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The Kurume Medical Journal May 2024In general anesthesia for Klippel-Feil syndrome (KFS) patients, there is a potential risk of difficult intubation. However, airway assessment to predict difficult...
In general anesthesia for Klippel-Feil syndrome (KFS) patients, there is a potential risk of difficult intubation. However, airway assessment to predict difficult intubation for KFS patients is not known. In Patient 1, cervical spine computed tomography (CT) revealed airway compression due to cervical fusion. For airway assessment, bronchofiberscopy, three-dimensional (3-D) CT, and virtual bronchoscopic image (VBI) construction were performed. Based on these images, fiberoptic nasotracheal awake intubation was performed. In Patient 2, magnetic resonance imaging and bronchofiberscopy showed no airway compression due to cervical fusion; therefore, tracheal intubation was performed using a video laryngoscope after anesthetic administration. Airway compression due to cervical fusion is considered one of the risk factors for difficult intubation in KFS patients.
PubMed: 38763739
DOI: 10.2739/kurumemedj.MS7012009 -
Ear, Nose, & Throat Journal May 2024Retiform hemangioendothelioma (RH) is a rare intermediate (locally aggressive) vascular tumor that mostly affects the dermis of the trunk and limbs, but has never been...
Retiform hemangioendothelioma (RH) is a rare intermediate (locally aggressive) vascular tumor that mostly affects the dermis of the trunk and limbs, but has never been reported in the inferior turbinate. A 10-year-old Chinese boy presented with recurrent epistaxis in his left nasal cavity and anemia for more than 2 years. Radiographic and electronic video laryngoscopic images showed an expansile mass in the left inferior turbinate. Endoscopic surgery and electrocautery were performed to resect the tumor beyond the macroscopic border. Histopathologically, the tissues were infiltrated by hyperplastic blood vessels arranged in a retiform pattern, and endothelial cells proliferate significantly in some areas. Immunohistochemistry showed a positive result for CD31, CD34, Fli-1, and ERG. No epistaxis, tumor recurrence, or metastasis was found on reexamination over 18 months after surgery.
PubMed: 38757668
DOI: 10.1177/01455613241253372 -
Postoperative radiotherapy versus surgery alone in pN1 oral cavity cancer patients: A meta-analysis.Laryngoscope Investigative... Jun 2024The aim of this meta-analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.
OBJECTIVES
The aim of this meta-analysis is to evaluate the potential benefits of postoperative radiotherapy (PORT) in patients with pN1 oral cavity squamous cell carcinoma.
METHODS
A literature search through major databases was conducted until January 2023. The adjusted hazard ratio (aHR) or risk ratio (RR) with 95% confidence intervals (CIs) of different survival outcomes were extracted and pooled.
RESULTS
Ten studies published between 2005 and 2022, with a pooled patient population of 2888, were included in this meta-analysis. Due to differences in study design and reported outcomes, the studies were categorized into distinct groups. In pN1 patients without extranodal extension (ENE), PORT was associated with a significant improvement in overall survival (OS) (aHR 0.76, 95% CI: 0.61-0.94). In pN1 patients without ENE and positive margins, PORT improved OS (aHR 0.71, 95% CI: 0.56-0.89) and was associated with a lower regional recurrence rate (RR 0.35, 95% CI: 0.15-0.83). However, in pN1 patients without ENE, positive margins, perineural invasion, and lymphovascular invasion, there were no significant differences observed between the PORT and observation groups in either 5-year OS (RR 0.48, 95% CI: 0.07-3.41) or 5-year disease-free survival (RR 0.37, 95% CI: 0.07-2.06).
CONCLUSIONS
The current study demonstrated that PORT has the potential to improve OS in pN1 disease. However, the decision of whether to administer PORT still hinges on diverse clinical scenarios, and additional research is necessary to furnish a more conclusive resolution.
LEVEL OF EVIDENCE
2.
PubMed: 38751691
DOI: 10.1002/lio2.1260 -
Laryngoscope Investigative... Jun 2024This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology-head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on...
OBJECTIVES
This study aimed to ascertain the prevalence of left-handedness (LH) among otolaryngology-head and neck surgery (ORLHN) practitioners, investigate dexterity's impact on LH trainees, and identify common patterns in their training to improve the training experience.
METHODS
A web-based survey was distributed anonymously via email to members of the Saudi Otorhinolaryngology Society. The survey targeted ORLHN attending consultants, board-certified registrars, and current residents. It consisted of three sections: the first focused on the experience of attending consultants in training LH individuals, the second investigated common maneuvers employed by rhinologists, and the third explored the experiences and impacts reported by LH trainees.
RESULTS
The study included 174 participants, and found a 13.2% LH prevalence among them. Rhinologists showed disparities, with 50% advising trainees to stand on the left side of the bed and use their left hand for the scope, whereas the other half asked otherwise. Additionally, 94.4% of the participants had not encountered any courses specifically tailored for LH trainees. Among LH trainees, 57% and 41% reported difficulties in learning and performing side-specific procedures such as functional endoscopic sinus surgery and endoscopic septoplasty, respectively, often attempting to switch to their nondominant hand, and feeling disadvantaged due to their laterality.
CONCLUSIONS
Left-handedness presents challenges for both LH trainees and their trainers in surgical specialties, particularly in ORLHN, in which specific positioning and instruments are crucial to gain access to the desired surgical field. Despite these challenges, there is insufficient support for LH individuals. We recommend encouraging LH trainees to openly disclose and discuss their left-handedness, provide them with mentors, establish standardized operating room setups and techniques, supply appropriate instruments, and demonstrate flexibility in accommodating their needs.
LEVEL OF EVIDENCE
Level 5.
PubMed: 38751690
DOI: 10.1002/lio2.1264 -
Acta Otorhinolaryngologica Italica :... May 2024To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS).
METHODS
To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES a paired match of 13 surgeries performed with TOLMS by the same surgeon.
RESULTS
No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS.
CONCLUSIONS
The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.
Topics: Humans; Microsurgery; Laser Therapy; Male; Female; Middle Aged; Aged; Mouth; Laryngeal Neoplasms; Treatment Outcome; Natural Orifice Endoscopic Surgery; Ergonomics; Adult; Larynx
PubMed: 38745511
DOI: 10.14639/0392-100X-suppl.1-44-2024-N2850 -
Laryngoscope Investigative... Jun 2024Eustachian tube dysfunction (ETD) is the predominant cause of otitis media with effusion in children and adults. Balloon dilatation of the Eustachian tube (BDET)...
BACKGROUND
Eustachian tube dysfunction (ETD) is the predominant cause of otitis media with effusion in children and adults. Balloon dilatation of the Eustachian tube (BDET) provides a new method for restoring the ventilatory function of Eustachian tube (ET). However, the differences in age-related morphological changes in the dimensions and positions of ET in children and adults are unclear.
PURPOSE
This study aimed to examine age-related morphological changes in bony and cartilage segments of the ET in a three-dimensional space in normal population.
METHODS
A total of 71 randomly selected computed tomography (CT) images of the temporal bones of 46 people were retrospectively studied in four age groups: A (0-3 years old); B (4-8 years old), C (9-18 years old), and D (19-65 years old). Space analytic geometry was assessed to calculate the dimensions and positions of ET.
RESULTS
The bony segment of ET lengthened from infancy to adulthood with age in groups A, B and C ( = 0.562**/0.000). The cartilage segment of ET mostly extended with age from infancy to 8 years old in children ( = 0.633**/0.000), but with bending close to the sagittal plane and away from the horizontal plane with age in groups A, B and C ( < .05), and with a constant angle to the coronal plane among the four groups ( > .05).
CONCLUSION
The bony and cartilaginous segments of ET exhibit distinct morphological changes in space with age. The bony segment of ET extends in a constant position from infancy to adulthood. In contrast, the cartilaginous segment of the ET indicates multidimensional positional changes until adulthood, in addition to the elongation from infancy to children. This may provide an accurate morphological basis for comparing the differences in ETD pathogenesis and surgical treatment between children and adults.
PubMed: 38741682
DOI: 10.1002/lio2.1262 -
Laryngoscope Investigative... Jun 2024Comprehensive studies in which the seasonal variation in peripheral vestibular disorders was evaluated using data from an entire population are insufficient. The...
OBJECTIVES
Comprehensive studies in which the seasonal variation in peripheral vestibular disorders was evaluated using data from an entire population are insufficient. The seasonal variation in peripheral vestibular disorders based on data from the entire Korean population was investigated in the present study.
METHODS
Retrospective data from the National Health Insurance Service of Korea from 2008 to 2020 was analyzed. Benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Meniere's disease (MD) were defined based on diagnostic, treatment, or audiovestibular test codes. The seasonal incidence for each peripheral vestibular disorder was calculated among all study subjects.
RESULTS
For the entire study cohort, the incidence of BPPV was significantly higher in spring (odds ratio [OR] = 1.031, 95% confidence interval [CI] = 1.026-1.037), autumn (OR = 1.024, 95% CI = 1.019-1.029), and winter (OR = 1.051, 95% CI = 1.046-1.056) than in summer. The incidence of VN was significantly lower in winter (OR = 0.917, 95% CI = 0.907-0.927) than in summer. The incidence of MD was significantly higher in spring (OR = 1.027, 95% CI = 1.015-1.039) and autumn (OR = 1.029, 95% CI = 1.017-1.041) and significantly lower in winter (OR = 0.919, 95% CI = 0.908-0.931) than in summer. Differences were also observed in seasonal variation based on sex and age.
CONCLUSIONS
Significant seasonal variation occurred in peripheral vestibular disorders including BPPV, VN, and MD based on the entire Korean population data. Furthermore, seasonal variation showed differences based on sex and age.
LEVEL OF EVIDENCE
4.
PubMed: 38736946
DOI: 10.1002/lio2.1254 -
Advantages and caveats of endoscopic to the infratemporal fossa as isolated and combined techniques.Laryngoscope Investigative... Jun 2024Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital,...
OBJECTIVE
Identify the benefits and caveats of combining minimal access approaches to the infratemporal fossa (ITF), such as the endoscopic transnasal, endoscopic transorbital, endoscopic transoral, and endoscopic sublabial transmaxillary approaches to address extensive lesions not amenable to a single approach. The study provides anatomical metrics including area of exposure and degree of surgical freedom.
METHODS
Five human cadaveric specimens (10 sides) were dissected to expose and methodically analyze the anatomical intricacies of the ITF using the following minimal access approaches: endoscopic transnasal transpterygoid (EETA), endoscopic sublabial transmaxillary, endoscopic transorbital via infraorbital foramen, and endoscopic transoral techniques. Area of exposure at the pterygopalatine fossa and surgical freedom at the ITF were obtained for each approach.
RESULTS
The endoscopic sublabial transmaxillary sinus and the combined approach afford a significantly greater exposure than an isolated EETA. The difference in exposure (mean) between the endoscopic sublabial transmaxillary and EETA was 1.62 ± 0.85 cm ( < 0.001), and the difference between the combined approach and EETA was 4.25 ± 0.85 cm ( < 0.001).
CONCLUSIONS
Combining minimal access endoscopic approaches to the ITF can provide significantly greater exposure than an isolated EETA; thus, providing enhanced access to address lesions with extensive involvement of the ITF, especially those with superolateral and inferolateral extensions. In addition, some approaches may have an adjunctive role to the resection, such as the endoscopic transoral approach offering the potential for early control of the internal maxillary artery and its branches, some of which may be supplying the tumor in the ITF; or the endoscopic transorbital approach yielding a direct line of sight to the superior ITF and middle cranial fossa.
LEVEL OF EVIDENCE
NA.
PubMed: 38736945
DOI: 10.1002/lio2.1242 -
Laryngoscope Investigative... Jun 2024To analyze the sizes of the stapedius and tensor tympani (TT) muscles using a temporal bone CT (TBCT) scan in patients with middle ear myoclonic tinnitus (MEMT) and...
OBJECTIVES
To analyze the sizes of the stapedius and tensor tympani (TT) muscles using a temporal bone CT (TBCT) scan in patients with middle ear myoclonic tinnitus (MEMT) and investigate their value for the diagnosis of this rare cause of tinnitus.
METHODS
Medical records and TBCT of patients with MEMT or vascular tinnitus (VT) at Seoul St. Mary's Hospital from January 2012 to December 2022 were reviewed. The stapedius and TT muscles were analyzed.
RESULTS
Thirty-eight patients with unilateral MEMT and 39 patients with VT were included. More males were in the MEMT group compared to the VT group (MEMT: = 24, VT: = 8, = .001). The mean age of the MEMT group was younger compared to the VT group (MEMT: 35 ± 12 years, VT: 44 ± 14.3 years, = .005). The mean BMI for the MEMT group was less than the VT group (MEMT: 22.3 ± 2.5, VT: 24.8 ± 4.36, = .010). The mean length and width of the stapedius in the MEMT group were larger than those of the VT group ( MEMT: 1.47 ± 0.60 mm, VT: 0.98 ± 0.24 mm, = .001; MEMT: 0.89 ± 0.32 mm, VT: 0.72 ± 0.19 mm, = .009). The mean length and width of the TT in the MEMT group were larger than that of the VT group ( MEMT: 3.10 ± 0.50 mm, VT: 2.27 ± 0.42, = .001; MEMT: 2.02 ± 0.36, VT: 1.75 ± 0.26 = .001).
CONCLUSION
The mean length and width of the stapedius and TT muscles measured in the MEMT group were longer and wider than the VT group. This suggests the use TBCT scan as a diagnostic tool for MEMT. Further studies with a larger study group to validate the results of this study are recommended.Level of Evidence: 4.
PubMed: 38736944
DOI: 10.1002/lio2.1243 -
Laryngoscope Investigative... Jun 2024In chronic rhinosinusitis (CRS), the congestion and blockage of the nose can cause anaerobic conditions within the sinus cavities which may promote the expression of...
INTRODUCTION
In chronic rhinosinusitis (CRS), the congestion and blockage of the nose can cause anaerobic conditions within the sinus cavities which may promote the expression of virulence and antibiotic resistance genes in invading pathogens. is a facultative anaerobic bacteria and causes severe recalcitrant CRS. In this study, we aimed to evaluate the antimicrobial resistance of isolates of CRS patients in planktonic and biofilm form grown in aerobic and anaerobic conditions.
METHODS
clinical isolates of CRS patients ( = 25) were grown in planktonic and biofilm form in aerobic and anaerobic conditions. Minimum inhibitory concentrations (MIC) of planktonic forms and minimum biofilm eradication concentrations (MBEC) were determined. Additionally, metabolic activity by fluorescein diacetate assay, biofilm biomass by crystal violet assay and eDNA concentration were assessed in both conditions.
RESULTS
planktonic cells grown in anaerobic condition exhibited increased gentamicin resistance ( < .01), whereas biofilms grown in anaerobic condition displayed significantly increased MBEC values for gentamicin ( < .0001) and levofloxacin ( < .001). The metabolic activity of anaerobic biofilms was significantly higher compared with aerobic biofilms ( < .0001). However, the biofilm biomass of isolates grown in aerobic conditions was higher than anaerobic conditions ( < .5).
CONCLUSION
isolates from CRS patients grown in anaerobic conditions showed significantly increased resistance to antibiotics with an increased metabolic activity but decreased biofilm biomass.
LEVEL OF EVIDENCE
NA.
PubMed: 38736943
DOI: 10.1002/lio2.1244