Relationship between the posterior septal artery and the upper edge of the choana

xlomafota13 shared this article with you from Inoreader Relationship between the posterior septal artery and the upper edge of the choana Via radiol anat Surg Radiol Anat. 2021 Mar 10. doi: 10.1007/s00276-021-02732-7. Online ahead of print. ABSTRACT BACKGROUND: The pedicled nasoseptal flap has been a key element in advancing the endoscopic transnasal approach (ETA) for the treatment of skull base lesions from the anterior cranial fossa to the occipitocervical junction. To preserve vascular supply, an anatomical knowledge of the location of the posterior septal artery (PSA) is essential. The objective of this work is to establ ish the relationship between PSA and the superior edge of the choana to define a safety margin during the opening of the sphenoidal rostrum preserving PSA. METHODS: One hundred and eighty angiotomographies of the brain were assessed. The sphenopalatine artery (SPA) was evaluated in the pterygopalatine fossa and PSA at its entrance into the nasal cavity and on the sphenoidal rostrum. RESULTS: PSA was found in all 3 tomographic planes (axial, coronal and sagittal) in 100 patients (200 PSAs). Thirty-five were male and 65 were females. Average age was 62 years with a range of 19-90 years. Total average distance between PSA and the superior edge of the choana was 8.5 mm with a range of 2.5-18 (12.45 90th percentile). CONCLUSION: Although the distance between the choanal edge and PSA is 8.5 mm on average, due to its variability, a distance of at least 12.45 mm for the opening of the sphenoidal sinus in the ETA approach should be considered as a safety margin. PMID: 33689006 | DOI:10.1007/s00276-021-02732-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis

xlomafota13 shared this article with you from Inoreader Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis 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 Mar 10. doi: 10.1007/s00405-021-06714-8. Online ahead of print. ABSTRACT PURPOSE: In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. METHODS: Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrosp ectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. RESULTS: LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047-66.81; Sensitivity 0.5; Specificity 0.9355). CONCLUSION: Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure. PMID:33689023 | DOI:10.1007/s00405-021-06714-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

One stop neck lump clinic: a boon for quick diagnosis and early management

xlomafota13 shared this article with you from Inoreader One stop neck lump clinic: a boon for quick diagnosis and early management 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 Mar 10. doi: 10.1007/s00405-021-06729-1. Online ahead of print. ABSTRACT INTRODUCTION: One-stop neck lump clinics (OSNLC) are gaining popularity worldwide especially in the UK hospitals following NICE recommendation. The main aim of this speciality clinic is a quick diagnosis and early management while simultaneously improving patient experience. OBJECTIVES: To analyse and compare the efficacy of OSNLC and general ENT/Head and neck clinic with specifics to a number of appointments required for formulating management plan and a number of 'one stop' visits. DESIGN: Retrospective observational study SETTING: Regional Head and Neck Cancer Center (Secondary care hospital) PARTICIPANTS: Patients referred by General practitioner with symptoms of a neck lump MAIN OUTCOME MEASURES: Patients seen in general ENT/Head and neck and OSNLC in 2 phases to understand the difference in a number of appointments , one-stop visits, the requirement of Ultrasound and efficiency of Fine needle aspiration. RESULTS AND CONCLUSIONS: Improved efficacy of OSNLC was noted as patients seen in the clinic required a lesser number of appointments, reached a faster diagnosis and management plan when compared to patients seen in general ENT clinic. PMID:33689020 | DOI:10.1007/s00405-021-06729-1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of tympanic membrane retractions: a systematic review

xlomafota13 shared this article with you from Inoreader Management of tympanic membrane retractions: a systematic review 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 Mar 10. doi: 10.1007/s00405-021-06719-3. Online ahead of print. ABSTRACT IMPORTANCE: Tympanic membrane retraction (TMR) is a relatively common otological finding. However, no consensus on its management exists. We are looking especially for a treatment strategy in the military population who are unable to attend frequent follow-up visits, and who experience relatively more barotrauma at great heights and depths and easily suffer from otitis externa from less hygienic circumstances. OBJECTIVE: To assess and summarize the available evidence for the effectiveness of surgical interventions and watchful waiting policy in patients with a tympanic membrane retraction. EVIDENCE REVIEW: The protocol for this systematic review was published at Prospero (207859). PubMed, Embase, and the Cochrane Database of Systematic Reviews were systematically searched from inception up to September 2020 for published and unpublished studies. We included randomized trials and observational studies that investigated surgical interventions (tympanoplasty, ventilation tube insertion) and wait-and-see policy. The primary outcomes of this study were clinical remission of the tympanic membrane retraction, tympanic membrane perforations and cholesteatoma development. FINDINGS: In total, 27 studies were included, consisting of 1566 patients with TMRs. We included data from 2 randomized controlled trials (76 patients) and 25 observational studies (1490 patients). Seven studies (329 patients) investigated excision of the TMR with and without ventilation tube placement, 3 studies (207 patients) investigated the wait-and-see policy and 17 studies (1030 patients) investigated tympanoplasty for the treatment of TMRs. CONCLUSIONS AND RELEVANCE: This study provides all the studies that have been published on the surgical management and wait-and-policy for tympanic membrane retractions. No high level of evidence comparative studies has been performed. The evidence for the management of tympanic membrane retractions is heterogenous and depends on many factors such as the patient population, location and severity of the TMR and presence of other ear pathologies (e.g., perforation, risk of cholesteatoma and serous otitis media). PMID:33689022 | DOI:10.1007/s00405-021-06719-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intra- and postoperative complications using LigaSure™ Small Jaw in patients undergoing thyroidectomy: a register-based study

xlomafota13 shared this article with you from Inoreader Intra- and postoperative complications using LigaSure™ Small Jaw in patients undergoing thyroidectomy: a register-based study 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 Mar 10. doi: 10.1007/s00405-021-06685-w. Online ahead of print. ABSTRACT PURPOSE: LigaSure™ Small Jaw (LSJ) reduces operation duration and intraoperative blood loss in patients undergoing thyroidectomy. However, the evidence is sparse regarding postoperative complications and among relevant patients subgroups. In a large cohort of patients including relevant patient subgroups, we evaluated intra- and postoperative complications using LSJ. METHODS: Single-centre register-based study evaluating 3346 patients undergoing hemi- or total thyroidectomy. We compared differences in intra- and postoperative complications using LSJ compared to conventional technique. Multivariate analyses were conducted to adjust for potential confounders. RESULTS: Compared to the conventional technique, LSJ was associated with less postoperative drainage (OR 0.4, p = 0.02) and postoperative haemorrhage (OR 0.3, p = 0 .02) among patients undergoing hemi- and total thyroidectomy with benign histology, respectively, but with increased risk of postoperative infection [3 (6.4%) vs. 0 (0.0%) patients, p = 0.04] among patients undergoing total thyroidectomy with malignant histology. LSJ was associated with reduced operation duration (- 12.2 min, p < 0.001, - 7.9 min, p < 0.001 and - 13.2 min, p = 0.002) and intraoperative blood loss (- 52.1 ml, p < 0.001, - 13.6 ml, p < 0.001 and - 12.9 ml, p = 0.02) compared to conventional technique among patients undergoing total and hemithyroidectomy with benign histology and hemithyroidectomy with malignant histology, respectively. CONCLUSION: LSJ was associated with a reduced risk of postoperative haemorrhage and less postoperative drainage but increased risk of postoperative infection depending on the type of thyroidectomy and histology of the thyroid gland. LSJ was associated with only a small reduction in operation duration and intraoperative blood loss. TRIAL REGISTRATION: The study was based on data prospectively registered in the Danish national database THYKIR. PMID:33689021 | DOI:10.1007/s00405-021-06685-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Auditory and imaging markers of atypical enlarged vestibular aqueduct

xlomafota13 shared this article with you from Inoreader Auditory and imaging markers of atypical enlarged vestibular aqueduct 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 Mar 9. doi: 10.1007/s00405-021-06700-0. Online ahead of print. ABSTRACT PURPOSE: To characterize the auditory and imaging markers of atypical enlarged vestibular aqueduct (EVA). METHODS: 15 EVA cases (26 ears) confirmed via high-resolution MRI (HRMRI) that did not meet the Valvassori criterion on high-resolution CT (HRCT) were classified as atypical EVA. Another 21 EVA cases (40 ears) meeting the Valvassori criterion were randomly chosen as typical EVA. The hearing loss (HL), HRCT, and HRMRI findings were compared between the two groups. RESULTS: The difference of HL severity between atypical and typical EVA was not statistically significant (χ2 = 0.12, P > 0.05. The vestibular aqueducts (VA) of atypical EVA cases manifested as borderline dilation (n = 17), focal dilation (n = 3), and normal appearance (n = 6) on the HRCT. The midpoint width of atypical and typical EVA cases wa s 1.06 ± 0.18 mm and 2.10 ± 0.55 mm, respectively, exhibiting a significant difference (t = - 9.20, P < 0.05). In the HRMRI, the degree of dilation and shape of the intraosseous partition of endolymphatic duct and sac (ES) was similar to that of VA on HRCT, while their extraosseous ES was depicted variable slighter dilation compared to that of typical one, the difference between them was statistically significant (t = - 4.10, P < 0.05). CONCLUSION: The HL severity of atypical EVA ears was similar to that of typical ones. Nevertheless, borderline, focal dilation and normal-like appearance of VAs on HRCT and variablely slighter dilation of the extraosseous ES on HRMRI are its characteristic imaging findings. PMID:33687508 | DOI:10.1007/s00405-021-06700-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The role of antibiotics in the surgical management of paediatric obstructive sleep apnoea (OSA): a cohort study

xlomafota13 shared this article with you from Inoreader The role of antibiotics in the surgical management of paediatric obstructive sleep apnoea (OSA): a cohort study 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 Mar 9. doi: 10.1007/s00405-021-06720-w. Online ahead of print. ABSTRACT PURPOSE: Obstructive sleep apnoea (OSA) describes an irregular night-time breathing pattern that is present in approximately 1.8% of children and can have a negative impact on quality of life. The use of antibiotics postoperatively is controversial. They are commonly prescribed; however, they can also be associated with side effects and resistance. This study explores the role of antibiotics in the post-operative management of children with OSA in a cohort of children. METHODS: We conducted a retrospective cohort study of children undergoing surgery for OSA or sleep disordered breathing (SDB) at a tertiary paediatric ENT referral centre from November 2018 to November 2019. RESULTS: This study identified 382 children who had undergone surgical treatment for OSA or sleep disordered breathing (SDB); 319 underwent adenotonsil lectomy, 53 adenoidectomy and 10 tonsillectomies. Antibiotics were given post-operatively to 158 (41%) patients and 18 (11%) of these patients presented to hospital with post-operative complications. A higher number of patients re-presented to hospital from the group who did not receive antibiotics (p = 0.982). Bleeding (p = 0.886) and infection (p = 0.823) were also more common in those children who did not receive antibiotics. CONCLUSION: Antibiotics led to fewer complications and re-presentations to hospital in children undergoing operative management of OSA; however, this trend was not found to be statistically significant. PMID:33687506 | DOI:10.1007/s00405-021-06720-w View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.