Evaluation of the Discharge Care Coordination Process for Elderly Patients

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A Rare Finding of Schwannoma of the Vidian Canal: A Case Report

Background: Schwannomas of the vidian canal are an extremely rare type of intracranial tumor that can have variable clinical presentations including headache, facial pain, facial muscle paralysis, decreased lacrimation, or nasal dryness. We present an atypical case of an incidentally identified asymptomatic vidian canal schwannoma. Case Description A 49-year-old woman with a history of multiple sclerosis presented for routine surveillance magnetic resonance imaging that detected an ovoid mass originating in the vidian canal. Given the unusual location of the lesion, an endoscopic endonasal biopsy was performed and confirmed the diagnosis of a vidian canal schwannoma, for which the patient chose to receive fractionated radiation therapy. Conclusion: When a vidian canal tumor is identified, endoscopic endonasal biopsy can be used to confirm the diagnosis before pursuing either surgical or radiotherapy treatment. In particular, fractionated radiation therapy offers a radiobiologically safe means of delivering radiation when there is concern for late radiation-related side effects following treatment completion

Excision of large cervical lymphatic malformations using a selective neck dissection approach

Objectives: Lymphatic malformations (LM) are uncommon expansile lesions that may lead to aesthetic or functional impairment requiring intervention. Although recurrence and treatment-related complications are often reported for a subset of patients with extensive cervical LM, primary excision with a selective neck dissection approach is safe and effective. Study design: Case series at a single academic tertiary care center. Methods: Retrospective chart review was performed of clinical presentation, radiographic characteristics, operative notes, and pathology reports of three patients with large cervical LM who underwent complete surgical excision between July 2012 and December 2017. Results: Two-thirds were female with a median age of 39 years (range 34–49 years) All patients had left-sided lesions ranging in size from 6 to 20 cm. Presenting symptoms included increasing neck discomfort and disfigurement. All patients had lesions that were mobile to palpation, macrocystic and well-circumscribed on preoperative imaging without invasion of the upper aerodigestive tract, and without cranial neuropathy. There were no postsurgical cranial nerve issues, complications, or recurrence at a median follow up of 14.7 months (range 10.0–74.9 months). Conclusion: Adult patients with mobile, primarily macrocystic, and well-circumscribed cervical LM with no preoperative cranial nerve deficits are excellent candidates for primary surgical excision, even in cases of exceptionally large multicompartment lesions. If patients are carefully selected, surgery offers the distinct advantage of definitive treatment with a single modality in a single stage and minimal post-treatment morbidity. Keywords: Cervical lymphatic malformation, Congenital malformation, Primary surgical excision, Selective neck dissectio

Defining Typical Acetaminophen and Narcotic Usage in the Postoperative Rhinoplasty Patient

Objective To characterize the acetaminophen and narcotic use pattern of the postoperative rhinoplasty patient. To describe a pain level and pain medication usage pattern of the typical post-rhinoplasty patient and identify demographic considerations. Study design Prospective cohort study at a tertiary care center. Methods Rhinoplasty patients were given standardized perioperative pain instructions and narcotic medication (18 tabs oxycodone) along with a pain medication use survey. Postoperatively, survey and tracking information was collected regarding narcotic and acetaminophen use at their first postoperative appointment. Patients were asked about non-steroidal anti-inflammatory drug, aspirin, and chronic opioid use. Narcotic and acetaminophen use along pain levels (1-10) at time of use were recorded by patients at 4-hour increments postoperatively until their first postoperative visit. Results Pain medication usage (oxycodone and acetaminophen) peaked on (postoperative day 1) POD1. Pain was significantly higher in younger patients (30 years old or younger), female patients, and primary rhinoplasty patients. Pain was correlated with acetaminophen and oxycodone use for women, and acetaminophen used for men. Autologous rib grafting was not correlated with higher narcotic use. Conclusion Describing a pain medication usage pattern for the typical post-rhinoplasty patient provides both patients and clinicians important knowledge of postoperative pain expectations and has the potential to reduce both the amount of narcotic prescribed by providers and the amount of narcotic used by patients. Level of evidence 4 (Case Series) Laryngoscope, 131:48-53, 2021

Tympanic Plexus Neurectomy for Intractable Otalgia

Objective: The goal of this study was to analyze whether tympanic plexus neurectomy is a successful surgical option in patients with intractable otalgia. Study Design A retrospective single institution study from the experience of two surgeons was conducted. Methods: Records of adult patients with intractable unilateral otalgia of likely glossopharyngeal origin were reviewed, with institutional review board approval. Patients who responded to a tympanic plexus block were considered for tympanic neurectomy. Twelve patients (13 ears) underwent the procedure. Surgical outcomes and the presence of persistent otalgia were evaluated. Results: Persistent otalgia was present for 16.7 months ± 8.6 standard‐error‐of‐the‐mean months prior to an intervention. Narcotic medication was used in 41.7% of patients prior to surgery. Patients received tympanic plexus blocks (median: 1, range 1–3) prior to tympanic neurectomy to evaluate candidacy for surgery. Intractable otalgia resolved in six of 13 ears (46.2%) after one surgery, with an average follow‐up of 25.5 months. A significant reduction in pain occurred in two of 13 ears (15.4%) after an initial surgery. One patient received no benefit from the initial procedure. Revision surgery occurred in four ears, resulting in pain relief in three of four cases. All together, nine of 13 ears received complete resolution of pain, and an additional two of 13 ears received partial benefit using our algorithm for treatment of intractable otalgia of tympanic plexus origin. Conclusion: Intractable otalgia treated with tympanic neurectomy is a viable treatment option in cases of failed medical management. These findings provide important information that will aid clinicians in counseling chronic otalgia patients. Level of Evidence NA

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe