Threshold changes in serum calcium and PTH, checked hours after surgery, can be used together to accurately predict whether a patient will become hypocalcemic after thyroidectomy.

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A modified coronal approach with dissection deep to the temporalis fascia offers a safe and reliable surgical technique for accessing the upper craniofacial skeleton. Observed complications were minimal, and despite this deeper plane of dissection, there were no cases of either temporary or permanent facial nerve weakness in a large retrospective series of patients from over the past 6 years. Consideration should be given for the routine use of this modified coronal approach for both reconstructive as well as cosmetic indications.

Objective. Learn the incidence of olfactory dysfunction in preoperative patients prior to nasal surgery and compare with a control group of patients who are not going to have such surgery. Assess the usefulness of the coffee/tea differentiation test in assessing preoperative dysosmia.Study Design. Prospective controlled cohort study. Setting. Urban medical center.Subjects and Methods. One hundred fifty-one adult patients (aged 18-65 years) whose olfactory function was tested using the Pocket Smell Test and a coffee/tea differentiation test. A failed test required missing at least 1 item on the card or failure to report a difference between tea and coffee. The statistical analysis using the t test and the Fisher exact test were calculated using MINITAB.Results. The study group (n = 55) had 38% men and 62% women compared with 58% men and 42% women in the control group (n = 96). The incidence of dysosmia was 32% in the study group and 14% in the control group. In the study group, 34.5% of patients failed the Pocket Smell Test and 12.4% failed the coffee/tea differentiation test as compared with 12.4% and 0%, respectively, in the control group. Conclusion.Patients who are scheduled for nasal surgery for medical or cosmetic indications are more likely to suffer from olfactory dysfunction before surgical intervention. This should be taken into consideration when counseling patients regarding possible postoperative complications. D isorders of the sense of smell (dysosmias) are important because they can adversely alter patients' quality of life. The prevalence of dysosmia has been studied by many authors who reported a wide range of estimated prevalence. Doty, 1 using objective smell tests, reported this prevalence to be 2% of the normal adult population younger than 65 years, although rates as high as 20% have been reported.2 This rate rises remarkably with age to approximately half of the adults aged 65 to 80 years and 75% of seniors older than age 80 years. 1,3A plethora of conditions leads to dysosmia, including age, smoking, nasal polyposis, and chronic rhinosinusitis. Surgery in the nasal cavity has been linked to olfactory loss in some studies.1 Although nasal surgery is often intended to improve olfactory function, many authors reported worsened olfaction postoperatively with hyposmia rates as high as 34% and anosmia rates of 1%. 4,5 The etiology of postoperative dysosmia has been studied but remains unclear. 5There are several smell function tests available that specifically assess olfactory range and function. Most commonly used in clinical practice are the odor identification tests. These multiple-choice tests challenge the patient to scratch a scented panel, then select from a list of forced choices and identify the smell they perceive. The Pocket Smell Test (PST) is a single booklet with a 3-item scratch-and-sniff

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The field of facial plastic and reconstructive surgery (FPRS) is an important part of otolaryngology-head and neck surgery and a certification board-mandated component of resident training. Creating a successful FPRS practice in an academic environment can be challenging, especially if the surgeon desires to provide cosmetic surgical services, because of the unique expenses with regard to practice environment, marketing costs, higher staff needs, and frequently evolving costs of equipment. Methods | This was a survey study of American otolaryngology department chairpersons who are members of the Association of Academic Departments of Otolaryngology. The survey consisted of 15 questions. The first survey was conducted in 2009, and a second similar survey was administered in 2013. Results | Responses were obtained from 39 chairpersons in 2009 and from 24 chairpersons in 2013. The Table summarizes the data from both surveys. Some questions in the survey were left blank by the respondents. Discussion | Advances in the field and in the education of residents depend on a robust community of FPRS surgeons in the academic arena. However, unlike other otolaryngology 384

Presentation schedule is subject to change. For the most up-to-date information, visit www.entnet.org/annual_meeting. compared in each patient to assess relative advantages of each modality. Micro-vascular architecture was described by IPCL classification.Results: A total of 110 patients were included and underwent video-stroboscopy, flexible distal-chip endoscopy, and NBI of the larynx. Thirty-two patients had a normal larynx, 54 had benign conditions, and 24 had malignant lesions. Distinct characteristics of vascular patterns were visualized by NBI in normal tissues, as well as a wide spectrum of benign and malignant conditions. In several patients with malignant and premalignant conditions, NBI revealed more extended disease than what was observed by white light imaging.Conclusions: Using NBI along with white light imaging, while understanding the unique microvascular fingerprint of each laryngeal pathologic condition, can assist the physician in differential diagnosis. In specific conditions, including malignant and premalignant lesions, NBI can bring better assessment of lesions' size and extension. New Algorithm for Supraglottitis Staging in AdultsTal Marom, MD (presenter); Sharon-Ovnat Tamir, MD; Irina Barbalat, MD; Yehudah Roth, MD Objectives: (1) Critically review the current staging systems of supraglottitis in adults. (2) Suggest a new algorithm for infections involving the supraglottis based on clinical staging considering anatomical subsites and outcome correlation.Methods: We retrospectively identified adult patients with acute supraglottitis during the years of 1990 through 2013 by using International Classification of Disease codes. Patients were graded by using 2 systems: the Scope grading system for epiglottitis, and our new suggested grading system, which relies on the edema in 3 subsites: the epiglottis, the aryepiglottic folds and arytenoids, and the larynx. Those subsites were given the following grades: 0 = no edema, 1 = mild edema, 2 = moderate edema, and 3 = severe edema. Summation of the 3 subsites scores was performed in order to assess the need for airway intervention.Results: A total of 288 eligible patients were enrolled. Diagnosis was made by either indirect or fiberoptic laryngoscopy (or by both modalities). One hundred seventy-eight patients (62%) had Scope grades of 0 or 1, and 110 patients (38%) had Scope grades of 2 or 3. Of these, 24% required an airway intervention. According to our classification, 236 patients (82%) who had a score of ≤4 were less likely to undergo a securing airway intervention, when compared with the 52 patients (18%) who had a score of ≥5, 4% vs 33%, respectively (P = .03). All patients graded with ≥8 score required airway intervention.Conclusions: Our new suggested flow chart of decisions is based on an easy grading system, which allows dynamic description of patient progression during sequential examinations, easy information transmission, and decision making.

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