-
Esophagus : Official Journal of the... Apr 2023Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for pharyngeal cancers. However, pharyngeal ESD is sometimes technically challenging because of...
BACKGROUND
Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for pharyngeal cancers. However, pharyngeal ESD is sometimes technically challenging because of the narrow and complex space in which to work. Traction is important to complete the procedure efficiently. Here, we report the technical details and efficacy of a new traction method for pharyngeal ESD using ring-shaped thread and grasping forceps.
METHODS
We analyzed pharyngeal ESD performed between January 2016 and March 2021 at our Institute. We designated cases resected using ring-shaped threads "Group R" and those resected without ring-shaped threads as conventional "Group C", and compared the technical outcomes between them. Multivariate analysis and the inverse probability treatment weighting (IPTW) method using propensity scores were adjusted by confounding variables.
RESULTS
We analyzed 89 lesions from 68 patients, of which 46 were in Group R and 43 in Group C. Median procedure time and median dissection speed were significantly shorter in Group R than C (37 min vs. 55 min, and 16.0 mm/min vs. 7.0 mm/min, respectively, both P < 0.05). These results were confirmed by both multivariate analysis and after IPTW adjustment. All lesions were resected en bloc, and the complete resection rate was not significantly different between Group R and C (91.3% vs. 79.1%, P = 0.14). There were no treatment-related adverse events in either group.
CONCLUSIONS
The traction method using ring-shaped thread increases the efficiency of pharyngeal ESD. This simple new traction method should be a useful option for pharyngeal ESD.
Topics: Humans; Treatment Outcome; Traction; Endoscopic Mucosal Resection; Pharynx; Surgical Instruments
PubMed: 36456753
DOI: 10.1007/s10388-022-00971-0 -
European Archives of... Jul 2018Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate....
BACKGROUND AND PURPOSE
Superiorly based posterior pharyngeal flap is performed via rotation of tissues of the posterior pharyngeal wall anteriorly and anchoring it to the soft palate. Unfortunately, bad healing of the donor site defect might be a considerable cause of morbidity of the surgery. With some modifications of flap elevation we could achieve better surgical outcomes. The aim of this study was to present the new modification of the conventional maneuver and its surgical/functional outcomes.
SUBJECTS AND METHODS
The study design is a case series. 17 patients underwent the de-mucosalized superiorly based pharyngeal flap for the treatment of velopharyngeal insufficiency. A wide laterally based (mucosa-only) flap was elevated off the submucosa of the posterior pharyngeal wall and then a superiorly based posterior pharyngeal flap (bared of its covering mucosa) was elevated and sutured to the palate. The mucosal flap was draped over the bed and sutured.
RESULTS
No significant complications as airway problems, infection and bleeding were reported. Also, the postoperative pain was tolerable and there were no reports of neck rigidity with early ambulation; VAS showed significant improvement. No patients showed flap dehiscence or palatal fistula. Speech assessment showed improvement.
CONCLUSION
The modified de-mucosalized, superiorly based pharyngeal flap technique ensured self-mucosal draping of the bed, thus it would enhance primary healing and decrease postoperative pain with the resultant early ambulation. We believe that the new modified technique could correct VPI, in addition to the improvement of patients' comfort and decrease the morbidity of the procedure.
Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Female; Humans; Male; Palate, Soft; Pharynx; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency; Wound Healing
PubMed: 29804131
DOI: 10.1007/s00405-018-5018-0 -
BMJ Supportive & Palliative Care Dec 2020To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT).
OBJECTIVE
To explore the relationships between swallowing functional outcomes and nutritional status in patients with head and neck cancer undergoing radiotherapy (RT).
METHODS
This longitudinal study included 122 patients. Data were collected at three time points: baseline (T), the third week of RT (T) and the completion of RT (T). The Common Terminology Criteria for Adverse Events was used to assess the symptom of dysphagia and other toxicities; the MD Anderson Dysphagia Inventory (MDADI) was used to assess the patient-perceived swallowing functional outcomes; the nutritional status was evaluated by the weight ratio and the Patient-Generated Subjective Global Assessment (PG-SGA). The generalised estimating equation (GEE) was used to measure the correlation of MDADI with the weight ratio or PG-SGA and also to analyse the influential factors of swallowing functional outcomes.
RESULTS
The participants' acute dysphagia rates were 5.7% at T, 69.7% at T and 77.9% at T. The swallowing functional outcomes worsen over RT (p<0.001) and were associated with weight ratio (β=0.032, p=0.008) and PG-SGA (β=-0.115, p<0.001). GEE models showed that patients with cancer of the pharynx region, advanced stage, chemoradiotherapy and high RT dose perceived worse swallowing functional outcomes. Oral mucositis, pharynx mucositis and salivary gland inflammation were positively correlated with swallowing functional outcomes, and the pharynx mucositis presented the highest absolute value of β.
CONCLUSION
The swallowing functional outcomes were negatively correlated with nutritional status. Healthcare professionals should identify early on the population at higher risk and focus on multiple toxicities, especially the management of pharynx mucositis, to improve nutritional status.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Deglutition; Deglutition Disorders; Female; Head and Neck Neoplasms; Humans; Longitudinal Studies; Male; Middle Aged; Mucositis; Nutritional Status; Pharyngeal Neoplasms; Prospective Studies; Radiation Dosage; Radiotherapy; Treatment Outcome; Young Adult
PubMed: 32404303
DOI: 10.1136/bmjspcare-2020-002216 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2018Introduction: Chronic inflammatory diseases of the mucous membranes of the nose, paranasal sinuses, and pharynx are the most common pathology of the upper airways.... (Review)
Review
OBJECTIVE
Introduction: Chronic inflammatory diseases of the mucous membranes of the nose, paranasal sinuses, and pharynx are the most common pathology of the upper airways. Pathological processes develop more often in the maxillary and ethmoidal sinuses than in the frontal ones; however, the clinical course of frontitis is more severe. Fundamental understanding of the specific structure of frontal sinuses is crucial in the awareness of the precursors of the onset and development of its pathology, the choice of methods of diagnostics and treatment. The aim: The paper was aimed at the analysis of the publications on current data related to the structure and functions of the human frontal sinus and its structural components. Materials and methods: The bibliosemantic method has been used during the study. Findings of the current research works on the study of the human frontal sinus have been analyzed.
RESULTS
Review: The resulting analysis shows that despite the significant amount of research works devoted to the study of the structure and functions of the frontal sinus, the morphofunctional features of its mucosa and the state of local immune protection remained unknown for a long time.
CONCLUSION
Conclusions: The resulting literature review showed that the study of the morphofunctional properties of the frontal sinus is relevant to date that is reflected in the number of research works, elucidating its topographoanatomical, histological, physiological and immunohistochemical features.
Topics: Chronic Disease; Frontal Sinus; Humans; Inflammation; Mucous Membrane
PubMed: 30267502
DOI: No ID Found -
PloS One 2014The pharyngeal phase of swallow has been thought to be a stereotypical motor behavior.
OBJECTIVE
The pharyngeal phase of swallow has been thought to be a stereotypical motor behavior.
STUDY DESIGN
This is a prospective, preclinical, hypothesis driven, one group by three-task design.
METHODS
We sought to compare the effects of pharyngeal swabbing, water only, and water plus punctate mechanical stimulation on the spatiotemporal features of the pharyngeal phase of swallow in the cat. Swallow was elicited under these three conditions in six anaesthetized cats. Electromyographic activity was recorded from seven muscles used to evaluate swallow: mylohyoid, geniohyoid, thyrohyoid, thyroarytenoid, thyropharyngeus, cricopharyngeus, and parasternal.
RESULTS
Pharyngeal swabbing in comparison to the other stimulus conditions, results in decreases in post-swallow cricopharyngeus activity (upper esophageal sphincter); a significant increase in parasternal (schluckatmung; swallow breath) activity; and increases in thyrohyoid (laryngeal elevator), thyroarytenoid (laryngeal adductor) and parasternal muscles burst duration. Pearson correlations were found of moderate strength between 19% of burst duration comparisons and weak to moderate relationships between 29% of burst amplitude comparisons. However, there were no positive significant relationships between phase durations and electromyogram amplitudes between any of the muscles studied during swallow.
CONCLUSIONS
The results support the concept that a stereotypical behavior, such as pharyngeal swallowing in animal models, can be modified by sensory feedback from pharyngeal mucosal mechanoreceptors. Furthermore, differences in swallow phase durations and amplitudes provide evidence that separate regulatory mechanisms exist which regulate spatial and temporal aspects of the behavior.
Topics: Animals; Cats; Deglutition; Electromyography; Muscle Contraction; Neck Muscles; Pharynx
PubMed: 25171095
DOI: 10.1371/journal.pone.0106121 -
Scientific Reports Apr 2022Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the infectious disease COVID-19, which has rapidly become an international pandemic with...
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the infectious disease COVID-19, which has rapidly become an international pandemic with significant impact on healthcare systems and the global economy. To assist antiviral therapy and vaccine development efforts, we performed a natural history/time course study of SARS-CoV-2 infection in ferrets to characterise and assess the suitability of this animal model. Ten ferrets of each sex were challenged intranasally with 4.64 × 10 TCID of SARS-CoV-2 isolate Australia/VIC01/2020 and monitored for clinical disease signs, viral shedding, and tissues collected post-mortem for histopathological and virological assessment at set intervals. We found that SARS-CoV-2 replicated in the upper respiratory tract of ferrets with consistent viral shedding in nasal wash samples and oral swab samples up until day 9. Infectious SARS-CoV-2 was recovered from nasal washes, oral swabs, nasal turbinates, pharynx, and olfactory bulb samples within 3-7 days post-challenge; however, only viral RNA was detected by qRT-PCR in samples collected from the trachea, lung, and parts of the gastrointestinal tract. Viral antigen was seen exclusively in nasal epithelium and associated sloughed cells and draining lymph nodes upon immunohistochemical staining. Due to the absence of clinical signs after viral challenge, our ferret model is appropriate for studying asymptomatic SARS-CoV-2 infections and most suitable for use in vaccine efficacy studies.
Topics: Animals; COVID-19; Ferrets; Nasal Mucosa; SARS-CoV-2; Viral Load
PubMed: 35383204
DOI: 10.1038/s41598-022-08431-6 -
Frontiers in Immunology 2023We describe a series of patients whose auto-immune bullous skin disease (AIBD) of the dermal-epidermal junction (DEJ) was characterized by clinical, immunological and...
INTRODUCTION
We describe a series of patients whose auto-immune bullous skin disease (AIBD) of the dermal-epidermal junction (DEJ) was characterized by clinical, immunological and ultrastructural features intermediate between bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP), and a recalcitrant course.
PATIENTS AND METHODS
From the database of the French reference centre for AIBD, we screened all the patients who were referred for an AIBD of the DEJ with a mucosal involvement, who neither met the diagnostic criteria for the diagnosis of BP, nor were typical of MMP. Sera were analysed by NC16A-ELISA and immunobloting against the C-terminal and LAD-1 parts of BP180. Skin biopsies were studied by direct immunoelectron microscopy (IEM).
RESULTS
Fifteen patients (4 males, 11 females) of mean age 70.8 ± 11.8 years were included. The mucosal involvement was localized in oral cavity in all cases and in pharyngeal/laryngeal or genital area in 8 (53%), and 6 patients (40%), respectively. No patient had ocular involvement, nor atrophic or fibrosing scars. All patients had extensive skin lesions (mean BPDAI score =65.9 ± 24.4), which predominated on the upper body part. Direct IEM performed on 8 patients showed IgG deposits on the lamina lucida in all cases, and the lamina densa in 5 cases. All sera recognized NC16A, while none recognized BP-230 in ELISA. 10 out of the 13 tested sera (76.9%) contained IgG which recognized the C-terminal domain of BP180 and 10 sera (76.9%) the LAD-1 domain of BP180. Patients poorly responded to super potent topical corticosteroids and were treated with oral corticosteroids ± immunosuppressant in 13 cases (86.6%).
CONCLUSION
This mixed muco-cutaneous pemphigoid differs from BP by the younger age of patients, multiple mucosae involvement, circulating antibodies against both the C- and N-terminal part of BP180, and very poor response to topical CS. It differs from MMP by extensive inflammatory skin lesions, absence of ocular involvement and atrophic/fibrosing scars.
Topics: Male; Female; Humans; Middle Aged; Aged; Aged, 80 and over; Pemphigoid, Bullous; Cicatrix; Non-Fibrillar Collagens; Skin; Immunoglobulin G
PubMed: 37006294
DOI: 10.3389/fimmu.2023.1134720 -
APMIS : Acta Pathologica,... Sep 2017Bacterial resistance is a growing phenomenon which led the scientific community to search for new therapeutic targets, such as biofilm. A bacterial biofilm is a... (Review)
Review
Bacterial resistance is a growing phenomenon which led the scientific community to search for new therapeutic targets, such as biofilm. A bacterial biofilm is a surface-associated agglomerate of microorganisms embedded in a self-produced extracellular polymeric matrix made of polysaccharides, nucleic acids, and proteins. Scientific literature offers several reports on a biofilm's role in infections regarding various body districts. The presence of a bacterial biofilm is responsible for poor efficacy of antibiotic therapies along with bacterial infections in ear, nose, and throat (ENT) districts such as the oral cavity, ear, nasal cavities, and nasal sinuses. In particular, bacterial biofilms are associated with recalcitrant and symptomatically more severe forms of chronic rhinosinusitis. As of today, there are no therapeutic options for the eradication of bacterial biofilm in ENT districts. Hyaluronic acid is a glycosaminoglycan composed of glucuronic acid and N-acetylglucosamine disaccharide units. Its efficacy in treating rhinosinusitis, whether or not associated with polyposis, is well documented, as well as results from its effects on mucociliary clearance, free radical production and mucosal repair. This review's aim is to evaluate the role of bacterial biofilms and the action exerted on it by hyaluronic acid in ENT pathology, with particular attention to the rhinosinusal district. In conclusion, this paper underlines how the efficacy of hyaluronate as an anti-bacterial biofilm agent is well demonstrated by in vitro studies; it is, however, only preliminarily demonstrated by clinical studies.
Topics: Anti-Bacterial Agents; Biofilms; Drug Resistance, Bacterial; Ear; Humans; Hyaluronic Acid; Nose; Pharyngitis; Pharynx; Sinusitis
PubMed: 28736916
DOI: 10.1111/apm.12728 -
International Journal of Pediatric... Dec 2018Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall...
INTRODUCTION
Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision.
AIM OF THE WORK
To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed.
METHODS
This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall.
RESULTS
13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ± 1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission.
CONCLUSIONS
The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.
Topics: Child; Child, Preschool; Endoscopy; Female; Follow-Up Studies; Humans; Male; Pharynx; Plastic Surgery Procedures; Speech; Surgical Flaps; Treatment Outcome; Velopharyngeal Insufficiency; Wound Healing
PubMed: 30368397
DOI: 10.1016/j.ijporl.2018.09.015 -
American Journal of Otolaryngology 2020Surgeons resuming elective procedures during the COVID-19 pandemic should consider strategies to mitigate risk of exposure. For otolaryngologists performing surgery on... (Review)
Review
PURPOSE
Surgeons resuming elective procedures during the COVID-19 pandemic should consider strategies to mitigate risk of exposure. For otolaryngologists performing surgery on children, unique vulnerability to SARS-CoV-2 results from a regular interface with the upper respiratory tract mucosa. A growing interest in perioperative application of povidone‑iodine (PVP-I) to the nasopharynx and oropharynx has emerged. The purpose of this review is to provide an evidence-based assessment of PVP-I in pediatric oral, nasal and pharyngeal surgery.
METHODS
A contemporary literature review with algorithmic approach to the potential use of PVP-I in pediatric mucosal surgery.
RESULTS
Several formulations of PVP-I have shown rapid in vitro virucidal activity against SARS-CoV-2. Antisepsis using 1.0% PVP-I mouthwash and 0.45% PVP-I throat spray can occur after 30 seconds of contact time. To date, in vivo effectiveness of PVP-I against SARS-CoV-2 has yet to be established and possible risks of its direct use on upper aerodigestive mucosa of children must be weighed.
CONCLUSION
Further research is required prior to strongly recommending PVP-I use in preparation for nasal, oral or pharyngeal surgery in children.
Topics: Anti-Infective Agents, Local; Betacoronavirus; COVID-19; Child; Coronavirus Infections; Humans; Infectious Disease Transmission, Patient-to-Professional; Nasopharynx; Oropharynx; Otorhinolaryngologic Surgical Procedures; Pandemics; Pneumonia, Viral; Povidone-Iodine; SARS-CoV-2
PubMed: 32979667
DOI: 10.1016/j.amjoto.2020.102737