The Versatility of Acellular Fetal Bovine Dermal Matrix for Head and Neck Surgical Reconstruction in Children

Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with chart review. Methods: A database of pediatric operative procedures was queried for the use of acellular fetal bovine dermal matrix over a 16-month period. Indications for reconstruction were assessed and initial parental and surgeon satisfaction with the product were noted. Results: During the time period of 3/2012 and 7/2013 a total of 8 reconstructive procedures were performed on pediatric patients using acellular fetal bovine dermal matrix. Indications for use varied and included open and transnasal endoscopic repair of encephaloceles and soft tissue reconstructions including lateral pharyngeal wall repair, cleft palate repair, and facial recontouring operations. Acellular fetal bovine dermal matrix had a subjectively increased ease of use as compared to the surgeon’s prior experience with human cadaveric acellular dermis. Every parent vocalized a greater comfort level with the use of a bovine product over the alternative of human cadaveric tissue. The cost of acellular fetal bovine dermal matrix is slightly lower than the cost of human cadaveric acellular dermis. Conclusions: Acellular fetal bovine dermal matrix appears to be an acceptable alternative to human cadaveric acellular dermis for various forms of head and neck soft tissue reconstruction in children. Further prospective studies are warranted to assess for any differences in the long-term efficacy of this product as compared to other forms of allograft reconstruction.

A current render of pediatric otolaryngology in the United States

Introduction Complex pediatric otolaryngology can be generally regarded as a subspecialty within otolaryngology focusing on the care of children with complex diseases of the head and neck and aerodigestive tract, or in some cases more common diseases in this anatomical region in otherwise medically complex children. This concept of the specialty was succinctly articulated by Charles Bluestone in 1995 when he wrote pediatric otolaryngologists treat 'special problems or special children, or both'.1 Increasingly, this care is delivered by multi-disciplinary pediatric health care providers working at highly specialized tertiary care centers for children. This review will briefly cover the historical evolution of the specialty's origins, along with its current state of graduate medical education training and sub-certification efforts.

Integrating Biodegradable 3-Dimensional-Printing into Tracheal Reconstruction

Background: Currently, there is no set standard treatment for long-segment tracheomalacia and stenosis. In this study we set out to explore the potential to create a tissue engineered, biodegradable and three-dimensionally (3D) printed tracheal ring as a first step towards bioengineering a long segment tracheal replacement. Method of Approach: A 3D-Computer aided design (CAD) model was produced with multiple channels to allow for cellular growth while mimicking the native anatomy. The design was optimized to allow for printability, cellular expansion, and integration and 3D printed using a modified commercial 3D printer. Results: The cells grown in the scaffold demonstrated a similar proliferation trend compared to control. Chondrocytes within the 3D printed ring retained their phenotypic properties and did not infer any significant change in flexibility, contour and strength to the scaffold. Conclusion: The combination of living cells and a 3D modeled patient specific graft may address some of the unmet clinical needs in the field of tracheal reconstruction. This proof of concept study represents a first step towards producing a 3D printed and tissue engineered long segment tracheal replacement graft for airway surgery.

Changes in otolaryngology application requirements and match outcomes:Are we doing any better?

Objectives:Otolaryngology-specific requirements were piloted to minimize applicant and program burdens.We investigated the impact of introducing and then removing these requirements on Match outcomes.Methods:2014-2021 National Resident Matching Program?data were examined.The primary outcome was the impact of Otolaryngology Resident Talent Assessment(ORTA;prematch 2017,postmatch 2019)and Program-Specific Paragraph(PSP;implemented 2016,optional 2018)on applicant numbers and match rates.Secondary survey analysis assessed candidate perceptions of PSP/ORTA.Results:Applicant numbers declined significantly during PSP/ORTA(18.9%;p=0.001).With the optional PSP and postmatch ORTA,applicant numbers increased significantly(39.0%;p=0.002).Examined individually,mandatory PSP was associated with a significant decline in applicants(p=0.007),whereas postmatch ORTA was associated with significant increases in applicants(p=0.010).ORTA and PSP negatively impacted the decision to apply to otolaryngology in 59.8%and 51.3%of applicants,respectively.Conversely,match rate success improved significantly from 74.8%to 91.2%during PSP/ORTA(p=0.014),followed by a significant decline to 73.1%after PSP was made optional and ORTA moved to postmatch(p=0.002).Conclusions:ORTA and PSP correlated with decreased applicant numbers and increased match rate success.As programs seek ways to remove barriers to applying to otolaryngology,the potential consequences of an increasing pool of unmatched candidates must also be considered.

Anatomy and physiology of the palatine tonsils, adenoids, and lingual tonsils

Objective::This review aims to discuss the basic anatomy and physiology of the palatine and pharyngeal tonsils,with reference to how this foundational understanding may affect patient management and surgical procedures in these regions of the upper airway.Methods::A literature search was performed using PubMed and Google Scholar using the MeSH terms tonsils,adenoids,anatomy,physiology,and adenotonsillectomy.Primary sources were excluded if they were abstracts only,non-English language,or non-human studies.Thirty-five sources were included in this review.Results and conclusions::The pharyngeal and palatine tonsils are compact yet physiologically complex mucosa-associated lymphoid tissues that make up a portion of Waldeyer’s ring.As part of the mucosal immune system,these structures function in exogenous antigen sampling and stimulation of immune responses.Aberrant immune activation and/or regulation can lead to a myriad of pathologies,with adenotonsillar hypertrophy,chronic tonsillitis/adenoiditis,and recurrent otitis media among the most commonly encountered conditions by otolaryngologists.While the pathophysiology of these conditions is still incompletely understood,current evidence and future investigations may reveal patterns amenable to targeted medical management.When medical management fails,tonsillectomy and/or adenoidectomy may be indicated for patient care.Though routine procedures,the execution of tonsil and/or adenoid removal requires a thorough understanding of the anatomy of these lymphoepithelial organs so as to minimize the risk for rare serious complications that can occur.

Improving outcomes in the management of first branchial cleft anomalies in children

Drs Liu and Zhang along with their co-authors present to us an extremely large series of first branchial cleft anomalies (FBCA) over only a 4-year time span.1 Perhaps one of the largest series of FBCA from a large children's hospital in Beijing,China.They reviewed their experience and found 70 patients with FBCA.Utilizing the Work classification for Type Ⅰ (ectodermal origin) and Type Ⅱ (ectoderm and mesoderm),they describe the incidence of the disorders in their population and the relationship of the anomalies with the facial nerve.