VD3 insufficiency/deficiency is common in CRSwNP patients, especially those of African American race. Lower levels of VD3 are associated with worse LMS on CT. The role of VD3 in CRSwNP warrants further investigation.

This is the first study to examine NPWT in the postoperative treatment of closed high-tension wounds following scapular or latissimus dorsi harvest for reconstruction of extensive head and neck defects. Our results suggest that NPWT is a safe technique in the management of massive scapular and latissimus free flap harvest sites that may decrease associated major donor wound complications.

A woman in her 70s presented for evaluation of a 3-month history of intermittent left-sided facial weakness associated with otalgia and facial pain. The patient also noted occasional left-sided facial twitching and mild imbalance during this time frame. Physical examination revealed a red, pulsatile bulging mass emanating from the superior two-thirds of the tympanic membrane extruding into the ear canal. At the time of her presentation, no facial weakness, spasm, or synkinesis were noted. An audiogram showed a 30-dB left-sided conductive hearing loss with bilateral moderate sensorineural hearing loss.A temporal bone computed tomographic (CT) scan was obtained. This revealed a 1.6 × 1.1-cm soft-tissue mass filling the left epitympanum ( Figure, A) and mesotympanum (Figure, B). The petrous portion of the temporal bone showed permeative bone destruction (Figure, C). Subsequent positron emission tomography-CT revealed a left temporal bone mass with metastatic disease in the cervical lymph nodes and thorax (Figure, D). What is your diagnosis?A

Objective: Determine the effect of vacuum assisted closure (VAC) on massive scapular and latissimus dorsi free flap donor site morbidity, when used over a closed incision line under great tension. Method: Patients who underwent complex head and neck reconstruction with scapular fasciocutaneous/osteocutaneous and latissimus dorsi myocutaneous free flaps between the years of 2006 and 2010 at a tertiary academic referral center were identified and a retrospective chart review was performed. Results: Seventy patients who underwent scapular or latissimus dorsi free flap reconstruction were identified. Those with and those without VAC over the closed incision line were identified. The method of application of the VAC dressing was performed by the same team at one institution. None of these patients required skin grafting, and only 1 patient had donor site breakdown secondarily requiring wound care and VAC replacement and 1 patient had an asymptomatic seroma; all others with VAC treatment over the closed incision line were without donor site complications. Conclusion: Vacuum-assisted closure is a safe technique in the postoperative management of massive back free flap donor sites closed under great tension, and may eliminate the need for skin grafting. In our study, data suggests this approach decreases seroma formation and secondary wound breakdown.