The current fiscal climate demands increasing emphasis on curbing hospital expenses incurred from... more The current fiscal climate demands increasing emphasis on curbing hospital expenses incurred from surgical procedures. Disposable instruments and consumables play a major role, but the end user (the surgeon) is often unaware of the cost of these materials. The objectives of our study were: 1) to assess knowledge of costs of disposable instruments and consumable products, and 2) to gauge interest in greater access to cost information and its potential to change practice. We used a cross-sectional survey study to meet our study's objectives. A paper-based anonymous questionnaire was administered in the Department of Otolaryngology at McGill University and at Western University asking for estimations of costs of 23 commonly used products in the operating room. Our primary outcome measure was accuracy of cost estimations, which were considered accurate if within ±50% of the true cost at the respective institution. The average accuracy was 29.9% (standard deviation = 16.7%). There was no significant difference between residents (32.5%, 95% confidence interval [CI]: 10.2%-54.7%) and staff (28.3%, 95% CI: 11.0%-45.6%). Less than 10% of participants were able to accurately estimate the costs of at least half of the disposable products. The majority of participants (82%) felt that greater information would change their use of consumables. Surgical residents and staff have a generally poor knowledge of the cost of common consumable products used in the operating room. There is potential for increased awareness of costs to change behavior. NA Laryngoscope, 2015.
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2010
ABSTRACT Complete removal of polyps and thick mucus from the severely diseased maxillary sinus is... more ABSTRACT Complete removal of polyps and thick mucus from the severely diseased maxillary sinus is key in allowing the resolution of symptoms. The canine fossa trephination (CFT) procedure is a highly effective means of clearing diseased material from all areas of the maxillary sinus and is especially useful in patients with Sampter's triad and fungal sinusitis. However, many surgeons have failed to adopt this technique for fear of its potential complications. Numerous technical refinements have been developed in recent years, significantly reducing the rate of adverse outcomes following CFT. This article describes the steps involved in performing the CFT, with an emphasis on the avoidance of complications.
Journal of Otolaryngology - Head & Neck Surgery, 2015
The Canadian Rhinologic workforce and future needs are not well defined. The objective of this st... more The Canadian Rhinologic workforce and future needs are not well defined. The objective of this study was to define the current demographics and practice patterns of the Canadian Rhinologic workforce. Outcomes from this study can be used to perform rhinologic workforce needs assessments. Methods: A national survey was administered to all Canadian otolaryngologists who were identified to have a clinical practice composed of >50% rhinology. Results: 42 surgeons participated in the survey (65% response rate). The mean age was 46 (SD 10.1) years and the average age of planned retirement was 66 (SD 4.0). Eighty three percent of respondents had completed a rhinology fellowship and 17% practiced exclusively rhinology. Thirty three percent hold advanced degrees. Forty two percent of surgeons felt their access to operative time was insufficient. Six percent of surgeons reported not having access to image guided surgery. Fourteen percent felt that there were too many practicing rhinologists in Canada while 17% believed there were too few practicing rhinologists. Seventeen percent have advised their residents to pursue other fields due to a perceived lack of future jobs. Overall, 66% of respondents were satisfied with their income, and 83% were satisfied with their careers. Conclusions: This study has demonstrated that there is a perceived mismatch between the current supply of Rhinology labor and the capacity to treat patients in a timely manner. Outcomes from this study will begin to improve Rhinologic workforce planning in Canada and reduce the gap between patient demand and access to high quality care.
Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis... more Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis of LH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and pathologically. While the etiology is poorly understood, a number of previous theories exist, which are included here in the context of a literature review. In this paper we present a case of severe pharyngeal lymphoid hyperplasia causing airway obstruction and requiring tracheotomy and subsequent surgical debulking.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2010
Modern methods for the study of genetics offer promising new means of exploring complex diseases ... more Modern methods for the study of genetics offer promising new means of exploring complex diseases such as chronic rhinosinusitis (CRS). Powerful new high-throughput tools extend the capabilities of existing technologies. However, for the inexperienced reader, a lack of familiarity with the techniques used may limit comprehension of the articles and hamper the appreciation of the potential of this area of research. To improve understanding, we present an introduction to research methods in common user language, describing the techniques and applications of each while outlining differences between techniques of study of gene expression and genetic association studies. Online tools for experiment design and data analysis are presented. Practical examples from our work in the genetics of CRS are used to help understand applications for these tools. It is expected that this article will allow physicians to acquire an improved understanding of the uses and limitations of these types of stu...
1. J Otolaryngol. 2006 Oct;35(5):355-7. Pneumomediastinum and cervicofacial emphysema following a... more 1. J Otolaryngol. 2006 Oct;35(5):355-7. Pneumomediastinum and cervicofacial emphysema following a nasally obstructed sneeze. Tewfik MA, Al-Qahtani K, Payne RJ, Frenkiel S. Department of Otolaryngology - Head and Neck ...
The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa o... more The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa of patients with untreated allergic rhinitis. We sought to examine the role of exogenous, as well as endogenous, NO in the production of collagen type I and type III by human nasal fibroblasts. Primary cultured fibroblasts derived from eosinophilic nasal polyps were exposed to NO donors (500 microM of S-nitroso-N-acetyl-D,L-penicillamine (SNAP) 1000 micoM of 3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene (DETA-NONOate)) and various other compounds over a 24-hour incubation period. Collagen production was evaluated qualitatively by immunocytochemistry and quantitatively by Western blot analysis. Maximally stimulated fibroblasts established a 2,2-fold increase in the production of type III collagen relative type 1, as compared with baseline. Oxyhemoglobin, an NO scavenger, abolished this effect. SNAP (500 microM) caused a 15.68 +/- 0.68% increase in collagen type I synthesis as compared wit...
Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepith... more Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepithelium 1 and is typically located in the upper nasal cavity and cribriform plate. 2 In this article we report a case of esthesioneuroblastoma presenting concomitantly with a growth-hormone (GH)-secreting pituitary macroadenoma. The combined open and endoscopic management of this patient is described, and a review of the literature presented.
Adequate surgical field visualization is among the most important factors in preventing complicat... more Adequate surgical field visualization is among the most important factors in preventing complications in functional endoscopic sinus surgery (FESS). The aim of this study was to assess the effect of topical cocaine vs adrenaline on surgical field visualization and intraoperative bleeding during FESS. A randomized controlled trial was conducted. A total of 37 patients that underwent FESS for chronic rhinosinusitis were randomized to the side of the nose that received adrenaline or cocaine-soaked patties, and the side that was operated first. The surgeon evaluating the bleeding was blinded to the vasoconstrictor allocation. At the commencement of surgery and at regular 15-minute intervals, the operating surgeon evaluated the extent of bleeding in the operative field according to a validated scale. At each assessment, mean arterial pressure (MAP), heart rate, and end tidal CO2 were also recorded. At the end of each side, total blood loss was measured. There was no difference in the mean surgical field scores between the adrenaline and cocaine sides (2.04 ± 0.75 vs 2.17 ± 0.7, p = 0.24), nor the total blood loss (p = 0.43). On the cocaine side, there was a correlation between surgical field grade and duration of surgery (p < 0.05) as well as blood loss (p < 0.05) and MAP (p < 0.05). There is no difference in the quality of the surgical field achieved through the use of topical cocaine or adrenaline during FESS. Either of these agents can be effectively used for topical decongestion at the onset of surgery.
International Journal of Pediatric Otorhinolaryngology Extra, 2006
the youngest patient for whom a midline odontogenic keratocyst in the anterior maxillary region h... more the youngest patient for whom a midline odontogenic keratocyst in the anterior maxillary region has been documented in the English literature. We designed a less-invasive surgical approach for transnasal endoscopic marsupialization instead of enucleation of this large pediatric odontogenic keratocyst.
Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcit... more Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcitrant maxillary sinusitis. CFT allows for disease clearance in areas of the maxillary sinus that are hard to reach with standard endoscopic techniques. The objective of this study was to compare the surgical outcome of CFT to standard middle meatal antrostomy (MMA) in matched patients with the severely diseased maxillary sinus. Prospective clinical study Patients undergoing sinus surgery were enrolled in either the CFT or MMA group. All patients had nasal polyps, Lund Mackay score of 2 in the maxillary sinus, and nasal endoscopy showing the maxillary sinus full of polyps. The patients were followed and the maxillary sinus was graded endoscopically at 3, 6 and 12 months after the surgery. Length of surgery, disease recurrence and need for revision surgery was documented. Forty-two CFTs and MMA were performed in each group. At 6 and 12 months the CFT group demonstrated statistically signifi...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2005
Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring usin... more Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post-thyroidectomy without compromising safety. This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6-hour critical level of PTH > or = 28 ng/L and simultaneous corrected calcium > or = 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1-hour PTH levels < or = 8 ng/L were prophylactically treated with calcium and vitamin D supplementation. This study demonstrates lower rates of transient hypocalcemia ...
Day surgery constitutes an important part of modern otolaryngology practice. However, high rates ... more Day surgery constitutes an important part of modern otolaryngology practice. However, high rates of unplanned admissions remain an issue. To determine the incidence, reasons, and predictive factors for unanticipated admission after ambulatory otolaryngologic surgery. A retrospective review of all cases of unplanned admission following otolaryngology day surgery at a tertiary care centre over a 4-year period from 2000 to 2004. Data relating to patient demographics, physical status, surgical procedure, perioperative complications, and reasons for hospital admission were recorded. A case-control analysis of these parameters with nonadmitted day surgery patients was used for comparison. During the above period, 1106 patients underwent otolaryngologic day surgery, of whom 74 (6.7%) required admission. Fifty-seven percent of the patients were male, and the average age was 48.9 years. The three most common procedures with unplanned admission were open neck biopsy (27%), functional endoscopic sinus surgery (20.3%), and panendoscopy (16.2%). The reasons for admission could be divided into airway monitoring (37.7%), postoperative bleeding (28.6%), the need for supportive or pain management (19.5%), anesthetic complication (5.2%), cardiovascular complication (3.9%), clerical error (3.9%), and suspicion of a cerebrospinal fluid leak (1.3%). Risk factors for admission were determined to be an American Society of Anesthesiologists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; class of 3 or greater, open neck surgical procedures, and a length of surgery of 60 minutes or greater. Minor factors included the use of general anesthesia, male gender, advanced age, and living far from a hospital. This study suggests strategies to reduce the rate of unplanned admission by means of careful preoperative assessment and planning, patient selection, careful scheduling of higher-risk patients, and appropriate postoperative observation and management.
Journal of Neurological Surgery Part B: Skull Base, 2015
Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (... more Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and subgroups at risk for internal carotid artery injury during transsphenoidal surgery. Design A retrospective case-control study. Setting This study was conducted at the McGill University Health Centre, a university-affiliated tertiary care center. Participants Patients with a sellar or parasellar tumor and nontumor controls were included in the study. Main Outcome Measures The smallest distance between the internal carotid arteries at the clival, cavernous, and paraclinoid segments on coronal magnetic resonance imaging was measured. Demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential determinants of the ICD. Results A total of 212 cases and 34 controls were analyzed. Widening of the ICD at the three segments of the internal carotid arteries was found in patients with pituitary macroadenomas (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Patients with a growth hormone-secreting adenoma had a markedly reduced ICD at the clivus compared with controls (1.59 cm versus 1.77 cm; p = 0.02; 95% confidence interval [CI], 0.03-0.32). The paraclinoid ICD was reduced in patients with an anterior fossa meningioma (1.24 cm versus 1.33 cm; p = 0.04; 95% CI, 0.01-0.45). Conclusion Identifying clinicopathologic factors affecting the ICD can help surgeons recognize constraints to endoscopic access of the skull base and avoid inadvertent arterial injury.
Journal of Neurological Surgery Part B: Skull Base, 2014
The endoscopic endonasal approach to the skull base is an established technique that has facilita... more The endoscopic endonasal approach to the skull base is an established technique that has facilitated the safe removal of a variety of benign and malignant cranial base tumors. The nasoseptal flap (NSF) has dramatically reduced the rate of postoperative cerebrospinal fluid (CSF) leakage. 1 There are drawbacks of NSF harvest, however, including increased surgical time, prolonged crusting of the donor site, septal cartilage necrosis, nasal obstruction, synechiae, and decreased olfaction. 2 In certain situations such as skull base meningiomas and other intradural pathologies, anticipation of dural reconstruction is obvious and an NSF is typically harvested at the outset of surgery. In other pathologies, such Keywords ► skull base defect ► CSF rhinorrhea ► endoscopic skull base surgery ► reconstruction ► nasoseptal flap
The current fiscal climate demands increasing emphasis on curbing hospital expenses incurred from... more The current fiscal climate demands increasing emphasis on curbing hospital expenses incurred from surgical procedures. Disposable instruments and consumables play a major role, but the end user (the surgeon) is often unaware of the cost of these materials. The objectives of our study were: 1) to assess knowledge of costs of disposable instruments and consumable products, and 2) to gauge interest in greater access to cost information and its potential to change practice. We used a cross-sectional survey study to meet our study&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s objectives. A paper-based anonymous questionnaire was administered in the Department of Otolaryngology at McGill University and at Western University asking for estimations of costs of 23 commonly used products in the operating room. Our primary outcome measure was accuracy of cost estimations, which were considered accurate if within ±50% of the true cost at the respective institution. The average accuracy was 29.9% (standard deviation = 16.7%). There was no significant difference between residents (32.5%, 95% confidence interval [CI]: 10.2%-54.7%) and staff (28.3%, 95% CI: 11.0%-45.6%). Less than 10% of participants were able to accurately estimate the costs of at least half of the disposable products. The majority of participants (82%) felt that greater information would change their use of consumables. Surgical residents and staff have a generally poor knowledge of the cost of common consumable products used in the operating room. There is potential for increased awareness of costs to change behavior. NA Laryngoscope, 2015.
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2010
ABSTRACT Complete removal of polyps and thick mucus from the severely diseased maxillary sinus is... more ABSTRACT Complete removal of polyps and thick mucus from the severely diseased maxillary sinus is key in allowing the resolution of symptoms. The canine fossa trephination (CFT) procedure is a highly effective means of clearing diseased material from all areas of the maxillary sinus and is especially useful in patients with Sampter&#39;s triad and fungal sinusitis. However, many surgeons have failed to adopt this technique for fear of its potential complications. Numerous technical refinements have been developed in recent years, significantly reducing the rate of adverse outcomes following CFT. This article describes the steps involved in performing the CFT, with an emphasis on the avoidance of complications.
Journal of Otolaryngology - Head & Neck Surgery, 2015
The Canadian Rhinologic workforce and future needs are not well defined. The objective of this st... more The Canadian Rhinologic workforce and future needs are not well defined. The objective of this study was to define the current demographics and practice patterns of the Canadian Rhinologic workforce. Outcomes from this study can be used to perform rhinologic workforce needs assessments. Methods: A national survey was administered to all Canadian otolaryngologists who were identified to have a clinical practice composed of >50% rhinology. Results: 42 surgeons participated in the survey (65% response rate). The mean age was 46 (SD 10.1) years and the average age of planned retirement was 66 (SD 4.0). Eighty three percent of respondents had completed a rhinology fellowship and 17% practiced exclusively rhinology. Thirty three percent hold advanced degrees. Forty two percent of surgeons felt their access to operative time was insufficient. Six percent of surgeons reported not having access to image guided surgery. Fourteen percent felt that there were too many practicing rhinologists in Canada while 17% believed there were too few practicing rhinologists. Seventeen percent have advised their residents to pursue other fields due to a perceived lack of future jobs. Overall, 66% of respondents were satisfied with their income, and 83% were satisfied with their careers. Conclusions: This study has demonstrated that there is a perceived mismatch between the current supply of Rhinology labor and the capacity to treat patients in a timely manner. Outcomes from this study will begin to improve Rhinologic workforce planning in Canada and reduce the gap between patient demand and access to high quality care.
Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis... more Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis of LH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and pathologically. While the etiology is poorly understood, a number of previous theories exist, which are included here in the context of a literature review. In this paper we present a case of severe pharyngeal lymphoid hyperplasia causing airway obstruction and requiring tracheotomy and subsequent surgical debulking.
Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale, 2010
Modern methods for the study of genetics offer promising new means of exploring complex diseases ... more Modern methods for the study of genetics offer promising new means of exploring complex diseases such as chronic rhinosinusitis (CRS). Powerful new high-throughput tools extend the capabilities of existing technologies. However, for the inexperienced reader, a lack of familiarity with the techniques used may limit comprehension of the articles and hamper the appreciation of the potential of this area of research. To improve understanding, we present an introduction to research methods in common user language, describing the techniques and applications of each while outlining differences between techniques of study of gene expression and genetic association studies. Online tools for experiment design and data analysis are presented. Practical examples from our work in the genetics of CRS are used to help understand applications for these tools. It is expected that this article will allow physicians to acquire an improved understanding of the uses and limitations of these types of stu...
1. J Otolaryngol. 2006 Oct;35(5):355-7. Pneumomediastinum and cervicofacial emphysema following a... more 1. J Otolaryngol. 2006 Oct;35(5):355-7. Pneumomediastinum and cervicofacial emphysema following a nasally obstructed sneeze. Tewfik MA, Al-Qahtani K, Payne RJ, Frenkiel S. Department of Otolaryngology - Head and Neck ...
The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa o... more The presence of nitric oxide (NO) in high concentrations has been described in the nasal mucosa of patients with untreated allergic rhinitis. We sought to examine the role of exogenous, as well as endogenous, NO in the production of collagen type I and type III by human nasal fibroblasts. Primary cultured fibroblasts derived from eosinophilic nasal polyps were exposed to NO donors (500 microM of S-nitroso-N-acetyl-D,L-penicillamine (SNAP) 1000 micoM of 3,3-bis(aminoethyl)-1-hydroxy-2-oxo-1-triazene (DETA-NONOate)) and various other compounds over a 24-hour incubation period. Collagen production was evaluated qualitatively by immunocytochemistry and quantitatively by Western blot analysis. Maximally stimulated fibroblasts established a 2,2-fold increase in the production of type III collagen relative type 1, as compared with baseline. Oxyhemoglobin, an NO scavenger, abolished this effect. SNAP (500 microM) caused a 15.68 +/- 0.68% increase in collagen type I synthesis as compared wit...
Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepith... more Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory neuroepithelium 1 and is typically located in the upper nasal cavity and cribriform plate. 2 In this article we report a case of esthesioneuroblastoma presenting concomitantly with a growth-hormone (GH)-secreting pituitary macroadenoma. The combined open and endoscopic management of this patient is described, and a review of the literature presented.
Adequate surgical field visualization is among the most important factors in preventing complicat... more Adequate surgical field visualization is among the most important factors in preventing complications in functional endoscopic sinus surgery (FESS). The aim of this study was to assess the effect of topical cocaine vs adrenaline on surgical field visualization and intraoperative bleeding during FESS. A randomized controlled trial was conducted. A total of 37 patients that underwent FESS for chronic rhinosinusitis were randomized to the side of the nose that received adrenaline or cocaine-soaked patties, and the side that was operated first. The surgeon evaluating the bleeding was blinded to the vasoconstrictor allocation. At the commencement of surgery and at regular 15-minute intervals, the operating surgeon evaluated the extent of bleeding in the operative field according to a validated scale. At each assessment, mean arterial pressure (MAP), heart rate, and end tidal CO2 were also recorded. At the end of each side, total blood loss was measured. There was no difference in the mean surgical field scores between the adrenaline and cocaine sides (2.04 ± 0.75 vs 2.17 ± 0.7, p = 0.24), nor the total blood loss (p = 0.43). On the cocaine side, there was a correlation between surgical field grade and duration of surgery (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) as well as blood loss (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and MAP (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). There is no difference in the quality of the surgical field achieved through the use of topical cocaine or adrenaline during FESS. Either of these agents can be effectively used for topical decongestion at the onset of surgery.
International Journal of Pediatric Otorhinolaryngology Extra, 2006
the youngest patient for whom a midline odontogenic keratocyst in the anterior maxillary region h... more the youngest patient for whom a midline odontogenic keratocyst in the anterior maxillary region has been documented in the English literature. We designed a less-invasive surgical approach for transnasal endoscopic marsupialization instead of enucleation of this large pediatric odontogenic keratocyst.
Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcit... more Canine fossa trephine (CFT) is an adjunctive technique to sinus surgery in patients with recalcitrant maxillary sinusitis. CFT allows for disease clearance in areas of the maxillary sinus that are hard to reach with standard endoscopic techniques. The objective of this study was to compare the surgical outcome of CFT to standard middle meatal antrostomy (MMA) in matched patients with the severely diseased maxillary sinus. Prospective clinical study Patients undergoing sinus surgery were enrolled in either the CFT or MMA group. All patients had nasal polyps, Lund Mackay score of 2 in the maxillary sinus, and nasal endoscopy showing the maxillary sinus full of polyps. The patients were followed and the maxillary sinus was graded endoscopically at 3, 6 and 12 months after the surgery. Length of surgery, disease recurrence and need for revision surgery was documented. Forty-two CFTs and MMA were performed in each group. At 6 and 12 months the CFT group demonstrated statistically signifi...
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2005
Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring usin... more Previous studies have established the efficacy of post-thyroidectomy hypocalcemia monitoring using parathyroid hormone (PTH) and corrected calcium levels at 1 and 6 hours. The goal of this study was to measure the impact of managing patients based on the above findings with respect to: duration of hospital stays, rates of transient hypocalcemia, number of blood tests, cost savings, and discharge from the hospital as early as 8 hours post-thyroidectomy without compromising safety. This is a prospective study involving 95 total thyroidectomy patients using historical data as controls. The previous protocol was modified in that all blood tests ceased for patients meeting the 6-hour critical level of PTH > or = 28 ng/L and simultaneous corrected calcium > or = 2.14 mmol/L (8.56 mg/dL). Furthermore, patients with 1-hour PTH levels < or = 8 ng/L were prophylactically treated with calcium and vitamin D supplementation. This study demonstrates lower rates of transient hypocalcemia ...
Day surgery constitutes an important part of modern otolaryngology practice. However, high rates ... more Day surgery constitutes an important part of modern otolaryngology practice. However, high rates of unplanned admissions remain an issue. To determine the incidence, reasons, and predictive factors for unanticipated admission after ambulatory otolaryngologic surgery. A retrospective review of all cases of unplanned admission following otolaryngology day surgery at a tertiary care centre over a 4-year period from 2000 to 2004. Data relating to patient demographics, physical status, surgical procedure, perioperative complications, and reasons for hospital admission were recorded. A case-control analysis of these parameters with nonadmitted day surgery patients was used for comparison. During the above period, 1106 patients underwent otolaryngologic day surgery, of whom 74 (6.7%) required admission. Fifty-seven percent of the patients were male, and the average age was 48.9 years. The three most common procedures with unplanned admission were open neck biopsy (27%), functional endoscopic sinus surgery (20.3%), and panendoscopy (16.2%). The reasons for admission could be divided into airway monitoring (37.7%), postoperative bleeding (28.6%), the need for supportive or pain management (19.5%), anesthetic complication (5.2%), cardiovascular complication (3.9%), clerical error (3.9%), and suspicion of a cerebrospinal fluid leak (1.3%). Risk factors for admission were determined to be an American Society of Anesthesiologists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; class of 3 or greater, open neck surgical procedures, and a length of surgery of 60 minutes or greater. Minor factors included the use of general anesthesia, male gender, advanced age, and living far from a hospital. This study suggests strategies to reduce the rate of unplanned admission by means of careful preoperative assessment and planning, patient selection, careful scheduling of higher-risk patients, and appropriate postoperative observation and management.
Journal of Neurological Surgery Part B: Skull Base, 2015
Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (... more Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and subgroups at risk for internal carotid artery injury during transsphenoidal surgery. Design A retrospective case-control study. Setting This study was conducted at the McGill University Health Centre, a university-affiliated tertiary care center. Participants Patients with a sellar or parasellar tumor and nontumor controls were included in the study. Main Outcome Measures The smallest distance between the internal carotid arteries at the clival, cavernous, and paraclinoid segments on coronal magnetic resonance imaging was measured. Demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential determinants of the ICD. Results A total of 212 cases and 34 controls were analyzed. Widening of the ICD at the three segments of the internal carotid arteries was found in patients with pituitary macroadenomas (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.01). Patients with a growth hormone-secreting adenoma had a markedly reduced ICD at the clivus compared with controls (1.59 cm versus 1.77 cm; p = 0.02; 95% confidence interval [CI], 0.03-0.32). The paraclinoid ICD was reduced in patients with an anterior fossa meningioma (1.24 cm versus 1.33 cm; p = 0.04; 95% CI, 0.01-0.45). Conclusion Identifying clinicopathologic factors affecting the ICD can help surgeons recognize constraints to endoscopic access of the skull base and avoid inadvertent arterial injury.
Journal of Neurological Surgery Part B: Skull Base, 2014
The endoscopic endonasal approach to the skull base is an established technique that has facilita... more The endoscopic endonasal approach to the skull base is an established technique that has facilitated the safe removal of a variety of benign and malignant cranial base tumors. The nasoseptal flap (NSF) has dramatically reduced the rate of postoperative cerebrospinal fluid (CSF) leakage. 1 There are drawbacks of NSF harvest, however, including increased surgical time, prolonged crusting of the donor site, septal cartilage necrosis, nasal obstruction, synechiae, and decreased olfaction. 2 In certain situations such as skull base meningiomas and other intradural pathologies, anticipation of dural reconstruction is obvious and an NSF is typically harvested at the outset of surgery. In other pathologies, such Keywords ► skull base defect ► CSF rhinorrhea ► endoscopic skull base surgery ► reconstruction ► nasoseptal flap
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