Feasibility of transoral robotic surgery using the da Vinci Xi system for oropharyngeal cancer and obstructive sleep apnea in low-volume center.

Transoral robotic surgery (TORS) has become a common surgical approach for the treatment of both benign and malignant conditions of the oropharynx. While the newer da Vinci Xi platform has largely replaced the previous Si model in many institutions, the reported outcomes with this system in head and neck surgery are limited. We report the feasibility of using the da Vinci Xi platform for managing oropharyngeal cancer and obstructive sleep apnea in a low-volume center.

Development of an murine model of perineural invasion and spread of cutaneous squamous cell carcinoma of the head and neck.

Introduction: Cutaneous squamous cell carcinoma of the head and neck (cSCCHN) can metastasize by invading nerves and spread toward the central nervous system. This metastatic process is called perineural invasion (PNI) and spread (PNS). An sciatic nerve mouse model is used for cSCCHN PNI/PNS.

Utilization of Silicone Sheet as a Protective Guide During Transoral Robotic Tongue Base Surgery.

This article presents a simple technique where a silicone sheet is used during transoral robotic surgery (TORS) to protect the upper airway structures from thermal damage during a base of tongue procedure. We review 10 cases of TORS tongue base reduction with the use of this technique, with no complications and with reduction of thermal damage to the lingual epiglottis and surrounding pharyngeal wall. Furthermore, it served as a guide during tongue base dissection to provide visual and tactile feedback to the inferior limit of resection, as well as to protect the endotracheal tube.

Aortitis in an Immunocompetent Host.

is a commensal organism of canine and feline oral flora known to cause severe infections most frequently reported in immunocompromised hosts. We describe a case of bacterial aortitis secondary to in an 80-year-old immunocompetent female, who presented with fever, non-specific lower back, and pelvic pain. Infection was confirmed with positive blood cultures and serial imaging.

Current Trends in the Evaluation and Management of Nondisplaced Femoral Neck Fractures in the Elderly.

Nondisplaced (Garden I and II) femoral neck (FN) fractures are commonly encountered by the practicing orthopaedic surgeon. Although these fractures are primarily classified based on the AP radiograph, the lateral radiograph should be closely scrutinized as well because posterior tilt has emerged as a consistent predictor of fixation failure. Internal fixation has for many years been the standard of care, with both cannulated screws and the sliding hip screw representing acceptable options.

Treatment of Intertrochanteric Femur Fractures with Long versus Short Cephalomedullary Nails.

Context: Prior studies regarding indications for long vs short cephalomedullary nails in the treatment of intertrochanteric fractures had limited sample sizes and follow-up, suggesting a need for further investigation.

Objective: To evaluate the association between cephalomedullary nail length and outcomes for the treatment of intertrochanteric femur fractures.

Design: Cohort study using Kaiser Permanente's Hip Fracture Registry.

Head and Neck Tumor Resection and Free Flap Reconstruction in Low-Volume Center.

Objective: To determine the surgical outcomes of free tissue transfer surgery following head and neck tumor extirpation in a low-volume medical center.

Methods: Retrospective chart review of patients who underwent free tissue transfer surgery for head and neck cancer at Moanalua Medical Center from 2015 to 2018.

Main Outcome Of Measure: Free flap failure rate and free flap-related complications.

The Association of Race/Ethnicity and Total Knee Arthroplasty Outcomes in a Universally Insured Population.

Background: Prior studies have documented racial/ethnic disparities in the United States for total knee arthroplasty (TKA) outcomes. One factor cited as a potential mediator is unequal access to care. We sought to assess whether racial/ethnic disparities persist in a universally insured TKA population.

Prospective, multicenter, randomized, controlled trial evaluating the performance of a novel combination powder vs hemostatic matrix in cardiothoracic operations.

Aim: This trial compared the hemostatic performance of a novel combination powder (CP) to a control hemostatic matrix (HM) in cardiothoracic operations.

Methods: Patients meeting eligibility criteria were enrolled after providing informed consent. Subjects were randomized intraoperatively to receive CP (HEMOBLAST Bellows; Biom'up, France) or HM (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, CA).

Supraclavicular Artery Island Flap in Head and Neck Reconstruction: A Case Series and Literature Review.

Introduction: Supraclavicular artery island flap (SCAIF) is emerging as an efficient and reliable flap for various complex head and neck defects after tumor extirpation.

Objective: To examine a series of cases using a SCAIF for head and reconstruction at our institution.

Methods: We performed a retrospective review of 8 patients who underwent SCAIF reconstruction of various head and neck defects from 2015 to 2018 at our institution.

Not All Garden-I and II Femoral Neck Fractures in the Elderly Should Be Fixed: Effect of Posterior Tilt on Rates of Subsequent Arthroplasty.

Background: Internal fixation is currently the standard of care for Garden-I and II femoral neck fractures in elderly patients. However, there may be a degree of posterior tilt (measured on preoperative lateral radiograph) above which failure is likely, and primary arthroplasty would be preferred. The purpose of this analysis was to determine the association between posterior tilt and the risk of subsequent arthroplasty following internal fixation of Garden-I and II femoral neck fractures in elderly patients.

A Comparison of Online Physician Ratings and Internal Patient-Submitted Ratings from a Large Healthcare System.

Background: Physician online ratings are ubiquitous and influential, but they also have their detractors. Given the lack of scientific survey methodology used in online ratings, some health systems have begun to publish their own internal patient-submitted ratings of physicians.

Objective: The purpose of this study was to compare online physician ratings with internal ratings from a large healthcare system.

Orthopaedic Faculty and Resident Racial/Ethnic Diversity is Associated With the Orthopaedic Application Rate Among Underrepresented Minority Medical Students.

Introduction: Orthopaedic surgery is among the least diverse fields in all of medicine. To promote the recruitment of minorities, a commonly proposed strategy is to increase the exposure of minority medical students to orthopaedic surgeons and residents who are minorities themselves. This study examines the degree to which the racial/ethnic diversity of the orthopaedic faculty and residency program influences underrepresented in medicine (URM) medical students at that institution to pursue a career in orthopaedics.

Association Between Race and Ethnicity and Hip Fracture Outcomes in a Universally Insured Population.

Background: Prior studies have documented racial and ethnic disparities in hip fracture treatment and outcome, and unequal access is commonly cited as a potential mediator. We sought to assess whether disparities in hip fracture outcome persist within a universally insured population of patients enrolled in a managed health-care system.

Methods: A U.

Effect of Surgeon and Hospital Volume on Morbidity and Mortality After Hip Fracture.

Background: Prior studies have examined the relationship between surgeon and hospital volumes and outcome following hip fracture surgical procedures, but the results have been inconclusive. The purpose of this study was to assess the hip fracture volume-outcome relationship by analyzing data from a large, managed care registry.

Methods: The Kaiser Permanente Hip Fracture Registry prospectively records information on surgically treated hip fractures within the managed health-care system.

Minimally Invasive Screw Fixation of Inferior Pubic Ramus Stress Fracture Nonunion in a Runner: A Case Report.

Case: A fifty-one-year-old female runner developed a stress fracture of the inferior pubic ramus. Nonoperative treatment was initiated, but the symptoms persisted and she was diagnosed with a nonunion. After eleven months of symptoms and ten months of nonoperative treatment, including four months of complete avoidance of running, percutaneous screw fixation was performed, with radiographic and clinical healing of the fracture.

Comparison of locked plate fixation and nonoperative management for displaced proximal humerus fractures in elderly patients.

Use of locked plate fixation for proximal humerus fractures in elderly patients has increased markedly in recent years. We conducted a study to compare outcomes of operative (locked plate fixation) and nonoperative management of these fractures. From our database, we identified 207 displaced proximal humerus fractures that met all inclusion and exclusion criteria.

Improving pain management in orthopedic surgical patients with opioid tolerance.

As increasing numbers of the baby boomer generation seek health care, nursing staff educated in the evidence-based practice process can make significant contributions to successful patient outcomes. Health care providers who anticipate the approaching perfect storm in health care and thoughtfully plan, collaborate, and incorporate evidence-based practice methods will be well prepared to improve the quality of care, realize cost savings, and meet the challenges ahead.