Max April | New York University (original) (raw)

Papers by Max April

Otolaryngology–Head and Neck Surgery, 1993

Male Aesthetic Surgery is now published in a second edition, ten years after the first. The first... more Male Aesthetic Surgery is now published in a second edition, ten years after the first. The first edition emphasized the differences between male and female cosmetic surgery, and covered a broad range of both facial and body surgery. The second edition contains updated chapters covering similar topics, but much information pertaining to suction lipectomy tissue expansion, and psychosocial evaluation of the male patient has been added. With the increasing percentage of male patients in any cosmetic surgery practice, this text is one of very few that concentrates on this expanding area. It is well-organized and illustrated, and specific areas of interest are easily found. One interesting feature is the insertion of editorial comments by Dr. Courtiss at key positions in the text to put the preceding information into proper clinical perspective. Overall, facial plastic surgeons will find this book a valuable addition to their libraries.

Laryngoscope, Sep 1, 1998

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 20, 2019

Archives of Otolaryngology-head & Neck Surgery, Mar 1, 2012

Annals of Otology, Rhinology, and Laryngology, Jun 15, 2022

Objective: This report describes a new observation of hyperglycemia in a child with Type 1 diabet... more Objective: This report describes a new observation of hyperglycemia in a child with Type 1 diabetes after off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage and reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients. Methods: We describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE. Results: A 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. While the patient’s airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient’s continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. We also review 21 pediatric otolaryngology cases of iatrogenic Cushing’s syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day. Conclusion: This is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions, to the best of our knowledge. Counseling families on precise dose administration and potential endocrine disturbances is critical when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 22, 2016

International Journal of Pediatric Otorhinolaryngology, May 1, 2022

BACKGROUND Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a poss... more BACKGROUND Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema. OBJECTIVE To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema. METHODS A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review. RESULTS/DISCUSSION Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Nov 30, 2020

Annals of Otology, Rhinology, and Laryngology, Apr 1, 2001

Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Contro... more Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Controversy exists as to the proper surgical management of an anterior neck EIC: is simple excision adequate treatment, or is a Sistrunk procedure necessary? A retrospective review of the operative logs of the two senior authors (M.M.A., R.F.W.) from 1993 to the present revealed 16 children, ages 6 months to 9 years (mean, 4.5 years), with a diagnosis of anterior neck EIC. An accurate intraoperative diagnosis of an EIC in all cases allowed for a simple excision of the mass rather than a Sistrunk procedure. The final histologic diagnosis was EIC in all 16 patients. Follow-up of these 16 patients for a mean of 4.5 years revealed no recurrences or complications. When the diagnosis of EIC can be made confidently in the operating room, simple excision is an adequate surgical treatment.

Annals of Otology, Rhinology, and Laryngology, May 1, 1998

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these chil... more We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. AH patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.

International Journal of Pediatric Otorhinolaryngology, Nov 1, 2002

To provide preliminary clinical data regarding endoscopically placed nitinol stents for children ... more To provide preliminary clinical data regarding endoscopically placed nitinol stents for children with tracheal obstruction as a temporizing measure to allow for trach tube decannulation while awaiting growth to allow for tracheal resection. This case series describes the experiences of two children (ages 5 and 15) who were dependent upon tracheotomy because of acquired tracheal obstruction. Both patients had combined tracheomalacia and tracheal stenosis. After failing tracheoplasty with rib graft augmentation both patients suffered from extensive tracheal disease, which was too long to allow for immediate tracheal resection. Endoscopic placement of nitinol stents in the obstructed tracheal segment using fluoroscopic guidance. All tracheotomy tubes were removed immediately after successful stent deployment with the patient still under general anesthesia. Four stents were placed in total. The first patient's initial stent was too narrow and was, therefore, removed and replaced at a later date with a larger diameter stent. The second patient experienced distal migration of his initial stent requiring stent removal and replacement at a later date. Both patients remain successfully decannulated (follow-up, 25 and 26 months) and are currently living more normal lives as they grow and await tracheal resection. Preliminary use of nitinol stents for pediatric tracheal obstruction has enabled successful decannulation in two children with complicated airways. Our results with this series of patients suggest that nitinol stents can be safely used in children as a temporizing measure until tracheal resection can be safely performed. With this approach children can live free from the hassles of trach care, social isolation and peer ridicule. Limited pediatric experience exists in the literature about nitinol stents. Thus, our experience with stent selection and placement will help others avoid problems encountered in this initial series.

Laryngoscope, Jun 1, 1989

Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have a... more Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have an intact otic capsule prior to implantation. However, the suitability for implantation of patients who have undergone extensive procedures involving the otic capsule such as labyrinthectomy has not been directly addressed. This report documents a case of a patient deafened by a transmastoid labyrinthectomy who subsequently received a cochlear implant. Postimplantation performance of this patient was compared with the performance of three other postlingual implant recipients. The results suggest that labyrinthectomy is not a contraindication to auditory rehabilitation by a cochlear implant. The implications of implantation in a surgically manipulated otic capsule are discussed.

Archives of Otolaryngology-head & Neck Surgery, Apr 1, 2002

Laryngoscope, Feb 1, 2004

To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatr... more To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA). Retrospective chart review and long-term follow-up in office or by telephone interview. We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms. All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had self-limited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission. Microdebrider-assisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow-up may define higher complication rates.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jul 29, 2015

Otolaryngology-Head and Neck Surgery, Nov 1, 2010

Operative Techniques in Otolaryngology-head and Neck Surgery, Sep 1, 1996

American Journal of Rhinology & Allergy, Jul 1, 2016

Otolaryngology-Head and Neck Surgery, 2006

OBJECTIVESTo discuss the cause and management of recurrent periorbital cellulitis (RPOC).STUDY DE... more OBJECTIVESTo discuss the cause and management of recurrent periorbital cellulitis (RPOC).STUDY DESIGNRetrospective case series and review of literature.MATERIALS AND METHODSIn the past 11 years, we have treated 6 patients for recurrent periorbital cellulitis (RPOC). Inclusion criteria were a minimum of 3 episodes of periorbital cellulitis (POC) within a 1‐year period, with interval convalescence lasting at least 1 month. All patients were followed for at least 1 year after resolution.RESULTSThe causes of RPOC were as follows: (1) 2 patients developed RPOC attributed to environmental allergies; (2) 1 was diagnosed with underlying recurrent sinusitis resistant to medical management with resolution attained through surgery; (3) 1 patient with vesicular RPOC was diagnosed with herpetic RPOC and treated medically with antiviral therapy; (4) 1 patient had allergic contact dermatitis from cosmetic make‐up use; and (5) 1 patient was suspected of malingering via repeat subcutaneous self‐injection of an irritant.CONCLUSIONSAlthough periorbital cellulitis is a commonly encountered and treatable condition, recurrent periorbital cellulitis is rare and may be challenging to manage. In our experience, the causes of recurrence varied, but resolution was achieved by identifying the underlying cause through continuous clinical reassessment and by appropriate medical or surgical management.EBM rating: C‐4

Otolaryngology–Head and Neck Surgery, 1993

Male Aesthetic Surgery is now published in a second edition, ten years after the first. The first... more Male Aesthetic Surgery is now published in a second edition, ten years after the first. The first edition emphasized the differences between male and female cosmetic surgery, and covered a broad range of both facial and body surgery. The second edition contains updated chapters covering similar topics, but much information pertaining to suction lipectomy tissue expansion, and psychosocial evaluation of the male patient has been added. With the increasing percentage of male patients in any cosmetic surgery practice, this text is one of very few that concentrates on this expanding area. It is well-organized and illustrated, and specific areas of interest are easily found. One interesting feature is the insertion of editorial comments by Dr. Courtiss at key positions in the text to put the preceding information into proper clinical perspective. Overall, facial plastic surgeons will find this book a valuable addition to their libraries.

Laryngoscope, Sep 1, 1998

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Oct 20, 2019

Archives of Otolaryngology-head & Neck Surgery, Mar 1, 2012

Annals of Otology, Rhinology, and Laryngology, Jun 15, 2022

Objective: This report describes a new observation of hyperglycemia in a child with Type 1 diabet... more Objective: This report describes a new observation of hyperglycemia in a child with Type 1 diabetes after off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage and reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients. Methods: We describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE. Results: A 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. While the patient’s airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient’s continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. We also review 21 pediatric otolaryngology cases of iatrogenic Cushing’s syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day. Conclusion: This is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions, to the best of our knowledge. Counseling families on precise dose administration and potential endocrine disturbances is critical when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jun 22, 2016

International Journal of Pediatric Otorhinolaryngology, May 1, 2022

BACKGROUND Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a poss... more BACKGROUND Pediatric otolaryngologists have seen an increased focus on upper lip frenum as a possible culprit for feeding difficulties and the development of maxillary midline diastema (MMD). This increase may be encouraged by parents' exposure to medical advice over the internet about breastfeeding and potential long-term aesthetic concerns for their children. Subsequently, there has been increased pressure on pediatric otolaryngologists to perform superior labial frenectomies. There has been a reported 10-fold increase in frenectomies since the year 2000. However, there is no consensus within the literature regarding the benefit of superior labial frenectomy in preventing midline diastema. OBJECTIVE To provide physicians and parents with the most updated information by systematically reviewing the available literature for the association between superior labial frenum and midline diastema. METHODS A literature search was performed in MEDLINE (PubMed), EMBASE, Web of Science, the Cochrane Library and Dental and Oral Sciences Source (DOSS). Using the Covidence platform, a systematic review was conducted. The initial 314 articles identified underwent systematic review and 11 studies were included in the final review. RESULTS/DISCUSSION Available data, primarily from the dental literature, showed that two subtypes of frenum: papillary and papillary penetrating frenum, are associated with maxillary midline diastema. Superior labial frenectomy should be delayed until permanent lateral incisors have erupted, as this can spontaneously close the physiological MMD. Current literature recommends against frenectomy before addressing the diastema with orthodontics, which helps to prevent diastema relapse. It is also imperative to rule out other odontogenic and oral cavity causes of diastema, such as thumb sucking, dental agenesis, and other causes. Online information may not always be fully representative and should be interpreted in the full context of the patient's medical history before referral for surgical intervention.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Nov 30, 2020

Annals of Otology, Rhinology, and Laryngology, Apr 1, 2001

Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Contro... more Epidermal inclusion cyst (EIC) is a recognized cause of an anterior neck mass in children. Controversy exists as to the proper surgical management of an anterior neck EIC: is simple excision adequate treatment, or is a Sistrunk procedure necessary? A retrospective review of the operative logs of the two senior authors (M.M.A., R.F.W.) from 1993 to the present revealed 16 children, ages 6 months to 9 years (mean, 4.5 years), with a diagnosis of anterior neck EIC. An accurate intraoperative diagnosis of an EIC in all cases allowed for a simple excision of the mass rather than a Sistrunk procedure. The final histologic diagnosis was EIC in all 16 patients. Follow-up of these 16 patients for a mean of 4.5 years revealed no recurrences or complications. When the diagnosis of EIC can be made confidently in the operating room, simple excision is an adequate surgical treatment.

Annals of Otology, Rhinology, and Laryngology, May 1, 1998

We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these chil... more We review our treatment experience of subglottic stenosis in 66 children. Sixty-one of these children required some form of airway expansion using cartilage grafts. Eight children had grade I (Cotton classification), 15 grade II, 28 grade III, and 15 grade IV stenosis. AH patients with grade I and II lesions were decannulated. Ninety-three percent of grade III patients and 67% of grade IV patients were also ultimately decannulated. Laryngotracheal reconstruction with costal cartilage grafting has become widely accepted for treatment of severe laryngotracheal stenosis. Several modifications of this technique have been employed to treat our patients. Recently, we have used a modified single-stage technique with an endotracheal tube stent, externally secured for 1 week, to avoid postoperative intensive care unit admission for sedation and/or paralysis, and its related complications. Posterior graft design and placement without sutures was also performed in 20 cases. A two-surgeon technique that involves a simultaneous endoscopic control of incision of the stenotic area was employed. These modifications will be described in detail.

International Journal of Pediatric Otorhinolaryngology, Nov 1, 2002

To provide preliminary clinical data regarding endoscopically placed nitinol stents for children ... more To provide preliminary clinical data regarding endoscopically placed nitinol stents for children with tracheal obstruction as a temporizing measure to allow for trach tube decannulation while awaiting growth to allow for tracheal resection. This case series describes the experiences of two children (ages 5 and 15) who were dependent upon tracheotomy because of acquired tracheal obstruction. Both patients had combined tracheomalacia and tracheal stenosis. After failing tracheoplasty with rib graft augmentation both patients suffered from extensive tracheal disease, which was too long to allow for immediate tracheal resection. Endoscopic placement of nitinol stents in the obstructed tracheal segment using fluoroscopic guidance. All tracheotomy tubes were removed immediately after successful stent deployment with the patient still under general anesthesia. Four stents were placed in total. The first patient's initial stent was too narrow and was, therefore, removed and replaced at a later date with a larger diameter stent. The second patient experienced distal migration of his initial stent requiring stent removal and replacement at a later date. Both patients remain successfully decannulated (follow-up, 25 and 26 months) and are currently living more normal lives as they grow and await tracheal resection. Preliminary use of nitinol stents for pediatric tracheal obstruction has enabled successful decannulation in two children with complicated airways. Our results with this series of patients suggest that nitinol stents can be safely used in children as a temporizing measure until tracheal resection can be safely performed. With this approach children can live free from the hassles of trach care, social isolation and peer ridicule. Limited pediatric experience exists in the literature about nitinol stents. Thus, our experience with stent selection and placement will help others avoid problems encountered in this initial series.

Laryngoscope, Jun 1, 1989

Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have a... more Hearing rehabilitation with an intracochlear prosthesis is well documented in patients who have an intact otic capsule prior to implantation. However, the suitability for implantation of patients who have undergone extensive procedures involving the otic capsule such as labyrinthectomy has not been directly addressed. This report documents a case of a patient deafened by a transmastoid labyrinthectomy who subsequently received a cochlear implant. Postimplantation performance of this patient was compared with the performance of three other postlingual implant recipients. The results suggest that labyrinthectomy is not a contraindication to auditory rehabilitation by a cochlear implant. The implications of implantation in a surgically manipulated otic capsule are discussed.

Archives of Otolaryngology-head & Neck Surgery, Apr 1, 2002

Laryngoscope, Feb 1, 2004

To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatr... more To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA). Retrospective chart review and long-term follow-up in office or by telephone interview. We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms. All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had self-limited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission. Microdebrider-assisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow-up may define higher complication rates.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature, Jul 29, 2015

Otolaryngology-Head and Neck Surgery, Nov 1, 2010

Operative Techniques in Otolaryngology-head and Neck Surgery, Sep 1, 1996

American Journal of Rhinology & Allergy, Jul 1, 2016

Otolaryngology-Head and Neck Surgery, 2006

OBJECTIVESTo discuss the cause and management of recurrent periorbital cellulitis (RPOC).STUDY DE... more OBJECTIVESTo discuss the cause and management of recurrent periorbital cellulitis (RPOC).STUDY DESIGNRetrospective case series and review of literature.MATERIALS AND METHODSIn the past 11 years, we have treated 6 patients for recurrent periorbital cellulitis (RPOC). Inclusion criteria were a minimum of 3 episodes of periorbital cellulitis (POC) within a 1‐year period, with interval convalescence lasting at least 1 month. All patients were followed for at least 1 year after resolution.RESULTSThe causes of RPOC were as follows: (1) 2 patients developed RPOC attributed to environmental allergies; (2) 1 was diagnosed with underlying recurrent sinusitis resistant to medical management with resolution attained through surgery; (3) 1 patient with vesicular RPOC was diagnosed with herpetic RPOC and treated medically with antiviral therapy; (4) 1 patient had allergic contact dermatitis from cosmetic make‐up use; and (5) 1 patient was suspected of malingering via repeat subcutaneous self‐injection of an irritant.CONCLUSIONSAlthough periorbital cellulitis is a commonly encountered and treatable condition, recurrent periorbital cellulitis is rare and may be challenging to manage. In our experience, the causes of recurrence varied, but resolution was achieved by identifying the underlying cause through continuous clinical reassessment and by appropriate medical or surgical management.EBM rating: C‐4