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Safeguarding Clinical Reasoning: A Defense Framework for Artificial Intelligence in Otolaryngology

Chin-Lung Kuo, MD, PhD

AI is rapidly evolving from a supportive tool into a core component of medical decision making and evidence synthesis, reshaping how clinicians interpret information at the point of care. Yet, while much of medical AI research emphasizes algorithmic performance and explainability, it seldom addresses the more practical question: how should physicians evaluate an AI recommendation in real-world, high-risk situations when fluent outputs can conceal critical errors. This Perspective offers a clinician-centered framework that treats AI outputs as provisional, testable hypotheses rather than definitive conclusions. By guiding users through premise verification, terminological precision, evidence appraisal, and causal analysis, it provides a structured defense against hallucinations, selective reporting, and data poisoning, using otolaryngology as a high-stakes, multimodal model. By placing clinical judgment at the center of AI use, this work shifts the field from passive automation toward safer, more accountable decision support grounded in patient safety.

Article: https://scitemed.com/article/5444/scitemed-aohns-2025-00204

PDF: https://scitemed.com/upload/3714/5444/scitemed.aohns.2025.00204.pdf?t=2211

Supermicrosurgical Replantation for Motorcycle Chain-Induced Fingertip Amputations: A Case Series

Ravikiran Naalla, MCh*; Srikant Aruna Samantray, DrNB; Palli Williams, PharmD

Motorcycle chain-induced fingertip amputations represent a reconstructive dead end, where severe crushing and contamination traditionally compel revision amputation. The authors dismantle this exclusion criterion, reporting an 83% salvage rate using a modified protocol of radical debridement, strategic skeletal shortening, and simplified single-vessel supermicrosurgery. By eschewing complex grafting for tension-free primary anastomosis, the authors successfully restored perfusion in ostensibly "unreconstructable" zones of injury. This case series serves as a critical proof of concept, suggesting that with precise soft-tissue management, the threshold for amputation in high-energy trauma should be re-evaluated to preserve function in young patients.

Article: https://scitemed.com/article/5433/scitemed-imj-2025-00201

PDF: https://scitemed.com/upload/171/5433/scitemed.imj.2025.00201.pdf?t=0117

Multifactorial Determinants of Opioid Prescribing After Ambulatory Otolaryngology Surgery

Colten Wolf, MD*; Sri Contractor, BS*; Elise Fournier, BS; Marina Feffer, MPH; Agnes M Hurtuk, MD

This study reframes postoperative opioid stewardship by showing that prescribing is not a uniform clinical reflex to pain. Instead, it is a multifactorial behavior shaped by procedure type, surgeon experience, and patient characteristics. An analysis of more than two thousand ambulatory otolaryngology cases revealed that surgical procedure exerts the strongest influence, with oropharyngeal operations linked to nearly threefold higher opioid quantities than nasal surgeries. Younger, recently trained surgeons prescribed substantially less. Counterintuitive racial and comorbidity patterns further exposed how implicit bias and clinical caution may coexist in prescribing behavior. By disentangling these procedural, provider, and patient determinants, the study challenges one-size-fits-all mandates and calls for precision prescribing frameworks that balance effective analgesia with the reduction of opioid-related harm. This paradigm shift urges clinicians and policymakers to replace volume-based control with individualized, evidence-driven stewardship grounded in real surgical practice.

Article: https://scitemed.com/article/5425/scitemed-aohns-2025-00200

PDF:https://scitemed.com/upload/5819/5425/scitemed.aohns.2025.00200.pdf

Reconstruction of Massive Chest Wall Defect After Bilateral Mastectomy Using a Bipedicled Deep Inferior Epigastric Perforator Flap: A Case Report

Samarth Gupta, MCh*; Rajan Arora, MCh; Kripa Shanker Mishra, MCh; Anchit Kumar, MCh; Nikhil Prasad, MCh

This case highlights the use of a bipedicled deep inferior epigastric perforator (DIEP) flap for reconstructing a massive 45 × 17 cm chest wall defect following bilateral mastectomy. By preserving abdominal musculature and utilizing preoperative computed tomographic angiography (CTA) for perforator mapping, the technique enabled tension-free bilateral microvascular anastomosis to the internal mammary arteries. The incorporation of submuscular mesh and minimal donor-site undermining maintained abdominal wall integrity. At six-month follow-up, no hernia or functional deficits were observed, and the patient reported high satisfaction on the BREAST-Q. This muscle-sparing strategy offers a viable alternative for large, midline-crossing chest wall defects where conventional flaps may be insufficient.

Article: https://scitemed.com/article/5378/scitemed-imj-2025-00198

PDF: https://scitemed.com/upload/5273/5378/scitemed.imj.2025.00198.pdf?t=0615

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