The use of Montgomery salivary bypass tubes and pharyngocutaneous fistula following salvage laryngectomy

Objectives:Pharyngocutaneous fistula(PCF)is the most common complication to follow total laryngectomy(TL)and is associated with increases in length of hospital stay and with a need for revision surgery or readmission,as well as with delays in return to oral diet.Patients who require salvageTL(STL)or primary(chemo)radiation therapy are at higher risk for developing PCF.Due to the quality‐of‐life burden of PCF on patients,limiting this occurrence is crucial.Methods:We conducted a retrospective cohort study of patients undergoing STL with placement of Montgomery salivary bypass tube(MSBT)^(TM)for at least 2 weeks duration between 2013 and 2017 at a single institution.Our patients all underwent free flap reconstruction.Our primary outcome of interest was development of PCF.Secondary outcomes included demographics,previous treatment,base of tongue(BOT)involvement,extent of defect,concurrent neck dissection(ND),and margin status.Univariateχ^(2) analysis was used to evaluate factors associated with PCF.Results:Forty‐four patients underwent STL with Montgomery tube placement and free flap reconstruction.Eight developed PCF(18.2%).The average age was 61.6 years;36 patients were male(81.8%),whereas eight patients were female(18.2%).There was no association between PCF and previous chemoradiation versus radiation(15.8%vs.33.3%,P<0.30),BOT involvement versus not(11.1 vs.22.2%,P<0.38),circumferential versus partial defect(18.8%vs.17.9%,P<0.94),ND versus none(10%vs.25%,P<0.20),or margin status.Conclusion:PCF complicated 18.2%of STL cases at our institution and was not associated with differences in primary treatment modality,presence of concomitant ND,extent of pharyngeal defect,BOT involvement,or positive frozen or permanent surgical margin.

Factors predictive of an academic otolaryngologist’s scholarly impact

Objectives:Describe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact.Identify which otolaryngology subspecialties are the most scholarly.Describe if NIH funding to one’s choice of medical school,residency,or fellowship has any impact on one’s scholarly output.Determine other factors predictive of an academic otolaryngologist’s productivity.Study design:Analysis of bibliometric data of academic otolaryngologists.Methods:Active grants from the National Institutes of Health(NIH)to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database.Faculty listings from these departments were gleaned from departmental websites.H index was calculated using the Scopus database.Results:Forty-seven otolaryngology programs were actively receiving NIH funding.There were 838 faculty members from those departments who had a mean h index of 9.61.Otology(h index 12.50)and head and neck(h index 11.96)were significantly(P<0.0001)more scholarly than the rest of subspecialists.H index was significantly correlative(P<0.0001)with degree of NIH funding at a given institution.H index was not significantly higher for those that attended medical school(P<0.18),residency(P<0.16),and fellowship(P<0.16)at institutions with NIH funding to otolaryngology departments.Conclusions:H index is a bibliometric that can be used to assess scholarly impact.Otology and head and neck are the most scholarly subspecialists within otolaryngology.NIH funding to an individual’s medical school,residency,or fellowship of origin is not correlative with one’s scholarly impact,but current institutional affiliation and choice of subspecialty are.