In our msTBI cohort, WOC was the most important predictor of in-hospital mortality. We identified several important independent predictors of WOC. Large within-center variability in msTBI outcome prognostication with varying levels of possible clinical nihilism exists, which may form the basis of self-fulfilling prophecies.

Rhinoplasty for saddle nose deformity is a safe and effective procedure in the setting of granulomatosis with polyangiitis. In the face of this disease, reconstruction should focus on placing a robust, L-shaped strut graft with autologous tissue over individual grafts. Additionally, the use of split-calvarial bone appears to have a slightly lower complication rate over costal cartilage.

Even today, sudden brain edema and herniation may occur in association with RRT in neurocritically ill patients. We call for the establishment of RRT guidelines in patients with acute neurological injuries.

Prognostic study, level III.

N odular fasciitis is a benign growth that results from fibroblast proliferation, often after trauma. 1 This typically arises from deep fascial layers and may mimic malignancy. In children, nodular fasciitis is most often reported in the head and neck. 2 Involvement of neurovascular structures such as the facial nerve has been described and in some cases has led to avoidance of surgical excision given risk of damage. 3 Here, we present the case of a young man with a 1-month history of an enlarging, painless temporal mass. His postoperative course was timed with a global pandemic but was amenable to telemedicine and demonstrated full return of nerve function.

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Objective Increasingly, total thyroidectomy is offered as an ambulatory procedure. Most of the relevant outcomes research derives from academic centers, but most thyroid surgeries are performed in the community. The goal of this study is to evaluate the safety of total thyroidectomy performed as an ambulatory procedure in a community otolaryngology practice. Study Design Retrospective review and national database analysis. Setting A single community otolaryngology practice. Methods Adult patients undergoing total thyroidectomy by a single otolaryngologist between 2013 and 2019 were divided into 2 cohorts: planned ambulatory and planned admission. Charts were reviewed for demographics and surgical outcomes in the 2 groups. The Healthcare Cost and Utilization Project databases for New York and Florida between 2015 and 2016 were also analyzed to compare outcomes of thyroidectomy as an ambulatory surgery between different practice settings. Results A total of 99 total thyroidectomies were performed during the study time period; 66 of 99 (67%) were planned as ambulatory procedures and 33 of 99 (33%) were planned admissions. Five of the 66 (8%) planned outpatient surgeries required admission. Complications of vocal fold dysfunction, symptomatic hypocalcemia, and seroma formation were more commonly seen in the inpatient cohort. Only 2 ambulatory patients required admission after discharge. Nationally, odds of complication were higher for ambulatory total thyroidectomy at nonteaching practice sites, which is not duplicated in our study. Conclusions Ambulatory total thyroidectomy can be undertaken safely in the community in carefully selected cases.