Treatment of Childhood High-Grade Subglottic Stenosis (SGS) Through Laryngotracheoplasty (LTP) in a Tertiary Pediatric Center from 2013 to 2020

xlomafota13 shared this article with you from Inoreader Treatment of Childhood High-Grade Subglottic Stenosis (SGS) Through Laryngotracheoplasty (LTP) in a Tertiary Pediatric Center from 2013 to 2020 Via Otolaryngology Indian Abstract Laryngotracheal reconstruction is the most common and effective treatment in childhood subglottic stenosis (SGS). Our aim is to review the success rate of laryngotracheoplasty (LTP) in pediatric high grade SGS cases in our tertiary center. The retrospective review was conducted on children with high grade subglottic stenosis who had undergone laryngotracheoplasty over a 7-year period (2013–2020) in tertiary pediatric care. A total of 20 patients who had history of high grade SGS during the stipulated period were included. All of them had undergone LTP. Decannulation was considered the primary outcome measure of success. Surveillance bronchoscopy was performed one year post airway reconstruction to detect residual stenosis. From January 2013 to December 2020, 20 patients aged between 1 and 16 years old underwent LTP. Among them, 10 patients (50%) had Grade III SGS while 5 had Grade III SGS with glottis stenosis (25%). The remaining 5 (25%) had severe Grade IV stenosis. Decannulation was achieved in 14 patients overall (70%) including 1 with revision. These 14 patients who achieved decannulation included 7 out of the 10 patients (70%) with Grade III, 2 out of the 5 (40%) patients with Grade III with glottic involvement, and 4 out of the 5 patients (80%) with Grade IV SGS. Fifteen (80%) patients had double stage LTP while 5 patients had single stage LTP. The study suggests that LTP is a promising approach in the treatment of Complex SGS. Furthermore, pediatric SGS, which is inherently complicated, can be treated with LTP effectively. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical Variations of Sphenoid Sinus

xlomafota13 shared this article with you from Inoreader Anatomical Variations of Sphenoid Sinus in South Indian Population: All That You Need for Trans-Sphenoidal Pituitary Surgery Via Otolaryngology Indian Abstract Pituitary adenomas are one among the most common neurosurgical tumors with an incidence of 10–25% among intracranial neoplasms (Ezzat et al., Cancer 101:613–619, 2004). Surgical management for the same has been practiced since long, and has evolved from trans cranial approach to endoscopic trans sphenoidal method (Hammer and Radberg, Acta Radiol 56:401–422, 1961). Preoperative radiological analysis with CT &MRI is inevitable in planning endonasal trans-sphenoid surgery to avoid complications because of the high variability concerned with sphenoid anatomy. The present study intends to analyze the incidence of various anatomical variations of sphenoid sinus in a cohort of south Indian population as detected by CT& MRI and assess its impact on surgical approach. Retrospective analysis of CT&MRI images of patients who underwent Endonasal Trans-sphenoidal resection of pituitary tumors at JSS Hospital Mysuru from a period of 2009 to 2020 is done. Anat omical variations of sphenoid sinus esp. degree of pneumatization, sellar configuration, septation pattern, inter carotid distance were evaluated. Results were significant and in concordance with other similar studies. Most frequently encountered pnuematization was sellar type and least was conchal type Sphenoid sinus pneumatization is directly linked to safe access to sella. Presence of septae within sinus need to be identified preoperatively to avoid damage and confusion intraoperatively. A meticulous preoperative analysis of sphenoid sinus anatomy will help surgeon in smooth conduct of a complication free surgery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of Thyroid surgery on Voice: A prospective study

xlomafota13 shared this article with you from Inoreader Impact of Thyroid surgery on Voice: A prospective study Via Otolaryngology Indian Abstract Background Thyroidectomy is one of the most common neck surgery done worldwide. It is associated with debilitating post-operative voice changes even without recurrent laryngeal nerve (RLN) injury. Aims and Objectives: To study the impact of thyroidectomy on voice parameters in the absence of Recurrent Laryngeal Nerve and External Branch of Superior Laryngeal Nerve injury and comparison between the pre and post-operative changes in the subjective and objective voice parameters. Methodology: Patients fulfilling the inclusion criteria underwent thyroidectomy. The Subjective voice assessment was done using Voice Impairment Score (VIS) and objective parameters were analyzed using Multi-Dimensional Voice Program (MDVP) pre-operatively and post-operatively at 1 week, 1 month and 3 months interval. Results: On MDVP analysis of patients, a fall in Mean F0 (Hz), Minimum F0 (Hz) and Maximum F0 (Hz) values was noted at 1 week after surgery. But a trend toward the pre-operative values was observed at 3 months post-operatively. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy

xlomafota13 shared this article with you from Inoreader The efficiency of polyglycolic acid felt in the prevention of pharyngocutaneous fistula after total laryngectomy Via American Journal of Otolaryngology Publication date: November–December 2021 Source: American Journal of Otolaryngology, Volume 42, Issue 6 Author(s): Taskin Tokat, Togay Muderris, Abdulhalim Aysel, Elif Sari, Ferda Erol View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology

xlomafota13 shared this article with you from Inoreader Risk stratification of parotid neoplasms based on intraoperative frozen section and preoperative fine needle aspiration cytology Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Aug 3. doi: 10.1007/s00405-021-07015-w. Online ahead of print. ABSTRACT PURPOSE: This study aims to determine the relationship of frozen section (FS) to final histology and determine how incorporating FS may change preoperative malignancy risk estimates based on preoperative fine needle aspiration cytology (FNAC). The secondary aim is to determine if FS is useful in influencing intraoperative decision-making. METHODS: Retrospective review of 426 intraoperative FS for parotidectomies performed for primary parotid lesions. RESULTS: Risk of malignancy with a benign FS was 2.5%, with indeterminate 36.1%, and with malignant 100%. Incorporating FS to fine needle aspiration for cytology helped to stratify malignancy risk especially in the Milan categories of atypia of undetermined significance, neoplasm of uncertain malignant potential and non-diagnostic categories, where a malignant FS increased ma lignancy risk significantly. FS was only able to identify 11% of high-risk histological subtypes for which a neck dissection would be recommended. CONCLUSIONS: FS may be used to stratify malignancy risk intraoperatively but has limited utility in clinical decision-making to perform a neck dissection and more extensive parotid resection in high-risk histological subtypes. PMID:34342679 | DOI:10.1007/s00405-021-07015-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Expression of Cyclin-D1 and p53 as Prognostic Markers in Treatment of Oral Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Expression of Cyclin-D1 and p53 as Prognostic Markers in Treatment of Oral Squamous Cell Carcinoma Via Otolaryngology Indian Abstract Cyclin D1 and p53 play an important role in tumorigenesis of human cancers. The present study aims to evaluate cyclin D1 and p53 expression in resectable OSCC, and to determine their prognostic significance at the end of 5 year follow-up: A total of 100 patients aged 31–74 years, stage 3/4 were recruited. Cyclin D1 and p53 expression in the tumour tissue was estimated by IHC and was statistically correlated with demographic and clinicopathological data and prognosis was evaluated at the end of 5 year outcome. The positive expression rate of cyclin D1 was 50% and p53 it was 40% and they neither showed any statistical significant correlation with each other nor with demographic or clinicopathological data. The OS was 32%.Negative and weak expression predicted better outcomes with regard to DFS and OS. DFS and OS were significantly worse in patients of overexpressed cyclin D1 (p < 0.001) and p53 (p = 0.008). Cyclin D1 is a better prognostic marker as compared to p53 for both DFS and OS. p53 expression (high versus low) for disease free non-survival and overall nonsurvival showed an OR of 3.576 (p = 0.003) and 8.803(p < 0.001) respectively for strong expression while in case of cyclin D1 it showed an OR of 13.067(p < 0.001) and 37.465(p < 0.001) for strong expression.So higher the level of expression of tumour markers higher is the odds ratio so poorer is the prognosis. Overexpression of cyclin D1 and p53 was significantly associated with poor prognosis in terms of DFS and OS View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A supervised machine learning algorithm predicts intraoperative CSF leak in endoscopic transsphenoidal surgery for pituitary adenomas: model development and prospective validation

xlomafota13 shared this article with you from Inoreader A supervised machine learning algorithm predicts intraoperative CSF leak in endoscopic transsphenoidal surgery for pituitary adenomas: model development and prospective validation Via leak of cerebrospinal fluid J Neurosurg Sci. 2021 Aug 3. doi: 10.23736/S0390-5616.21.05295-4. Online ahead of print. ABSTRACT BACKGROUND: Despite advances in endoscopic transnasal transsphenoidal surgery (ETNS) for pituitary adenomas (PAs), cerebrospinal fluid (CSF) leakage remains a life-threatening complication predisposing to major morbidity and mortality. In the current study we developed a supervised ML model able to predict the risk of intraoperative CSF leakage by comparing different machine learning (ML) methods and explaining the functioning and the rationale of the best performing algorithm. METHODS: A retrospective cohort of 238 patients treated via E-TNS for PAs was selected. A customized pipeline of several ML models was programmed and trained; the best five models were tested on a hold-out test and the best classifier was then prospectively validated on a cohort of 35 recently treated patients. RESULTS: Intraoperative CSF leak occurred in 54 (2 2,6%) of 238 patients. The most important risk's predictors were: non secreting status, older age, x-, y- and z-axes diameters, ostedural invasiveness, volume, ICD and R-ratio. The random forest (RF) classifier outperformed other models, with an AUC of 0.84, high sensitivity (86%) and specificity (88%). Positive predictive value and negative predictive value were 88% and 80% respectively. F1 score was 0.84. Prospective validation confirmed outstanding performance metrics: AUC (0,81), sensitivity (83%), specificity (79%), negative predictive value (95%) and F1 score (0,75). CONCLUSIONS: The RF classifier showed the best performance across all models selected. RF models might predict surgical outcomes in heterogeneous multimorbid and fragile populations outperforming classical statistical analyses and other ML models (SVM, ANN etc.), improving patient management and reducing preventable morbidity and additional costs. PMID:34342190 | DOI:10.23736/S0390-5616.21.05295-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery

xlomafota13 shared this article with you from Inoreader To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery Via The Laryngoscope Objectives/Hypothesis The objective of this study was to compare ventilation techniques utilized in microlaryngeal surgery. Study Design Retrospective cohort study. Methods Two-hundred surgeries performed from May 1, 2018 to March 1, 2020 and stratified as intubated, intermittently intubated (AAIV) or apneic. Patient demographics, comorbidities, anesthetic agents, intraoperative parameters/events, and complications were studied and compared across the three groups using inferential analyses. Results Median body mass index in the AAIV group was significantly higher (33 vs. 29; P = .0117). Median oxygen nadirs were lower in AAIV cases (81% vs. 91–92%) while CO2 peak measurements were lower (33 mmHg vs. 48 mmHg) in the fully apneic cohort which were significantly shorter cases (P < .0001). CO2 peak measurements were comparable between AAIV and intubated cohorts (median 48.5 mmHg vs. 48.0 mmHg). Median apnea times were significantly prolonged by 2–5.5 minutes using nasal cannula and THRIVE/Optiflow in fully apneic cases when compared to no supplementary oxygenation (P = .0013). Systolic blood pressures following insertion of laryngoscope were higher (159.5 vs. 145 mmHg) and postoperative diastolic pressures were lower (68.5 vs. 76.5 mmHg) in fully apneic cases than intubated cases. No differences existed between frequencies of complications. Conclusions This study compares intubated, intermittently apneic, and fully apneic surgeries. No statistically significant differences were noted in comorbid conditions. While intraoperative hemodynamic fluctuations were more pronounced in the fully apneic cohort, and oxygenation distributions were lower in the AAIV cohort, no significant differences existed between events and complications. Apneic techniques are as safe and effective as traditional intubation. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

xlomafota13 shared this article with you from Inoreader Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas Via The Laryngoscope Objectives/Hypothesis Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs. Study Design Retrospective chart review. Methods Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics. Results Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7–7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%). Conclusions Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques. Level of Evidence IV Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Above and Beyond: Periorbital Suspension for Endoscopic Access to Difficult Frontal Sinus Pathology

xlomafota13 shared this article with you from Inoreader Above and Beyond: Periorbital Suspension for Endoscopic Access to Difficult Frontal Sinus Pathology Via The Laryngoscope Objectives/Hypothesis The periorbital suspension (PS) is an advanced adjunctive technique performed during endoscopic approaches to frontal sinus pathology that would be too far lateral or superior to address using traditional endoscopic transnasal approaches. The objectives of this study are to characterize the utility of this technique for frontal sinus pathology, determine anatomic limitations, and assess clinical outcomes following surgical treatment. Study Design Prospective case series. Methods Patient data including demographics, etiology, technique, complications, and clinical follow-up were collected. Preoperative computed tomography scans were reviewed for maximum lateral and superior extent of pathology, supraorbital recess height, anterio-posterior (AP) diameter of the frontal sinus, interorbital distance, and orbital—first olfactory neuron distance. Results The PS approach was used in 30 surgeries (29 patients) for cerebrospinal fluid leaks (n = 5), benign tumors (n = 17), malignant tumors (n = 5), allergic fungal sinusitis (n = 2), and mucocele (n = 1) between 2018 and 2020. Approaches included 15 Draf IIB and 15 Draf III frontal sinusotomies. All pathology was surgically accessible using the PS approach and there were no intraoperative or postoperative complications. Postoperative follow-up was 11.7 ± 7.6 months. Mean recorded measurements (in mm) were as follows: maximum lateral extent −15.0 ± 7.7, superior extent 21.2 ± 7.7 in surgical plane and 20.9 ± 9.8 in the vertical plane, supraorbital recess height −2.6 ± 1.9, AP frontal sinus diameter −13.2 ± 4.7, interorbital distance −29.8 ± 5.4, and orbital-olfactory neuron distance −14.8 ± 2.9. Conclusions The PS technique can be safely and successfully utilized to provide endoscopic endonasal access to lateral and superior frontal sinus pathology. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis

xlomafota13 shared this article with you from Inoreader The Impact of Laryngopharyngeal Reflux on Occurrence and Clinical Course of Recurrent Respiratory Papillomatosis Via The Laryngoscope Objectives/Hypothesis Laryngopharyngeal reflux (LPR) has been proposed both as a trigger for recurrent respiratory papillomatosis (RRP) onset and as a factor favoring an aggressive clinical course. Study Design In this prospective study, 106 participants were recruited within a period of 24 months at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana. Methods This study compared a group of RRP patients (N = 36) with a group of LPR patients (N = 28) and a group of healthy participants (N = 42) based on Reflux Symptom Index (RSI), Reflux Finding Scores (RFS), and saliva analyses (pH, pepsin concentration, bile acid concentration, and pepsin enzymatic activity). Results The RRP group compared to the LPR group showed a statistically significant difference only in RSI and RFS scores, while the RRP group compared to healthy controls showed significantly higher values in all tested parameters (RSI score, RFS, saliva pH, pepsin concentration, bile acids concentration, pepsin enzymatic activity). Conclusions LPR is common in RRP patients and significantly more prevalent compared to healthy controls. Our results show that saliva analyses are a better office-based tool than RSI questionnaires and RFS scores for diagnosing LPR in RRP patients. Level of Evidence Level 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.