Pain Management Following Otological Surgery: A Prospective Study of Different Strategies

xlomafota13 shared this article with you from Inoreader Pain Management Following Otological Surgery: A Prospective Study of Different Strategies Via The Laryngoscope Objectives The aim of this study was to prospectively assess pain and associated analgesic consumption after otological surgery comparing two prescription patterns. Study Design A prospective nonrandomized consecutive cohort study. Methods 125 adult patients undergoing ambulatory otologic surgery-cochlear implantation and endaural middle ear surgery, were assigned (according to surgeon's preference) and prospectively studied in two arms: 1) acetaminophen 500 mg + ibuprofen 400 mg; 2) acetaminophen 500 mg + codeine 30 mg. Pain levels, medication dose, disposal patterns of opioids, and suspected side effects were evaluated. Results All patients reported mild to moderate pain. There was a statistically significant reduction of pain from day to day, which was on average 0.26 lower than the day before. Sufficient pain control could be achieved with both drug regimens with no significant difference in pain levels. Only 50% of patients who were prescribed opioids used them. Additionally, the median tablet intake was 3 tablets while 10 to 20 tablets were prescribed. The majority of patients (97%) did not dispose of these drugs safely. Conclusion Adequate analgesia was achieved in both arms of this study. Pain control following otologic surgery with a combination of acetaminophen and nonsteroidal anti-inflammatory drugs is recommended unless contraindications or chronic opioid use are present. If opioids such as codeine (30 mg) are prescribed, the amount should be reduced as low as possible, such as five tablets, based on our studied population. Level of Evidence Level 3—a prospective nonrandomized consecutive cohort study Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy: Efficacy of the pretreatment Geriatric Nutritional Risk Index for predicting severe adverse events

xlomafota13 shared this article with you from Inoreader Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy: Efficacy of the pretreatment Geriatric Nutritional Risk Index for predicting severe adverse events Via Auris Nasus Larynx Publication date: Available online 9 September 2021 Source: Auris Nasus Larynx Author(s): Masahiro Nakayama, Kayoko Ohnishi, Masahiro Adachi, Rieko Ii, Shin Matsumoto, Masatoshi Nakamura, Hidetaka Miyamoto, Yuki Hirose, Bungo Nishimura, Shuho Tanaka, Tetsuro Wada, Keiji Tabuchi View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Recurrent Giant Mucoepidermoid Carcinoma of the Parotid: A Case Report and Review of Literature

xlomafota13 shared this article with you from Inoreader Recurrent Giant Mucoepidermoid Carcinoma of the Parotid: A Case Report and Review of Literature Via Otolaryngology Indian Abstract Mucoepidermoid carcinoma is the most common salivary gland malignancy and about one third occurs in the parotid gland. The peak incidence is commonly seen between the third and fifth decades of life. It routinely presents as a fixed, painless mass below the ear. However, its presentation as a giant mass is exceedingly rare. Here, we report a case of a recurrent giant exophytic mucoepidermoid carcinoma in a young male. He underwent Revision Total Parotidectomy with Modified Radical neck dissection with Sural nerve grafting and an Anterolateral thigh flap reconstruction followed by Adjuvant radiotherapy. The rarity of the clinical presentation and the management challenges faced in a young male are being discussed in this case report. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neck Mass in an Adolescent

xlomafota13 shared this article with you from Inoreader Message: Neck Mass in an Adolescent Saikrishna C. Gourishetti, MD1; Jamie Hittman, MD2; Kevin D. Pereira, MD, MS1,3 Author Affiliations 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Maryland School of Medicine, Baltimore 2Department of Pathology, University of Maryland School of Medicine, Baltimore 3Department of Pediatrics, University of Maryland School of Medicine, Baltimore JAMA Otolaryngol Head Neck Surg. Published online September 9, 2021. doi:10.1001/jamaoto.2021.2314 Full Text A 13-year-old male presented to the pediatric otolaryngology clinic with a 2-year history of a right neck mass that had slowly increased in size. He denied any associated symptoms of pain, fevers, chills, malaise, night sweats, unintentional weight loss, prior history of neck masses, recent upper respiratory tract infections, or skin lesions. He was the product of a full-term pregnancy with up-to-date immunizations. Physical examination revealed a 2.5-cm firm, ovoid, mobile, and nontender mass at the apex of the posterior triangle of the right neck without any associated overlying skin changes. The remainder of the head and neck examination was unremarkable. Doppler ultrasonography revealed a 1.9 × 1.8 × 0.9-cm hypoechoic mass, and subsequent fine-needle aspirates demonstrated cells with elongated nuclei and eccentric blue cytoplasm in a background of myxoid stroma. The mass was excised in entirety without issue. At the time of surgery, the deep surface of the mass was foun d to be adherent to the sternocleidomastoid muscle. The lesion was resected with a cuff of muscle and sent for permanent histopathological examination. This revealed proliferation of bland spindle cells with plump nuclei and eosinophilic cytoplasm arranged as loose fascicles in a background of myxoid stroma (Figure 1). These cells were positive for mucin 4 (MUC4), epithelial membrane antigen (EMA), and transducing-like enhancer of split 1 (TLE1) immunohistochemical stains. Fluorescence in situ hybridization (FISH) revealed a positive FUS (16p11) gene rearrangement. Neck Mass in an Adolescent Via JAMA Otolaryngology–Head & Neck Surgery Online First This case report describes a 13-year-old male who presented with a 2-year history of a right neck mass that had slowly increased in size. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Message: Do children with nonsevere obstructive sleep apnea experience resolution of nocturnal enuresis after adenotonsillectomy? Findings In this econdary analysis of a randomized clinical trial including 393 of the 453 totally enrolled children, those with nonsevere obstructive sleep apnea, those who underwent adenotonsillectomy were more likely to experience resolution of nocturnal enuresis compared with children who did not receive surgery. Nocturnal enuresis was less frequent in girls; other clinical factors, such as age, obesity, and severity of sleep apnea, were not associated with improvement of nocturnal enuresis. Meaning The findings of this study suggest that it may be useful for clinicians to inquire about nocturnal enuresis in children with obstructive sleep apnea and counsel caregivers on the potential benefit associated with adenotonsillectomy. Abstract Importance Children with obstructive sleep apnea (OSA) are at increased risk for nocturnal enuresis (NE). However, randomized clinical trials assessing NE outcomes in children randomized to adenotonsillectomy (AT) vs watchful waiting are lacking. Objective To assess the outcomes of AT vs watchful waiting in children with nonsevere OSA who experience NE. Design, Setting, and Participants Secondary analysis of data from a multicenter randomized clinical trial conducted at tertiary children's hospitals was performed. Participants included 453 children aged 5.0 to 9.9 years with nonsevere OSA who were randomized to either watchful waiting or AT as part of the multicenter Childhood Adenotonsillectomy Trial. Caregivers completed the Pediatric Sleep Questionnaire, which includes a binary item on bed-wetting, at baseline and 7-month follow-up. The trial was conducted between October 2007 and June 2012. Evaluation in this secondary analysis involving NE occurred from October 2019 to March 2021. Interventions Adenotonsillectomy vs watchful waiting in children with NE. Main Outcomes and Measures Prevalence of NE as defined by parental response to the Pediatric Sleep Questionnaire bed-wetting item at baseline and 7-month follow-up. Results Of the 453 children enrolled, 393 were included in analysis; of these, 201 were girls (51.1%). Mean (SD) age at baseline was 6.54 (1.40) years. At baseline, the number of children with NE was similar (2.6%; 95% CI, −0.12% to 0.07%) between the AT (59 [30.7%]) and watchful-waiting (67 [33.3%]) groups. The odds of NE in the watchful-waiting group were approximately 2 times higher than the AT group after 7 months (odds ratio, 2.0; 95% CI, 1.3 to 3.1). Following AT, there was a decrease (−11.0%; 95% CI, −16.3% to −5.7%) in the number of children with NE (n = 38). The prevalence of NE did not change significantly (−0.5%; 95% CI, −5.4% to 6.4%) in the watchful-waiting group (n = 66) at follow-up. Although NE was less frequent in girls (adjusted odds ratio, 0.53; 95% CI, 0.33-0.85), other clinical factors, such as age, race and ethnicity, obesity, and apnea-hypopnea index, were not associated with improvement of NE. Conclusions and Relevance In this secondary analysis of a randomized clinical trial, AT for the treatment of pediatric OSA appears to result in improvement in NE. Further research is needed to assess whether AT is associated with long-term benefits for NE compared with watchful waiting. Trial Registration ClinicalTrials.gov Identifier: NCT00560859 Evaluation of Nocturnal Enuresis After Adenotonsillectomy in Children With Obstructive Sleep Apnea Via JAMA Otolaryngology–Head & Neck Surgery Online First This secondary analysis of a randomized clinical trial of children who underwent adenotonsillectomy for nonsevere obstructive sleep apnea evaluates the prevalence of nocturnal enuresis after the operation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nodular Mass in the Earlobe of an 18-Month-Old Girl

xlomafota13 shared this article with you from Inoreader Message: An 18-month-old girl presented with a 1-year history of a slow-growing mass in the right earlobe. There were no symptoms, such as tenderness or discharge, associated with the mass. She had no history of underlying medical disease or trauma. On physical examination, a 1.5 × 1.0–cm, firm, nodular, angulated, pinkish, nontender mass was observed in the posterior aspect of the right earlobe (Figure, A). The skin over the mass was semitransparent, and the mass moved freely beneath the skin. Under suspicion of a tumorous lesion, complete excision was performed after the patient received general anesthesia. Histopathologic findings were characteristic for 2 cell types; basaloid cells with a nucleus were present in the periphery, and ghost cells without a nucleus were present in the center (Figure, B). Six months after surgery, the wound had healed well, and there has been no recurrence. Nodular Mass in the Earlobe of an 18-Month-Old Girl Via JAMA Otolaryngology–Head & Neck Surgery Current Issue An 18-month-old girl presents with a firm, nodular, angulated, pinkish, nontender mass in the posterior aspect of the right earlobe. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pulsatile Tinnitus in a Patient With a Skull Base Lesion

xlomafota13 shared this article with you from Inoreader Message: An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness. Her symptoms were more prominent at night and in the quiet and improved when upright. Physical examination demonstrated an intact tympanic membrane with no middle ear mass; there was no neck mass palpated or bruit auscultated. The patient had further workup with magnetic resonance imaging (MRI) and a computed tomographic scan (Figure 1). The patient was taken to the operating room for a right transtemporal biopsy. Operative findings demonstrated extensive tumor extending along the posterior fossa dura and deep to the jugular foramen that filled the area of the skull base. The tumor was debulked and sent for pathologic evaluation. Pulsatile Tinnitus in a Patient With a Skull Base Lesion Via JAMA Otolaryngology–Head & Neck Surgery Current Issue An 80-year-old woman presented with a 1-year history of right pulsatile tinnitus and aural fullness; her symptoms were more prominent at night and in the quiet and improved when upright. What is your diagnosis? View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Unilateral aberrant anatomy of the hypoglossal nerve

xlomafota13 shared this article with you from Inoreader Unilateral aberrant anatomy of the hypoglossal nerve Via radiol anat Surg Radiol Anat. 2021 Sep 9. doi: 10.1007/s00276-021-02828-0. Online ahead of print. ABSTRACT PURPOSE: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein. METHODS: A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap. RESULTS: A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good re covery and suffered no neurological complications. CONCLUSION: Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity. PMID:34498101 | DOI:10.1007/s00276-021-02828-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas

xlomafota13 shared this article with you from Inoreader Residual Tumor Volume and Tumor Progression after Subtotal Resection and Observation of WHO Grade I Skull Base Meningiomas Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1733974 Objective This study investigated the impact of residual tumor volume (RTV) on tumor progression after subtotal resection and observation of WHO grade I skull base meningiomas. Study Design This study is a retrospective volumetric analysis. Setting This study was conducted at a single institution. Participants Patients who underwent subtotal resection of a WHO grade I skull base meningioma and postsurgical observation (July 1, 2007–July 1, 2017). Main Outcome Measure The main outcome was radiographic tumor progression. Results Sixty patients with residual skull base meningiomas were analyzed. The median (interquartile range) RTV was 1.3 (5.3) cm3. Tumor progression occurred in 23 patients (38.3%) at a mean duration of 28.6 months postsurgery. The 1-, 3-, and 5-year actuarial progression-free survival (PFS) rates were 98.3, 58.6, and 48.7%, respectively. The Cox multivariate analysis identified increasing RTV (p = 0.01) and history of more than 1 previous surgery (p = 0.03) as independent predictors of tumor progression. In a Kaplan–Meier analysis for PFS, the RTV threshold of 3 cm3 maximized log-rank testing significance between groups of patients dichotomized at 0.5 cm3 thresholds (p < 0.01). The 3-year actuarial PFS rates for meningiomas with RTV ≤3 cm3 and >3 cm3 were 76.2 and 32.1%, respectively. When RTV >3 cm3 was entered as a covariate in the Cox model, it was the only factor independently associated with tumor progression (p < 0.01). Conclusion RTV was associated with tumor progression after subtotal resection of WHO grade I skull base meningioma in this cohort. An RTV threshold of 3 cm3 was identified that minimized progression of the residual tumor when gross total resection was not safe or feasible. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.