Τρίτη 8 Ιουνίου 2021

Emergency presentations of head and neck cancer: our experience in the wake of the Covid‐19 pandemic

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Abstract

The COVID-19 pandemic imposed dramatic changes on delivery of medical services, leading to significant reductions in urgent referrals for suspected cancer. A resultant surge in patients presenting with advanced disease, potentially in an emergency context, has been anticipated but, until now, no real-world data have been disseminated. Herein, we report a dramatic surge in new and newly recurrent HNCs presenting with advanced disease in an emergency context in the period immediately following the COVID-19-induced UK national lockdown. To minimise adverse outcomes HNC services should prepare for a fluctuant but ongoing increase in such presentations, with expansion and streamlining of secondary healthcare capacity, together with accurate public health messaging tailored towards patients and primary care. These data are likely to have lasting significance and will help inform practice and healthcare policy during and following any future COVID-19 outbreaks.

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Bezold's abscess complicating acute otomastoiditis: transmastoid approach for surgical drainage with an exoscope (with video)

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Publication date: Available online 8 June 2021

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): Pedro Correia-Rodrigues, João Levy, Leonel Luís

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Modified Transpterygoid Approach to Sphenoid Meningoencephaloceles: A Shorter Run for a Longer Slide

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Objectives

Cerebrospinal fluid (CSF) leaks and meningoencephaloceles originating in the lateral recess of the sphenoid sinus can be challenging. The traditional transpterygoid approach through the pterygopalatine fossa (PPF) is time consuming and places important structures at risk, which can lead to significant morbidity. We report a multi-institutional experience using a simplified, endoscopic modified transpterygoid approach (MTPA), which spares the PPF contents in the management of lateral sphenoid sinus meningoencephaloceles and CSF leaks.

Study Design

Multi-Institutional, Retrospective Case Series.

Methods

Patients with lateral sphenoid recess CSF leaks and meningoencephaloceles between 2014 and 2020 who underwent the MTPA at two academic medical centers were identified. Repair techniques and outcomes were evaluated.

Results

Thirty-three patients underwent the MTPA for management. Skull base reconstruction was performed using a free mucosal graft (24/33, 72.7%), nasoseptal flap (4/33, 12.1%), bone grafts (3/33, 9.1%), and abdominal fat grafts (2/33, 6.1%). Lumbar drains and perioperative intracranial pressure measurements were routinely employed. Postoperative complications were uncommon and included three patients (9.7%) with temporary V2 anesthesia, one patient (3.2%) with prolonged V2 anesthesia, and one patient (3.2%) with subjective dry eye, all of which resolved at 9 months postoperatively. There were no recurrent CSF leaks resulting in a 100% success rate. Average follow-up was 13 months.

Conclusion

The MTPA reduces morbidity and greatly simplifies access to the lateral sphenoid sinus for the management of CSF leaks and meningoencephaloceles, without compromising exposure. This technique avoids the need for extensive PPF dissection and should be considered for the management of benign lesions involving the lateral sphenoid sinus.

Level of Evidence

IV Laryngoscope, 2021

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Management Strategy of Local Subcutaneous Effusion After Auricle Reconstruction

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Ear Nose Throat J. 2021 Jun 7:1455613211022104. doi: 10.1177/01455613211022104. Online ahead of print.

ABSTRACT

OBJECTIVES: Microtia is a severe congenital malformation of the external ear, and auricular reconstruction is still a challenge for plastic surgeons because of the complicated procedures and rare conditions. This study aimed to describe the location of subcutaneous effusion after auricular reconstruction and explore the clinical efficacy of the indwelling needle pu ncture drainage method in the treatment of local subcutaneous effusion.

METHODS: From January 2017 to December 2019, 1240 patients (1296 affected sides) who underwent auricular reconstruction using autogenous cartilage framework in the Plastic Surgery Hospital of Chinese Academy of Medical Science and Peking Union Medical College were selected. The local subcutaneous effusion occurred within 5 days after the drainage tube was removed, and the indwelling needle was used for puncture and drainage in the postoperative treatment.

RESULTS: A total of 55 patients had subcutaneous effusion after the operation, including 24 cases with Nagata's method and 31 cases with the expanded single-flap method. One patient showed no obvious reduction after puncture and drainage by indwelling needle and improved after the secondary operation. Two patients had slight cartilage absorption. The remaining patients had good results.

CONCLUSIONS: The method of the indwelling needle for punc ture and drainage is easy to operate. The problem of local subcutaneous effusion after auricular reconstruction can be solved and good efficacy can be obtained.

PMID:34098768 | DOI:10.1177/01455613211022104

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The Diagnostic Yield of Excisional Biopsy in Cervical Lymphadenopathy: A Retrospective Analysis of 158 Biopsies in Adults

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Ear Nose Throat J. 2021 Jun 7:1455613211023009. doi: 10.1177/01455613211023009. Online ahead of print.

ABSTRACT

OBJECTIVES: Cervical lymph nodes are the most common site of peripheral lymphadenopathy. The underlying etiologies are usually benign and self-limiting but may include malignancies or other severe life-threatening diseases. The aim of the current study was to investigate the various underlying pathologies of cervical lymphadenopathy as assessed by the diagnostic yi eld of excisional lymph node biopsies of the neck in a tertiary adult practice. The evaluation was performed in light of previous literature and regional epidemiological patterns.

METHODS: Retrospective analysis of hospital charts of 158 adult patients who underwent an excisional biopsy for suspected cervical lymphadenopathy at a tertiary referral head and neck service between January 2017 and December 2019.

RESULTS: The most common underlying pathology was unspecific and/or reactive lymphadenitis in 44.5% of specimens, followed by malignant disease in 38.6% of cases. An age above 40 years was significantly correlated with an increased likelihood of malignant disease. Lower jugular and posterior triangle lymph nodes showed higher malignancy rates than other groups (100% and 66.7%, respectively). The overall surgical complication rate was 2.5%.

CONCLUSIONS: The results of the current study serve as an indicator of the variety of etiologies causing cervical lymphaden opathy. In particular, given the increasing incidence of malignant diseases in recent decades, the findings should alert physicians to the importance of lymph node biopsy for excluding malignancy in persistent cervical lymphadenopathy especially in older adults. The findings emphasize the value of excisional lymph node biopsy of the neck as a useful diagnostic tool in adult patients with peripheral lymphadenopathy.

PMID:34098767 | DOI:10.1177/01455613211023009

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A Study on Surgical Implications and Variations of Suprameatal Spine and Other Landmarks on the Lateral Surface of Temporal Bone

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Abstract

Mastoidectomy forms the main surgical procedure for eradication of disease in chronic otitis media. Such a surgery which contemplates a complete exenteration of all the tympano-mastoid cavities is rightly considered as a difficult one mainly because a large number of vitally important structures are crowded together in the small field of operation and there is always a risk of damaging them. It is therefore, extremely important that the otologist who would undertake this surgery be thorough with the details of the surgical relations of this region. Out of the various structures seen on the lateral surface of temporal bone one very important structure is the suprameatal spine. It is shown to have great variations in shape and size and has been a mystery to researchers due to the implications it is known to have on mastoid region anatomy. In this study we have evaluated the various types of suprameatal spine, prevalence of each type and the effect of each to other landmarks encountered during surgery and also the effect of mastoid pneumatisation on the same.

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Alteration of Smell and Taste Sensations in Covid-19 Positive Patients: A Prospective Cohort Study in Western India

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Abstract

Loss/alteration of Smell and taste sensation is common in CoViD-19 infection. We conducted present study to find out the frequency, onset and severity of these lost sensations and their recovery in mild, moderate and severe COVID 19 positive patients in our setup. A questionnaire based study on 574 COVID-19 positive patients admitted in a dedicated COVID hospital between September–November, 2020 were followed up until their sensations recovered completely or maximum for two months. Fever was the most common symptom reported. Loss of smell and taste sensation is seen in 200 (34.84%) and 269 (46.86%) patients respectively; 163 (28.4%) developed both. Males were affected significantly more than females (p = 0.030 and 0.027). Approximately 1/4th patients [49 (24.5%) and 55 (20.45%)] reported loss of smell and taste sensation as their first symptom. Most common taste sensation lost was salty 191 (71.0%). Loss of smell sensation is seen maximally in mild cases and the difference among mild, moderate and severe cases is statistically significant (p = 0.00001); while the difference in loss of taste among all three grades of severity is statistically insignificant (p = 0.0770). Most of the patients [smell (142; 71%) and taste (198; 73.6%)] recovered after 2 weeks of onset of lost sensations while 96.5% (193/200) and 98.1% (264/269) patients reported complete recovery of smell and taste sensations after two months of onset. Present study shows that high percentage of COVID-19 positive patients develop loss of either one or both of smell and taste sensations but recovery is fast and complete in most of them.

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Potential implications of slim modiolar electrodes for severely malformed cochlea: A comparison with the straight array with circumferential electrodes

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Clin Exp Otorhinolaryngol. 2021 Jun 8. doi: 10.21053/ceo.2021.00752. Online ahead of print.

ABSTRACT

OBJECTIVES: Malformations of the inner ear account for approximately 20% of congenital deafness. In current practice, the straight arrays with circumferential electrodes (i.e., full-banded electrodes) are widely used in severely malformed cochlea. However, the unpredictability of the location of residual spiral ganglion neurons in such malformations argues against obligatorily pursuing the full-banded electrode in all cases. Here, we present an experience of electrically evoked compound action potential (ECAP) and radiography-based selection of an appropriate electrode for severely malformed cochlea.

METHODS: Three patients with the severely malformed cochlea, showing cochlear hypoplasia type II (CH-II), incomplete partition type I (IP-I), and cochlear aplasia with a dilated vestibule (CADV), were included, and the cochlear nerve deficiency (CND) was evaluated. Full-banded electrode (CI24RE(ST)) and slim modiolar electrode (CI632) were alternately inserted to compare ECAP responses and electrode position.

RESULTS: In patient 1 (CH-II with CND) who had initially undergone cochlear implantation (CI) using the lateral wall electrode (CI422), a revision CI was performed due to incomplete insertion of CI422 and resultant unsatisfactory performance, thus explanting the CI422 and re-inserting the CI24RE(ST) and CI632 sequentially. Although both electrodes elicited reliable ECAP responses with correct positioning, CI24RE(ST) showed overall lower ECAP thresholds compared to CI632; thus, CI24RE(ST) was selected. In patient 2 (IP-I with CND), CI632 elicited superior ECAP responses relative to CI24RE(ST), with correct positioning of the electrode; CI632 was chosen. In patient 3 (CADV), CI632 did not elicit an ECAP response while meaningful ECAP responses were obtained with the CI24RE(ST) array once correct positio ning was achieved. All patients markedly improved auditory performance postoperatively.

CONCLUSION: ECAP and radiography-based strategy for an appropriate electrode may be useful for severely malformed cochlea, leading to enhanced functional outcomes. Additionally, the practice of sticking to the full-banded straight electrode may not always be the best for IP-I and CH-II.

PMID:34098628 | DOI:10.21053/ceo.2021.00752

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Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

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Clin Exp Otorhinolaryngol. 2021 Jun 1. doi: 10.21053/ceo.2021.00633. Online ahead of print.

ABSTRACT

Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profil es are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation's strengths are adjusted to consider the level of evidence resulting in the recommendation and are divided into strong and weak. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

PMID:34098629 | DOI:10.21053/ceo.2021.00633

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Comparative assessment of three posterior fossa decompression techniques and evaluation of the evidence supporting the efficacy of syrinx shunting and filum terminale sectioning in Chiari malformation type I. A systematic review and network meta-analysis

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World Neurosurg. 2021 Jun 4:S1878-8750(21)00819-6. doi: 10.1016/j.wneu.2021.05.124. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to compare the effectiveness of posterior fossa decompression (PFD), posterior fossa decompression with duraplasty (PFDD), and posterior fossa decompression with resection of tonsils (PFDRT) in Chiari malformation type I (CMI). Furthermore, we aimed to evaluate the evidence supporting the efficacy of filum terminale sectioning (FTS), syringo-subarachnoid shunting (SSS), and syringo-peritoneal shunting (SPS) in CMI.

METHODS: PubMed, Cochrane, and Embase databases were screened for English-language studies published from inception until 11 of August 2020. A total of 3593 studies were identified through the searching process. Finally, 15 cohort studies were included in the systematic review and network meta-analysis.

RESULTS: No studies concerning FTS, SSS, and SPS were found eligible. There fore only PFD, PFDD, and PFDRT were compared. PFDD showed significantly higher incidence of complications (RR, 3.79; 95% CI, 2.54-5.64) cerebrospinal fluid (CSF) leak (RR, 9.74; 95% CI, 2.33-40.78) and neurologic deficit (RR, 8.76; 95% CI, 2.08-36.90) than PFD. Both PFDD and PFDRT achieved higher syringomyelia improvement (RR, 1.23; 95% CI, 1.09-1.39), (RR, 1.32; 95% CI, 1.15-1.51) and greater clinical improvement (RR, 1.24; 95% CI, 1.10-1.39), (RR, 1.24; 95% CI, 1.08-1.44) than PFD. We have not found any differences between PFDD and PFDRT.

CONCLUSIONS: PFDD and PFDRT are superior to PFD, especially in patients with syringomyelia-Chiari complex, due to greater syringomyelia reduction and better clinical improvement. However, PFDD and PFDRT can be considered equally efficient. There is no evidence pleading in favor of the SFT, SSS, and SPS over any posterior fossa decompression technique.

PMID:34098134 | DOI:10.1016/j.wneu.2021.05.124

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A Comparative Study of Cold Dissection Tonsillectomy and Harmonic Scalpel Tonsillectomy Under Microscope- Our Experience

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Abstract

Tonsillectomy is one of the most common proceduresin routine otolaryngology.Given that the pediatric demographic is usually in question, ENT surgeons are resorting to newer modalities that minimize the dreaded complication of intra-operative and post-operative hemorrhage and have shorter operative time. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3–4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. The present study was conducted on patients admitted in ward in the Department of Otorhinolaryngology at SMS Medical College and Hospital, JaipurFrom July 2019 to June 2020 on a sample size of 40 patient diagnosed as adeno-tonsillar hypertrophy of grade 3–4. Each patient underwent tonsillectomy by cold dissection method on one side and by ultrasonic scalpel on other. In our study Mean operation time, mean blood loss, Analogue score for post-operative pain at 24hrs and 7th postoperative day respectively and Healing of wound on 14th post-operative day were significantly lower in cases of tonsillectomy with harmonic scalpel than cold dissection method tonsillectomy. The novel technique of tonsillectomy harmonic scalpel is proven to be better with regard to lesser operative time, blood loss and lesser post-operative morbidity.

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