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Journal of Otolaryngology - Head and Neck Surgery
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  This is an Open Access Journal Open Access journal
     ISSN (Print) 1916-0216
     Published by Biomed Central Ltd. Homepage  [268 journals]   [SJR: 0.564]   [H-I: 11]
  • Mixed reality temporal bone surgical dissector: mechanical design

    • Authors: Jordan Hochman, Nariman Sepehri, Vivek Rampersad, Jay Kraut, Milad Khazraee, Justyn Pisa, Bertram Unger
      First page: 23
      Abstract: ObjectiveThe Development of a Novel Mixed Reality (MR) Simulation.An evolving training environment emphasizes the importance of simulation. Current haptic temporal bone simulators have difficulty representing realistic contact forces and while 3D printed models convincingly represent vibrational properties of bone, they cannot reproduce soft tissue. This paper introduces a mixed reality model, where the effective elements of both simulations are combined; haptic rendering of soft tissue directly interacts with a printed bone model.This paper addresses one aspect in a series of challenges, specifically the mechanical merger of a haptic device with an otic drill. This further necessitates gravity cancelation of the work assembly gripper mechanism. In this system, the haptic end-effector is replaced by a high-speed drill and the virtual contact forces need to be repositioned to the drill tip from the mid wand.Previous publications detail generation of both the requisite printed and haptic simulations.MethodCustom software was developed to reposition the haptic interaction point to the drill tip. A custom fitting, to hold the otic drill, was developed and its weight was offset using the haptic device. The robustness of the system to disturbances and its stable performance during drilling were tested. The experiments were performed on a mixed reality model consisting of two drillable rapid-prototyped layers separated by a free-space. Within the free-space, a linear virtual force model is applied to simulate drill contact with soft tissue. Results: Testing illustrated the effectiveness of gravity cancellation. Additionally, the system exhibited excellent performance given random inputs and during the drill’s passage between real and virtual components of the model. No issues with registration at model boundaries were encountered. Conclusion: These tests provide a proof of concept for the initial stages in the development of a novel mixed-reality temporal bone simulator.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:23
      PubDate: 2014-08-08T12:00:00Z
      DOI: 10.1186/s40463-014-0023-9
      Issue No: Vol. ${item.volume} (2014)
  • Cochlea sparing effects of intensity modulated radiation therapy in head
           and neck cancers patients: a long-term follow-up study

    • Authors: Eleonoor Theunissen, Charlotte Zuur, Marta Yurda, Sieberen van der Baan, Anne Kornman, Jan de Boer, Alfons Balm, Coen Rasch, Wouter Dreschler
      First page: 30
      Abstract: Background: Radiation to the inner ear may lead to (irreversible) sensorineural hearing loss. The purpose of this study was to demonstrate the long-term effect of radiotherapy on hearing in patients treated with Intensity Modulated Radiation Therapy (IMRT), sparing the inner ear from high radiation dose as much as possible. Methods: Between 2003 and 2006, 101 patients with head and neck cancer were treated with IMRT. Audiometry was performed before, short-term, and long-term after treatment. Data were compared to normal hearing levels according to the International Organisation for Standardization (ISO). Statistical analysis was done using repeated measurements. None of the patients received chemotherapy. Results: In 36 patients a audiogram at long-term follow-up (median 7.6'years) was available. The mean dose to the cochlea was 17.8'Gy (1.0-66.6'Gy). A hearing deterioration of 1.8'dB at Pure Tone Average (PTA) 0.5-1-2'kHz (p'='0.11), 2.3'dB at PTA 1-2-4'kHz (p'='0.02) and 4.4'dB at PTA 8-10-12.5'kHz (p'='0.01) was found. According to the ISO, the expected age-related hearing loss was 2.7, 4.8, and 8.8'dB at PTA 0.5-1-2'kHz, 1-2-4'kHz and 8-10-12.5'kHz, respectively. Conclusions: After IMRT with radiation dose constrain to the cochlea, potential long-term adverse effects of IMRT remained subclinical. The progressive hearing loss over time was mild and could be attributed to the natural effects of ageing. Therefore, we recommend that a dose constraint to the cochlea should be incorporated in the head and neck radiotherapy protocols.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:30
      PubDate: 2014-08-06T12:00:00Z
      DOI: 10.1186/s40463-014-0030-x
      Issue No: Vol. ${item.volume} (2014)
  • Comparison of cadaveric and isomorphic virtual haptic simulation in
           temporal bone training

    • Authors: Dana Wong, Bertram Unger, Jay Kraut, Justyn Pisa, Charlotte Rhodes, Jordan Hochman
      First page: 31
      Abstract: Background: Virtual surgery may improve learning and provides an opportunity for pre-operative surgical rehearsal. We describe a novel haptic temporal bone simulator specifically developed for multicore processing and improved visual realism. A position locking algorithm for enhanced drill-bone interaction and haptic fidelity is further employed. The simulation construct is evaluated against cadaveric education. Methods: A voxel-based simulator was designed for multicore architecture employing Marching Cubes and Laplacian smoothing to perform real-time haptic and graphic rendering of virtual bone.Ten Otolaryngology trainees dissected a cadaveric temporal bone (CTB) followed by a virtual isomorphic haptic model (VM) based on derivative microCT data. Participants rated 1) physical characteristics, 2) specific anatomic constructs, 3) usefulness in skill development and 4) perceived educational value. The survey instrument employed a Likert scale (1-7). Results: Residents were equivocal about the physical properties of the VM, as cortical (3.2 ± 2.0) and trabecular (2.8 ± 1.6) bone drilling character was appraised as dissimilar to CTB. Overall similarity to cadaveric training was moderate (3.5 ± 1.8). Residents generally felt the VM was beneficial in skill development, rating it highest for translabyrinthine skull-base approaches (5.2 ± 1.3). The VM was considered an effective (5.4 ± 1.5) and accurate (5.7 ± 1.4) training tool which should be integrated into resident education (5.5 ± 1.4). The VM was thought to improve performance (5.3 ± 1.8) and confidence (5.3 ± 1.9) and was highly rated for anatomic learning (6.1 ± 1.9). Conclusion: Study participants found the VM to be a beneficial and effective platform for learning temporal bone anatomy and surgical techniques. They identify some concern with limited physical realism likely owing to the haptic device interface. This study is the first to compare isomorphic simulation in education. This significantly removes possible confounding features as the haptic simulation was based on derivative imaging.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:31
      PubDate: 2014-10-13T12:00:00Z
      DOI: 10.1186/s40463-014-0031-9
      Issue No: Vol. ${item.volume} (2014)
  • Current management of papillary thyroid microcarcinoma in Canada

    • Authors: Mazin Merdad, Antoine Eskander, John De Almeida, Jeremy Freeman, Lorne Rotstein, Shereen Ezzat, Anna Sawka, David Goldstein
      First page: 32
      Abstract: IntroductionThe detection of papillary thyroid microcarcinoma (PTMC) is on the rise and its optimal management remains controversial. Our aim was to determine the current self-reported management of PTMC amongst Canadian otolaryngologist-head and neck surgeons (OHNS) and endocrinologists and to identify factors influencing their management decisions. Methods: A nine item web-based questionnaire was distributed to Canadian OHNS and endocrinologists. The three main domains were demographics, current management of PTMC scenarios, and factors influencing the decisions. Results: One hundred and thirteen OHNS and endocrinologists completed the survey. Respondents were closely divided between recommending hemithyroidectomy (47%) or total thyroidectomy (43%) for a newly diagnosed PTMC in a low risk patient. Observation was the preferred method for managing PTMC detected incidentally after hemithyroidectomy (76%). Respondents chose more aggressive treatment for males patients compared to female patients. A positive history of thyroid cancer or previous radiation exposure was the most important factor influencing the management of PTMC. Conclusion: The current practices of Canadian OHNS and endocrinologist largely coincide with available guidelines. The slight variation in practice might be explained by the opposing evidence supporting different management options. Given the dramatic increase in the incidence of PTMC we suggest future guidelines address the management of PTMC independently.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:32
      PubDate: 2014-08-14T00:00:00Z
      DOI: 10.1186/s40463-014-0032-8
      Issue No: Vol. ${item.volume} (2014)
  • Metabolic tumour volume as a prognostic factor for oral cavity squamous
           cell carcinoma treated with primary surgery

    • Authors: Han Zhang, Hadi Seikaly, Jonathan Abele, Dean Jeffery, Jeffrey Harris, Daniel O¿Connell
      First page: 33
      Abstract: Background: Metabolic tumour volume (MTV) obtained from pre-treatment 18 F-fluorodeoxydeglucose positron emission tomography with computed tomography (PET-CT) has been validated as an independent predictive factor of outcomes in head and neck cancer patients (HNC) treated with primary chemoradiotherapy (CRT). However its role in patients treated with primary surgery has not yet been studied.ObjectiveTo evaluate the prognostic value of MTV in patients treated with primary surgery for oral cavity squamous cell carcinoma (OCSCC).MethodDemographic and survival data was obtained from patients diagnosed with OCSCC from 2008–2012 in Alberta, Canada. All patients included in the study had PET-CT scan before curative surgical resection. MTV and maximum standardized uptake value (SUVmax) value was delineated from pre-treatment PET-CT scans using Segami Oasis software (Columbus, OH). MTV and SUVmax were divided into intertertile thirds before statistical analysis to allow for in-group comparison of survival. Results: A total of 80 patients were analyzed using SPSS ver. 20.0 (SPSS Inc, Chicago, IL). Five-year overall, and disease-free survival using Kaplan-Meier curves were 70% and 73% respectively. When the combined SUVmax (tumour primary and locoregional metastasis) was evaluated, it failed to predict overall (HR = 1.0, p = 0.99) or disease-free survival (HR = 1.0, p = 0.227).Conversely an increase in MTV of 17.5 mL (difference between the highest and lowest MTV tertile) was associated with a 12.4 fold increase in risk of disease recurrence (p 
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:33
      PubDate: 2014-10-13T12:00:00Z
      DOI: 10.1186/s40463-014-0033-7
      Issue No: Vol. ${item.volume} (2014)
  • Factors associated with severe deep neck space infections: targeting
           multiple fronts

    • Authors: Brittany Barber, Peter Dziegielewski, Vincent Biron, Andrew Ma, Hadi Seikaly
      First page: 35
      Abstract: ObjectivesTo determine factors predictive of a severe deep neck space infection (DNSI), defined as those requiring surgery and/or postoperative intensive care unit (ICU) admission. To specifically examine dental practices and socioeconomic factors that may contribute to the development of a DNSI.Study designRetrospective review. Methods: This study was conducted at 2 tertiary care academic referral centers from January 2007 to September 2011. The study was composed of 2 arms: a prospective questionnaire and data collection to identify modifiable risk factors such as dental practices and socioeconomic considerations for a DNSI, and a retrospective review of deep neck space infections to identify commonly associated risk factors predictive of a severe DNSI, requiring surgery and/or postoperative ICU admission. Results: 233 patients were reviewed retrospectively and 25 patients prospectively. Patients with a low level of education (p = 0.03), those living greater than 1 hour from a tertiary care center (p = 0.002), those that have tonsils (p = 0.03), and those with Streptococcus infections (p = 0.03) have an increase risk of developing a severe DNSI. Patients that were smokers (p = 0.02) or had diabetes (p = 0.02), and those that presented with airway compromise (p = 0.03) were more likely to have a prolonged hospital stay. Conclusions: Factors predictive of severe DNSIs are Streptococcus infections, the presence of tonsils, education level, and geographic location.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:35
      PubDate: 2014-08-16T12:00:00Z
      DOI: 10.1186/s40463-014-0035-5
      Issue No: Vol. ${item.volume} (2014)
  • Eyelid and brow asymmetry in patients evaluated for upper lid

    • Authors: Kristian Macdonald, Adrian Mendez, Robert Hart, S Taylor
      First page: 36
      Abstract: IntroductionIn evaluation for blepharoplasty, patients often desire improved cosmesis and/or correction of visual field deficits. However, patients are usually unaware of eyelid or brow asymmetry. Furthermore, the prevalence of eyelid and brow asymmetry is infrequently reported in the medical literature.PurposeTo determine the prevalence of brow and eyelid asymmetry in patients evaluated for upper lid blepharoplasty. Methods: One hundred consecutive patients evaluated for upper lid blepharoplasty were included in the study. Standard pre-operative photographs were taken of all patients using consistent background and photographic equipment. Two of the authors (KM & AM) independently recorded the margin pupil (MPD), central eyebrow (CED), nasal eyebrow (NED) and temporal eyebrow (TED) distances. To test the inter-observer reliability, the senior author (SMT) recorded the same measurements for 10% of randomly selected patients. We calculated 95% confidence intervals to compare symmetry between the right and left sides. Results: One hundred patients (94 female, mean age 57.7) were included in the study. The average MPD, CED, NED and TED distances were 0.55 mm (95% CI 0.45-0.65), 1.77 mm (95% CI 1.47-2.07), 1.34 mm (95% CI 1.14-1.54), and 1.78 mm (95% CI 1.50-2.06), respectively. Ninety-three percent of patients had at least one asymmetric measurement of greater than 1 mm. Seventy-five percent of patients studied had at least one measurement greater than 2 mm while 37 percent had at least one greater than 3 mm. Conclusion: Brow and eyelid asymmetry is common in patients being evaluated for upper lid blepharoplasty. The facial plastic surgeon should identify and document facial asymmetry pre-operatively, and discuss it with prospective blepharoplasty patients. This will improve informed consent and patient expectations.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:36
      PubDate: 2014-10-02T00:00:00Z
      DOI: 10.1186/s40463-014-0036-4
      Issue No: Vol. ${item.volume} (2014)
  • Otolaryngology ¿ Head and Neck Surgeon unemployment in Canada: a
           cross-sectional survey of graduating Otolaryngology ¿ Head and Neck
           Surgery residents

    • Authors: Michael Brandt, Grace Scott, Philip Doyle, Robert Ballagh
      First page: 37
      Abstract: ObjectiveRecently graduated Otolaryngology - Head and Neck Surgeons (OTO-HNS) are facing an employment crisis. To date, there has been no systematic evaluation of the factors contributing to this situation, graduating OTO-HNS trainee employment rates, nor the employment concerns of these graduating residents. This investigation sought to empirically evaluate prospective OTO-HNS graduate employment, identify factors contributing to this situation, and provide suggestions going forward. Methods: A cross-sectional survey of the 2014 graduating cohort of OTO-HNS residents was conducted 6-months prior to graduation, and immediately following residency graduation. Surveyed items focused on the demographics of the graduating cohort, their future training and employment plans, and their concerns relative to the OTO-HNS employment situation. Results: All twenty-nine Canadian medical school graduated OTO-HNS residents completed the initial survey, with 93% responding at the completion of residency. Only 6 (22%) indicated confirmed employment following residency training. 78% indicated that they were pursuing fellowship training. 90% identified the pursuit of fellowship training as a moderately influenced by limited job opportunities. The ability to find and secure full-time employment, losing technical skills if underemployed/unemployed, and being required to consider working in a less-desired city/province were most concerning. 34% of the residents felt that they were appropriately counseled during their residency training about employment. 90% felt that greater efforts should be made to proactively match residency-training positions to forecasted job opportunities. Conclusions: Canadian OTO-HN Surgeons lack confirmed employment, are choosing to pursue fellowship training to defer employment, and are facing startling levels of under- and unemployment. A multitude of factors have contributed to this situation and immediate action is required to rectify this slowly evolving catastrophe.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:37
      PubDate: 2014-09-16T12:00:00Z
      DOI: 10.1186/s40463-014-0037-3
      Issue No: Vol. ${item.volume} (2014)
  • Gesture-controlled interactive three dimensional anatomy: a novel teaching
           tool in head and neck surgery

    • Authors: Jordan Hochman, Bertram Unger, Jay Kraut, Justyn Pisa, Sabine Hombach-Klonisch
      First page: 38
      Abstract: Background: There is a need for innovative anatomic teaching tools. This paper describes a three dimensional (3D) tool employing the Microsoft Kinect™. Using this instrument, 3D temporal bone anatomy can be manipulated with the use of hand gestures, in the absence of mouse or keyboard. Methods: CT Temporal bone data is imported into an image processing program and segmented. This information is then exported in polygonal mesh format to an in-house designed 3D graphics engine with an integrated Microsoft Kinect™. Motion in the virtual environment is controlled by tracking hand position relative to the user’s left shoulder. Results: The tool successfully tracked scene depth and user joint locations. This permitted gesture-based control over the entire 3D environment. Stereoscopy was deemed appropriate with significant object projection, while still maintaining the operator’s ability to resolve image details. Specific anatomical structures can be selected from within the larger virtual environment. These structures can be extracted and rotated at the discretion of the user. Voice command employing the Kinect’s™ intrinsic speech library was also implemented, but is easily confounded by environmental noise. Conclusion: There is a need for the development of virtual anatomy models to complement traditional education. Initial development is time intensive. Nonetheless, our novel gesture-controlled interactive 3D model of the temporal bone represents a promising interactive teaching tool utilizing a novel interface.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:38
      PubDate: 2014-10-07T00:00:00Z
      DOI: 10.1186/s40463-014-0038-2
      Issue No: Vol. ${item.volume} (2014)
  • `The air that we breathe¿: assessment of laser and electrosurgical
           dissection devices on operating theater air quality

    • Authors: Matthew Brace, Elizabeth Stevens, S Taylor, Sarah Butt, Zhennan Sun, Licai Hu, Megan Borden, Neeraj Khanna, James Kuchta, Jonathan Trites, Robert Hart, Mark Gibson
      First page: 39
      Abstract: ObjectivesTo measure changes in air quality during surgery. Methods: Operating room (OR) and hallway air quality was continuously monitored over a 3-month period. Rooftop monitoring was used to control for environmental changes and to account for the infiltration of outdoor air pollutants. Air quality measurements were correlated with operative times and electro-dissection equipment used. Results: OR air is cooler and drier compared to the adjacent hallway. Volatile organic compounds and other gases are below indoor air exposure limit guidelines. Lasers create greater 2.5 μm particulate matter (PM2.5) mass concentration, and greater fine and coarse particle number than cautery or cold tissue dissection. Cautery produces more ultrafine particles (UFP) than other dissection techniques. OR air has lower particle counts than outdoor environmental air by virtue of air conditioning HEPA filtration. Conclusion: Compared to the outside air, operating room air has lower particle counts. Lasers produce higher concentrations of PM2.5 mass and, fine and coarse particle number counts. Cautery produces higher concentrations of UFP number counts than other modalities and warrants consideration of the use of masks with ultrafine particle filtration capacity. Operating room air is consistently cooler with decreased humidity, which may cause airway irritation.
      Citation: Journal of Otolaryngology - Head & Neck Surgery 2014, null:39
      PubDate: 2014-10-13T12:00:00Z
      DOI: 10.1186/s40463-014-0039-1
      Issue No: Vol. ${item.volume} (2014)
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