Δευτέρα 7 Δεκεμβρίου 2020

The use of grafts in frontal sinus drill-outs

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Purpose of review A significant complication of the frontal sinus drill-out procedure is restenosis of the frontal neo-ostium. To improve postoperative healing in this region, various mucosal grafts and pedicled flaps have been designed to reconstruct the mucosal lining of the frontal neo-ostium. We provide an overview of the types of grafts described for reconstruction and discuss the latest evidence on their efficacy. Recent findings Frontal neo-ostium mucosal reconstruction may be performed using free, pedicled, or a combination of grafts. There are several case series that report good outcomes and low revision rates following the use of grafts in frontal sinus drill-outs, and one randomized controlled study demonstrating increased ostial patency. However, the use of grafts did not alter the rate of revision surgery and only one study reported an improvement in Sino-Nasal Outcome Test-22 scores after one year. Summary Studies have suggested that frontal sinus drill-out grafts result in favorable restenosis and graft success rates. However, larger randomized control trials will be required to determine whether frontal sinus drill-out grafts contribute to a tangible clinical benefit for patients. Correspondence to Richard Douglas, FRACP, FRACS, MD, Department of Surgery, The University of Auckland, Auckland, New Zealand. Tel: +64 9 9239820; e-mail: richard.douglas@auckland.ac.nz Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer

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Purpose of review Persistent or recurrent disease in the neck lymphatics is an unusual pattern of failure in nasopharyngeal carcinoma (NPC) after definitive radiotherapy or chemoradiotherapy. The purpose of this review is to critically synthesize the current knowledge regarding salvage treatment of this unique form of failure in NPC. Recent findings Surgery in the form of radical neck dissection has been established as the standard salvage treatment with 5-year regional control of 60--86%. Recent shift in paradigm has resulted in the use of modified or selective neck dissection as salvage surgery in some centers. Risk factors for poor survival outcome include recurrent nodal disease, number of involved lymph nodes, extracapsular extension, high lymph node ratio, and positive resection margin. There are no well controlled studies on the role of additional radiotherapy or chemotherapy to improve local control or survival after salvage neck dissection in this group of patients with regional failure. Summary There is limited literature regarding the extent of surgical dissection in treating nodal persistent or recurrent disease. Prospective studies are also needed to determine whether adjuvant therapy improves treatment outcomes. Correspondence to Wai-Tong Ng, Department of Clinical Oncology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China. Tel: +852 2255 4352; fax: +852 2872 6426; e-mail: ngwt1@hku.hk Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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The role of endoscopic medial maxillectomy in sinus disease

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Purpose of review The endoscopic medial maxillectomy (EMM) has remained a relevant procedure for certain sinus diseases and at the same time reemerged as a salvage technique or even as a primary procedure for other diseases. Several mucosal-sparing techniques have also been described and the outcome of the surgeries is available for review. Recent findings Modifications of the EMM technique in the last two decades, aimed at mucosal preservation of the inferior turbinate, nasolacrimal duct, and medial maxillary wall have been successful in addressing a multitude of diseases. There are also evidences to support adjunct procedures/methods to improve access, healing, and to address associated dysfunction such as impaired mucociliary clearance. Tailored approaches have shown favourable outcomes with a low rate of adverse effects. Summary The EMM is appropriate for selected indications, in particular lesions causing medial wall destruction or extensive tumour involving the anterior wall or the prelacrimal recess. As for other maxillary sinus diseases including those identified to a limited site, a modified EMM is a reasonable consideration. The choice is appropriate provided instrument access, visualization, the ability for complete resection, postoperative care, and the requirement for surveillance is not compromised. A tailored approach with or without adjunct procedures is recommended. Correspondence to Narayanan Prepageran, Department of Otorhinolaryngology – Head and Neck Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel: +60379492062; e-mail: prepageran@yahoo.com Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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Tracheal Squamous Metaplasia in Children with Endotracheal Intubation or Tracheostomy

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Publication date: Available online 6 December 2020

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Hanaa Knaneh-Monem, Beth Osterbauer, Christian Hochstim

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Recurrent aspiration pneumonia precipitated by obstructive sleep apnea

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Publication date: Available online 6 December 2020

Source: Auris Nasus Larynx

Author(s): Kiminori Sato, Shun-ichi Chitose, Kiminobu Sato, Fumihiko Sato, Takeharu Ono, Hirohito Umeno

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Differences in bone conduction ocular vestibular evoked myogenic potentials to 500 Hz narrow band chirp stimulus and 500 Hz tone burst

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This study aims to investigate the differences of N1 latency, P1 latency and N1P1 amplitude in response to bone conducted 500 Hz tone burst and narrowband CE chirp stimulus in ocular vestibular evoked myogenic potentials (oVEMPs).
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Limitations of non-echo planar diffusion weighted magnetic resonance imaging (non-EPI MRI) in cholesteatoma surveillance after ossicular chain reconstruction. A prospective study

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Non-echo planar diffusion weighted magnetic resonance imaging is a reliable surveillance tool of residual cholesteatoma nowadays. It is not known whether the material of the ossicular chain prosthesis modifies the sensitivity and specificity of MRI in these cases. The aim of the study was to compare the sensitivity, specificity and a localization-specific accuracy of non-EPI DW MRI sequences for residual cholesteatoma in the following 3 subgroups: patients with titanium ossicular prosthesis (group T), with autologous cortical bone columella (group A) or without any reconstruction (group WR) of hearing bones.
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Restoration of soft triangle of the nose using auricular composite graft and fibrin glue

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Volume 5, Issue 1, November 2020, Page 96-100
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Silicone plug insertion for treatment of refractory patulous eustachian tube after irradiation

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Volume 5, Issue 1, November 2020, Page 106-110
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A collagen membrane influences bone turnover marker in vivo after bone augmentation with xenogenic bone

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The aim was to compare early biochemical and histological osseous healing of chronic mandibular defects regenerated with bovine bone substitute with and without collagen membrane in vivo.
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'Shh-don't say the Q-word' or do you?

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"Shh-don't say the Q-word" or do you?

Br J Oral Maxillofac Surg. 2020 Aug 20;:

Authors: Singh Dubb S, Ferro A, Fowell C

Abstract
We aimed to assess the superstitious belief that saying the word 'quiet' during an on-call period in oral and maxillofacial surgery (OMFS) causes a disproportionate increase in workload. A two-armed, single-centre, randomised trial was performed in a single-blinded fashion within the OMFS department at Addenbrookes Hospital, Cambridge. Duty on-call OMFS SHOs were assigned to a 'quiet group' or 'non-quiet group'. The former group was actively told that the on-call period would be 'quiet' whilst in all contexts in the latter this word was not used. Data were collected from 8am to 7pm from a period that spanned a total of 40 week-day on calls. The total number of bleeps was 491, the mean (SD) bleep count/day irrespective of treatment was 12.3 (4.6). The mean (SD) bleep count was 11.45 (4.15) for the control group and 13.1 (4.9) for the quiet (treatment) group. Welch's independent-sample t test identified no significant difference in the mean number of bleeps encountered between groups. Moreover, ANOVA identified no significant difference in the mean number of bleeps between days (F(4,35)=0.086, p=0.986). Statistical analysis was performed using R package version 3.6.2 (The R Foundation). Our study refutes the central dogma of all of medicine, which suggests that saying the word 'quiet' increases the clinician's workload during the working day. We identified no significant difference in the number of bleeps between different days of the week. OMFS sees a large breadth of presentations within the head and neck that requires a diverse set of skills to manage the varying presentations when on call.

PMID: 33279295 [PubMed - as supplied by publisher]

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