Browsing by Author "Vernon, Dominic"
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Item Extra-ocular movement restriction and diplopia following orbital fracture repair(Elsevier, 2017) Shah, H. A.; Shipchandler, Taha; Vernon, Dominic; Baumanis, Maraya; Chan, David; Nunery, William R.; Lee, Hui Bae Harold; Department of Otolaryngology -- Head and Neck Surgery, School of MedicinePurpose To report a series of patients with extra-ocular movement restriction and diplopia after orbital fracture repair, and determine the effect of timing of repair and the type of implant used. Methods A chart review was conducted identifying all patients > 18 years of age at our institution between June 2005 and June 2008 who underwent orbital fracture repair, and presented with clinically significant diplopia and extra-ocular movement restriction persisting longer than one month after repair. Data collected included timing of repair, implant used within the orbit, and need for revision. Results Ten patients were identified with a mean time to primary orbital fracture repair at 9 days (range 1–48). Seven patients underwent revision of their orbital fracture repair with removal of the previously placed implant and replacement with non-porous 0.4 mm Supramid Foil, whereas one patient underwent lateral and inferior rectus recessions without revision of primary fracture repair. Titanium mesh was the intra-orbital implant found in all patients requiring revision of orbital fracture repair. All revisions resulted in resolution of clinically significant diplopia. Conclusions Clinically significant diplopia and extra-ocular movement restriction is not an uncommon complication after orbital fracture repair. In our series, there was a strong association between these complications and the use of porous titanium mesh implants. Revision of fractures significantly improved diplopia in all but one patient. This suggests that meticulous fracture repair and the use of non-porous implants primarily or secondarily may preclude the need for strabismus surgery after orbital trauma.Item Lateral Crural Insertion Graft for External Nasal Valve Collapse(Liebert, 2020) Vernon, Dominic; Lee, Andrew; Papel, Ira; Otolaryngology -- Head and Neck Surgery, School of MedicineItem Nasal Bone Fractures and the Use of Radiographic Imaging: An Otolaryngologist Perspective(Elsevier, 2019-11) Westfall, Edward; Nelson, Benton; Vernon, Dominic; Saltagi, Mohamad Z.; Mantravadi, Avinash V.; Schmalbach, Cecelia; Ting, Jonathan Y; Shipchandler, Taha Z.; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective To determine radiologic preferences of practicing otolaryngologists regarding isolated nasal bone fractures. Study design An 8-question survey on isolated nasal bone fractures was designed. Setting Surveys were sent to all otolaryngology residency program directors for distribution among residents and faculty. Additional surveys were distributed to private practice otolaryngology groups. Results 140 physicians responded to the survey. 57% of the respondents were practicing otolaryngologists (75% with 10+ years of experience), while 43% of respondents were residents-in-training. 56% of respondents treated 1–5 nasal bone fractures per month. 80% of all respondents reported imaging being performed prior to consultation. If imaging was obtained before consultation, plain films and computed tomography (CT) maxillofacial/sinus scans were the most frequent modalities. 33% of residents and 70% of practicing otolaryngologists report imaging as ‘rarely’ or ‘never’ helpful in guiding management. 42% of residents and 20% of practicing otolaryngologists report asking for imaging when it wasn't already obtained. Decreased use of radiography was associated with greater years in practice and higher frequency of fractures treated. Conclusions and relevance Otolaryngologists seldom request imaging to evaluate and treat isolated nasal bone fractures. When ordered, imaging is utilized more often among residents-in-training and non-otolaryngology consulting physicians. This study highlights an opportunity to educate primary care and emergency room providers as well as otolaryngology residents on the value of comprehensive physical exam over radiographic imaging in the work-up of isolated nasal fractures. In addition, widespread adoption of a “no x-ray policy” in this setting may result in better resource utilization.Item Reconstruction of midface defect from idiopathic destructive process using Medpor implant(Elsevier, 2017-05) Franko, Joel; Harris, Michael S.; Vernon, Dominic; Shipchandler, Taha Z.; Otolaryngology -- Head and Neck Surgery, School of MedicineImportance Reconstruction of the midface remains a challenging task for even the most experienced surgeon, with a host of reconstructive options including free tissue transfer, allografts, or prosthetic implants. Presented here is a case of idiopathic bony destruction of the right midface in a 19 year old female, creating a unique defect requiring repair. Objective Demonstrate a unique case of severe maxillary degeneration and discuss the associated reconstructive challenges and final repair with a prosthetic implant. Design Case report. Results The patient presented with a 7 month history of an idiopathic progressive deformity of the right cheek. Computed tomography of the paranasal sinuses revealed extensive bone loss of the right midface and orbit. The patient underwent facial reconstruction using a customized Medpor (Stryker Corp, Kalamazoo, MI) implant. At 6 month follow-up the patient and physician were both pleased with the patient's overall appearance. The patient did have some residual lower lid retraction present as well as some lateral pull at the lateral canthus outward from the orbit itself. Conclusions Preoperative planning for midface reconstruction requires a deep understanding of the aesthetic, functional, and supportive roles this structure holds. Computer assistance allows the creation of custom made implants, providing the reconstructive surgeon with innovative options for reconstruction with minimal morbidity to the patient. As the technology around the design and creation of the custom implants continues to improve, the role of computer assistance in reconstruction will become more prominent.Item Telemedicine in Otolaryngology During COVID-19: An Exploratory Assessment of Provider and Patient Attitudes(Sage, 2023) Alwani, Mohamedkazim; Campiti, Vincent; Nesemeier, Ryan; Vernon, Dominic; Shipchandler, Taha; Ting, Jonathan; Parker, Noah; Otolaryngology -- Head and Neck Surgery, School of MedicineObjective: To determine provider and patient attitudes toward telemedicine in Otolaryngology-Head and Neck Surgery (OHNS). Methods: Otolaryngology practitioners conducting outpatient clinics at an academic tertiary referral center were provided with a pre-Study Provider Perception Questionnaire (pre-PPQ) designed to evaluate pre-study perception of telemedicine in otolaryngology. A post-study Provider Perception Questionnaire (post-PPQ) designed to evaluate elements similar to those constituting the PrePPQ was completed at 6 weeks. Additionally, following each visit, providers and patients completed Individual Encounter Survey Questionnaires (IESQ) to evaluate the virtual clinical encounter experience. Results: The pre-PPQ was completed by 29 providers, while the post-PPQ was completed by 12 providers. A total of 236 post-visit provider IESQs were completed, of which 208 were deemed successful. Audio/visual (AV) difficulties and limited server connectivity for the patient were most common causes for unsuccessful encounters. Providers reported that the most appropriate use of telemedicine, on both pre-PPQ and post-PPQ, was triaging patients to determine the need for in-person visits. The inability to perform a physical exam was rated as the primary barrier to telemedicine in OHNS on both pre-PPQ and post-PPQ. Patients strongly agreed with the statements, "My healthcare provider was able to understand my healthcare condition" and, "I felt comfortable communicating with my healthcare provider" 92.0% and 95.4% of the time, respectively. Conclusion: Both providers and patients demonstrated an overall positive attitude toward the use of telemedicine in the provision of otolaryngologic care.