Seth J. Davis, MD

All Publications

• Evaluation of Rhinoplasty Information from ChatGPT, Gemini, and Claude for Readability and Accuracy. Aesthetic plastic surgery Meyer, M. K., Kandathil, C. K., Davis, S. J., Durairaj, K. K., Patel, P. N., Pepper, J. P., Spataro, E. A., Most, S. P. 2024

  Abstract

  Assessment of the readability, accuracy, quality, and completeness of ChatGPT (Open AI, San Francisco, CA), Gemini (Google, Mountain View, CA), and Claude (Anthropic, San Francisco, CA) responses to common questions about rhinoplasty.Ten questions commonly encountered in the senior author's (SPM) rhinoplasty practice were presented to ChatGPT-4, Gemini and Claude. Seven Facial Plastic and Reconstructive Surgeons with experience in rhinoplasty were asked to evaluate these responses for accuracy, quality, completeness, relevance, and use of medical jargon on a Likert scale. The responses were also evaluated using several readability indices.ChatGPT achieved significantly higher evaluator scores for accuracy, and overall quality but scored significantly lower on completeness compared to Gemini and Claude. All three chatbot responses to the ten questions were rated as neutral to incomplete. All three chatbots were found to use medical jargon and scored at a college reading level for readability scores.Rhinoplasty surgeons should be aware that the medical information found on chatbot platforms is incomplete and still needs to be scrutinized for accuracy. However, the technology does have potential for use in healthcare education by training it on evidence-based recommendations and improving readability.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  View details for DOI 10.1007/s00266-024-04343-0

  View details for PubMedID 39285054

  View details for PubMedCentralID 9931230

• Buccal Fat Advancement-Transposition Flap for Reconstruction of Midface Volume Defects. Facial plastic surgery & aesthetic medicine Davis, S. J., Park, C., Shipchandler, I. T., Abdulhak, A., Vernon, D., Lee, H. B., Mantravadi, A. V., Ting, J., Shipchandler, T. Z. 2024

  Abstract

  Background: The buccal fat pad (BFP) has previously been utilized for repair of various defects of the head and neck. Objectives: We explore the utility of a pedicled buccal fat advancement-transposition (BFAT) flap in various forms of midface reconstruction through a variety of surgical approaches and characterize its volume and axial reach in human anatomic specimens. Methods: Ten adult full-head human anatomic specimens were dissected, and a single surgical case demonstrating the use of a BFAT flap is described. Results: Nasolabial, subciliary, and deep plane facelift incisions all provided access to the BFP for use as a BFAT flap. The mean volume of mobilizable fat contained within a BFAT flap accessible through external incision was 7.1 cm3. Once fully mobilized, the externalized BFAT flap had a mean axial reach of 6.9 cm without tension. We also present a case illustrating the successful use of a BFAT flap for volumization of a large midface defect secondary to Mohs micrographic surgical resection of a cutaneous malignancy. Discussion: The BFAT flap, which exhibited substantial volume and reach in this study, can be harvested through multiple dissection windows or pre-existing defects and be used to reconstruct a variety of midface defects.

  View details for DOI 10.1089/fpsam.2023.0303

  View details for PubMedID 38597716

• Clinical and surgical factors associated with opioid refill rates following septorhinoplasty. American journal of otolaryngology Park, C., Reategui Via Y Rada, M. L., Pandhiri, T., Davis, S., Shipchandler, T., Vernon, D. 2024; 45 (4): 104268

  Abstract

  Septorhinoplasty is one the most common class of procedures performed worldwide, and opioids are frequently prescribed for post-operative pain [1].The objective of this study was to examine the rate of post-operative opioid prescription refills following septorhinoplasty.This study was a case-control study of patients who underwent septoplasty and other secondary concomitant procedures.Of the 249 patients included in this study, the majority of patients (94.8%) were prescribed 12 tablets of hydrocodone-acetaminophen 5 mg - 325 mg and only 31 patients (13.3%) received refills. The presence of osteotomies and history of prior opioid use were associated with refills. Nasal valve repair type, open versus closed approach, and presence of autologous auricular cartilage graft harvest were not.Our study highlights factors that surgeons should consider when prescribing opioids after septorhinoplasty. Twelve tablets of an opioid are likely sufficient for the majority of patients, but if osteotomies are performed or the patient has a history of prior opioid use, more may be indicated to avoid the need for refills. Additional narcotics are not necessary for an open approach or for patients in which auricular cartilage is needed.

  View details for DOI 10.1016/j.amjoto.2024.104268

  View details for PubMedID 38579507

• Assessing the feasibility of a multimodal liquid biopsy for the diagnosis of HPV-associated oropharyngeal squamous cell carcinoma. American journal of clinical pathology Lewis, J. S., Naegele, S., Efthymiou, V., Mehrad, M., Ely, K. A., Waterboer, T., Lang Kuhs, K. A., Davis, S. J., Richard, K., Das, D., Faden, D. L. 2024

  Abstract

  In this feasibility study, we explored the combined use of circulating tumor human papillomavirus (HPV) DNA (ctHPVDNA) and HPV serology as diagnostic tests for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC).Among patients with research-banked serum or plasma at diagnosis, IgG antibodies to oncoproteins from HPV types 16, 18, 31, 33, 35, 45, 52, and 58 were detected with multiplex serology. Positivity for HPV 16 was defined based on detection of combinations of anti-E6, E1, E2, and E7 and for other high-risk types on detection of anti-E6 and anti-E7. Circulating tumor HPV DNA was detected by custom digital droplet polymerase chain reaction (ddPCR) assays for HPV types 16, 18, 33, 35, and 45. p16 immunohistochemistry and high-risk HPV RNA in situ hybridization (ISH) using a cocktail of 18 high-risk HPV types were performed on tissue.Of 75 patients, 67 (89.3%) were HPV-associated (p16 and HPV RNA ISH positive) and 8 (10.7%) were HPV-independent. All 8 HPV-independent patients were seronegative and negative for ctHPVDNA (100% specificity). Serology was positive in 53 (79.1%) of 67 HPV-associated patients, while ddPCR was positive for ctHPVDNA in 59 (88.6%) of 67 HPV-associated patients. Requiring both tests to be positive resulted in a sensitivity of 50 (74.6%) of 67 while combining assays (either positive) improved sensitivity to 62 (92.6%) of 67.Compared to HPV RNA ISH, HPV serology and ctHPVDNA are sensitive and highly specific biomarkers for HPV-associated OPSCC at the time of presentation.

  View details for DOI 10.1093/ajcp/aqad185

  View details for PubMedID 38349613

• Forehead Flap Practices: A Cross-Sectional Survey of Facial Plastic and Reconstructive Surgeons. Facial plastic surgery & aesthetic medicine DeSisto, N. G., Arnaud, E. H., Chowdhury, N., Davis, S. J., Kimura, K. S., Stephan, S. J., Patel, P. N., Yang, S. F. 2023

  Abstract

  Background: The paramedian forehead flap (PMFF) is a well-established technique utilized for reconstruction of complex nasal defects. Objective: To identify the different techniques and management of patients undergoing PMFF reconstruction and compare these with current literature. Methods: Members of the American Academy of Facial Plastic and Reconstructive Surgery were sent a practice survey highlighting various nuances in PMFF reconstruction. The survey included questions about flap design, operative techniques, and perioperative care. Results: In total, 172 responses were received (14% response rate). Mean years of practice after fellowship was 15.8 years with most respondents performing either 1-5 (33.1%) or 6-10 (27.3%) PMFFs per year. Common practices included the use of general anesthesia, elevation of PMFF in the subgaleal plane (59.6%), and pedicle division at 3 weeks (80%) (p < 0.001). Complication rates ranged between 1% and 5%. The nose was the most common site for revision (p < 0.001) and the average number of secondary procedures after forehead flap division was 1.1 (standard deviation 0.81). The most variability in responses was seen for methods of internal lining reconstruction. Conclusion: Reconstructive surgeons frequently divide the PMFF pedicle at 3 weeks or later and have variable approaches to reconstruction of the internal lining with low complication rates overall.

  View details for DOI 10.1089/fpsam.2023.0115

  View details for PubMedID 38150510

• Utility of PET-CT in Newly Diagnosed HPV-Associated Oropharyngeal Squamous Cell Carcinoma. The Annals of otology, rhinology, and laryngology Lee, J., Davis, S. J., Amin, S. N., Rohde, S. L., Kim, Y. J. 2023; 132 (10): 1133-1139

  Abstract

  To compare the utility of positron emission tomography-computed tomography (PET-CT) versus contrasted CT neck combined with routine chest imaging for disease staging and treatment planning in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) with clinically evident sites of primary disease.All adult patients with primary HPV-associated OPSCC at a single quaternary care cancer center from 2018 to 2019 were reviewed, and those with images available for re-review were included. Primary outcomes included concordance in clinical staging between the 2 imaging modalities of interest (PET-CT vs CT), as well as independent agreement of each with pathologic staging. Analysis was performed via ordinal logistic regression. A secondary outcome was treatment selection after diagnostic imaging, analyzed via chi-squared testing.In total, 100 patients were included for evaluation, of which 89% were male, 91% Caucasian, and mean age was 61.2 years (SD 9.6). Clinical disease staging agreed between imaging modalities in 95% of cases (54 of 57 patients). Pathologic staging agreed with clinical staging from CT neck in 93% of cases (25 of 27 patients; P = .004), and with PET-CT in 82% (14 of 17 patients; P =.003). No differences were observed between the 2 imaging modalities for subsequent treatment selection (P = .39).In uncomplicated HPV-associated OPSCC, CT offers equivalent diagnostic accuracy to that of combined whole-body PET-CT for clinical staging, and has no appreciable impact on treatment selection. A reduced reliance on routine PET-CT during initial workup of HPV-associated OPSCC may be favorable for otherwise healthy patients with clinically evident sites of primary disease.

  View details for DOI 10.1177/00034894221135934

  View details for PubMedID 36453776

• Septal Perforation Repair Using a Temporoparietal Fascia and Polydioxanone Plate Construct: A Multi-Institutional Analysis. Facial plastic surgery & aesthetic medicine Davis, S. J., Rossi Meyer, M., Misch, E., McLeod, M., Occhiogrosso, J., Yau, J., Mims, M., Dedhia, R. D., Sowder, J. C., Shockley, R., Cerrati, E., Shaye, D., Shockley, W., Owen, S., Stephan, S. J. 2023; 25 (3): 212-219

  Abstract

  Background: Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)-polydioxanone (PDS) plate interposition grafting. Objectives: To compare rates of NSP closure with TPF-PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors. Methods: Retrospective review of patients undergoing TPF-PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications. Results: Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm2. NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors. Conclusions: TPF-PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.

  View details for DOI 10.1089/fpsam.2021.0421

  View details for PubMedID 36173756

• Chemodenervation of the Posterior Belly of the Digastric Muscle in Facial Synkinesis. Facial plastic surgery & aesthetic medicine Longino, E. S., Davis, S. J., Landeen, K. C., Kimura, K. S., Sharma, R. K., Ortiz, A. S., Yang, S. F., Patel, P. N., Stephan, S. J. 2023; 25 (5): 378-383

  Abstract

  Background: Patients with facial synkinesis may have jaw tightness and swallow discomfort despite chemodenervation of facial mimetic musculature, and the posterior belly of the digastric (PBD) muscle is a logical target to treat these symptoms. Learning/Study Objective: To compare patient-reported outcomes of botulinum toxin (BT) chemodenervation of the posterior belly of digastric muscle in patients with postparalytic facial synkinesis. Design Type: Retrospective review. Methods: Patients with facial synkinesis who underwent electromyography (EMG)-guided PBD BT chemodenervation in addition to their baseline therapeutic regimen were included. Pre- and post-treatment Synkinesis Assessment Questionnaires (SAQ) and a two-question survey regarding jaw tightness and swallow discomfort were administered. Results: Twenty-nine patients were included. An average of 5 U of BT-A was injected into the PBD, and 46.5 U across all facial muscles. From pre- to post-injection, patients demonstrated improvement in jaw tightness at rest (3.02 vs. 1.98/5.0, p < 0.001), with swallow (2.78 vs. 1.94/5.0, p < 0.001), and total SAQ (64.3 vs. 51.2/100, p < 0.001). Patients rated subjective benefit from PBD injection compared with prior treatments without PBD injection as 4.5/5.0. Conclusion: Synkinesis patients with jaw tightness or swallow discomfort may benefit from the addition of PBD injections to the therapeutic regimen.

  View details for DOI 10.1089/fpsam.2022.0207

  View details for PubMedID 36067327

• Professional Social Media in Facial Plastic and Reconstructive Surgery: Usage, Resources, and Barriers. The Annals of otology, rhinology, and laryngology Landeen, K. C., Smetak, M. R., Keah, N. M., Davis, S. J., Shastri, K., Patel, P., Stephan, S. J., Yang, S. F. 2023; 132 (9): 1085-1089

  Abstract

  Social media is an important tool for networking, recruitment, and promoting clinical practice. No study has specifically assessed which FPRS practitioners have professional social media accounts, how they utilize them, and what barriers or resources exist to their use.This study aims to examine differences in social media use based on provider demographics and practice setting, and identify resources and barriers to professional social media use.This cross-sectional analysis was an anonymous survey sent to AAFPRS members. Data collected included demographics, practice setting, resources, and barriers encountered to use of professional social media.Most facial plastic surgeons (80%) use professional social media, notably Instagram and Facebook, and mostly post patient photos and stories (67.9%). Social media is more commonly utilized in private practice (56% vs 23%, P = .0016), where there are less institutional barriers (10% vs 40%, P = .02) and more resources available (82.5% vs 12.5%, P = .01).Social media is widely used in FPRS. Working in private practice is associated with increased availability of resources for support, and a reduction in institutional barriers to maintaining a social media presence. With this understanding, facial plastic surgeons can be better equipped for networking, marketing, and promoting the field of FPRS.

  View details for DOI 10.1177/00034894221133746

  View details for PubMedID 36330593

• Balloon Sinuplasty and Stenting in the Management of Complex Frontal Sinus Outflow Tract Fractures. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery Davis, S. J., Naguib, M., Dedhia, R. D., Bauer, A. M., Stephan, S. J., Russell, P. T. 2023; 169 (2): 397-405

  Abstract

  Classical management of complex fractures involving the frontal sinus outflow tract (FSOT) favors obliteration or cranialization to avoid delayed complications. We aim to exhibit success with a novel application of balloon sinuplasty and frontal stenting in the management of complex injuries disrupting the FSOT, which might have otherwise required more invasive interventions.Retrospective review.Single institution, level 1 trauma center.Retrospective review of patients presenting to a level 1 trauma center with fractures involving the FSOT. Outcomes include patency of the FSOT on imaging and endoscopy, rate of complications, degree of residual tabular displacement, and need for revision surgery.Twenty-five patients met inclusion criteria, with complete FSOT obstruction seen in all cases on computed tomography. All patients underwent balloon sinuplasty with frontal sinus stenting; 48% underwent concurrent anterior table repair, and 36% open repair of nasoorbitoethmoid complex fractures. The mean follow-up length was 13.9 months, at which time 91.3% of patients demonstrated radiographic and endoscopic FSOT patency. No residual sinus opacification or pneumocephalus was observed.Balloon sinuplasty with frontal sinus stenting is a straightforward and minimally invasive technique that can create a safe sinus in complex fractures disrupting the FSOT while avoiding the need for more invasive procedures.

  View details for DOI 10.1002/ohn.243

  View details for PubMedID 36807365

• Varicella Zoster Virus Reactivation Involving the Vagus Nerve. The Annals of otology, rhinology, and laryngology Davis, S., Thomas, E., Lowery, A., Kahue, C., Gelbard, A. 2023; 132 (7): 818-824

  Abstract

  To characterize the presentation, clinical course and functional outcomes of patients with varicella zoster virus (VZV) reactivation involving the vagus nerve. To highlight the role of otolaryngology in acute and long-term management of laryngopharyngeal VZV and its sequelae.Retrospective review of 3 patients with laryngopharyngeal VZV, managed at a tertiary referral center.All cases presented with vesicular lesions involving mucosa of the laryngopharynx. Each experienced vocal fold hypomobility, among other otolaryngologic sequelae. All were treated with systemic antivirals and corticosteroids. Mucosal lesions resolved within 7 days of treatment initiation; functional deficits persisted for months to years. Dysphonia improved to a plateau at 3 months, while dysphagia took longer to resolve. One patient with disseminated disease experienced bilateral vocal fold paralysis requiring temporary tracheostomy.Vagal neuropathy secondary to VZV reactivation is a rare clinical entity with a variety of laryngeal manifestations. Early initiation of systemic therapy and serial endoscopic evaluations are critical components of acute management when laryngopharyngeal involvement is suspected. Otolaryngologists should plan for long-term phonatory and deglutitive therapy in these cases, as neurologic sequelae can persist for months to years following initial insult.Level 4 (Case-series).

  View details for DOI 10.1177/00034894221111259

  View details for PubMedID 35833239

• Single Institution Experience With Sinonasal Glomangiopericytoma: A Case Series. Ear, nose, & throat journal Schauwecker, N., Davis, S., Perez, A., Labby, A., Mannion, K., Sinard, R., Lewis, J. S., Chandra, R. 2023: 1455613231179688

  Abstract

  Introduction: Sinonasal glomangiopericytoma (GPC) is an uncommon neoplasm, accounting for less than 0.5% of all sinonasal tumors. It is characterized as having low malignant potential, with complete surgical excision representing optimal treatment. Presenting symptoms are typically due to mass effect and vascularity of this tumor, often including unilateral nasal obstruction or epistaxis. Accounts of this tumor in the literature remain sparse. Methods: Single institution retrospective review. Results: Six cases of sinonasal GPC were identified from a review of the electronic medical records spanning from 2009 through 2021. Age at diagnosis ranged from 48 to 67 years, with a gender distribution of 5 males and 1 female. Most subjects presented with unilateral sinonasal obstruction of variable duration. Each underwent endoscopic resection of the mass with negative margins, and no adjuvant therapy was pursued. Pathologic specimens demonstrated a vascular patterned tumor with spindled cells surrounding vessels and were positive for smooth muscle actin and negative for cytokeratin. Active post-surgical follow-up ranged from 11 months to 10 years. All patients were without endoscopic evidence of recurrence, and 2 had post-operative imaging which showed no evidence of disease. Conclusions: This review of 6 cases of sinonasal GPC represents the largest known series of this rare pathology in the literature to date. Based on our experience, and in agreement with the available literature, this disease is reliably managed with complete surgical excision. Adjuvant therapy can be avoided in otherwise uncomplicated cases. Although rare, GPC should be considered in the differential diagnosis of all vascular sinonasal tumors.

  View details for DOI 10.1177/01455613231179688

  View details for PubMedID 37329279

• Normative Values of the Nasal Obstruction Symptom Evaluation Scale. Facial plastic surgery & aesthetic medicine Shastri, K., Gao, Y., Davis, S. J., Kimura, K. S., Patel, P. N., Stephan, S. J., Yang, S. F. 2023; 25 (1): 35-39

  Abstract

  Background: The Nasal Obstruction Symptom Evaluation (NOSE) scale is widely used by clinicians in evaluation of nasal airway obstruction (NAO). Objective: To determine normative values for the NOSE scale among both symptomatic and asymptomatic members of the general U.S. population. Methods: A survey of NAO symptoms in adults of age 18 years and older was performed. The distribution of NOSE scores among the general population was estimated. Influence of features including age, gender, race, location, and symptomatology on NOSE scores was evaluated. Results: Surveys were completed by 2333 participants. Mean NOSE score was 11 (standard deviation [SD] 11) in the asymptomatic, and 28 (SD 22) in the symptomatic population (p < 0.0001). Increasing age was associated with an increase in scores until 45 years, after which it was associated with decreasing scores. No significant differences were found related to other investigated demographics. Conclusions: Normative ranges for the NOSE scale are established, and are largely consistent with values in the existing literature. NOSE scores do not appear to be influenced by gender, race, or geography, although age should be considered in their interpretation.

  View details for DOI 10.1089/fpsam.2021.0303

  View details for PubMedID 35593902

• Augmented Skin Grafting: A New Rung in the Reconstructive Ladder. Facial plastic surgery & aesthetic medicine Landeen, K. C., Davis, S. J., Dedhia, R. D., Shastri, K. S., Ries, W. R., Stephan, S. J. 2022; 24 (2): 126-129

  Abstract

  Importance: A gap in the reconstructive ladder exists in which complex defects may benefit from skin grafting but are not amenable due to their anatomic limitations. Similarly, some patients are intolerant of more invasive techniques in cosmetically sensitive areas. In these scenarios, augmented skin grafts may represent a unique alternative to traditional reconstructive options. Observations: This report is a clinical overview of skin grafting in complex nasal defects. We describe three types of augmented skin grafts, with examples of each. These include preliminarily augmented grafts with a dermal biomatrix, simultaneous augmentation with a perichondrocutaneous pseudo-composite graft, and delayed augmentation with staged structural grafting. Conclusions and Relevance: Augmented skin grafts represent unique methods of reconstruction for complex wounds in cosmetically sensitive areas. We propose these techniques as an evolving unique rung in the reconstructive ladder.

  View details for DOI 10.1089/fpsam.2021.0112

  View details for PubMedID 34780298

• Optimizing Flap Harvest in Auricular Reconstruction. The Journal of craniofacial surgery Fernando, S. J., Davis, S. J., Dedhia, R. D., Sowder, J. C., Ramachandra, T., Stephan, S. J. 2022; 33 (8): 2659-2664

  Abstract

  The temporoparietal fascial (TPF) and occipital cranial fascial (OCP) flaps are the mainstay of implant coverage in alloplastic auricular reconstruction. Their optimal design is critical for elevating a robust flap that ultimately leads to favorable outcomes.Sixteen TPF and OCP dissections were performed on 8 cadaveric specimens. Vascular anatomy and key landmarks were documented. The minimum flap size that incorporated ideal vasculature and would appropriately cover a porous polyethylene implant was measured.The minimum flap dimensions (length × width × base width) to cover a standard PPE auricular implants were on average 11×8.3×6.4 cm for TPF and 13.1×8.6×6.5 cm for OCP. The average axial length of the superficial temporal artery and occipital artery were 12.51 and 13.2 cm, respectively. An "occipital elbow" was located on average 8.2 cm posterior to the external acoustic canal. The postauricular fascia contained additional contributions from the occipital artery and mastoid emissary vein, which was located on average 5.9 cm posterior to the superficial temporal artery.This study highlights the anatomic features behind optimal TPF and OCP flap design for auricular reconstruction. Contributions to axial length and anatomic relationships of their primary arterial supply, significance of the occipital elbow as a reliable landmark for fascial dissection, and importance of the postauricular fascia and its vascular supply for flap viability are emphasized. Ultimately, the authors provide minimal dimensions for both TPF and OCP flaps to obtain adequate alloplastic implant coverage.

  View details for DOI 10.1097/SCS.0000000000008698

  View details for PubMedID 36217234

• Complications Associated with Use of Porous High-Density Polyethylene in Rhinoplasty. Facial plastic surgery & aesthetic medicine Davis, S. J., Landeen, K. C., Sowder, J. C., Kimura, K. S., Shastri, K. S., Clymer, M. C., Stephan, S. J. 2022; 24 (5): 337-343

  Abstract

  Background: Porous high-density polyethylene (pHDPE) has successfully been used as an alternative to cartilage for grafting in rhinoplasty; however, concerns exist surrounding its potential for infection and/or extrusion. Objectives: To analyze the relationship between complication rates associated with pHDPE in rhinoplasty and graft location relative to shear force applied by external manipulation. Methods: Retrospective review of 116 patients undergoing pHDPE rhinoplasty for 10 years. Results: Minor postoperative complications occurred in 3.4% of patients, each resolving with conservative management. Major complications including infection or extrusion occurred in 5.2% of all patients, at an average of 36.9 months postoperatively. All major complications occurred in patients with grafts extending into the caudal nose, and two-thirds ultimately necessitated surgical intervention. Conclusions: Cephalically contained pHDPE grafts are less prone to failure than those extending into the caudal nose. Long-term follow-up is recommended for all patients based on the risk for delayed complications.

  View details for DOI 10.1089/fpsam.2021.0090

  View details for PubMedID 35802490

• Genetic variation within the human papillomavirus type 16 genome is associated with oropharyngeal cancer prognosis. Annals of oncology : official journal of the European Society for Medical Oncology Lang Kuhs, K. A., Faden, D. L., Chen, L., Smith, D. K., Pinheiro, M., Wood, C. B., Davis, S., Yeager, M., Boland, J. F., Cullen, M., Steinberg, M., Bass, S., Wang, X., Liu, P., Mehrad, M., Tucker, T., Lewis, J. S., Ferris, R. L., Mirabello, L. 2022; 33 (6): 638-648

  Abstract

  A significant barrier to adoption of de-escalated treatment protocols for human papillomavirus-driven oropharyngeal cancer (HPV-OPC) is that few predictors of poor prognosis exist. We conducted the first large whole-genome sequencing (WGS) study to characterize the genetic variation of the HPV type 16 (HPV16) genome and to evaluate its association with HPV-OPC patient survival.A total of 460 OPC tumor specimens from two large United States medical centers (1980-2017) underwent HPV16 whole-genome sequencing. Site-specific variable positions [single nucleotide polymorphisms (SNPs)] across the HPV16 genome were identified. Cox proportional hazards model estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival by HPV16 SNPs. Harrell C-index and time-dependent positive predictive value (PPV) curves and areas under the PPV curves were used to evaluate the predictive accuracy of HPV16 SNPs for overall survival.A total of 384 OPC tumor specimens (83.48%) passed quality control filters with sufficient depth and coverage of HPV16 genome sequencing to be analyzed. Some 284 HPV16 SNPs with a minor allele frequency ≥1% were identified. Eight HPV16 SNPs were significantly associated with worse survival after false discovery rate correction (individual prevalence: 1.0%-5.5%; combined prevalence: 15.10%); E1 gene position 1053 [HR for overall survival (HRos): 3.75, 95% CI 1.77-7.95; Pfdr = 0.0099]; L2 gene positions 4410 (HRos: 5.32, 95% CI 1.91-14.81; Pfdr = 0.0120), 4539 (HRos: 6.54, 95% CI 2.03-21.08; Pfdr = 0.0117); 5050 (HRos: 6.53, 95% CI 2.34-18.24; Pfdr = 0.0030), and 5254 (HRos: 7.76, 95% CI 2.41-24.98; Pfdr = 0.0030); and L1 gene positions 5962 (HRos: 4.40, 95% CI 1.88-10.31; Pfdr = 0.0110) and 6025 (HRos: 5.71, 95% CI 2.43-13.41; Pfdr = 0.0008) and position 7173 within the upstream regulatory region (HRos: 9.90, 95% CI 3.05-32.12; Pfdr = 0.0007). Median survival time for patients with ≥1 high-risk HPV16 SNPs was 3.96 years compared with 18.67 years for patients without a high-risk SNP; log-rank test P < 0.001. HPV16 SNPs significantly improved the predictive accuracy for overall survival above traditional factors (age, smoking, stage, treatment); increase in C-index was 0.069 (95% CI 0.019-0.119, P < 0.001); increase in area under the PPV curve for predicting 5-year survival was 0.068 (95% CI 0.015-0.111, P = 0.008).HPV16 genetic variation is associated with HPV-OPC prognosis and can improve prognostic accuracy.

  View details for DOI 10.1016/j.annonc.2022.03.005

  View details for PubMedID 35306154

  View details for PubMedCentralID PMC9350957

• Trends in Maxillofacial Trauma During COVID-19 at a Level 1 Trauma Center. Ear, nose, & throat journal Longino, E. S., Landeen, K. C., Wessinger, B. C., Kimura, K. S., Davis, S. J., Shastri, K. S., Stephan, S. J., Patel, P. N., Yang, S. F. 2022: 1455613221088697

  View details for DOI 10.1177/01455613221088697

  View details for PubMedID 35414268

  View details for PubMedCentralID PMC9008470

• In Response to In Reference to 3D Customization for Microtia Repair in Hemifacial Microsomia. The Laryngoscope Kimura, K. S., Ortiz, A., Davis, S., Patel, P., Stephan, S. 2022; 132 (4): E12-E13

  View details for DOI 10.1002/lary.29947

  View details for PubMedID 34784057

• 3D Customization for Microtia Repair in Hemifacial Microsomia. The Laryngoscope Kimura, K., Davis, S., Thomas, E., Dedhia, R., Shastri, K., Patel, P., Stephan, S., Pruthi, S., Griffith, B. 2022; 132 (3): 545-549

  View details for DOI 10.1002/lary.29823

  View details for PubMedID 34546598

• Utility of PET-CT for Clinical Evaluation of Newly Diagnosed HPV-Associated Oropharyngeal Squamous Cell Carcinoma Lee, J., Davis, S., Amin, S. Ann Otol Rhinol Laryngol. 2022

  Abstract

  10.1177/00034894221135934

• Rhinoplasty Complications Associated with Use of High-Density Porous Polyethylene Grafts Davis, S., Landeen, K., Sowder, J. Facial Plast Surg Aesthet Med. 2022

  Abstract

  24(5):337-343. doi: 10.1089/fpsam.2021.0090

• Septal Perfoplasty for Management of Symptomatic Nasal Septal Perforation: An Alternative to Surgical Closure. Facial plastic surgery & aesthetic medicine Davis, S. J., Morse, J. C., Kimura, K. S., Dedhia, R. D., Bauer, A. M., Beckler, A. D., Wright, H. V., Russell, P. T., Stephan, S. J. 2021; 23 (2): 103-109

  Abstract

  Importance: Symptomatic septal perforations are often difficult to manage and can have a significant impact on patient quality of life. Available surgical techniques for repair have demonstrated a varying rate of success, presenting a need for reliable interventions targeting symptom control. Objectives: To describe the modified surgical technique here termed septal perfoplasty. To demonstrate that creation of favorable septal perforation characteristics is effective in managing symptoms and improving patient quality of life. Design, Setting, and Participants: A retrospective review of the medical record was performed of patients who underwent the procedure of interest between July 1, 2006 and October 1, 2019 at Vanderbilt University Medical Center. All patients with symptomatic septal perforation who underwent septal perfoplasty within the timeframe reviewed were included. Septal perfoplasty was standardly performed in combination with turbinate reduction in all cases. This was combined with other indicated procedures for chronic sinusitis, repair of vestibular stenosis or nasal deformity. Main Outcomes and Measures: Creation of a well-mucosalized septal perforation, combined with patient-reported acceptable symptom control, was the primary outcome. Secondary outcomes include time to resolution, duration of follow-up, postsurgical complications, and need for further intervention. Results: Twenty patients (70% female; mean [range] age, 45.8 [15-72] years) underwent septal perfoplasty over the course of 13 years. The most common etiology of perforation was trauma (40%), presenting symptom was crusting (95%), and size of perforation repaired was large (60%). Mean follow-up was 37.6 months (range, 1-153 months). Overall, favorable perforation characteristics were created in 95% of cases by the first postoperative appointment. Acceptable symptomatic control was achieved in 18 out of 20 patients (90%), with a median time to improvement of 66 days. Eight patients required additional surgery to address chronic sinusitis or vestibular stenosis. Two patients experienced postoperative infections, treated conservatively with antibiotics. Conclusion and Relevance: Septal perfoplasty is a safe, simple, and effective method for management of symptomatic nasal septal perforation, which provides an alternative to more complicated interventions with comparable rates of symptomatic resolution. This procedure should particularly be considered for patients in which difficult repair is anticipated.

  View details for DOI 10.1089/fpsam.2020.0155

  View details for PubMedID 32779939

• Oropharyngeal Squamous Cell Carcinoma With Discordant p16 and HPV mRNA Results: Incidence and Characterization in a Large, Contemporary United States Cohort. The American journal of surgical pathology Shinn, J. R., Davis, S. J., Lang-Kuhs, K. A., Rohde, S., Wang, X., Liu, P., Dupont, W. D., Plummer, D., Thorstad, W. L., Chernock, R. D., Mehrad, M., Lewis, J. S. 2021; 45 (7): 951-961

  Abstract

  Early studies estimate that 5% to 10% of oropharyngeal squamous cell carcinomas overexpress p16 but are unassociated with transcriptionally-active high-risk human papillomavirus (HPV). Patients with discordant HPV testing may experience clinical outcomes that differ from traditional expectations. To document the rate of p16 and HPV mRNA positivity, characterize patients with discordant testing, and identify features that may warrant selective use of HPV-specific testing after p16 IHC, a multi-institutional, retrospective review of oropharyngeal squamous cell carcinoma patients with p16 IHC and HPV mRNA testing by reverse transcriptase polymerase chain reaction was performed. Of the 467 patients, most had T1 or T2 tumors (71%), 82% were p16 positive, and 84% were HPV mRNA positive. Overall, most tumors were nonkeratinizing (378, 81%), which was strongly associated with p16 and HPV positivity (93% and 95%, respectively). Overall, 81% of patients were double positive, 14% double negative, and 4.9% discordant (3.4% p16 negative/HPV mRNA positive and 1.5% p16 positive/HPV mRNA negative). The survival rates of these discordant patient groups fell squarely between the 2 concordant groups, although in multivariate analysis for both disease-free survival and overall survival, discordant patients were not found to have statistically significantly different outcomes. Reclassifying patients by applying HPV mRNA testing when p16 results and morphology do not match, or when p16 results are equivocal, improved prognostication slightly over p16 or HPV mRNA testing alone. Patients with discordant testing demonstrate a borderline significant trend toward survival differences from those with concordant tests. When evaluated independently, patients who were p16 negative but HPV mRNA positive had a prognosis somewhat closer to double-positive patients, while those who were p16 positive, but HPV mRNA negative had a prognosis closer to that of double-negative patients. We suggest an algorithm whereby confirmatory HPV mRNA testing is performed in patients where p16 status is not consistent with tumor morphology. This captures a majority of discordant patients and improves, albeit modestly, the prognostication.

  View details for DOI 10.1097/PAS.0000000000001685

  View details for PubMedID 33739785

  View details for PubMedCentralID PMC8192336

• Optimizing septal perforation repair techniques. Current opinion in otolaryngology & head and neck surgery Dedhia, R. D., Davis, S. J., Stephan, S. J. 2020; 28 (4): 212-217

  Abstract

  Multiple successful techniques and approaches for nasal septal perforation repair have been described, yet consistency in perforation and outcome metrics is required to identify the optimal approach to repair. The present article will review the recent literature.Computational fluid dynamic studies continue to expand our understanding of the airflow dynamics in nasal septal perforation and after repair. Combining rhinoplasty and nasal septal perforation repair in appropriately selected patients can be safely done with excellent results. There has been a rise in utilization of a temporoparietal fascia with polydiaxonone plate construct for septal perforation repair with excellent outcomes.The present review provides the reconstructive surgeon with an update on nasal septal perforation repair and describes a recently popularized technique of temporoparietal fascia-polydiaxonone plate for perforation reconstruction.

  View details for DOI 10.1097/MOO.0000000000000631

  View details for PubMedID 32628414

• Use of Concentrated Epinephrine in the Operating Room Procedural Complications in Nasal and Sinus Surgery Davis, S., Morrel , W., Dedhia , R., Stephan , S. 2020
• Hearing Loss Otolaryngology Residents, V., Davis, S. YouTube. 2019

  Abstract

  YouTube, Uploaded by VUMC O-HNS. https://www.youtube.com/watch?v=t6G0WSgoJKQ.

• Tissue-Specific MicroRNA Expression Patterns in Four Types of Kidney Disease. Journal of the American Society of Nephrology : JASN Baker, M. A., Davis, S. J., Liu, P., Pan, X., Williams, A. M., Iczkowski, K. A., Gallagher, S. T., Bishop, K., Regner, K. R., Liu, Y., Liang, M. 2017; 28 (10): 2985-2992

  Abstract

  MicroRNAs contribute to the development of kidney disease. Previous analyses of microRNA expression in human kidneys, however, were limited by tissue heterogeneity or the inclusion of only one pathologic type. In this study, we used laser-capture microdissection to obtain glomeruli and proximal tubules from 98 human needle kidney biopsy specimens for microRNA expression analysis using deep sequencing. We analyzed specimens from patients with diabetic nephropathy (DN), FSGS, IgA nephropathy (IgAN), membranoproliferative GN (MPGN) (n=19-23 for each disease), and a control group (n=14). Compared with control glomeruli, DN, FSGS, IgAN, and MPGN glomeruli exhibited differential expression of 18, 12, two, and 17 known microRNAs, respectively. The expression of several microRNAs also differed between disease conditions. Specifically, compared with control or FSGS glomeruli, IgAN glomeruli exhibited downregulated expression of hsa-miR-3182. Furthermore, in combination, the expression levels of hsa-miR-146a-5p and hsa-miR-30a-5p distinguished DN from all other conditions except IgAN. Compared with control proximal tubules, DN, FSGS, IgAN, and MPGN proximal tubules had differential expression of 13, 14, eight, and eight microRNAs, respectively, but expression of microRNAs did not differ significantly between the disease conditions. The abundance of several microRNAs correlated with indexes of renal function. Finally, we validated the differential glomerular expression of select microRNAs in a second cohort of patients with DN (n=19) and FSGS (n=21). In conclusion, we identified tissue-specific microRNA expression patterns associated with several kidney pathologies. The identified microRNAs could be developed as biomarkers of kidney diseases and might be involved in disease mechanisms.

  View details for DOI 10.1681/ASN.2016121280

  View details for PubMedID 28663230

  View details for PubMedCentralID PMC5619963