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Auris, Nasus, Larynx Oct 2020The aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS)...
OBJECTIVE
The aim of this study was to evaluate the efficacy and safety of local steroid injections to prevent scar contracture after transoral videolaryngoscopic surgery (TOVS) in hypopharyngeal cancer patients.
METHODS
Patients were enrolled in this study if they had received a local steroid injection during TOVS and had attended an outpatient clinic after at least three months. All patients were being treated for hypopharyngeal cancer and received a single session of triamcinolone acetonide, injected using a 21-gage needle. Retrospective chart reviews were performed, and the degree of scar contracture, pharyngeal stenosis, vocal fold movements, and adverse events were evaluated. Scar contracture was assessed using a scoring system, which compared the endoscopic findings of treatment and matched pair control groups.
RESULTS
A total of 20 patients received local steroid injections during TOVS and were enrolled in the treatment. Scar contracture was seen in 14 patients (70%); however, the degree of scar contracture was significantly decreased when compared to control cases. Vocal fold immobility was observed in five patients, but no pharyngeal stenosis was noted. Adverse effects, such as postoperative laryngeal chondritis or cervical spondylitis, were seen in three patients who had previously been treated with resection to the muscularis propria or definitive irradiation.
CONCLUSION
Local steroid injection during TOVS significantly reduced the degree of postoperative scar contracture. However, caution should be used when treating with local steroid injection during TOVS, as this may complicate wound healing in patients who have already received treatment.
Topics: Aged; Cicatrix; Contracture; Female; Glucocorticoids; Humans; Hypopharyngeal Neoplasms; Injections, Intralesional; Laryngoscopy; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Postoperative Complications; Retrospective Studies; Triamcinolone Acetonide; Video-Assisted Surgery
PubMed: 32107068
DOI: 10.1016/j.anl.2020.02.007 -
The International Journal of Medical... Dec 2014Pharyngeal stenosis is a complication of head and neck cancer and sleep apnea treatment that results in functional impairment. Due to the location of the stenosis and...
BACKGROUND
Pharyngeal stenosis is a complication of head and neck cancer and sleep apnea treatment that results in functional impairment. Due to the location of the stenosis and tendency to recur, surgical management is challenging. Robotic surgery may allow these areas to be treated with surgical technique that would be difficult using traditional approaches.
METHODS
A retrospective chart review was performed to identify patients who underwent transoral robotic surgery (TORS) for pharyngeal stenosis at a tertiary hospital system.
RESULTS
Five patients were identified, ages 8-75 years. Length of follow-up ranged from 1-12 months. There was one failure, a 74 year old male with a history of chemoradiation to the area who has required additional procedures.
CONCLUSION
TORS may offer improved surgical access to the pharynx in patients who require complex reconstruction that would otherwise be very difficult. Appropriate patient selection is necessary and long-term follow-up is warranted for the selected cases.
Topics: Adolescent; Adult; Aged; Child; Constriction, Pathologic; Female; Humans; Male; Middle Aged; Pharyngeal Diseases; Retrospective Studies; Robotic Surgical Procedures
PubMed: 24737499
DOI: 10.1002/rcs.1591 -
ORL; Journal For Oto-rhino-laryngology... 2023Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However,... (Observational Study)
Observational Study
INTRODUCTION
Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However, improvements in patients' quality of life after surgery require a further statistical approach.
METHODS
An observational, retrospective, multivariate analysis was designed to report the incidence of postoperative complications and their association with clinical factors in 101 patients who underwent total pharyngo-laryngo-esophagectomy and FJF reconstruction for head and neck cancer at a university hospital between January 2007 and December 2020.
RESULTS
Postoperative complications were observed in 69% of patients. In the reconstructive site, anastomotic leak, observed in 8% of patients was associated with vascular anastomosis in the external jugular vein system (age-adjusted odds ratio [OR]: 9.05, p = 0.044) and anastomotic stricture, observed in 11% of patients was associated with postoperative radiotherapy (age-adjusted OR: 12.60, p = 0.02). Cervical skin flap necrosis was the most common complication (34%) and was associated with vascular anastomosis on the right cervical side (age- and sex-adjusted OR: 4.00, p = 0.005).
CONCLUSION
Although FJF reconstruction is a useful procedure, 69% of patients suffer a postoperative complication. We suppose that anastomotic leak is related to the low blood flow resistance of the FJF and inadequate drainage of the external jugular venous system, and anastomotic stricture is related to the vulnerability of the intestinal tissue to radiation. Furthermore, we hypothesized that the location of the vascular anastomosis may affect the mesenteric location of the FJF and the dead space in the neck, leading to the development of cervical skin flap necrosis. These data contribute to increasing our knowledge about postoperative complications related to FJF reconstruction.
Topics: Humans; Esophagectomy; Anastomotic Leak; Retrospective Studies; Constriction, Pathologic; Quality of Life; Head and Neck Neoplasms; Postoperative Complications; Necrosis; Esophageal Neoplasms
PubMed: 37285823
DOI: 10.1159/000530920 -
The Laryngoscope Jan 2019Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of...
OBJECTIVE
Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.
METHODS
Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two-clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.
RESULTS
The mean age of the cohort was 83 ( ± 12) years. Fifty-three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty-seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty-two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.
CONCLUSION
The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.
LEVEL OF EVIDENCE
3b Laryngoscope, 129:63-66, 2019.
Topics: Aged; Aged, 80 and over; Cadaver; Deglutition Disorders; Esophagoscopy; Female; Humans; Male; Pharyngeal Diseases; Pharyngeal Muscles; Prevalence
PubMed: 30408176
DOI: 10.1002/lary.27529 -
International Journal of Pediatric... Nov 2016Rarely the tonsillar pillars and the soft palate became adherent to the posterior nasopharyngeal wall by strong fibrous tissue due to excessive dissection and...
OBJECTIVE
Rarely the tonsillar pillars and the soft palate became adherent to the posterior nasopharyngeal wall by strong fibrous tissue due to excessive dissection and cauterization during surgery leading to nasopharyngeal stenosis. Therefore, many treatment modalities are being tried to cure this problem. The aim of this study is to explore our results of modifying the basic technique to accommodate those patients with combined nasopharyngeal stenosis and tonsillar pillars adhesions in one stage.
STUDY DESIGN
Case series.
METHODS
This study was conducted on 10 patients with combined nasopharyngeal stenosis and tonsillar pillars adhesions after adenotonsillectomy. They were subjected to treatment by palatal eversion through dividing the soft palate in the midline to separate each pillar from the pharyngeal wall in continuation with each half of soft palate and removal of the fibrous tissue causing stenosis. This was followed by eversion and fixation of the two palatal divisions on either side to allow complete epithelialization of the stenotic area. Postoperative follow-up was done for one year by the flexible nasopharyngoscopy, perceptual speech analysis, and polysomnography.
RESULTS
The flexible nasopharyngosopic examination of the 10 patients at the end of post-operative period revealed a freely mobile soft palate with no nasopharyngeal stenosis or palatal fistula. Velopharyngeal function and speech assessment by perceptual speech analysis was normal in all 10 cases. No obstructive episodes were recorded in polysomnograms.
CONCLUSIONS
Palatal eversion is a promising technique in the treatment of post-adenotonsillectomy of combined nasopharyngeal stenosis and tonsillar pillars adhesion. It is recommended to be used on a wider scale of patients and other indications as nasopharyngeal stenosis following uvulopalatoplasty and post nasopharyngeal radiotherapy. The level of evidence: 4 (case series).
Topics: Adenoidectomy; Airway Obstruction; Child; Child, Preschool; Constriction, Pathologic; Dissection; Endoscopy; Female; Humans; Male; Nasopharyngeal Diseases; Palate, Soft; Polysomnography; Postoperative Complications; Speech; Tissue Adhesions; Tonsillectomy; Treatment Outcome; Velopharyngeal Insufficiency
PubMed: 27729138
DOI: 10.1016/j.ijporl.2016.09.028 -
The Journal of Laryngology and Otology May 2018Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to... (Review)
Review
BACKGROUND
Pharyngocutaneous fistula is a cause of significant morbidity following laryngectomy. Routine use of salivary bypass tubes during laryngectomy has been proposed to reduce the incidence of fistulae and neopharyngeal strictures.
METHOD
Following a systematic search of Embase, Medline and Cochrane databases (1946 - current), included articles were assessed for bias according to the Cochrane Handbook for Systematic Reviews of Interventions.
RESULTS
Three case-control trials showed reduced pharyngocutaneous fistula rates with the use of salivary bypass tubes; six case series reported widely varied fistula rates. With regards to stricture rates, the largest case-control trial found no improvement with salivary bypass tube use. No fatal adverse events were observed among the 204 patients who received a salivary bypass tube.
CONCLUSION
Low-level evidence suggests salivary bypass tubes may reduce the incidence of fistula in high-risk patient groups. A robust randomised controlled trial, or large, multicentre cohort studies, are needed to further examine this intervention.
Topics: Adult; Aged; Case-Control Studies; Constriction, Pathologic; Cutaneous Fistula; Female; Fistula; Humans; Laryngectomy; Male; Middle Aged; Pharyngeal Diseases; Postoperative Complications; Salivary Ducts; Stents; Treatment Outcome
PubMed: 29444718
DOI: 10.1017/S0022215118000154 -
Head & Neck Oct 2015Early oral feeding for patients who underwent total laryngectomy is still controversial. The purpose of this study was to evaluate the safety of initiating early oral... (Review)
Review
BACKGROUND
Early oral feeding for patients who underwent total laryngectomy is still controversial. The purpose of this study was to evaluate the safety of initiating early oral feeding after total laryngectomy regarding pharyngocutaneous fistula. The survey included research in MEDLINE, EMBASE, and LILACS.
METHODS
The intervention analyzed was early oral feeding (<5 days), whereas the control group received late oral feeding (>7 days) after total laryngectomy.
RESULTS
From 304 studies, 4 randomized clinical trials with 180 patients were selected. In the early oral feeding group, the incidence was 6.7%, whereas in the late oral feeding group it was 10%, with no statistically significant difference (IC95% -0.11 to 0.05; p = .42; I(2) = 0%). Four cohort studies with 490 patients were also selected. In the early oral feeding group, the incidence was 12.2%, whereas in the other group, it was 10.1%, with no statistically significant difference (IC95% -0.05 to 0.08; p = .67; I2 = 0%).
CONCLUSION
There is no increase in pharyngocutaneous fistula rates in patients who receive early oral feeding after total laryngectomy.
Topics: Constriction, Pathologic; Cutaneous Fistula; Enteral Nutrition; Female; Humans; Laryngeal Neoplasms; Laryngectomy; Male; Pharyngeal Diseases; Postoperative Care; Postoperative Complications; Surveys and Questionnaires; Time Factors
PubMed: 24816775
DOI: 10.1002/hed.23755 -
La Radiologia Medica Sep 2016To investigate the feasibility and effectiveness of integrated self-expanding Y-shaped airway stent placement for patients with carinal stenosis.
PURPOSE
To investigate the feasibility and effectiveness of integrated self-expanding Y-shaped airway stent placement for patients with carinal stenosis.
MATERIALS AND METHODS
From May 2010 to March 2015, 12 consecutive patients with carinal stenosis, treated by placement of integrated self-expanding Y-shaped airway stent, were included this retrospective study. Data on technical success, clinical success, and follow-up were analyzed.
RESULTS
Technical success was 100 %. Eleven uncovered stents and one covered stent placed in 12 patients. Eleven patients underwent stent insertion under local pharyngeal anesthesia, and one patient underwent stent insertion under general anesthesia. Clinical success was 100 %. The respiratory difficulty improved instantly after treatment. The average Hugh-Jones classification grade and arterial oxygen saturation improved from 4.3 ± 0.6 and 83.0 ± 2.6 % before treatment to 1.4 ± 0.5 (p < 0.001) and 95.4 ± 1.2 % (p < 0.001) after treatment, respectively. During 3-15 months (mean 6.5 ± 3.3 months) of follow-up, two patients experienced the re-stenosis of the stent 75 and 78 days after treatment. All patients died during the follow-up. Survival after stent insertion ranged from 96 to 432 days (median 165 days). The cumulative 6- and 12-month survival rates were 41.7 and 8.3 %, respectively.
CONCLUSIONS
Placement of integrated self-expanding Y-shaped airway stent is a simple, safe, and effective method for patients with carinal stenosis.
Topics: Aged; Bronchoscopy; Feasibility Studies; Female; Humans; Male; Middle Aged; Prosthesis Design; Radiography, Interventional; Retrospective Studies; Stents; Survival Rate; Tracheal Stenosis; Treatment Outcome
PubMed: 27262577
DOI: 10.1007/s11547-016-0653-2 -
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke... Jul 2022To investigate the morphological characteristics of upper airway and laryngopharyngeal reflux in obese patients with obstructive sleep apnea (OSA). A retrospective...
To investigate the morphological characteristics of upper airway and laryngopharyngeal reflux in obese patients with obstructive sleep apnea (OSA). A retrospective analysis was performed on the clinical data of 284 adult patients who underwent polysomnography (PSG) from April 2020 to April 2021 in the Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, including 83 males and 201 females, aged (32.70±7.74) years. Patients were divided into obese group (=234) and non-obese group (=50) according to body mass index (BMI). Patients were divided into mild OSA group, moderate OSA group, severe OSA group and extremely severe OSA group by PSG.The results of sleepiness and laryngopharyngeal reflux questionnaire, nasolaryngoscopy and polysomnography were compared in each group. SPSS (version 22.0) software was used in data analysis. Compared with the non-obese OSA group, the lymphoid hyperplasia of tongue root was more heavy in the obese OSA group, and Mueller's maneuver showed that the left-right lateral collapse of the velopharyngeal plane was more serious. Meanwhile, the scores of reflux symtom index (RSI) and reflux finding score (RFS) in the obese OSA group were significantly increased, and the scores of RSI and RFS increased with the increase of OSA severity. The main respiratory events in obese patients with OSA were obstructive hypopnea, their apnea-hypopnea indices(AHI) during REM (AHI) was significantly higher than non-REM (AHI), and they had lower average blood oxygen saturation. Yet, there was no significant difference in the lowest blood oxygen saturation between the two groups. Our study suggests that lateral pharyngeal wall stenosis in velopharyngeal plane and the lymphoid hyperplasia of tongue root in glossopharyngeal plane occurs more frequently in obese patients with OSA. Laryngopharyngeal reflux is significantly increased in obese patients, and OSA increases laryngopharyngeal reflux in obese patients.
Topics: Adult; Body Mass Index; Female; Humans; Hyperplasia; Laryngopharyngeal Reflux; Male; Obesity; Polysomnography; Retrospective Studies; Sleep Apnea, Obstructive
PubMed: 35866282
DOI: 10.3760/cma.j.cn115330-20211104-00715 -
Medicine Mar 2020Sleep-disordered breathing symptoms may recur in some children after successful adenoidectomy. A potential etiology that warrants consideration is torus tubarius... (Observational Study)
Observational Study
Sleep-disordered breathing symptoms may recur in some children after successful adenoidectomy. A potential etiology that warrants consideration is torus tubarius hypertrophy (TTH) as well as residual or recurrent adenoid hypertrophy. Here, we report our experience and the treatment outcomes with microscopic coblator-assisted partial resection of TTH.Seven children who had undergone coblator-assisted partial resection of TTH under microscopy from April 2000 through January 2017 were retrospectively reviewed. The patient age at the time of initial adenotonsillectomy and the interval between the first operation and partial resection of TTH were identified. Lateral cephalometry and scores on the Korean version of the obstructive sleep apnea-18 (KOSA-18) questionnaire were reviewed.The median age at the time of the first operation was 3.0 years and the average time interval between the first operation and subsequent tubal tonsillectomy was 44.0 months. The average width between the torus tubarius was 2.1 mm preoperatively. Symptoms of sleep-disordered breathing were relieved in all patients after operation. Preoperative and postoperative KOSA-18 scores were 73.5 and 35.5, respectively (P = .024). On polysomnography, the preoperative and postoperative apnea-hypopnea index scores were 22.9 and 4.7, respectively (P = .068). The patients were followed up for an average of 1.3 years. One patient developed a recurrence of symptoms and underwent a revision operation. Complications such as bleeding and nasopharyngeal stenosis were not observed.Otorhinolaryngologists should keep TTH in mind as one of the differential diagnoses for recurrent upper airway obstruction symptoms after adenoidectomy. Microscopic coblator-assisted partial resection of TTH is likely to be safe and effective.
Topics: Adenoids; Case-Control Studies; Child, Preschool; Humans; Hypertrophy; Infant; Male; Republic of Korea; Retrospective Studies; Sleep Apnea Syndromes; Snoring; Surveys and Questionnaires; Treatment Outcome
PubMed: 32150069
DOI: 10.1097/MD.0000000000019329