel for Microsurgical Lateral Plantar Forefoot Reconstruction

Division of the lateral plantar artery does not jeopardize the foot circulation because of anastomosis of the lateral plantar artery with the dorsalis pedis artery at the first intermetatarsal space. However, care should be taken with patients with peripheral artery occlusive disease and the flow of dorsalis pedis artery should be confirmed before surgery. Given the advantages of sizable vessel, easy dissection, and proximity to the defect, we believe that the lateral plantar artery might be a valuable option as recipient vessel for lateral plantar forefoot reconstruction.

The Versatility of Pedicled Anterolateral Thigh Flap - A Tertiary Re-ferral Center Experience from India

Pedicled anterolateral thigh flap is a versatile option for reconstruction of complex soft tissue defects in varied anatomical regions. Its wide arc of rotation and less donor site morbidity are its added advantages.

A Great Opportunity to Meet and Learn from Peripheral Nerve Experts

The 2nd instructional course for adult brachial plexus injuries is a fantastic opportunity to meet and learn from experts in the field. We cordially invite you to visit Chang Gung Memorial Hospital to participate in this unique learning experience.

Interview with Dr. Murray Grossan, the Honorary Editor-in-Chief of AOHNS

An exciting conversation with Dr. Murray Grossan, the Honorary Editor-in-Chief of Archives of Otorhinolaryngology-Head & Neck Surgery (AOHNS). Dr. Murray Grossan talked about AOHNS’s new direction and the important means for communicating scientific work to complement teaching and training in the field of medicine.