Brian Nuyen, MD, is a board-certified otolaryngologist-head and neck surgeon and fellowship trained laryngologist who developed a keen interest and passion for head and neck gender affirmation for transgender/gender-nonconforming communities during his residency at Stanford Medicine. He completed his James Thomas, MD Voice Surgery Fellowship 2021-2022 in Portland, Oregon subspecializing in gender-affirming voice medicine and surgery. He was a visiting Fellow in Summer 2022 with Dr. Hyung-Tae Kim at the Yeson Voice Center in Seoul, South Korea with a focus on international perspectives on gender-affirming endoscopic vocal surgical innovation. Dr. Nuyen is a clinical assistant professor with the Stanford School of Medicine Department of Otolaryngology.

Dr. Nuyen specializes in managing vocal fold disorders, with a particular interest in gender affirmation voice surgery. Dr. Nuyen completed two fellowship programs focused on gender affirmation voice surgery.

He obtained his medical degree from the University of California, San Diego. Dr. Nuyen completed his residency at Stanford School of Medicine’s Department of Otolaryngology-Head and Neck Surgery.

Dr. Nuyen is a prolific author and researcher in his field. Multiple peer-reviewed journals have published his work and he has authored several textbook chapters. His recent articles focus on gender affirmation voice surgery. He also peer-reviews research manuscripts for the Journal of Voice. He has presented his insights and research at various medical conferences.

Dr. Nuyen speaks Spanish fluently. In his free time, he is an avid instrumental musician, singer, and swing dancer.

Clinical Focus

  • Otolaryngology-Head and Neck Surgery
  • Otolaryngology

Academic Appointments

  • Clinical Assistant Professor, Otolaryngology (Head and Neck Surgery)

Honors & Awards

  • Resident Leadership Grant, AAO-HNS/F Board of Governors/Leadership Forum Spring Meeting 2017 (March 2017)
  • Howard Hughes Medical Institute Medical Fellow Keynote Speaker, Howard Hughes Medical Institute Medical Research Fellowship 2015-2016 (2016)
  • Clinical Honors – Otology, Otolaryngology, University of California, San Diego School of Medicine (2012-2013)
  • Medical Scholars Combined Degree Program, University of California, San Diego School of Medicine (2006-2010)

Boards, Advisory Committees, Professional Organizations

  • Stanford Residency Program Representative, Academy of Otolaryngology-Head and Neck Surgery/Foundation (2016 - Present)
  • Regional Representative – Arizona, California, Hawaii, Nevada, Academy of Otolaryngology-Head and Neck Surgery/Foundation (2016 - Present)
  • Resident Member, AO CMF - – Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (2016 - Present)
  • Resident Member, American Academy of Otolaryngic Allergy (2016 - Present)
  • Social Chair, Stanford Graduate Medical Education Diversity Committee (2016 - Present)
  • Member, International Society for Otitis Media (2015 - 2017)
  • Co-Chair, West Coast Region, HHMI Medical Research Fellowship (2014 - 2016)
  • Associate Member, History of Otolaryngology Committee Member, Association of Research in Otolaryngology (2014 - Present)
  • Member, Gold Humanism Honor Society, Arnold P. Gold Foundation (2013 - Present)
  • Member, Phi Beta Kappa Honor Society (2008 - Present)

Professional Education

  • Board Certification: American Board of Otolaryngology, Otolaryngology (2022)
  • Fellowship: James P Thomas MD Laryngology Fellowship (2022) OR
  • Residency: Stanford University Otolaryngology Residency (2021) CA
  • Medical Education: University of California San Diego School of Medicine (2016) CA
  • Doctor of Medicine, University of California, San Diego School of Medicine, Medicine (2016)
  • Research Fellow, Howard Hughes Medical Student Medical Research Fellowship, Otitis Media (2015)
  • Bachelor of Science, Revelle College - University of California, San Diego, General Biology (2010)

All Publications

  • Response to "The Role of the Otolaryngologist in Sexual Health". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Kiessling, P., Nuyen, B. 2023

    View details for DOI 10.1002/ohn.622

    View details for PubMedID 38123760

  • The Effect of Surgeon Vocal Pitch and Gender on Patient Satisfaction Nuyen, B., Wang, A., Ayoub, N. F., Rakkar, M., Kearney, A., Alyono, J. LIPPINCOTT WILLIAMS & WILKINS. 2023: S264
  • Diagnosis and Management of Vocal Complications after Chondrolaryngoplasty. The Laryngoscope Nuyen, B., Qian, Z. J., Rakkar, M., Thomas, J. P., Erickson-DiRenzo, E., Sung, C. K. 2022


    OBJECTIVE: Transfeminine patients (transwomen/feminine nonbinary folks assigned male at birth) can undergo chondrolaryngoplasty ("tracheal shave") to feminize their neck appearance. While isolated cases of vocal complications have been reported following the procedure, aggregated outcomes have not been quantitatively studied. We present acoustic and stroboscopic data to describe a patient cohort with vocal complications after chondrolaryngoplasty and discuss reparative surgical technique.METHODS: Subjective and objective data, including videostroboscopy, were collected from patients with voice complaints after chondrolaryngoplasty. Dislocated anterior commissures were reconstructed with feminization laryngoplasty. Postoperative voice data were recorded and statistically compared to preoperative data using paired t-tests.RESULTS: On consecutive chart review, of the 94 transfeminine women with prior outside history of chondrolaryngoplasty, 27 (29%) reported chronic postoperative hoarseness, deepened pitch, or loss of upper register. On endoscopy, short, lax vocal folds with persistent anterior glottic gap and phase asymmetry were commonly noted; anterior commissure dislocation was confirmed in-office by using needle localization through absent thyroid cartilage. After open resuspension of the anterior commissure with feminization laryngoplasty, post-repair modal-speaking, minimum, and maximum fundamental frequencies (F0) increased on average by 7, 8, and 5 semitones, respectively (p<0.01), when compared to pre-repair values. On average, perioperative maximum phonation time did not change significantly (p=0.15). Average self-assessment of vocal femininity increased by 48% (p<0.01).CONCLUSION: Anterior commissure dislocation should be suspected with signs of vocal impairment after chondrolaryngoplasty. Following proper diagnosis, resuspension of the anterior commissure via feminization laryngoplasty approach can be an effective reparative technique.LEVEL OF EVIDENCE: This work represents a 2011 OCEBM Level 4 evidence as a case series Laryngoscope, 2022.

    View details for DOI 10.1002/lary.30518

    View details for PubMedID 36576093

  • Social Perception of External Laryngeal Anatomy Related to Gender Expression in a Web-based Survey. The Laryngoscope Kiessling, P., Balakrishnan, K., Fauer, A., Sanan, A., McDonald, D., Thomas, J., Erickson-Direnzo, E., Sung, C. K., Nuyen, B. 2022


    To quantify the effect of laryngeal prominence size on socially perceived attributes relating to gender expression. Chondrolaryngoplasty ("tracheal shave") is a common procedure performed for transgender women to feminize neck appearance. The extent of thyroid cartilage resection needed to convey socially-perceived feminine gender expression without destabilizing the voice is incompletely understood.Cross-sectional evaluation of a randomized allocation of images of varying laryngeal prominence to a non-repeated, random sample from November 2021 to December 2021. Photos of laryngeal prominence were isolated against a constant neck baseline with lateral, oblique, and frontal views. The images were embedded into a web-based survey with visual analog scales to capture perceived scaled gender expression (masculinity, femininity) and social traits (e.g., attractiveness, friendliness, leadership). We performed bivariate and multivariate analyses relating the laryngeal prominence to perceived gender expression and social traits.The analytic sample included 1,026 respondents. Laryngeal grades similar to the demonstrated "grade M" in this study and smaller demonstrated similar perceptions of increased femininity and decreased masculinity. Grades larger than M demonstrate significantly increased perceived masculinity and significantly decreased perceived femininity. The lateral and oblique views of the neck appear to be the most gender-informative.This crowd-sourced analysis of external laryngeal anatomy by a large population of observers provides clear, reproducible insights into social perceptions of gender identity and specifically femininity. These data will meaningfully inform patient counseling and surgical planning for gender-affirming interventions by establishing normative data representing the general public's perceptions.N/A Laryngoscope, 2022.

    View details for DOI 10.1002/lary.30498

    View details for PubMedID 36453533

  • Timing of postoperative oral feeding after head and neck mucosal free flap reconstruction. Laryngoscope investigative otolaryngology Stramiello, J., Nuyen, B., Saraswathula, A., Blumenfeld, L., Divi, V., Rosenthal, E., Orosco, R., Starmer, H. M. 2021; 6 (5): 1031-1036


    Fistula remains a common complication of upper aerodigestive tract reconstruction. Optimal timing of oral feeding is unknown and the impact of early feeding on swallow function and fistula rates remains controversial. The purpose of this study is to better understand the effects of "early feeding" on fistula rate and swallow in patients with free flap reconstruction of upper aerodigestive tract defects.Retrospective cohort study. One hundred and four patients undergoing free flap reconstruction of mucosalized head and neck defects. Two groups, early feeding (oral intake on or before postoperative day 5) and late-feeding (oral intake after postoperative day 5). Primary outcome was incidence of salivary fistula. Secondary outcomes included Functional Oral Intake Scale scores.Fistula rate was 16.5% in late-feeding group and 0% in early-feeding group (P = .035). Patients who were fed early had an association with progression to a full oral diet by 30 days (P = .027).This cohort analysis suggests that in properly selected patients with free flap reconstruction for mucosal defects, early feeding may not increase risk of salivary fistula and may improve swallow functional outcomes earlier. Level of Evidence: 3.

    View details for DOI 10.1002/lio2.655

    View details for PubMedID 34667846

    View details for PubMedCentralID PMC8513441

  • Timing of postoperative oral feeding after head and neck mucosal free flap reconstruction LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY Stramiello, J., Nuyen, B., Saraswathula, A., Blumenfeld, L., Divi, V., Rosenthal, E., Orosco, R., Starmer, H. M. 2021

    View details for DOI 10.1002/lio2.655

    View details for Web of Science ID 000695542500001

  • Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Nuyen, B. A., Qian, Z. J., Campbell, R. D., Erickson-DiRenzo, E., Thomas, J., Sung, C. K. 2021: 1945998211036870


    OBJECTIVES: Transfeminine patients can experience significant gender dysphoria in vocal communication. Feminization laryngoplasty (FL) is a gender-affirming surgery developed to elevate speaking vocal range, as well as alter vocal resonance and laryngeal cosmesis. The purpose here was to appraise FL's long-term voice outcomes across a 17-year review period.STUDY DESIGN: Level III, retrospective study and description of technique.SETTING: A single-institution transfeminine voice clinic.METHODS: Voice data (speaking fundamental frequency [F0], lowest F0, highest F0, F0 range in both Hertz and semitones, and maximum phonation time [MPT]) were collected and assessed. Self-assessment of voice femininity and complications were documented.RESULTS: The 162 patients, all transfeminine women, had a mean age of 40 years with 36-month mean follow-up. There were significant increases in mean speaking F0 (Delta = 50 ± 30 Hz, Delta = 6 ± 3 semitones; P < .001) and mean change in lowest F0 (Delta = 58 ± 31 Hz, Delta = 8 ± 4 semitones; P < .001). There was no significant difference in mean change in highest F0 or MPT. There was significant improvement (Delta = 60% ± 39%; P < .001) in perceptual self-assessment of vocal femininity. There was a 1.2% rate of major postoperative complications requiring inpatient admission or operative intervention. There were no differences in vocal outcomes between those patients who had less than 1-year follow-up and those who had 5-year follow-up.CONCLUSION: FL in this cohort was a safe and effective technique for increasing mean speaking F0, mean lowest F0, and voice gender perception over a prolonged follow-up period. These findings add to the possible treatments aimed at addressing the morbid dysphoria related to voice and communication for our transfeminine patients.

    View details for DOI 10.1177/01945998211036870

    View details for PubMedID 34399638

  • The impact of living with transfeminine vocal gender dysphoria: Health utility outcomes assessment INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH Nuyen, B., Kandathil, C., McDonald, D., Thomas, J., Most, S. P. 2021
  • Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery Nuyen, B., Altamirano, J., Fassiotto, M., Alyono, J. 2021


    BACKGROUND: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.METHODS: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. chi2 tests and generalized estimating equation regression models were run to assess correlation.RESULTS: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making.CONCLUSION: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.

    View details for DOI 10.1016/j.surg.2020.12.006

    View details for PubMedID 33531133

  • Social Perceptions of Pediatric Hearing Aids. The Laryngoscope Qian, Z. J., Nuyen, B. A., Kandathil, C. K., Truong, M., Tribble, M. S., Most, S. P., Chang, K. W. 2021


    OBJECTIVES: To determine whether hearing aid (HA) use affects social perceptions of general public adults and age-matched peers and if so, determine if effects are modulated by lack of societal representation of pediatric HAs.METHODS: A 10-year-old boy was presented in six photographic conditions with and without HAs and eyeglasses (a worn sensory aid with wider societal representation). HAs were presented in neutral skin tone and bright blue colors. Photographic conditions were embedded into web-based surveys with visual analog scales to capture social perceptions data and sourced to 206 adults (age 18-65) and 202 peers (age 10) with demographic characteristics representative of the general US population. Mean differences in scores for each condition compared to control images were computed using two-tailed t-tests.RESULTS: In both adult and child respondents, HAs were associated with decreased athleticism, confidence, health, leadership, and popularity. Glasses were associated with decreased athleticism and popularity but increased intelligence, overall success, and in the child respondents, friendliness. When worn in combination, the beneficial effects of glasses were mitigated by brightly colored but not neutrally colored HAs.CONCLUSION: Negative effects of pediatric HAs on social perceptions may be influenced by poor societal representation of HAs. These results suggest that greater representation of pediatric HAs is necessary to make society more inclusive for children with hearing loss.LEVEL OF EVIDENCE: 4 Laryngoscope, 2021.

    View details for DOI 10.1002/lary.29369

    View details for PubMedID 33405290

  • The Health Burden of Transfeminine Facial Gender Dysphoria: An Analysis of Public Perception. Facial plastic surgery & aesthetic medicine Nuyen, B., Kandathil, C., McDonald, D., Chou, D. W., Shih, C., Most, S. P. 2020


    Objectives/Hypothesis: The face is a major communicator of gender identity. Transfeminine individuals report debilitating quality-of-life deficits as a result of their gender dysphoria, which may be addressed with feminizing therapies. We aimed to quantify the potential impact of facial gender dysphoria experienced by transfeminine patients, as well as associated treatments, including feminizing facial gender surgery, through validated health state utility measures. Methods: A transfeminine patient volunteer who underwent head and neck gender-affirming treatments was consented for research use of perioperative photographs. These media aided in the description of two transfeminine health states, pre- and postfacial feminization facial gender dysphoria. Monocular blindness and binocular blindness were two health state controls. General population adults rated these four health states through visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO), which were used to calculate the quality-adjusted life years (QALYs). Results: Survey respondents totaled 206 with a mean (standard deviation [SD]) age of 35.8 (11.9) years. Mean (SD) health utility measures included 0.75 (0.22) QALYs for VAS, 0.82 (0.19) QALYS for SG, 0.79 (0.21) QALYS for TTO for pretreatment facial gender dysphoria, and 0.81 (0.21), 0.86 (0.19), 0.83 (0.20) QALYS for postgender-affirming treatments for facial gender dysphoria. The health utility scores for the postgender-affirming treatments for facial gender dysphoria (+0.06 VAS, p=0.005) were significantly improved compared with the pretreatment state. Conclusions: To our knowledge, this study is the first to examine how the general population perceives the health burden of facial gender dysphoria experienced by transfeminine patients. Facial gender dysphoria is perceived to have a negative impact on health states, not dissimilar to monocular blindness in our sample. Feminizing facial gender surgery appears to significantly increase health utility measures.

    View details for DOI 10.1089/fpsam.2020.0192

    View details for PubMedID 33054404

  • Effect of Surgeon Sociodemographics on Patient-Reported Satisfaction Nuyen, B. A., Altamirano, J., Fassiotto, M., Alyono, J. ELSEVIER SCIENCE INC. 2020: S138
  • The Social Perception of Microtia and Auricular Reconstruction. The Laryngoscope Nuyen, B. A., Kandathil, C. K., Saltychev, M. n., Firmin, F. n., Most, S. P., Truong, M. T. 2020


    To examine the social perception of microtia and quantify the effect of reconstruction on socially perceived attributes.Parental consent was obtained for peri-reconstruction photographs in a patient with unilateral grade 3 microtia without an underlying craniofacial syndrome. With computer simulation, the normal, preoperative microtia, and postoperative reconstruction ear were isolated and blended into the oblique and lateral views of that volunteer's face to isolate ear morphology as a variable against a constant facial baseline. These photographs were embedded into Web-based surveys with visual analogue scales to capture social perception data and then were sourced to general population adults.Survey respondents totaled 631. On average, the face with the microtia ear was perceived to be less friendly (P = .015), less healthy (P = .022), and less successful (P = .005) than the same face with the "normal" ear. There were no statistically significant differences in socially perceived attributes between the face with the normal ear and the face with the reconstructed ear.This is the first study to examine the social perception consequences of microtia and microtia reconstruction in children. These findings may explain the significant psychosocial distress experienced by these patients by exploring the social perception of specific attributes perceived. Lastly, this study may better inform microtia patients and their physicians on the impact of auricular reconstruction on third party's perception of social attributes.N/A Laryngoscope, 2020.

    View details for DOI 10.1002/lary.28619

    View details for PubMedID 32275329

  • Social Perception of the Nasal Dorsal Contour in Male Rhinoplasty. JAMA facial plastic surgery Nuyen, B., Kandathil, C. K., Saltychev, M., Most, S. P. 2019


    Importance: The social perception of nasal dorsal modification for male rhinoplasty is poorly understood.Objective: To investigate the association of modifying the male nasal dorsum with the perception of such social attributes as youth, approachability, healthiness, masculinity/femininity, intelligence, successfulness, and leadership.Design, Setting, and Participants: Using computer simulation software, 12 images with varied combinations of the nasal dorsal shape, nasofrontal angle (NFA), and nasolabial angle (NLA) were generated from a photograph of a male volunteer's face in profile. These photographs were then sent to participants at a university clinic who were English-speaking adult internet users who were masked to the purpose of the study, which asked them to value different social attributes regarding the face in the photograph in a 16-question survey. The study was conducted in September 2018 and the data were analyzed thereafter until March 2019.Exposures: Twelve photographs embedded in a 16-question survey.Main Outcomes and Measures: Population proportions of responses and chi2 test and graphical analysis based on 95% confidence intervals.Results: Of 503 respondents (survey provision rate, 100%), 412 (81.9%) were women, 386 (76.7%) were white, 32 (6.4%) were Hispanic or Latinx, 63 (12.5%) were black/African American, 10 (2.0%) were Asian/Pacific Islander, and the median age was 46 years (interquartile range, 32-61 years). The man with ski slope-shaped nose with an NFA of 130° and NLA of 97° was often associated with frequently perceived positive characteristics; specifically, he was judged to be the most attractive (95% CI, 18%-26%; P<.001). Participants also often associated superlative youth (95% CI, 15%-24%; P<.001), approachability (95% CI, 13%-20%; P=.002), and femininity (95% CI, 14%-22%; P<.001) with dorsal contours that did not feature a dorsal hump. The man with a dorsal hump-shaped nose with an NFA of 140° and NLA of 105° was associated by the highest proportion of participants with being the oldest (95% CI, 35%-44%; P<.001), least approachable (95% CI, 27%-35%; P<.001), least attractive (95% CI, 37%-42%; P<.001), and least healthy (95% CI, 26%-34%; P<.001). Subset analyses also revealed statistically significant dorsal contour preferences by observers' age, gender, and race/ethnicity.Conclusions and Relevance: A reduced dorsal slope combined with more acute NFAs and NLAs was associated with positively perceived social attributes. The results may be of interest to rhinoplasty surgeons and their male patients when planning changes to the nasal dorsal contour.Level of Evidence: NA.

    View details for DOI 10.1001/jamafacial.2019.0321

    View details for PubMedID 31219525

  • Relationship of Sociodemographic Factors and Outcomes in Functional Rhinoplasty FACIAL PLASTIC SURGERY Nuyen, B., Spataro, E. A., Olds, C., Kandathil, C. K., Most, S. P. 2019; 35 (1): 85–89
  • Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study FACIAL PLASTIC SURGERY Spataro, E., Olds, C., Nuyen, B., Kandathil, C. K., Most, S. P. 2019; 35 (1): 65–67
  • Relationship of Sociodemographic Factors and Outcomes in Functional Rhinoplasty. Facial plastic surgery : FPS Nuyen, B., Spataro, E. A., Olds, C., Kandathil, C. K., Most, S. P. 2019


    The objective of this article was to compare the effect of such sociodemographic factors as gender, age, marital status, employment status, race, and income on short- and long-term rhinoplasty outcomes using a validated disease-specific instrument-Nasal Obstruction Symptom Evaluation (NOSE) scale, as well as complication and revision rates. Patients who underwent a functional (+/- cosmetic) rhinoplasty with the senior author between January, 1 2012, and September 9, 2017, and had both a preoperative and at least one postoperative NOSE score, were included in the study. Sociodemographic variables of binary gender, age, marital status, employment status, race, and income based on zip code were collected. The primary outcomes were the differences between the preoperative and postoperative NOSE scores with short-term (less than 3 months) and longer-term (greater than 3 months) follow-up. Secondary outcomes were general complications and specifically revision surgery. Standard descriptive statistics, as well as univariable linear and logistic regressions, were conducted with each outcome measure. A total of 341 patients were included in this study. No individual patient-level variables were found to significantly affect the short- or longer-term average change in NOSE scores, although older age trended toward significance in longer-term average change in NOSE scores (p=0.07). No factors significantly affected the rate of complications or revision surgery in this cohort. The authors found improvement in NOSE scores after rhinoplasty was not related to factors of age, gender, race, employment status, income, and marital status. This cohort also did not demonstrate differential rates in complications or revision surgery based on sociodemographic variables.

    View details for PubMedID 30654390

  • Evaluation of Antibiotic Prophylaxis in Rhinoplasty A Systematic Review and Meta-analysis JAMA FACIAL PLASTIC SURGERY Nuyen, B., Kandathil, C. K., Laimi, K., Rudy, S. F., Most, S. P., Saltychev, M. 2019; 21 (1): 12–17
  • Comparison of Primary and Secondary Anterior Septal Reconstruction: A Cohort Study. Facial plastic surgery : FPS Spataro, E., Olds, C., Nuyen, B., Kandathil, C. K., Most, S. P. 2018


    This article compares outcomes in patients presenting for either primary or secondary (revision) anterior septal reconstruction (ASR) to treat caudal septal deviation. Patients undergoing ASR by senior author (S. P. M.) between January 1, 2012 and September 1, 2017, with both preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores documented in the chart were included. Data were compared between patients undergoing primary and secondary ASR by univariable and multivariable logistic regression. A total of 199 patients were included in this study; 128 (64%) underwent primary ASR and 71 (36%) underwent secondary ASR. After multivariable analysis, a greater ratio of females and autologous rib graft harvest in the secondary compared with primary ASR, and decreased odds of inferior turbinate reduction in the secondary group was found. There was no significant difference in NOSE scores between the primary and secondary group, and there were very few complications or revision surgeries. While outcomes are similar between primary and secondary (revision) ASR to treat caudal septal deviation, there was a significantly higher rate of autologous rib harvest, highlighting the importance of addressing deviations of the caudal septum at the primary procedure to reduce morbidity related to rib graft harvest and revision surgery.

    View details for PubMedID 30566990

  • Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions A Systematic Review JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Gao, R. W., Nuyen, B. A., Divi, V., Sirjani, D., Rosenthal, E. L. 2018; 144 (8): 746–52
  • Dysphagia and Pharyngeal Obstruction in a Nonsmoker JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY Nuyen, B. A., Berry, G., Megwalu, U. 2018; 144 (2): 171–72

    View details for PubMedID 29222562

  • Outcomes in Head and Neck Resections That Require Multiple-Flap Reconstructions: A Systematic Review. JAMA otolaryngology-- head & neck surgery Gao, R. W., Nuyen, B. A., Divi, V. n., Sirjani, D. n., Rosenthal, E. L. 2018


    Complex head and neck cancer defects that require multiflap reconstructions are technically feasible, but the morbidity and patient outcomes of such large-scale head and neck operations have yet to be systematically reviewed.To systematically review existing literature to characterize the outcomes of large-scale head and neck resections that require multiple-flap reconstructions (defined as defects that require >1 flap [free, pedicled, or combinations thereof]).Two authors independently searched PubMed, Embase, and the Cochrane Review databases for English-only texts published on any date. Included studies examined patients who underwent complex head and neck surgical resections that required multiple simultaneous flaps for reconstruction. Included studies reported results on at least one of the following outcomes: functional and aesthetic, patient survival, or cost (estimated by operating room time, length of stay, and/or complications). Methodological Index for Non-Randomized Studies (MINORS) criteria for bias and modified Oxford Centre for Evidence-Based Medicine recommendations were used to assess study quality.Twenty-four studies published from November 1, 1992, through September 1, 2016, met the final inclusion criteria, with a total of 487 patients (370 male [79.4%]; mean [SD] weighted age, 55.1 [4.1] years). Sixty-two of 250 patients (24.8%) were partially or fully dependent on feeding tubes at follow-up. Twenty-two of 75 patients (29.3%) had poor postoperative oral competence, causing moderate to severe drooling. Nineteen of 108 patients (17.6%) had unintelligible speech. Nine of 64 patients (14.1%) were unsatisfied with their aesthetic outcome. The mean (SD) reported survival was 2.36 (1.39) years. The mean (SD) length of stay was 24.5 (12.2) days in 219 patients. Eighty-eight minor complications (eg, partial flap necrosis, donor site complications) and 185 major complications (eg, surgical reexplorations, flap loss, or cardiopulmonary complications) were reported in 380 patients. Mean (SD) MINORS scores were 16.0 (3.2) for comparison studies and 11.4 (1.8) for noncomparison studies.Because of limited patient life expectancies, modest functional and aesthetic outcomes, and significant associated costs, surgeons should weigh the curative potential and palliative benefits for individual patients with a comprehensive view of the overall outcomes of extensive head and neck resections and reconstructions. Realistic expectations should be emphasized during preoperative discussions with patients.

    View details for PubMedID 29978196

  • Evaluation of Antibiotic Prophylaxis in Rhinoplasty: A Systematic Review and Meta-analysis. JAMA facial plastic surgery Nuyen, B. n., Kandathil, C. K., Laimi, K. n., Rudy, S. F., Most, S. P., Saltychev, M. n. 2018


    Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed.To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis.MEDLINE, Embase, CINAHL, Central (Cochrane Controlled Register of Trials), Scopus, and Web of Science were searched with prospectively designed search phrases on February 16, 2018. All databases were searched from database inception. Key search terms included rhinoplasty, nasal valve repair, and antibacterial agent.Randomized clinical trials (RCTs) with adults (≥18 years) undergoing rhinoplasty and including systemic antibiotic medications administered in the absence of other reasons for use of an antibiotic (eg, localized or systemic infection), without restrictions on language or the time of publication, were included in the study. Interventions of interest were classified into 3 types: (1) single-dose systemic antibiotic administered within 24 hours before the first incision, (2) multidose systemic antibiotic treatment started within 24 hours before the first incision and continuing after the operation, and (3) systemic antibiotic therapy (single dose or multidose) started within 24 hours after the first incision. The following comparisons were made: for the interventions of type 1, no antibiotic; for the interventions of types 2 or 3, no antibiotic or an intervention of type 1.Data extraction was compliant with PRISMA guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Two independent reviewers assessed the relevance of the remaining records at abstract and full-text stages. Meta-analysis pooled with random-effects model.Difference in infectious complication rate between groups.A total of 262 records were identified; of these, only 5 RCTs fulfilled predetermined population, intervention, comparison, and outcome criteria. The pooled study sample consisted of 589 participants. No significant differences in outcome of preventive antibiotic therapy given either preoperatively or postoperatively were found, with a pooled risk ratio of 0.92 (95% CI, 0.35-2.43; P = .86).This study appears to be the first Cochrane-protocol systematic review and meta-analysis investigating preventive antibiotics in rhinoplasty. This study's results suggest that pooled evidence from the 5 RCTs does not support the use of preventive antibiotic therapy in rhinoplasty.1.

    View details for PubMedID 30489601

  • Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study. JAMA otolaryngology-- head & neck surgery Megwalu, U. C., Nuyen, B. A. 2017

    View details for DOI 10.1001/jamaoto.2017.0025

    View details for PubMedID 28301632