Objective: Determine whether the type (paramedian forehead [PMFF] vs nasolabial [NLF]) or the defect thickness (full vs partial) play a role in take rates of interpolation flaps in nasal reconstruction. Method: A retrospective chart review was performed on patients who underwent nasal reconstruction with 2-stage paramedian forehead or nasolabial flaps between 2002 and present. Defect characteristics recorded were thickness, size, location; flap type used for repair, utilization of cartilage grafts; and comorbidities, including diabetes, peripheral vascular or coronary artery disease, and smoking habits. Results: A total of 107 total patients; 82 (76%) reconstructed using 2-stage paramedian forehead flap; 25 (24%) using a 2-stage nasolabial flap (NLF). A total of 47 PMFF and 12 NLF were used for full thickness defects. Overall failure rate was 5%, both partial and complete. Five PMFF failed (7%), 3 full thickness. One NLF failed (4%), also full thickness. Any use of cartilage in reconstruction did not affect failure rates. Both flaps with complete failure were used more distally, while partial failure flaps for more proximal defects. No comorbities were noted to have a significant effect on failure rates, 5 out of 6 failures were in smokers. Conclusion: This study provides outcome data when interpolation flap reconstruction, with or without cartilage grafts, is offered. Overall success rates for nasal reconstruction using interpolation flaps in this study were 94%. Thickness of defect and type of flap did not affect outcome, while positive smoking status did significantly affect failure rate.

CMPA is difficult to diagnose because of limited accurate diagnostic tools, especially in young children. This study suggests a relationship between CMPA and otolaryngologic conditions in children younger than 2 years. Some patients in this study showed symptom improvement via an elimination diet. Early recognition of otolaryngologic manifestations of CMPA may help manage this condition in young children.

The overall success rate of interpolation flaps in nasal reconstruction was 94.4%. Defect thickness, use of a cartilage graft, type of flap used, and presence of comorbidities did not affect outcome. Although the comparison was not statistically significant (P  = .21), flap failures were more commonly observed in smokers.

ORAL PRESENTATIONSand May 2009. Charts of patients with revision adenoidectomies were reviewed for sex, age at surgery, indication for surgery, training level of surgeon, surgical technique, and history of allergies, asthma or GERD.Results: Of 8472 surgical cases (54% male), 202 were revision adenoidectomies (2.4%). Children less than 2 years old at initial surgery had increased rate of revision (23.5% of revision cases compared with 4.7% of all surgical cases). Of patients with revision adenoidectomy, 31.1% had curettage and 68.9% had electrocautery or coblation adenoidectomy at initial surgery. Patients with revision adenoidectomy were 3 times more likely to have a PGY1 or 2 as surgeon in initial surgery. The revision patients were found to have a higher incidence of allergies (32%), asthma (23%), and/or GERD (16%) than the general population.Conclusion: Several risk factors were associated with revision adenoidectomy. Children 3 years and under (especially under 2 years), at initial adenoidectomy have a higher incidence of revision surgery. Other factors identified with increased need for revision adenoidectomy include: medical history of allergies, asthma and/or GERD, and level of training of surgeon. Pediatric OtolaryngologyFood Hypersensitivity and Ear, Nose, and Throat Pathology in Children less than 2 Years of Age Angela Cogburn Paddack (presenter); Chandra Smith; Gresham T. Richter, MD; Troy Gibbons, MD Objective: Explore the relationship between food hypersensitivity associated with cows milk protein allergy (CMPA) and common gastrointestinal and upper aerodigestive disorders found in children less than two years of age.Method: Two-year retrospective chart review of a common cohort of children less than 2 years of age, managed in both a tertiary pediatric gastroenterology and otolaryngology clinic. Comparison with a control pediatric population was performed.Results: Of 191 children reviewed with CMPA, 141 demonstrated upper gastrointestinal (GI) complaints. Twenty-five (18%) of these children had otolaryngologic (ENT) conditions refractory to standard therapy with the majority being chronic otitis media (70%) and oropharyngeal dysphagia (80%). In contrast, only 2% of patients in a GI control group demonstrated ENT disease. Dairy elimination improved GI symptoms in 92 patients, and ENT disease improved in 60%. ENT conditions improved in the control group via standard therapy. Conclusion:This study suggests a relationship between CMPA and ENT concerns in children less than 2 years old, whereby food hypersensitivity can be associated with recalcitrant otits media and oropharyngeal dysphagia. Elimination diets can improve both GI and ENT conditions refractory to GERD therapy in patients with CMPA. Pediatric Otolaryngology impact of Endoscopic Sinus Surgery on Pulmonary Function in Children with Cystic FibrosisJordan J. Rihani, MD (presenter); John E. McClay, MD Objective: Determine the impact of endoscopic sinus surgery on pulmonary function in children with cystic fibrosis.Method: Retrospective chart rev...