Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P60

Facial

P60		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
prominent and the hump is frequently associated with a low
preoperative diet, 17% had improvement at 3 months, 33% at
nasal dorsum and radix with underprojected nasal tip. Thus,
1 year, and 26% at 5 years (P < .001). Osteonecrosis recurred
the management strategy should focus on achieving ideal
in 14% (n = 29/204), median 12 months (mean 21 months).
nasal profile and not on hump removal.
Cancer recurrence was 14% (n = 28/202), median 32 months
Methods: Forty-eight patients who underwent rhinoplasty
(mean 54 months). UW-QOL questionnaire results were as
for hump nose between January 2011 and June 2018 were anafollows: no pain (44%), minor or no change in appearance
lyzed retrospectively. Surgical techniques, results, and com(66%), return to baseline endurance level (37%), no recreation
plications were evaluated. Surgical outcomes were evaluated
limitations (39%), no changes in diet (28%), minor limitations
based on the preoperative and postoperative photo taken of the
in mastication (44%), minor speech difficulties (64%), no
patient's nose by 2 independent ear, nose, and throat doctors.
changes in shoulder function (81%), normal taste function
Results: The esthetic deformity accompanying the nasal
(17%), normal saliva production (26%), generally excellent
hump were relatively low dorsum and tip, deviated nose, and
mood (42%), no or minimal anxiety about their cancer (59%).
low radix. The addition of surgical techniques included osteConclusions: This series is the largest to date reporting on
otomy (50%), spreader graft (65%), tip surgery (100%), and
long-term outcomes and quality of life in patients with osteodorsal augmentation (90%) for improvement of low nasal dornecrosis of the head and neck requiring free flap reconstrucsum and camouflage of dorsal irregularities. The complete
tion. The majority of patients had advancement in diet
correction of hump was performed in 32 patients, and partial
following reconstruction, with low rates of osteonecrosis or
correction of hump was performed in 14 patients.
cancer recurrence and above average scores on the UW-QOL
Conclusions: Most humps in Korean noses may be corrected
survey, suggesting good return of function and quality of life.
well by using nasal tip and dorsal augmentation with the
appropriate hump removal. The strengthening and augmentaThe Impact of Treatment Delay on Malunion
tion of the nasal structure using autologous cartilage with taiand Nonunion After Open Reduction
lored removal of the hump may accomplish the balanced
Internal Fixation of Mandible Fractures
correction of hump nose in Korean patients, both esthetically
Daniel Lander (Presenter); Jake J. Lee, MD; Dorina Kallogieri;
and functionally.
Margaret Olsen, PhD, MPH; Dustin Stwalley, MA; Jay F.
Piccirillo, MD; Emily A. Spataro, MD
Microvascular Reconstruction of
Objectives: The ideal timing for surgical repair after mandiOsteonecrosis: Assessment of Long-term
ble fracture is not well established. This study aims to evaluate
Quality of Life
the impact of time to surgical repair on rates of mandibular
Larissa Sweeny, MD (Presenter); Joseph Curry, MD;
malunion and nonunion, specifically in patients treated with
Brian P. Swendseid, MD; Erica Mayland, MD; Carissa M.
open reduction internal fixation (ORIF).
Thomas, MD, PhD; Mark K. Wax, MD
Methods: This was a retrospective cohort study using the
Objectives: (1) Understand the challenges of treating osteoHealthcare Cost and Utilization Project New York State
necrosis of the head and neck. (2) Understand the expected
Inpatient, State Emergency Department, and State Ambulatory
quality of life following reconstruction of osteonecrosis of the
Surgery Databases from 2005 to 2016. It included adults seen
head and neck. (3) Understand the incidence of cancer recurin the emergency department or admitted to the hospital, with
rence and management in patients treated for osteonecrosis of
a primary International Classification of Diseases, Ninth
the head and neck.
Revision (ICD-9) diagnosis code of mandible fracture treated
Methods: This retrospective multi-institutional review
with ORIF in either the inpatient or ambulatory surgery setincluded all consecutive patients undergoing free flap reconting. The primary outcome was an ICD-9/10 diagnosis code
structions of the head and neck for osteonecrosis between
for mandibular malunion/nonunion. The impact of time to
2000 and 2018 (n = 204). Collected data were on selected
surgical repair on malunion/nonunion was analyzed using
variables: demographics, anatomic location of the defect,
multivariable Poisson regression and restricted cubic splines.
donor site, history of radiation therapy, perioperative manageCovariates included patient demographics, comorbidities, and
ment, diet status, recurrence rates of malignancy and osteonefracture characteristics.
crosis, and long-term quality-of-life outcomes. Interventions
Results: A total of 7757 adults with mandible fractures
and impact on outcomes and quality of life were assessed. The
were treated with ORIF. After treatment, 156 patients (2.0%)
University of Washington Quality of Life (UW-QOL) queswere diagnosed with malunion/nonunion. Patients with open
tionnaire was administered to all available patients at 1 year or
fractures (odds ratio [OR] 1.73), body fractures (OR 1.73),
greater following reconstruction (n = 83).
alcohol abuse (OR 1.63), and renal failure (OR 2.65) had
Results: Flap survival was 89% (n = 181). Median radiation
increased risk of malunion/nonunion. After controlling for
dose was 70 Gy and median time from radiation completion to
these factors, ORIF occurring 3 to 7 days after presentation
reconstruction was 43 months (mean 62 months). Regular diet
was associated with higher risk of malunion/nonunion (OR
was tolerated following reconstruction in 35% at 3 months,
1.47, 95% CI, 1.00-2.17) compared with ORIF the day of
42% at 1 year, and 48% at 5 years (P < .0001). Compared with
presentation.
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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