Essential inpatient otolaryngology: what COVID-19 has revealed

xlomafota13 shared this article with you from Inoreader Essential inpatient otolaryngology: what COVID-19 has revealed 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 Jul 10. doi: 10.1007/s00405-021-06963-7. Online ahead of print. ABSTRACT PURPOSE: To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. METHODS: Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. RESULTS: The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults-most of which were tracheostomy-related-greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55-92%), whereas there was a dramatic decrease in the proportion of less frequent consults. CONCLUSION: The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis. PMID:34247264 | DOI:10.1007/s00405-021-06963-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis

xlomafota13 shared this article with you from Inoreader Comparison of Conventional and Platelet-Rich Plasma-Assisted Fat Grafting: A Systematic Review and Meta-analysis Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 12:S1748-6815(21)00298-9. doi: 10.1016/j.bjps.2021.05.046. Online ahead of print. ABSTRACT BACKGROUND: Autologous fat grafting (FG) is a popular technique for soft-tissue augmentation, but the fat survival rate is unpredictable. Platelet-rich plasma (PRP) has emerged as an adjuvant to enhance fat graft survival. OBJECTIVES: This literature review and meta-analysis aimed to investigate the effect of PRP on the survival rate of fat grafting. METHODS: A comprehensive systematic literature search was done to identify clinical studies on PRP and fat cotransplantation in PubMed, Cochrane Library, Web of Science, and EMBASE databases up to May 2020. The reference lists of selected articles were reviewed to identify any additional related articles. A meta-analysis was conducted to compare PRP + FG and conventional FG in terms of fat graft survival rate, patient satisfaction rate, and recovery time after surgery. RESULTS: Eleven studies consisting of 1125 patients were analyzed. Patients were followed up from 3 to 24 months post-FG. The fat survival rate varied from 20.5% to 54.8% in FG alone and from 24.1% to 89.2% in the PRP + FG groups. The survival rate was significantly higher and recovery time was significantly lower in the PRP + FG group than in the FG alone group. However, there was no significant difference in the patient satisfaction rate between the groups. CONCLUSIONS: This study demonstrates that PRP-enhanced fat transplantation has better efficacy than conventional fat grafting. Further studies are required to provide the optimum concentration of PRP and the long-term efficacy of the technique. There is not enough evidence to compare the rate of complications with PRP and fat cotransplantation and conventional fat grafting. PMID:34246590 | DOI:10.1016/j.bjps.2021.05.046 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic transpterygoid approach to repair lateral sphenoid recess cerebrospinal fluid leak by multilayered reconstruction

xlomafota13 shared this article with you from Inoreader Endoscopic transpterygoid approach to repair lateral sphenoid recess cerebrospinal fluid leak by multilayered reconstruction Via leak of cerebrospinal fluid Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Jul 7:S1879-7296(21)00146-0. doi: 10.1016/j.anorl.2021.06.010. Online ahead of print. ABSTRACT Cerebrospinal fluid (CSF) leak and encephalocele from the middle cranial fossa into the sphenoid sinus lateral recess (SSLR) is a rare condition. It is often associated with obesity, female sex, well-pneumatized sinus, and prolonged intracranial hypertension. Endoscopic repair has emerged as the mainstay treatment with a success rate increasing to over 90% by refining reconstruction methods and controlling intracranial pressure. Here, we describe how a female with SSLR CSF leak and encephalocele successfully managed with endoscopic transpterygoid approach and multilayered repair. The defect was closed using four indifferent tissues, including the duragen patch, sinus mucosal flaps, the middle turbinate bone, and free mucosa flap, from the inside out. The patient had an uneventful postsurgical course and r emained disease-free during the 9-month follow-up. To conclude, the technique of using sinus mucosal flaps in the context of multilayered reconstruction might be a useful method to repair CSF leak. PMID:34246589 | DOI:10.1016/j.anorl.2021.06.010 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review

xlomafota13 shared this article with you from Inoreader Neuromuscular electrical stimulation for motor recovery in pediatric neurological conditions: a scoping review Via Traditional dysphagia therapy Dev Med Child Neurol. 2021 Jul 11. doi: 10.1111/dmcn.14974. Online ahead of print. ABSTRACT AIM: To explore the breadth of pediatric neurological conditions for which neuromuscular electrical stimulation (NMES) has been studied. METHOD: Databases (PubMed, Google Scholar, Scopus, and Embase) were searched from 2000 to 2020, using the search terms 'neuromuscular electrical stimulation' OR 'functional electrical stimulation' with at least one of the words 'pediatric OR child OR children OR adolescent', and without the words 'dysphagia OR implanted OR enuresis OR constipation'. Articles focused on adults or individuals with cerebral palsy (CP) were excluded. RESULTS: Thirty-five studies met the inclusion criteria, with a total of 353 pediatric participants (293 unique participants; mean age 7y 4mo, range 1wk-38y). NMES was applied in a range of pediatric conditions other than CP, including stroke, spinal cord injury, myelomeningocele, scoliosis, congenital clubfoot, obstetric brachial plexus injury, genetic neuromuscular diseases, and other neuromuscular conditions causing weakness. INTERPRETATION: All 35 studies concluded that NMES was well-tolerated and most studies suggested that NMES could augment traditional therapy methods to improve strength. Outcome measurements were heterogeneous. Further research on NMES with larger, randomized studies will help clarify its potential to improve physiology and mobility in pediatric patients with neuromuscular conditions. PMID:34247385 | DOI:10.1111/dmcn.14974 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial

xlomafota13 shared this article with you from Inoreader Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial Via swallowing exercises Gerontology. 2021 Jul 9:1-10. doi: 10.1159/000516968. Online ahead of print. ABSTRACT INTRODUCTION: Oral frailty describes a trivial decline in the oral function and is considered to be related to frailty. Thus, effective management of oral frailty could prevent or ameliorate physical frailty and the need for care. However, there is a lack of consensus regarding specific interventions for oral frailty. In this cluster-randomized controlled trial, we investigated the effects of a ne wly developed oral frailty measures program mentored by dentists and dental hygienists for elderly people in a clinical setting. METHODS: Of 3,296 participants included in a field survey, 219 who regularly visited dental clinics and met at least 3 of the following 6 criteria for oral frailty were considered eligible: <20 natural teeth, decreased chewing ability, decreased articulatory oral-motor skills, decreased tongue pressure, and substantial subjective difficulties in eating and swallowing. After applying the inclusion and exclusion criteria, we studied 51 patients in the intervention group (14 men and 37 women; mean age, 78.6 years) and 32 patients in the control group (7 men and 25 women; mean age, 78.0 years). We implemented a 12-week oral frailty measures program only for the intervention group. The program included preparatory oral exercises, mouth-opening training, tongue pressure training, prosodic training, and masticatory training. Primary outcome measures were the chewing ability score, articulatory oral motor skill for /ta/, tongue pressure, subjective difficulty in eating tough foods, and subjective difficulty in swallowing. We compared baseline characteristics using the Mann-Whitney U and χ2 tests for continuous and categorical variables, respectively. A repeated-measures two-way ANOVA was used to determine the efficacy of independent intervention variables, following the Wilcoxon signed-rank test. The groups (intervention/control) and time (baseline/week 12) were the independent variables. Oral frailty measures were the dependent variables. RESULTS: Baseline characteristics and assessment results were similar between groups. We observed significant improvements in the intervention group in terms of articulatory oral motor skill for /ta/ and tongue pressure (p < 0.001). No improvements were observed in the control group. DISCUSSION/CONCLUSION: Our results suggest that our oral frailty measures program effectively allev iates oral frailty. Future studies are needed to clarify the impact on preventing physical frailty and improving the nutritional status. PMID:34247160 | DOI:10.1159/000516968 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review

xlomafota13 shared this article with you from Inoreader Radiation-induced swallowing dysfunction in patients with head and neck cancer: A literature review Via swallowing exercises J Formos Med Assoc. 2021 Jul 7:S0929-6646(21)00300-4. doi: 10.1016/j.jfma.2021.06.020. Online ahead of print. ABSTRACT Swallowing dysfunction is a prevailing state following radiotherapy in patients with head and neck cancer. Following the advancement of cancer treatment in recent years, the survival rate of head and neck cancer has gradually increased. Simultaneously, patients with head and neck cancer suffer due to the long-duration and more prominent swallowing dysfunction states . Based on an extensive literature review, we aimed to explore the mechanisms, risk factors, and clinical evaluations of swallowing dysfunction and their related symptoms following radiotherapy. These include functional changes of the muscles, trismus, xerostomia, neuropathy, and lymphedema. When swallowing dysfunction occurs, patients usually seek medical help and are referred for rehabilitation therapy, such as muscle strengthening and tongue resistance exercise. Furthermore, clinicians should discuss with patients how and when to place the feeding tube. Only through detailed evaluation and management can swallowing dysfunction resolve and improve the quality of life of patients with head and neck cancer following radiotherapy. PMID:34246510 | DOI:10.1016/j.jfma.2021.06.020 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The nerve supply to the pectoralis major: An anatomical study and clinical application of the denervation in subpectoral breast implant surgery

xlomafota13 shared this article with you from Inoreader The nerve supply to the pectoralis major: An anatomical study and clinical application of the denervation in subpectoral breast implant surgery Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 13:S1748-6815(21)00314-4. doi: 10.1016/j.bjps.2021.05.055. Online ahead of print. ABSTRACT BACKGROUND: Using the subpectoral approach, animation deformity or breast distortion due to pectoralis muscle contraction is common. Although the anatomy of the pectoral nerves has been extensively studied, only few studies have related the location of these nerves to bony landmarks. OBJECTIVE: Our aim is to clarify the anatomy and possible variations of the innervation of the pectoralis major in relation to bony landmarks useful for surgery and to identify the preferred level for (selective) denervation by 1) transecting the nerves and 2) splitting the muscle in subpectoral breast implant surgery in cadavers. METHODS: Fourteen pectoral regions (both left and right side) were dissected on 7 formaldehyde-fixed cadavers. The origin, locations, and course were mapped and (distances to) landmarks we re reported. RESULTS: The lateral pectoral nerve, medial pectoral nerve, and ansa pectoralis were identified in all cadavers. Nerve branches pierce the pectoralis minor or run along its upper or lower border. The piercing nerves vary from one to three branches and were consistently located lateral to the midclavicular line. The horizontal and vertical distances to bony landmarks varied greatly and depended on the size and location of the pectoralis minor, except for the nerve running along the upper border of the PMin, which was located consistently around 30% of the clavicular line from the acromioclavicular joint to the sternoclavicular joint. CONCLUSION: We were unable to define a fixed landmark to mark pre- or peroperatively. However, we could define guidelines that help to identify and excise or preserve nerves of interest. PMID:34247965 | DOI:10.1016/j.bjps.2021.05.055 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A multivariate analysis after preservation rhinoplasty (PR) - a prospective study

xlomafota13 shared this article with you from Inoreader A multivariate analysis after preservation rhinoplasty (PR) - a prospective study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 17:S1748-6815(21)00333-8. doi: 10.1016/j.bjps.2021.05.073. Online ahead of print. ABSTRACT BACKGROUND: Preservation rhinoplasty (PR) is considered to be an innovative approach with high patient satisfaction. However, little is known about its functional outcomes and radiological analyses. PATIENTS AND METHODS: In this prospective clinical study, 30 patients (20 female and 10 male patients, mean age 30.7 ±9.8 years) were operated on between 2017 and 2021. Radiological assessment was evaluated by cone beam computed tomography before surgery and at final follow-up. Patient assessment regarding their outcome was assessed at final follow-up using a validated questionnaire (rhinoplasty outcomes evaluation questionnaire = ROE). RESULTS: After a mean follow-up of 8.4 ± 5 months (range = 1 - 18 months), radiological analyses denoted an overall improved internal nasal valve (INV) angle after surgery (preoperative = 20.77° ± 3.2° vs. postoperative = 21.82° ± 5.7°, p = 0.18). Those results are in accordance with an overall high patient satisfaction for both function and aesthetics (ROE score 18.4 ± 4.3). CONCLUSION: Our study showed a preserved and widened INV angle after PR, along with high patient satisfaction. LEVEL OF EVIDENCE: III. PMID:34247959 | DOI:10.1016/j.bjps.2021.05.073 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical relationship between distal interosseous membrane thickness measured through magnetic resonance imaging and distal radioulnar joint stability: A retrospective study

xlomafota13 shared this article with you from Inoreader Clinical relationship between distal interosseous membrane thickness measured through magnetic resonance imaging and distal radioulnar joint stability: A retrospective study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 25:S1748-6815(21)00327-2. doi: 10.1016/j.bjps.2021.05.065. Online ahead of print. ABSTRACT BACKGROUND: Cadaveric studies suggest that a thick part of the distal interosseous membrane (DIOM), known as the distal oblique bundle (DOB), contributes to the distal radioulnar joint (DRUJ)'s stability. We hypothesized that the DIOM thickness, measured through magnetic resonance imaging (MRI), has a clinically significant association with DRUJ stability. METHODS: We retrospectively reviewed patients, from February 2018 to April 2019, who underwent wrist MRI examination with physical examination for DRUJ stability. We evaluated the correlation between their MRI findings (i.e., triangular fibrocartilage complex [TFCC] tears and presence of the DOB) and DRUJ instability. RESULTS: Out of 85 patients with an average age of 42 years, 45 (53%) had foveal TFCC tears, 29 (34%) had a DOB, and 38 patient s (45%) had clinical DRUJ instability. Patients with DRUJ instability had a significantly higher incidence of foveal TFCC tears (30/38, vs 15/47, p < 0.001), while DOB was absent (36/38 vs. 20/47, p < 0.001). Among 45 patients with foveal TFCC tears, only 1 out of 13 patients with a DOB had DRUJ instability, whereas 29 out of 32 patients without a DOB had DRUJ instability (p < 0.001). The odds ratio for DRUJ instability was 11.7 (95% CI 2.9-47.5, p = 0.001) for foveal TFCC tear and 54.2 (95% CI 8.2-358.2, p < 0.001) for the absent DOB. CONCLUSIONS: Clinical DRUJ instability was less common when the DOB is present in patients with foveal TFCC tears, which supports DOB's role as a secondary DRUJ stabilizer. PMID:3 4247961 | DOI:10.1016/j.bjps.2021.05.065 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale

xlomafota13 shared this article with you from Inoreader Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 27:S1748-6815(21)00350-8. doi: 10.1016/j.bjps.2021.06.015. Online ahead of print. NO ABSTRACT PMID:34247963 | DOI:10.1016/j.bjps.2021.06.015 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study

xlomafota13 shared this article with you from Inoreader Safety of Reconstructive Microsurgery in the Elderly Population: a Multicentric Prospective Study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 22:S1748-6815(21)00299-0. doi: 10.1016/j.bjps.2021.05.048. Online ahead of print. ABSTRACT BACKGROUND: Safety of reconstructive microsurgery in elderly patients is still a topic of debate, because no conclusive evidence exists that provides indications and risk evaluation in elderly patients. The purpose of this study, which the Italian Society for Plastic, Reconstructive, and Aesthetic Surgery (SICPRE) has promoted, is to evaluate the safety and the complication risk of elective reconstructive microsurgery in elderly patients as well as to identify patient- or procedure-related risk factors. The secondary aim is to evaluate the predictive role for complications of the Geriatric 8 score (G8). METHODS: A total of 194 consecutive patients from 18 centers, aged 65 or older, who received an elective microsurgical flap between April 2018 and April 2019 were prospectively evaluated. Patient-relat ed, treatment-related, and outcomes data were recorded and statistically analyzed through multiple-adjusted logistic regression models. RESULTS: Our study showed an increased risk of complications and a longer hospitalization in patients aged ≥75 years with the American Society of Anesthesiologists (ASA) score ≥3 (or G8 score ≤11) as compared to patients >65 years of age and <75 years of age who undergo reconstruction with a microsurgical flap. Instead, flap survival did not significantly vary with age, but was associated only with ASA score ≥3 (or G8 score ≤11) and surgeries that last longer than 480 min; however, flap survival (92.3%) was slightly lower than that commonly reported for in the general population. CONCLUSIONS: Reconstructive microsurgery in the elderly is generally safe. The ASA score is easier and quicker than the G8 score and equally useful for risk stratification. PMID:34247960 | DOI:10.1016/j.bjps.2021.05.048 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.