Revisions and Complications with Gore‐Tex Medialization Laryngoplasty: A 19‐year Experience

xlomafota13 shared this article with you from Inoreader Revisions and Complications with Gore‐Tex Medialization Laryngoplasty: A 19‐year Experience Via Clinical Otolaryngology Abstract Medialization laryngoplasty, also known as type I thyroplasty is widely accepted as a definitive treatment for paralytic and nonparalytic glottal incompetence. This technique uses material to medialize the vocal fold to restore glottal contact and function. Common materials that are used include Gore‐Tex (expanded polytetrafluoroethylene), silicone, calcium hydroxyapatite and titanium. Gore‐Tex has been in use since the 1970s in vascular surgery and facial reconstruction with good biocompatibility and first described for use as a medialization implant in 1998 by McCulloch and Hoffman.1,2 In a 2010 national survey, the percentage of surgeons using Gore‐Tex increased from 36% to 64% compared to the decrease in surgeons carving Silastic from 76% to 24%.3 Gore‐Tex is increasing in popularity as an implant material because of its pliability, ease of placement and removal, and biocompatibility. Despite the apparent short‐term effectiveness of Gore‐Tex in treating glottal incompetence, there is a lack of long‐term data related to its use reported in the literature. To understand the long‐term effectiveness of Gore‐Tex and its associated complications, we performed a review of cases at our institution over the past 19 years. Materials and Methods The Partners Institutional Review Board approved this retrospective case series (IRB 2109P0002165). Electronic medical record data from consecutive patients who underwent medialization laryngoplasty by the senior author (R.A.F.) between 1 January 2001 and 30 June 2019 at Massachusetts Eye and Ear were reviewed in this study. Patients included were adults (≥18 years old) who underwent medialization laryngoplasty with Gore‐Tex. Exclusion criteria consisted of patients who had an adduction arytenopexy and/or cricothyroid subluxation performed at time of surgery. The study aims included understanding the long‐term effectiveness by analyzing the revision rate and complications associated with Gore‐Tex. The primary outcome measures were revision procedures and complications. The revision procedures were categorized as either a touch‐up injection laryngoplasty or revision surgery and complications included but were not limited to hematoma, dyspnea, implant extrusion, and need f or emergency tracheotomy. The STROCSS (Strengthening the Reporting of Cohort Studies in Surgery) 2019 reporting guideline was followed. Surgical technique Medialization laryngoplasty was performed according to techniques previously described by McCullough and Hoffman1 with the following modifications. Surgery was performed under local anesthesia through an open approach using 1.0 mm thick Gore‐Tex soft tissue patch (W.L. Gore & Associates, Inc., Flagstaff, AZ). The Gore‐Tex patch is cut into a ribbon that is 1cm in width (Figure 1). A thyrotomy window was planned 5‐7 mm from midline and 2‐3 mm from the inferior border of the thyroid cartilage. The sagittal saw with a 1 mm blade was used to create the thyrotomy window (approximately 2 mm by 3 mm). The window should be sufficiently large enough to enable insertion of the Gore‐Tex strip and the manipulating instrument (Figure 2). The inner perichondrium was incised but not removed, to improve precise placement of the implant. The length of Gore‐Tex inserted and unilateral versus bilateral nature of medialization was determined intra‐operatively based on voi ce quality and surgeon preference. Surgical end‐points were based on improved voice quality and medialization of the true vocal fold viewed with a fiberoptic nasolaryngoscope. The technique was not modified during the duration of the study period. Statistical Analysis Preoperative and postoperative data were compared, and all data were analyzed using SPSS Statistics (version 25.0; IBM). The continuous variables were reported as mean with ranges (minimum‐maximum). Categorical variables were reported as numbers (n) and proportions (%). Results: We identified 73 patients who met inclusion and exclusion criteria (Table 1). There were a total of 46 unilateral and 27 bilateral Gore‐Tex cases. The mean duration of follow up was 1303 ± 1445 days (62‐5214). There were 8 patients who were lost to follow‐up. There were no cases of hematoma or need for emergency tracheotomy. In the 3 patients who had revision surgery within 48 hours due to dyspnea, 2 cases were unilateral and 1 case was bilateral. Touch‐up injections were performed in 10/73 patients (13.7%) and revision surgeries were performed in 7 patients (9.6%). The overall complication rate was 11% (8/73 patients): 3 patients experienced dyspnea within 48 hours after Gore‐Tex insertion and 5 patients had delayed Gore‐Tex extrusion (Table 2). There were 2/60 patients with a history of neck radiation in the non‐extrusion group. There were 2/5 with radiation exposure in the extrusion group (P‐value=0.027). There were 1/5 with excessing coughing in the extrusion group and 1/60 in the non‐extrusion group (P‐value=0.149). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nivolumab for recurrent/metastatic hypopharyngeal squamous cell carcinoma in a liver transplant recipient

xlomafota13 shared this article with you from Inoreader Nivolumab for recurrent/metastatic hypopharyngeal squamous cell carcinoma in a liver transplant recipient Via Auris Nasus Larynx Publication date: Available online 18 February 2021 Source: Auris Nasus Larynx Author(s): Takahito Kondo, Shigeyuki Kawachi, Munehide Nakatsugawa, Atsuo Takeda, Naiue Kikawada, Yusuke Aihara, Akira Okimura, Hiroshi Hirano, Yasuo Ogawa, Kiyoaki Tsukahara View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy of Transnasal Endoscopic Fine‐Needle Aspiration Biopsy in Diagnosing Submucosal Nasopharyngeal Carcinoma

xlomafota13 shared this article with you from Inoreader Efficacy of Transnasal Endoscopic Fine‐Needle Aspiration Biopsy in Diagnosing Submucosal Nasopharyngeal Carcinoma Via The Laryngoscope Objectives/Hypothesis The routine practices of examining submucosal lesions are not suitable for deep lesions. Therefore, we evaluated the efficacy of non‐real‐time image‐guided transnasal endoscopic fine‐needle aspiration biopsy (FNAB) in diagnosing nasopharyngeal carcinoma (NPC) with submucosal lesions. Study Design The effectiveness evaluation of diagnostic methods. Methods Fifty suspected NPC patients who failed in conventional biopsies were enrolled in this study. The efficacy, maneuverability, and safety of FNAB in diagnosing these intractable cases were evaluated. Results The definitive diagnostic results of these 50 patients were NPC (34/50, 68.0%), nasopharyngeal necrosis (1/50, 2.0%), nasopharyngeal mucositis (12/50, 24.0%), and other cancers (3/50, 6.0%), respectively. The results of the diagnostic efficacy of FNAB were sensitivity, 89.2%; specificity, 100.0%; positive predictive value, 100.0%; negative predictive value, 76.5%; and accuracy, 92.0%, respectively. The area under the receiver operating characteristic curves was 0.946 (95% confidence interval = 0.884–1.00, P < .001). No severe complications occurred after FNAB. Conclusions FNAB can improve the diagnostic efficiency of NPC occurring in the submucosal space. It can be an additional option for routine nasopharyngeal biopsy and is worthy of clinical application. Level of Evidence 4. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cryosurgical Ablation for Treatment of Rhinitis: Two‐Year Results of a Prospective Multicenter Study

xlomafota13 shared this article with you from Inoreader Cryosurgical Ablation for Treatment of Rhinitis: Two‐Year Results of a Prospective Multicenter Study Via The Laryngoscope Objectives/Hypothesis To assess the long‐term (12–24 months) safety and effectiveness of cryoablation of the posterior nasal nerve as treatment for chronic rhinitis. Study Design A multicenter, prospective, single‐arm clinical study. Methods The study was conducted from February 2017 to April 2020. Study endpoints included change from baseline in the reflective Total Nasal Symptom Score (rTNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), physician assessment of improvement using the Clinical Global Impression–Improvement (CGI–I), and the incidence of treatment‐related adverse events. Results Ninety‐one participants completed the study through the initial 12‐month study period. Sixty‐two participants consented to the long‐term follow‐up with 57 completing the 24‐month follow‐up. Significant improvements in the total rTNSS were reflected in a median change from baseline of −3.0 or −4.0 at all timepoints (P < .001). Greater than 80.0% of participants achieved the minimum clinically important difference (MCID) of improvement by ≥1 point on the rTNSS at all follow‐ups. Total RQLQ scores indicated significant improvement (P < .0001) in quality of life. Over 77% of participants achieved the MCID (≥0.5 points) for the total RQLQ score. According to the CGI–I, ≥83.0% experienced improvement at all but the 12‐month visit (61.9%). One participant experienced two treatment‐related serious adverse events (epistaxis and retained pledget). A total of 29 nonserious treatment‐related AEs were reported in 23 participants; mo st events were transient and resolved with little to no intervention. Conclusions Cryotherapy significantly and clinically improves rhinitis symptoms and quality of life with outcomes that are durable through 24 months after treatment. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopy‐Assisted Transoral Approach to Resect Parapharyngeal Space Tumors: A Systematic Review and Meta‐Analysis

xlomafota13 shared this article with you from Inoreader Endoscopy‐Assisted Transoral Approach to Resect Parapharyngeal Space Tumors: A Systematic Review and Meta‐Analysis Via The Laryngoscope Abstract Objectives By comparing the endoscopy‐assisted transoral approach (EATA) with external approaches (EAs) for the resection of parapharyngeal space tumors (PPSTs), we determined whether the EATA has advantages in terms of operation time, intraoperative bleeding volume, postoperative hospitalization, drainage volume, and complications. At the same time, we summarized the surgical indications for the EATA. Methods Systematic literature retrieval was performed in the PubMed, Web of Science, Embase, CNKI, Wanfang, and CQVIP databases up to February 2020. We calculated the mean difference (MD) with a 95% confidence interval (CI) for continuous outcomes and pooled odds ratio (OR) with 95% CI for dichotomous outcomes. The measured outcomes were operative time, bleeding volume, postoperative hospitalization, drainage volume, and complications. Results Seven studies involving 318 patients were eligible. Of these patients, 145 patients underwent EATA and 173 patients underwent EA surgery. All the former tumors were benign and located medial or anteromedial to the carotid sheath except for the unrecorded tumors. Compared with EAs, the EATA significantly shortened the operation time (MD = −5.56 min, 95% CI: −9.58 to −1.55), shrank the bleeding volume (MD = −89.02 ml, 95% CI: −126.16 to −51.88), shortened the postoperative hospitalization (MD = −2.44 days, 95% CI: −3.37 to −1.51), reduced the drainage volume (MD = −32.97 ml, 95% CI: −36.24 to −29.70), and lowered the incidence of complications (OR = 0.30, 95% CI: 0.16 to 0.59). Conclusion As for PPSTs, with an appropriate and precise patient selection, the EATA is a safe, effective, minimally invasive, and aesthetic surgical modality. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cone-beam computed tomography cinematic rendering: clinical, teaching and research applications

xlomafota13 shared this article with you from Inoreader Cone-beam computed tomography cinematic rendering: clinical, teaching and research applications Via Brazilian Oral Research Abstract Cone-beam computed tomography (CBCT) is an essential imaging method that increases the accuracy of diagnoses, planning and follow-up of endodontic complex cases. Image postprocessing and subsequent visualization relies on software for three-dimensional navigation, and application of indexation tools to provide clinically useful information according to a set of volumetric data. Image postprocessing has a crucial impact on diagnostic quality and various techniques have been employed on computed tomography (CT) and magnetic resonance imaging (MRI) data sets. These include: multiplanar reformations (MPR), maximum intensity projection (MIP) and volume rendering (VR). A recent advance in 3D data visualization is the new cinematic rendering reconstruction method, a technique that generates photorealistic 3D images from conventional CT and MRI data. This review discusses the importance of CBCT cinematic rendering for clinical decision-making, teaching, and research in Endodon tics, and a presents series of cases that illustrate the diagnostic value of 3D cinematic rendering in clinical care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Zervikofaziale Aktinomykose

xlomafota13 shared this article with you from Inoreader Zervikofaziale Aktinomykose Via Laryngo-Rhino-Otologie Laryngorhinootologie DOI: 10.1055/a-1381-8406 Die Aktinomykose ist eine durch grampositive, fakultativ anaerobe Bakterien verursachte Infektionskrankheit, die sich in den meisten Fällen im zervikofazialen Bereich manifestiert und oft einen dentogenen Fokus aufweist. Das klinische Bild reicht vom akuten Abszessgeschehen bis zu chronisch fistulierenden Gewebeprozessen. Eine frühzeitige Diagnose und ein angemessenes therapeutisches Vorgehen mit einer Kombination aus ausgedehnter antibiotischer Behandlung und ggf. chirurgischer Sanierung sind für einen günstigen Krankheitsverlauf entscheidend. In diesem Artikel werden 5 Fälle von Aktinomyzeteninfektionen dargestellt, welche die Vielfalt der klinischen Erscheinungsbilder, die Pro blematik auf dem Weg zur richtigen Diagnose und mögliche Therapieverläufe illustrieren sollen. [...] 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.

Putting the Pieces Back Together Optimizing Function and Appearance after Orbital Surgery

xlomafota13 shared this article with you from Inoreader Putting the Pieces Back Together Optimizing Function and Appearance after Orbital Surgery Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722631 Objectives To describe medical and surgical options and techniques for functional and aesthetic abnormalities after orbital surgery and multidisciplinary approaches that include the orbit. Design A review of current management options in outpatient clinics and ambulatory surgery centers with selected illustrative cases. The rationale for choosing specific medical and surgical interventions will be discussed with a focus on eyelid malposition and double vision. Setting Outpatient clinics and ambulatory surgery centers. Participants Patients with eyelid, orbital, eye muscle, and scalp contour abnormalities as a result of medical and surgical interventions for brain and/or orbital tumors. Main Outcome Measures Descriptive outcomes. Results A variety of medical and surgical options are available to optimize eyelid, orbit, extraocular muscle, and scalp structure and function. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full t ext View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach”

xlomafota13 shared this article with you from Inoreader Cerebellopontine Angle Epidermoids: Comparative Results of Microscopic and Endoscopic Excision Using the Retromastoid Approach" Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722713 Background Densely packed neurovascular structures, often times inseparable capsular adhesions and sometimes a multicompartmental tumor extension, make surgical excision of cerebellopontine angle epidermoids (CPEs) a challenging task. A simultaneous or an exclusive endoscopic visualization has added a new dimension to the classical microscopic approaches to these tumors recently. Method Eighty-six patients (age: 31.6 ± 11.7 years, M:F = 1:1) were included. Nineteen patients (22.1%) had a multicompartmental tumor. Tumor extension was classified into five subtypes. Sixty-two patients underwent a pure microscopic approach (72%) out of which 10 patients (16%) underwent an endoscope-assisted surgery (11.6%) and 24 patients (28%) underwent an endoscope-controlled excision. Surgical outcomes were retrospectively analyzed. Results Headache (53.4%), hearing loss (46.5%), and trigeminal neuralgia (41.8%) were the leading symptoms. Interestingly, 21% of the patients had at least one preexisting cranial nerve deficit. Endoscopic assistance helped in removing an unseen tumor lobule in 3 of 10 patients (30%). Pure endoscopic approach significantly reduced the hospital stay from 9.2 to 7.3 days (p = 0.012), and had a statistically insignificant yet a clearly noticeable lesser incidence of subtotal tumor excision (0 vs. 10%, p = 0.18) with comparable cranial nerve deficits but with a higher postoperative cerebrospinal fluid (CSF) leak rate (29% vs. 4.8%, p = 0.004). Conclusion Endoscope assistance in CPE surgery is a useful addition to conventional microscopic retromastoid approach. Pure endoscopic excision in CPE is feasible, associated with a lesser duration of hospital stay, better extent of excision in selected cases, and it has a comparable cranial nerve morbidity profile albeit with a higher rate of CSF leak. [...] 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.

Reconstructive Outcomes of Multilayered Closure of Large Skull Base Dural Defects Following Open Anterior Craniofacial Resection

xlomafota13 shared this article with you from Inoreader Reconstructive Outcomes of Multilayered Closure of Large Skull Base Dural Defects Following Open Anterior Craniofacial Resection Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0041-1722899 Background Standardized reconstruction protocols for large open anterior skull base defects with dural resection are not well described. Here we report the outcomes and technique of a multilayered reconstructive algorithm utilizing local tissue, dural graft matrix, and microvascular free tissue transfer (MVFTT) for reconstruction of these deformities. Design This study is a retrospective review. Results Eleven patients (82% males) met inclusion criteria, with five (45%) having concurrent orbital exenteration and eight (73%) requiring maxillectomy. All patients required dural resection with or without intracranial tumor resection, with the average dural defect being 36.0 ± 25.9 cm2. Dural graft matrices and pericranial flaps were used for primary reconstruction of the dural defects, which were then reinforced with free fascia or muscle overlay by means of MVFTT. Eight (73%) patients underwent anterolateral thigh MVFTT, with the radial forearm, fibula, and vastus lateralis comprising the remainder. Average total surgical time of tumor resection and reconstruction was 14.9 ± 3.8 hours, with median length of hospitalization being 10 days (IQR: 9.5, 14). Continuous cerebrospinal fluid drainage through a lumber drain was utilized in 10 (91%) patients perioperatively, with an average length of indwelling drain of 5 days. Postoperative complications occurre d in two (18%) patients who developed asymptomatic pneumocephalus that resolved with high-flow oxygen therapy. Conclusion A standardized multilayered closure technique of dural graft matrix, pericranial flap, and MVFTT overlay in the reconstruction of large open anterior craniofacial dural defects can assist the reconstructive team in approaching these complex deformities and may help prevent postoperative complications. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  | &nb sp;Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pathological Spectrum of Dura-Based Nonmeningothelial Lesions: 5 Years' Experience from a Tertiary Care Centre

xlomafota13 shared this article with you from Inoreader Pathological Spectrum of Dura-Based Nonmeningothelial Lesions: 5 Years' Experience from a Tertiary Care Centre Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1721817 Introduction Nonmeningothelial lesions arising from the dura comprise a wide spectrum of pathologies ranging from neoplastic to infective etiologies. They have overlapping clinical and radiologic findings necessitating histopathological evaluation for the final diagnosis which in turn dictates management and prognosis. Therapeutic strategies are different for each of the lesion. There is scarcity of large case series detailing clinicopathological spectrum of dura-based nonmeningothelial lesions. Materials and Methods In this study, we analyzed the neuropathological spectrum of dura-based nonmeningothelial lesions diagnosed over a period of 5 years in our tertiary care center. Results There were 79 cases of dura-based nonmeningothelial lesions constituting 7.3% of all dura-based lesions (age range: 2–75 years; M:F = 2:3). Basal region was more frequently involved than the convexities. On histopathology, neoplastic lesions predominated (92.4%) and included in order of frequency solitary fibrous tumor/hemangiopericytoma (35.6%), gliomas (27.4%), metastasis (27.4%), mesenchymal tumors (4%), primitive neuroectodermal tumor (2.73%), and medulloblastoma (2.73%). Infective lesions were less frequent (7.6%), included fungal infections and Rosai-Dorfman disease. Conclusion Awareness of the spectrum of nonmeningothelial dural lesions is useful for pathologists as well as the treating surgeon. [...] 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.