Scholars@Duke
Liana Puscas

Liana Puscas

Professor of Head and Neck Surgery & Communication Sciences
Head & Neck Surgical Oncology
liana.puscas@duke.edu
Duke South Yellow Zone 4000, DUMC Box 3805, Durham, NC 27710
40 Duke Medicine Circle, DUMC Box 3805, Durham, NC 27710
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Selected Publications

Examining Trends in Implantable Arterial Doppler Usage Among North American Head and Neck Microsurgeons: A Survey Study.

Journal Article Ann Vasc Surg · November 2023 BACKGROUND: There are variations in implantable arterial Doppler usage for microvascular free tissue monitoring among North American surgeons. Identifying utilization trends among the microvascular community may elucidate practice patterns that may be usef ... Full text Link to item Cite

Clinical outcomes following intraoperative pedicle disruption in fibula free flaps.

Journal Article Head Neck · August 2023 OBJECTIVES: Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of ... Full text Link to item Cite

Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy.

Journal Article Gland Surg · July 31, 2023 BACKGROUND: Increased surgeon volume is associated with decreased complications for many surgeries, including thyroidectomy. We sought to use two national databases to assess for associations between surgeon volume and complications in patients undergoing ... Full text Link to item Cite

Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: Toward Improvements in Completion Disparities.

Journal Article Otolaryngol Head Neck Surg · July 2023 OBJECTIVE: To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts. STUDY DESIGN: Retrospective pre-post analysis. SETTING: Academic ... Full text Link to item Cite

Octreotide may improve pharyngocutaneous fistula healing through downregulation of cystatins: A pilot study.

Journal Article Laryngoscope Investig Otolaryngol · February 2023 BACKGROUND: Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hyp ... Full text Link to item Cite

The Management of Salivary Fistulas.

Journal Article Semin Plast Surg · February 2023 Postoperative salivary fistula is an especially undesirable complication because it can be difficult to address, may delay postoperative radiation, and always delays enteral nutrition. Patients who are malnourished, have already undergone radiotherapy, or ... Full text Link to item Cite

Milestones 2.0: Otolaryngology Resident Competency in the Postpandemic Era.

Journal Article Otolaryngol Head Neck Surg · April 2022 The Accreditation Council for Graduate Medical Education and the American Board of Otolaryngology-Head and Neck Surgery Milestones Project grew out of a continued need to document objective outcomes within resident education. Milestones 2.0 began its work ... Full text Link to item Cite

Parathyroid

Chapter · January 1, 2022 This chapter uses real-life clinical cases to present the history of illness, physical examination, and clear and up-to-date explanations of treatment strategies for parathyroid. It contains full-color photographs, illustrations, and diagrams to better sup ... Full text Cite

Oropharynx

Chapter · January 1, 2022 This chapter uses real-life clinical cases to present the history of illness, physical examination, and clear and up-to-date explanations of treatment strategies for oropharynx. It contains full-color photographs, illustrations, and diagrams to better supp ... Full text Cite

Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis.

Journal Article Otolaryngol Head Neck Surg · December 2021 OBJECTIVE: To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. STUDY DESIGN: Retrospective review. SETTING: Two US databases spanning 2000 to 2014. METHODS: Neck dissecti ... Full text Link to item Cite

Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy.

Journal Article JAMA Otolaryngol Head Neck Surg · November 1, 2021 IMPORTANCE: Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors th ... Full text Link to item Cite

Assessing Interpersonal and Communication Skills.

Journal Article J Grad Med Educ · April 2021 Full text Link to item Cite

Association of Lymph Node Ratio With Overall Survival in Patients With Metastatic Papillary Thyroid Cancer.

Journal Article JAMA Otolaryngol Head Neck Surg · October 1, 2020 This cohort study examines the association of the lymph node ratio with overall survival in patients with papillary thyroid cancer. ... Full text Link to item Cite

Advanced head and neck surgery training during the COVID-19 pandemic.

Journal Article Head Neck · July 2020 BACKGROUND: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. METHODS: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 o ... Full text Link to item Cite

The effect of lateral neck dissection on complication rate for total thyroidectomy.

Journal Article Am J Otolaryngol · 2020 PURPOSE: To determine the complication profile for total thyroidectomy with and without concomitant lateral neck dissection using a large administrative database. MATERIALS AND METHODS: The IBM MarketScan® Commercial Database (2010-2014) analytic cohort wa ... Full text Link to item Cite

Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.

Journal Article OTO Open · 2020 OBJECTIVE: To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. METHODS: Videos are recorded from multiple viewpoints within the operating room and com ... Full text Link to item Cite

Junior otolaryngology resident in-service exams predict written board exam passage.

Journal Article Laryngoscope · January 2019 OBJECTIVE: The purpose of this study was to assess the association between the Otolaryngology Training Examination (OTE) taken during residency and the passage rate of first-time examinees on the American Board of Otolaryngology-Head and Neck Surgery Writt ... Full text Link to item Cite

Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach.

Journal Article Head Neck · January 2019 BACKGROUND: Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy. METHODS: Multicenter retrospective review at 33 inst ... Full text Link to item Cite

Otolaryngologist adherence to the AAO-HNSF Allergic Rhinitis Clinical Practice Guideline.

Journal Article Int Forum Allergy Rhinol · June 2018 BACKGROUND: In February 2015, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) published the Allergic Rhinitis Clinical Practice Guideline (AR-CPG). The objective of this study was to assess otolaryngologists' perception of the accur ... Full text Link to item Cite

Examining Trends in Implantable Arterial Doppler Usage Among North American Head and Neck Microsurgeons: A Survey Study.

Journal Article Ann Vasc Surg · November 2023 BACKGROUND: There are variations in implantable arterial Doppler usage for microvascular free tissue monitoring among North American surgeons. Identifying utilization trends among the microvascular community may elucidate practice patterns that may be usef ... Full text Link to item Cite

Clinical outcomes following intraoperative pedicle disruption in fibula free flaps.

Journal Article Head Neck · August 2023 OBJECTIVES: Iatrogenic injury of the fibula free flap pedicle is rare. Postoperative flap survival and reconstructive outcomes following intraoperative pedicle severance are unknown. This study assesses free flap outcomes following accidental severance of ... Full text Link to item Cite

Lateral neck dissection surgeon volume and complications in head and neck endocrine malignancy.

Journal Article Gland Surg · July 31, 2023 BACKGROUND: Increased surgeon volume is associated with decreased complications for many surgeries, including thyroidectomy. We sought to use two national databases to assess for associations between surgeon volume and complications in patients undergoing ... Full text Link to item Cite

Integrated Health Maintenance Reminders for Improved HPV Vaccine Administration: Toward Improvements in Completion Disparities.

Journal Article Otolaryngol Head Neck Surg · July 2023 OBJECTIVE: To evaluate the effect of a health maintenance reminder (HMR) on human papillomavirus (HPV) vaccine administration and completion across different age, insurance, and race cohorts. STUDY DESIGN: Retrospective pre-post analysis. SETTING: Academic ... Full text Link to item Cite

Octreotide may improve pharyngocutaneous fistula healing through downregulation of cystatins: A pilot study.

Journal Article Laryngoscope Investig Otolaryngol · February 2023 BACKGROUND: Pharyngocutaneous fistula (PCF) and salivary leaks are well known complications of head and neck surgery. The medical management of PCF has included the use of octreotide without a well-defined understanding of its therapeutic mechanism. We hyp ... Full text Link to item Cite

The Management of Salivary Fistulas.

Journal Article Semin Plast Surg · February 2023 Postoperative salivary fistula is an especially undesirable complication because it can be difficult to address, may delay postoperative radiation, and always delays enteral nutrition. Patients who are malnourished, have already undergone radiotherapy, or ... Full text Link to item Cite

Milestones 2.0: Otolaryngology Resident Competency in the Postpandemic Era.

Journal Article Otolaryngol Head Neck Surg · April 2022 The Accreditation Council for Graduate Medical Education and the American Board of Otolaryngology-Head and Neck Surgery Milestones Project grew out of a continued need to document objective outcomes within resident education. Milestones 2.0 began its work ... Full text Link to item Cite

Parathyroid

Chapter · January 1, 2022 This chapter uses real-life clinical cases to present the history of illness, physical examination, and clear and up-to-date explanations of treatment strategies for parathyroid. It contains full-color photographs, illustrations, and diagrams to better sup ... Full text Cite

Oropharynx

Chapter · January 1, 2022 This chapter uses real-life clinical cases to present the history of illness, physical examination, and clear and up-to-date explanations of treatment strategies for oropharynx. It contains full-color photographs, illustrations, and diagrams to better supp ... Full text Cite

Surgeon Volume and Complications in Lateral Neck Dissection for Squamous Cell Carcinoma: A Multidatabase Analysis.

Journal Article Otolaryngol Head Neck Surg · December 2021 OBJECTIVE: To determine whether annual surgeon volume of lateral neck dissections for squamous cell carcinoma is associated with complication rates. STUDY DESIGN: Retrospective review. SETTING: Two US databases spanning 2000 to 2014. METHODS: Neck dissecti ... Full text Link to item Cite

Nonsurgical Risk Factors Associated With Pharyngocutaneous Fistula in Patients Who Have Undergone Laryngectomy.

Journal Article JAMA Otolaryngol Head Neck Surg · November 1, 2021 IMPORTANCE: Pharyngocutaneous fistula (PCF) is a serious complication after total laryngectomy. Despite the well-described clinical risk factors for PCF and its association with poor quality of life, there is a paucity of data on the nonclinical factors th ... Full text Link to item Cite

Assessing Interpersonal and Communication Skills.

Journal Article J Grad Med Educ · April 2021 Full text Link to item Cite

Association of Lymph Node Ratio With Overall Survival in Patients With Metastatic Papillary Thyroid Cancer.

Journal Article JAMA Otolaryngol Head Neck Surg · October 1, 2020 This cohort study examines the association of the lymph node ratio with overall survival in patients with papillary thyroid cancer. ... Full text Link to item Cite

Advanced head and neck surgery training during the COVID-19 pandemic.

Journal Article Head Neck · July 2020 BACKGROUND: The COVID-19 pandemic has significantly impacted medical training. Here we assess its effect on head and neck surgical education. METHODS: Surveys were sent to current accredited program directors and trainees to assess the impact of COVID-19 o ... Full text Link to item Cite

The effect of lateral neck dissection on complication rate for total thyroidectomy.

Journal Article Am J Otolaryngol · 2020 PURPOSE: To determine the complication profile for total thyroidectomy with and without concomitant lateral neck dissection using a large administrative database. MATERIALS AND METHODS: The IBM MarketScan® Commercial Database (2010-2014) analytic cohort wa ... Full text Link to item Cite

Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.

Journal Article OTO Open · 2020 OBJECTIVE: To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. METHODS: Videos are recorded from multiple viewpoints within the operating room and com ... Full text Link to item Cite

Junior otolaryngology resident in-service exams predict written board exam passage.

Journal Article Laryngoscope · January 2019 OBJECTIVE: The purpose of this study was to assess the association between the Otolaryngology Training Examination (OTE) taken during residency and the passage rate of first-time examinees on the American Board of Otolaryngology-Head and Neck Surgery Writt ... Full text Link to item Cite

Salvage laryngectomy and laryngopharyngectomy: Multicenter review of outcomes associated with a reconstructive approach.

Journal Article Head Neck · January 2019 BACKGROUND: Surgeons have developed various reconstructive techniques to minimize the rate of pharyngocutaneous fistula and optimize functional outcome after salvage laryngectomy or laryngopharyngectomy. METHODS: Multicenter retrospective review at 33 inst ... Full text Link to item Cite

Otolaryngologist adherence to the AAO-HNSF Allergic Rhinitis Clinical Practice Guideline.

Journal Article Int Forum Allergy Rhinol · June 2018 BACKGROUND: In February 2015, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) published the Allergic Rhinitis Clinical Practice Guideline (AR-CPG). The objective of this study was to assess otolaryngologists' perception of the accur ... Full text Link to item Cite

Facilitation and Debriefing in Simulation Education.

Journal Article Otolaryngol Clin North Am · October 2017 Successful simulation requires effective facilitation and debriefing to achieve educational goals. Simulation educational methods are diverse, ranging from partial task training to complicated, interdisciplinary team training. Various debriefing models hav ... Full text Link to item Cite

Current Interview Trail Metrics in the Otolaryngology Match.

Journal Article Otolaryngol Head Neck Surg · June 2017 Objectives To identify how applicants to otolaryngology residency determine how to apply to, interview with, and rank programs on the interview trail and to determine the extent of the financial burden of the otolaryngology interview trail. Study Design We ... Full text Link to item Cite

USMLE and Otolaryngology: Predicting Board Performance.

Journal Article Otolaryngol Head Neck Surg · June 2017 Objective To ascertain what relationship exists between the United States Medical Licensing Examination (USMLE) and the American Board of Otolaryngology Written Qualifying Examination (WQE). Study Design Retrospective, longitudinal study. Setting De-identi ... Full text Link to item Cite

Survey of Current Practice Patterns in the Management of Frontal Sinus Fractures.

Journal Article Craniomaxillofac Trauma Reconstr · June 2017 The management of frontal sinus fractures has evolved in the endoscopic era. The development of functional endoscopic sinus surgery (FESS) has been incorporated into management algorithms proposed by otolaryngologists, but the extent of its influence on pl ... Full text Link to item Cite

Trends in Otolaryngology Consultation Patterns at an Academic Quaternary Care Center.

Journal Article JAMA Otolaryngol Head Neck Surg · May 1, 2017 IMPORTANCE: The consultation patterns of an otolaryngology-head and neck surgery service have not previously been reported. The time, resources, and attention required to operate such a consultation service are unknown. OBJECTIVE: To assess trends in otola ... Full text Link to item Cite

Variation in tonsillectomy rates by health care system type.

Journal Article Int J Pediatr Otorhinolaryngol · March 2017 OBJECTIVE: To analyze variation in tonsillectomy procedure rates between health care system types around the world. STUDY DESIGN: International database analysis. METHODS: The 2015 Organization for Economic Co-operation and Development (OECD) Health Statis ... Full text Link to item Cite

Persistent Acute Onset Macroglossia Treated with Compression Therapy.

Journal Article Case Rep Otolaryngol · 2017 Acute macroglossia, while rare and often limited in duration, can present significant management challenges. The anatomic position of the tongue, which can result in airway compromise in cases of enlargement, contributes significantly to difficulty with ma ... Full text Link to item Cite

Opportunity Cost of Surgical Management of Craniomaxillofacial Trauma.

Journal Article Craniomaxillofac Trauma Reconstr · March 2016 The provision of trauma care is a financial burden, continually associated with low reimbursement, and shifts the economic burden to major trauma centers and providers. Meanwhile, the volume of craniomaxillofacial (CMF) trauma and the number of surgically ... Full text Link to item Cite

Facial Fractures in the Aging Population.

Journal Article Plast Reconstr Surg · February 2016 BACKGROUND: As the U.S. population ages and life expectancy increases, the number of elderly patients seeking trauma care and treatment for facial fractures will increase. Understanding age-related differences in the pattern, cause, and management of these ... Full text Link to item Cite

Ensuring Competent Care by Senior Physicians.

Journal Article J Contin Educ Health Prof · 2016 The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have i ... Full text Link to item Cite

Use of a Secondary Essay in the Residency Application Process.

Journal Article JAMA Otolaryngol Head Neck Surg · July 2015 Full text Link to item Cite

Midline cervical cleft: review of an uncommon entity.

Journal Article Int J Pediatr · 2015 Introduction. Midline cervical cleft is a rare congenital malformation which nonetheless has a classic presentation. This study presents one of the largest single series of new patients with MCC and provides an exhaustive review and catalogue of publicatio ... Full text Link to item Cite

A Video-Based Module for Teaching Communication Skills to Otolaryngology Residents.

Journal Article J Surg Educ · 2015 OBJECTIVE: To determine whether instructional videos modeling examples of "good" and "bad" patient communication skills are useful as an educational tool for improving resident-patient communication. DESIGN: Retrospective study in which resident participan ... Full text Link to item Cite

Lip cancer

Chapter · November 3, 2014 Cite

Mandibular mass. Focal cemento-osseous dysplasia (FCOD).

Journal Article JAMA Otolaryngol Head Neck Surg · October 2014 Full text Link to item Cite

Physician and Patient and Caregiver Health Attitudes and Their Effect on Medicare Resource Allocation for Patients With Advanced Cancer.

Journal Article JAMA Otolaryngol Head Neck Surg · June 2014 IMPORTANCE: Physicians must participate in end-of-life discussions, but they understand poorly their patients' end-of-life values and preferences. A better understanding of these preferences and the effect of baseline attitudes will improve end-of-life dis ... Full text Link to item Cite

Physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act.

Journal Article Otolaryngol Head Neck Surg · February 2014 OBJECTIVE: To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. STUDY DESIGN: Cross-s ... Full text Link to item Cite

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

Journal Article Med Educ Online · October 29, 2013 INTRODUCTION: Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of ... Full text Link to item Cite

Physician allocation of Medicare resources for patients with advanced cancer.

Journal Article J Palliat Med · August 2013 BACKGROUND: Little is known about what patients and physicians value in end-of-life care, or how these groups would craft a health plan for those with advanced cancer. OBJECTIVE: The study objective was to assess how otolaryngology, head and neck surgery ( ... Full text Link to item Cite

Surgical Training and Education in Promoting Professionalism: a comparative assessment of virtue-based leadership development in otolaryngology-head and neck surgery residents.

Journal Article Med Educ Online · January 2013 Introduction Surgical Training and Education in Promoting Professionalism (STEPP) was developed in 2011 to train tomorrow's leaders during residency. It is based on virtue ethics and takes an approach similar to West Point military academy. The purpose of ... Full text Link to item Cite

Utility of Intraoperative Frozen Sections during Thyroid Surgery.

Journal Article Int J Otolaryngol · 2013 Objective. To describe the usefulness of intraoperative frozen section in the diagnosis and treatment of thyroid nodules where fine needle aspirate biopsies have evidence of follicular neoplasm. Study Design. Retrospective case series. Methods. All patient ... Full text Open Access Link to item Cite

Upper Airway Surgery in Patients with Sleep Apnea.

Conference Otolaryngol Head Neck Surg · August 2012 Objective: 1) Evaluate the safety of outpatient and overnight observation of sleep apnea surgery patients using new preoperative screening criteria. 2) Compare the cost-effectiveness of outpatient and overnight observational sleep apnea surgery compared to ... Full text Link to item Cite

Otolaryngology resident in-service examination scores predict passage of the written board examination.

Journal Article Otolaryngol Head Neck Surg · August 2012 OBJECTIVE: The purpose of this study was to assess the association between the Otolaryngology Training Examination (OTE) and the passage rate of first-time examinees on the American Board of Otolaryngology (ABOto) Written Qualifying Examination (WQE). STUD ... Full text Link to item Cite

Treatment-induced changes in vocal cord mobility and subsequent local recurrence after organ preservation therapy for laryngeal carcinoma.

Journal Article Head Neck · June 2012 BACKGROUND: As multidisciplinary cancer treatment evolves, strategies to identify patients needing early resection/salvage are necessary. Some have suggested that vocal cord function after organ-preservation treatment may be an indicator. METHODS: A retros ... Full text Link to item Cite

Qualities of residency applicants: comparison of otolaryngology program criteria with applicant expectations.

Journal Article Arch Otolaryngol Head Neck Surg · January 2012 OBJECTIVES: To evaluate the criteria used by otolaryngology programs in ranking residency candidates and to compare residency candidate ranking criteria among otolaryngology programs and applicant expectations. DESIGN: Cross-sectional, anonymous survey adm ... Full text Link to item Cite

Detection of squamous cell carcinoma and corresponding biomarkers using optical spectroscopy.

Journal Article Otolaryngol Head Neck Surg · March 2011 OBJECTIVES: Investigate the use of optical reflectance spectroscopy to differentiate malignant and nonmalignant tissues in head and neck lesions and characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosis. STUDY DE ... Full text Link to item Cite

Comparison of applicant criteria and program expectations for choosing residency programs in the otolaryngology match.

Journal Article Otolaryngol Head Neck Surg · February 2011 OBJECTIVE: To evaluate criteria used by residency applicants in ranking otolaryngology residency programs and to compare applicant criteria with program expectations of ranking otolaryngology residency programs. STUDY DESIGN: Cross-sectional survey. SETTIN ... Full text Link to item Cite

Computer modeling and navigation in maxillofacial surgery.

Journal Article Curr Opin Otolaryngol Head Neck Surg · August 2009 PURPOSE OF REVIEW: To review the accuracy and effectiveness of current technology available for computer-aided maxillofacial surgery. RECENT FINDINGS: New developments in computer technology can help surgeons with preoperative planning and intraoperative n ... Full text Link to item Cite

The role of human papilloma virus infection in the etiology of oropharyngeal carcinoma.

Journal Article Curr Opin Otolaryngol Head Neck Surg · August 2005 PURPOSE OF REVIEW: Evidence is growing that human papilloma virus is responsible for a subset of head and neck carcinomas. This review analyzes the history and current thinking regarding this relatively new etiologic agent of squamous cell carcinoma. RECEN ... Full text Link to item Cite

Delegate's report

Other JAMA · September 29, 1999 Full text Cite

Delegate's report

Other JAMA · February 10, 1999 Full text Cite