Background: Loss of brow elevation in the early postoperative period has been well documented; however, there has been no study quantifying the minimum time necessary to achieve lasting brow elevation. Previous work in our laboratory has demonstrated that complete readherence of periosteum to bone can take 12 weeks to occur after periosteal elevation. The correlation between adherence and the development of strength has never been examined.Objective: To correlate histological characteristics of raised forehead periosteum with the strength of the periosteum-bone union postoperatively.Subjects: Eighteen New Zealand white rabbits.Methods: Rabbit foreheads were elevated in a subperiosteal plane and the flap reapproximated with chromic sutures. Animals were killed at 14, 28, 45, 63, or 84 days postoperatively, and all tissue superficial to the periosteum removed. The tension required to avulse sections of periosteum was then measured. Skulls were then sectioned and prepared for histological analysis of remaining periosteum. Avulsion forces and histological findings were compared with those unoperated-on controls.Results: The forces necessary to avulse periosteum in the 14-and 28-day groups were significantly lower than for control animals; values at 45, 63, and 84 days were not significantly different from control animals. Healing periosteum displayed varying degrees of thickness, cellularity, edema, and vascular congestion. These features peaked at 28 days postoperatively then gradually resolved to near-control values by 84 days. Significant periosteal-to-bone contact did not appear until 45 days postoperatively. Conclusion:Our results promote the use of methods of brow fixation that support mobilized soft tissues for a minimum of 6 weeks, until the elevated periosteum has significantly readhered to the underlying bone.

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We describe our method for reconstructing microtic auricles using a porous polyethylene framework in two stages. The first stage of the procedure involves rotating a superficial temporoparietal fascial (TPF) flap over the framework. The inferior two-thirds of this framework is next inset into a local temporal skin pocket, while the superior one-third is covered with a full thickness skin graft from the contralateral postauricular sulcus. Lobular transposition is commenced in a second stage procedure at the three-month postoperative period. Hearing restoration surgery is encouraged at a later date in selected patients with unilateral microtia. Use of the porous polyethylene framework permits a more expedient, less invasive, and more reliable method for auricular reconstruction than does the traditional method that employs costal cartilage.

The purpose of this study was to evaluate the types of consultations received by an otolaryngology service at a 772-bed large metropolitan, MI-based hospital. METHODS METHODS The authors performed a retrospective review of the specific types of consultations received during calendar year 2016. RESULTS RESULTS A total of 518 consultations were reviewed and analyzed by the first and second authors (MM, CB). Consultations with low intervention rates included dysphagia (difficulty swallowing) (32.3%), dysphonia (difficulty speaking) (16%), otalgia (earache) (20.8%), hearing loss (13.3%), rule out vocal cord dysfunction (0%), and vertigo/dizziness (0%). Epistaxis (nosebleed) was the most frequent reason for consultations, and angioedema (lip or airway swelling) was the most common airway-related consultation. Notably, emergent or urgent surgery was only performed on 4.6% of sample patients. Several common consultation reasons (e.g., longer-term hearing loss evaluation and cerumen ("earwax") removal) could have been deferred for clinic-based evaluation where audiograms and microscopes are more readily available. CONCLUSIONS CONCLUSIONS These findings suggest areas for continuing education for primary care provider and resident education to place more appropriate hospital consultations. Annual resident lectures to prepare junior residents for the most common call scenarios (i.e., control epistaxis and incision and drainage of peritonsillar abscesses) could be helpful in this area. In addition, didactic lectures for primary care physicians on how to evaluate patients with dysphagia may be of value as this was a common consult for otolaryngologist referrals.