Brian Cervenka - Academia.edu (original) (raw)
Papers by Brian Cervenka
Facial Plastic Surgery & Aesthetic Medicine
International Journal of Radiation Oncology*Biology*Physics
Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiati... more Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiation therapy for head and neck cancer. Multi-disciplinary diagnosis and treatment is essential. Despite evidence guiding individual aspects of care for osteoradionecrosis, there is a lack of broad consensus on the overall diagnosis and management of this condition. This study comprehensively reviews the literature, with a focus on the past 10 years, to guide evaluation and treatment.
Current Opinion in Otolaryngology & Head and Neck Surgery, 2015
Free flap surgery has revolutionized our ability to perform composite reconstructions following a... more Free flap surgery has revolutionized our ability to perform composite reconstructions following ablative surgery. Although flap failure is rare (∼5%), it results in high patient morbidity if not recognized and corrected early. There are numerous means to assess flap viability. We review the recent literature on flap monitoring, and discuss the difference between techniques in regard to overall flap survival, cost, and ease of use. The current literature on implantable Doppler, microdialysis, video-based application (Eulerian), fluorescence angiography, spectroscopy, contrast-enhanced duplex, and activated clotting time is reviewed. Of these methods, implantable Doppler and spectroscopy have the most recent and largest series of data describing efficacy with implantable Doppler, demonstrating comparable flap survival rates to clinical monitoring. Arterial implantable Doppler has the additional benefit of less false-positives than venous Doppler. Spectroscopy demonstrates promise with commensurate flap survival rates and improved salvage rates over clinical monitoring. Clinical monitoring alone has proven to be so effective that it is difficult to demonstrate better outcomes with alternative methods. That said, a minimally invasive, reliable method that does not require physician assessment on a frequent basis would prove ideal in many small centers and academic centers limited by resident hours. Venous and, more recently, arterial monitoring have been successfully implemented at many programs. Spectroscopy appears promising, but the data are still limited.
JAMA facial plastic surgery, Jan 2, 2015
Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to diff... more Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to difficulty with communication and quality of life. The pharyngeal flap is a workhorse to address hypernasality and nasal air escape. However, there is a paucity of literature on the characteristics of cases that require revision. To measure the revision rate of pharyngeal flaps, compare the preperceptual and postperceptual speech scores, and identify the characteristics of those patients who required revision. A retrospective medical record review was completed for patients who underwent pharyngeal flap surgery from June 1, 2008, through January 31, 2013, at a tertiary academic center. Perceptual speech analyses and surgical revision rates. Perceptual speech patterns before and after surgery were compared using nasal air emission and resonance scores. The association between requiring revision surgery and covariates was analyzed using multivariable mixed-effects logistic regression. Sixty-on...
Case Reports in Otolaryngology, 2013
Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere... more Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere in the body. Presentations in the hypopharynx are extremely rare with only two previous cases reported. We report the first case of postcricoid SFT occurring in a 58-year-old male requiring a microsuspension laryngoscopy excision following an unsuccessful transoral robotic attempt. The excision was uneventful, and the patient is currently without recurrence. Current management strategies of the hypopharyngeal SFT, the unique differential diagnosis, and challenges in surgical approaches in the postcricoid region are discussed.
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2015
ABSTRACT The cleft palate is an important craniofacial defect resulting in direct functional defi... more ABSTRACT The cleft palate is an important craniofacial defect resulting in direct functional deficits and is related to a variety of genetic syndromes. It varies in degree and clinical setting. Repair is important for oral and nasal function. This article describes methods for repair including 2-flap palatoplasty and V–Y pushback. Patient evaluation, post-operative care and potential complications are discussed. Multidisciplinary team care is vital for these patients because of the variety of functions affected by this entity, and the need for timely diagnosis and intervention.
Facial Plastic Surgery & Aesthetic Medicine
International Journal of Radiation Oncology*Biology*Physics
Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiati... more Osteoradionecrosis is a relatively rare but potentially morbid and costly complication of radiation therapy for head and neck cancer. Multi-disciplinary diagnosis and treatment is essential. Despite evidence guiding individual aspects of care for osteoradionecrosis, there is a lack of broad consensus on the overall diagnosis and management of this condition. This study comprehensively reviews the literature, with a focus on the past 10 years, to guide evaluation and treatment.
Current Opinion in Otolaryngology & Head and Neck Surgery, 2015
Free flap surgery has revolutionized our ability to perform composite reconstructions following a... more Free flap surgery has revolutionized our ability to perform composite reconstructions following ablative surgery. Although flap failure is rare (∼5%), it results in high patient morbidity if not recognized and corrected early. There are numerous means to assess flap viability. We review the recent literature on flap monitoring, and discuss the difference between techniques in regard to overall flap survival, cost, and ease of use. The current literature on implantable Doppler, microdialysis, video-based application (Eulerian), fluorescence angiography, spectroscopy, contrast-enhanced duplex, and activated clotting time is reviewed. Of these methods, implantable Doppler and spectroscopy have the most recent and largest series of data describing efficacy with implantable Doppler, demonstrating comparable flap survival rates to clinical monitoring. Arterial implantable Doppler has the additional benefit of less false-positives than venous Doppler. Spectroscopy demonstrates promise with commensurate flap survival rates and improved salvage rates over clinical monitoring. Clinical monitoring alone has proven to be so effective that it is difficult to demonstrate better outcomes with alternative methods. That said, a minimally invasive, reliable method that does not require physician assessment on a frequent basis would prove ideal in many small centers and academic centers limited by resident hours. Venous and, more recently, arterial monitoring have been successfully implemented at many programs. Spectroscopy appears promising, but the data are still limited.
JAMA facial plastic surgery, Jan 2, 2015
Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to diff... more Velopharyngeal insufficiency in children with cleft palate (and other causes) contributes to difficulty with communication and quality of life. The pharyngeal flap is a workhorse to address hypernasality and nasal air escape. However, there is a paucity of literature on the characteristics of cases that require revision. To measure the revision rate of pharyngeal flaps, compare the preperceptual and postperceptual speech scores, and identify the characteristics of those patients who required revision. A retrospective medical record review was completed for patients who underwent pharyngeal flap surgery from June 1, 2008, through January 31, 2013, at a tertiary academic center. Perceptual speech analyses and surgical revision rates. Perceptual speech patterns before and after surgery were compared using nasal air emission and resonance scores. The association between requiring revision surgery and covariates was analyzed using multivariable mixed-effects logistic regression. Sixty-on...
Case Reports in Otolaryngology, 2013
Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere... more Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that can present essentially anywhere in the body. Presentations in the hypopharynx are extremely rare with only two previous cases reported. We report the first case of postcricoid SFT occurring in a 58-year-old male requiring a microsuspension laryngoscopy excision following an unsuccessful transoral robotic attempt. The excision was uneventful, and the patient is currently without recurrence. Current management strategies of the hypopharyngeal SFT, the unique differential diagnosis, and challenges in surgical approaches in the postcricoid region are discussed.
Operative Techniques in Otolaryngology-Head and Neck Surgery, 2015
ABSTRACT The cleft palate is an important craniofacial defect resulting in direct functional defi... more ABSTRACT The cleft palate is an important craniofacial defect resulting in direct functional deficits and is related to a variety of genetic syndromes. It varies in degree and clinical setting. Repair is important for oral and nasal function. This article describes methods for repair including 2-flap palatoplasty and V–Y pushback. Patient evaluation, post-operative care and potential complications are discussed. Multidisciplinary team care is vital for these patients because of the variety of functions affected by this entity, and the need for timely diagnosis and intervention.