Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

xlomafota13 shared this article with you from Inoreader Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach Via The Laryngoscope Objectives/Hypothesis Revision endoscopic dacryocystorhinostomy (END‐DCR) is the preferred approach for failed primary surgeries, yet quality data on long‐term outcomes are lacking. This study aimed to evaluate three aspects of revision END‐DCR: 5‐year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. Methods This retrospective study included all revision END‐DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long‐term follow‐up analysis, two subgroups of first and second revision END‐DCRs with a minimum of documented 5‐year follow‐up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. Results After exclusions, a total of 45 eyes from 38 patients who underwent revision END‐DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5‐year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END‐DCR showed favorable 5‐year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT‐DCR) in both first and second revisions, but this did not reach significance. Conclusions Revision END‐DCR carries an excellent short‐term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow‐up should be maintained within this timeframe. Revision END‐DCR following either primary endoscopic or EXT‐DCR produces comparable surgical outcomes and patient‐reported satisfaction. Level of Evidence 3b Laryngoscope, 131:E682–E688, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Taste Dysfunction in Chronic Rhinosinusitis

xlomafota13 shared this article with you from Inoreader A Systematic Review and Meta‐Analysis of Taste Dysfunction in Chronic Rhinosinusitis Via The Laryngoscope Objectives Patients with chronic rhinosinusitis (CRS) often describe alterations in sense of taste. These complaints have historically been attributed to olfactory dysfunction; however, there is evidence of direct, objective, gustatory disturbances in the setting of CRS that are not thoroughly characterized. This study sought to investigate and summarize gustatory dysfunction experienced by patients with CRS. Methods PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were reviewed following PRISMA guidelines. English language, original studies investigating objective taste in adult patients with CRS were included. A meta‐analysis with inverse variance, random‐effects model was performed. Results Of 2750 studies screened, 11 articles with 471 unique patients were included. Patients with CRS exhibit worse gustatory function compared to healthy controls (standardized mean difference 0.94 [95% CI, 0.44–1.45]). Hypogeusia was identified in 32/95 (33.7%) patients from three studies that used methods with a validated definition of hypogeusia. Older age, male gender, and smoking history were associated with taste dysfunction, while objective gustatory and olfactory dysfunction were not correlated. Subjective taste and quality of life measures were also not associated with objective taste. The impact of sinus surgery on objective taste is unclear. Conclusion Approximately 34% of patients with CRS experience hypogeusia. Neither olfactory function nor subjective taste were associated with objective gustatory function. Given the substantial prevalence of taste dysfunction patients with CRS, there is significant potential for growth in understanding of pathogenesis, impact on quality of life, and potential treatment strategies of taste impairment in the CRS patient population. Level of Evidence 1 Laryngoscope, 131:482–489, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma

xlomafota13 shared this article with you from Inoreader Embolization of Internal Carotid Artery Branches in Juvenile Nasopharyngeal Angiofibroma Via The Laryngoscope Objective Preoperative embolization of juvenile nasopharyngeal angiofibroma (JNA) is usually performed by the occlusion of branches of the external carotid artery (ECA). However, a significant proportion of JNAs also receive blood from the internal carotid artery (ICA). The objective of this study was to report on the feasibility and clinical impact of superselective embolization of ICA branches in complex cases of JNA. Methods This was a single‐center retrospective study of all patients operated on for JNA between 2000 and 2018. The patients treated with embolization of branches of the ICA were identified. The results in terms of complications, intraoperative blood loss, and rate of residual disease were analyzed and compared to those of a control group of patients treated only with embolization of ECA branches and matched by age, stage, angiographic pattern, surgical approach, and previous surgery. Results Ninety‐two patients were included. Embolization of branches of the ICA was attempted in 14 cases of advanced or recurrent tumors and was ultimately possible in nine cases. There were no complications after embolization. The mean intraoperative blood loss was 1428 mL. Residual disease was found in three cases (33%). There was no significant difference compared with the control group (mean intraoperative blood loss = 1355 mL, residual disease = 4 (44%); all P > .05). Conclusion In this retrospective study, we report the feasibility of superselective embolization of ICA branches in selected cases of JNA. There was no observed benefit of this technique in terms of intraoperative bleeding or decreased risk of residual disease. Level of Evidence 4 Laryngoscope, 131:E775–E780, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative Fluorescence‐Guided Surgery in Head and Neck Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Intraoperative Fluorescence‐Guided Surgery in Head and Neck Squamous Cell Carcinoma Via The Laryngoscope The rate of positive margins in head and neck cancers has remained stagnant over the past three decades and is consistently associated with poor overall survival. This suggests that significant improvements must be made intraoperatively to ensure negative margins. We discuss the important role of fluorescence imaging to guide surgical oncology in head and neck cancer. This review includes a general overview of the principles of fluorescence, available fluorophores used for fluorescence imaging, and specific clinical applications of fluorescence‐guided surgery, as well as challenges and future directions in head and neck surgical oncology. Laryngoscope, 131:529–534, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Rare Cause of Extremely Loud Expiratory Stridor in a 11‐Year‐Old Patient

xlomafota13 shared this article with you from Inoreader A Rare Cause of Extremely Loud Expiratory Stridor in a 11‐Year‐Old Patient Via The Laryngoscope Stridor can be a very alarming symptom in children, as it is typically caused by turbulent airflow through a partially obstructed airway, due to an organic cause. An abnormal respiratory sound can induce the suspicion of a life‐threatening clinical condition and requires an immediate diagnostic assessment. The aim of this article is to describe a very peculiar case of loud expiratory stridor, with an abrupt onset and no other associated symptoms, occurring in an 11‐year‐old girl. The stridor sounds ceased only during sleep at night. Videolaryngoscopy demonstrated that the anatomy and patency of the larynx were normal, and expiratory noise was generated by vibration of the supraglottic structures. Voice therapy led to remission of stridor within 3 weeks. To the best of our knowledge, this is the first reported case of expiratory stridor with such striking volume and characteristics related to psychological causes. This peculiar clinical condition need s to be taken into consideration in the differential diagnosis of pediatric stridor to avoid unnecessary and invasive procedures and treatments. Laryngoscope, 131:E929–E931, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Iatrogenic Cholesteatoma Presenting as Neck Mass

xlomafota13 shared this article with you from Inoreader Iatrogenic Cholesteatoma Presenting as Neck Mass Via The Laryngoscope We present a rare iatrogenic cholesteatoma of the neck in a ten year old male four years after tympanomastoidectomy, an entity that to our knowledge has not been published in the literature for over 30 years. Furthermore, we discuss the diagnostic uncertainty of typical magnetic resonance imaging protocols for pediatric neck lesions and the improved diagnostic specificity of diffusion weighted magnetic resonance imaging. En bloc surgical extirpation was performed. Laryngoscope, 131:E882–E884, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chloroquine, Hydroxychloroquine and Hearing Loss: A Study in Systemic Lupus Erythematosus Patients

xlomafota13 shared this article with you from Inoreader Chloroquine, Hydroxychloroquine and Hearing Loss: A Study in Systemic Lupus Erythematosus Patients Via The Laryngoscope Objectives/Hypothesis Antimalarial drugs (chloroquine and hydroxychloroquine) are widely used for the treatment of systemic lupus erythematosus (SLE). However, these drugs may have side effects such as hearing loss. This study aimed to describe the hearing function in SLE patients using antimalarials. Secondarily, this study aimed to investigate whether SLE causes hearing loss and if there are any serological or clinical aspects of this diseases associated with inner ear damage. Study Design Cross‐sectional study. Methods This study included 84 individuals (43 SLE patients and 41 controls) with audiometry and tympanometry tests. Epidemiological, clinical, serological, and treatment profiles of SLE patients were extracted from the charts. Results SLE patients had more sensorineural hearing loss than controls (23.2% vs. 0; P = .001). Pure‐tone averages in SLE patients using antimalarials and not using antimalarials were similar (8.75 vs. 8.75; P = .63). At 8,000 Hz, antimalarial dug nonusers performed worse than users (10.00 vs. 22.50; P = .03). Tympanometry was normal in all participants. SLE serological and clinical profiles in patients with and without hearing loss were the same (all P = nonsignificant). Conclusions There is a high prevalence of hearing loss in SLE that is not affected by antimalarial drug use. Level of Evidence 3b Laryngoscope, 131:E957–E960, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predicting the Premorbid Shape of a Diseased Mandible

xlomafota13 shared this article with you from Inoreader Predicting the Premorbid Shape of a Diseased Mandible Via The Laryngoscope Objectives/Hypothesis Virtual surgical planning (VSP) for reconstructions of advanced mandibular neoplasms that have distorted the contour of the mandible is challenging, as the premorbid shape of the mandible is unknown. We introduce a novel modeling technique, based on a statistical shape model (SSM), that has learned the shape of a normal mandible from a set of 84 mandibles, such that given a diseased mandible, the model can determine its premorbid shape. Methods Eighty‐four control mandibles were used to generate an SSM. Various mandibular defects were created, and the SSM was applied to predict the shape of the original mandible. The predicted and original shape of the defect were compared for accuracy using volumetric overlap and Hausdorff distance. All mandibular VSP cases in the past 2 years were reviewed to identify those that required virtual preprocessing due to significantly distorted mandibular contours. The SSM was compared to those cases requiring preprocessing and highlighted in one prospective VSP. Results The average volumetric overlap and Hausdorff distance between the defect replacement and the defect are 73.9% ± 13.3% and 4.51 mm ± 2.65 mm, respectively. The SSM is more accurate for smaller defects, and those not including the condyle. Ten out of 40 VSP cases required preprocessing using four different techniques. Qualitatively, the SSM outperformed those preprocessing techniques applied in the retrospective cases. Conclusions The SSM can accurately predict the premorbid shape of a distorted mandible and is superior to current preprocessing techniques. The SSM was successfully applied to a retrospective series and one prospective index case. Level of Evidence 4 Laryngoscope, 131:E781–E786, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Modified Posterior Pedicle Middle Turbinate Flap: An Additional Option for Skull Base Resurfacing

xlomafota13 shared this article with you from Inoreader Modified Posterior Pedicle Middle Turbinate Flap: An Additional Option for Skull Base Resurfacing Via The Laryngoscope Objectives/Hypothesis Although the Hadad‐Bassagusteguy flap represents the first choice for middle and posterior skull base reconstruction and coverage of exposed bony areas, in some cases it is unavailable. The aim of this study is to describe, as an alternative option in selected cases, a modified posterior pedicle middle turbinate flap (mPPMTF) extended to the lacrimal area. Anatomical features, step‐by‐step harvesting technique, and surgical applications are presented. Study design Anatomic dissection study and case report. Methods Four mPPMTFs were raised in two fresh‐frozen cadaver heads. A study of the vascular supply and measurements of length, width, and area of the flap were performed. The ability of the flap to cover the ventral skull base, particularly the upper clivus area, was tested. A clinical case in which an mPPMTF was used for clivus resurfacing after osteoradionecrosis is reported. Results The vascular supply of the mPPMTF was identified as the middle turbinate branch of the sphenopalatine artery. The flap had a mean length of 6.92 cm, mean maximum width of 1.08 cm, and mean total area of 5.33 cm2. The flap was able to reach the upper clivus, with a clival coverage ratio of 70.66%. In the clinical case, good surgical outcomes were observed, with accelerated re‐epithelization without complications. Conclusions The mPPMTF represents an alternative to the Hadad‐Bassagusteguy flap for posterior cranial fossa and nasopharynx resurfacing. The main drawbacks are its technically demanding and time‐consuming harvesting. Level of Evidence 4 Laryngoscope, 131:E767–E774, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

An Evaluation of the Presence of Spin in the Abstracts of Tonsillectomy Systematic Reviews

xlomafota13 shared this article with you from Inoreader An Evaluation of the Presence of Spin in the Abstracts of Tonsillectomy Systematic Reviews Via The Laryngoscope Objectives/Hypothesis Spin—the practice of adding or omitting information intentionally or unintentionally to make the results of a study more favorable—may influence clinical decision making, especially when present in study abstracts. Here, we quantify and characterize the presence of spin in the abstracts of systematic reviews regarding tonsillectomy. Methods This study is an analysis of systematic review abstracts. Searches were conducted on September 23, 2019 on PubMed and Embase using the advanced search feature to retrieve systematic reviews regarding tonsillectomies. The nine most severe forms of spin were then evaluated. Spin was classified by two investigators in parallel, with each blinded to the classifications of the other. Study characteristics were also recorded in duplicate. Consensus meetings between investigators were held to resolve disagreements. Results In the 85 included systematic reviews, at least one form of spin was present in 44.7% (38/85) of abstracts. Journals with higher impact factors were less likely to contain spin in the abstracts of systematic reviews (point biserial correlation coefficient of −0.30). No statistically significant associations were found between the presence of spin and intervention type (P = .56) or adherence to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (P = .08); however, there was a significant association between spin and funding source (P = .03). Conclusions Spin was common in the abstracts of our sample of tonsillectomy systematic reviews. Researchers, clinicians, and peer reviewers could benefit from learning to recognize spin in medical literature. Further research is needed into the effects of spin on clinical decision making. Level of Evidence NA Laryngoscope, 131:E727–E731, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Surgical Management in Tracheobronchopathia Osteochondroplastica: A Case Study

xlomafota13 shared this article with you from Inoreader Surgical Management in Tracheobronchopathia Osteochondroplastica: A Case Study Via The Laryngoscope Tracheobronchopathia Osteochondroplastica is a benign condition characterized by osseous and cartilaginous submucosal growths of the tracheobronchial tree. This is a case report of an individual that was to undergo elective surgery using general anesthesia with endotracheal tube intubation. However, the anesthesiologist encountered a large osseous mass of the precricoid region and could not be intubated. This case report describes the technique for removal of the obstructing lesion using a Sonopet ultrasonic aspirator. Laryngoscope, 131:E911–E913, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes

xlomafota13 shared this article with you from Inoreader Clinical Versus Pathologic Laryngeal Cancer Staging and the Impact of Stage Change on Outcomes Via The Laryngoscope Objectives/Hypothesis Evaluate the impact and accuracy of clinical laryngeal cancer staging. Study Design Retrospective cohort study. Methods Two hundred sixty‐five consecutive patients with laryngeal squamous cell carcinoma who underwent total laryngectomy from 2001 to 2017 were studied. Clinical versus pathologic tumor (T) and nodal (N) categories were compared. Logistic regression and Cox proportional hazards analyzed the association of stage change with perioperative factors and outcomes. Results Forty‐seven patients (17.7%, accuracy = 0.969 ± 0.010 [standard error]) changed between T1‐2 and T3‐4. Sixty‐four patients (24.1%, accuracy = 0.866 ± 0.020) had inaccurate N category. Salvage patients were less likely to have stage change (downstage: odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.08‐0.50, P < .001; upstage: OR = 0.41, 95% CI: 0.23‐0.74, P = .003), but more likely to have inaccurate nodal category (39.8% vs. 11.7%, P < .001). Patients with stage change tended to have greater odds of positive/close margins (upstage: OR = 1.78, 95% CI: 0.91‐3.5, P = .092) and chemotherapy (downstage: OR = 2.21, 95% CI: 0.80‐6.14, P = .128; upstage: OR = 1.87, 95% CI: 0.85‐4.11, P = .119). Stage change was associated with recurrence (P = .047) with downstaged patients less likely to recur (hazard ratio = 0.26, 95% CI: 0.08‐0.82, P = .021). Stage change was not associated with positron emission tomography scan, subsite, time to surgery, or mortality. Conclusions A third of laryngeal cancer patients were downstaged or upstaged after laryngectomy with 18% and 24% of clinical T and N categories inaccurate, respectively. Stage change was less common for salvage patients and associated with risk of recurrence. Level of Evidence 3 Laryngoscope, 131:559–565, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.