Endoscopic Muscle Repair of Right Internal Carotid Artery Rupture Following Endovascular Procedure

xlomafota13 shared this article with you from Inoreader Endoscopic Muscle Repair of Right Internal Carotid Artery Rupture Following Endovascular Procedure Via The Laryngoscope Carotid artery blowout syndrome (CBS) is a deadly complication usually linked to head and neck cancer therapy. We present a different etiology of endoscopic CBS, a complication of endovascular coiling of an intracranial aneurysm, treated with sternocleidomastoid (SCM) muscle graft packing. Case Presentation: An otherwise healthy 55‐year‐old female presented to the emergency room with right‐sided painless vision loss of 23 days. Computed tomography angiography demonstrated a right ophthalmic ICA aneurysm eroding into the right sphenoid sinus with optic nerve compression. Attempted endovascular repair of the aneurysm was complicated by ICA rupture into the sphenoid. An endovascular balloon was inflated proximal to the aneurysm to reduce hemorrhage as ENT performed an endoscopic sphenoidotomy. A hematoma was seen overlying the aneurysm in the superior lateral sphenoid sinus. Layers of SCM muscle were morselized and packed serially. Post‐repair angiography showed no further extravasation. Aggressive antiplatelet therapy was initiated. Packing was removed after 14 days. Twenty days postoperatively, the patient had profuse left‐sided epistaxis requiring a left sphenopalatine artery ligation. The patient's vision recovered. Discussion: Whereas CBS is often managed by endovascular coil embolism, in our case CBS was caused by this very treatment itself. This case shows the use of SCM muscle graft as an effective repair modality of ICA rupture due to endovascular coiling. Laryngoscope, 131:E764–E766, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Regarding Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy

xlomafota13 shared this article with you from Inoreader Regarding Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Proximal Airway Is a Reservoir for Adaptive Immunologic Memory in Idiopathic Subglottic Stenosis

xlomafota13 shared this article with you from Inoreader The Proximal Airway Is a Reservoir for Adaptive Immunologic Memory in Idiopathic Subglottic Stenosis Via The Laryngoscope Objectives/Hypothesis Characterization of the localized adaptive immune response in the airway scar of patients with idiopathic subglottic stenosis (iSGS). Study Design Basic Science. Methods Utilizing 36 patients with subglottic stenosis (25 idiopathic subglottic stenosis [iSGS], 10 iatrogenic post‐intubation stenosis [iLTS], and one granulomatosis with polyangiitis [GPA]) we applied immunohistochemical and immunologic techniques coupled with RNA sequencing. Results iSGS, iLTS, and GPA demonstrate a significant immune infiltrate in the subglottic scar consisting of adaptive cell subsets (T cells along with dendritic cells). Interrogation of T cell subtypes showed significantly more CD69+ CD103+ CD8+ tissue resident memory T cells (TRM) in the iSGS airway scar than iLTS specimens (iSGS vs. iLTS; 50% vs. 28%, P = .0065). Additionally, subglottic CD8+ clones possessed T‐cell receptor (TCR) sequences with known antigen specificity for viral and intracellular pathogens. Conclusions The human subglottis is significantly enriched for CD8+ tissue resident memory T cells in iSGS, which possess TCR sequences proven to recognize viral and intracellular pathogens. These results inform our understanding of iSGS, provide a direction for future discovery, and demonstrate immunologic function in the human proximal airway. Laryngoscope, 131:610–617, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery

xlomafota13 shared this article with you from Inoreader Tolerance of Continuous Positive Airway Pressure After Sinonasal Surgery Via The Laryngoscope Objectives/Hypothesis For patients with obstructive sleep apnea (OSA) undergoing sinonasal surgery, there is a lack of consensus on the risk and appropriate postoperative use of continuous positive airway pressure (CPAP). The aim of this study was to assess the tolerability of restarting CPAP on postoperative day one. Study Design Prospective cohort study. Methods A prospective study on patients with OSA on CPAP who required a septoplasty/turbinectomy and/or functional endoscopic sinus surgery (FESS) was performed. Data from the memory card of a patient's CPAP machine and subjective information were obtained on the day of surgery and at scheduled follow‐up visits. All subjects were instructed to restart CPAP on the first postoperative night. Results A total of 14 patients were analyzed; nine underwent FESS and five had a septoplasty/turbinectomy. There were no postoperative complications encountered. The only significant change in the first postoperative week was a reduction in the percentage of nights used over 4 hours (P < .05). By the third postoperative visit, average 22‐item Sino‐Nasal Outcome Test, Nasal Obstruction Symptom Evaluation, and CPAP tolerance scores improved from preoperative values. CPAP pressures, residual apnea–hypopnea index, and number of hours and mean percentage of nights used remained stable throughout the study period. Conclusions Both quality‐of‐life and CPAP outcomes improved or remained the same when restarting CPAP immediately postoperatively. Combined with a lack of significant complications, this study suggests that CPAP is well‐tolerated when restarted the day after a septoplasty/turbinectomy or FESS. Level of Evidence 4 Laryngoscope, 131:E1013–E1018, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Differentiated Thyroid Cancer: The Role of ATA Nodal Risk Factors in N1b Patients

xlomafota13 shared this article with you from Inoreader Differentiated Thyroid Cancer: The Role of ATA Nodal Risk Factors in N1b Patients Via The Laryngoscope Objectives/Hypothesis Nodal involvement is frequent in patients with differentiated thyroid cancers (DTCs), but its prognostic relevance is not univocal. Some characteristics of nodal metastases can increase the risk of recurrence. We attempted to quantify the impact on survival of nodal factors included in the American Thyroid Association (ATA) risk stratification system in N1b patients with DTC. Study Design Retrospective study. Methods A retrospective analysis of patients affected by DTC who underwent therapeutic lateral neck dissection (ND) was performed. The impact on the prognosis of the number of positive lymph nodes (LNs), dimension of nodal metastasis, and microscopic and macroscopic extranodal extension (miENE and maENE, respectively) was investigated. Results The study included 347 N1b patients who underwent 401 therapeutic lateral NDs. Mean number of positive LNs was nine, mean nodal ratio was 0.27, and mean diameter of metastasis was 15.5 mm. ENE was detected in 25.9% of patients (22.5% miENE and 3.5% maENE). In univariate analysis, the presence of maENE had an impact on disease specific survival (DSS) (P = .023); increasing number of positive LNs affected DSS and locoregional control (LRC) (P = .009 and =.006, respectively); increasing metastatic node dimension was a risk factors for overall survival, DSS, and metastases free survival (MFS) (P = .05, =.013 and =.016). In multivariate analysis, number of positive LNs and LN dimension were independent risk factors for LRC and MFS, respectively (HR 1.1, P = .028; HR 1.1, P = .026). Conclusions In our analysis on a cohort of N1b patients, the number of positive LNs and LN dimension were confirmed as independent risk factors for locoregional and distant recurrence, respectively. Level of Evidence 4 Laryngoscope, 131:E1029–E1034, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Transoral Versus Endoscopic Examination in Predicting Outcomes of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Transoral Versus Endoscopic Examination in Predicting Outcomes of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea Via The Laryngoscope Objectives/Hypothesis To examine the correlation between transoral and awake endoscopic examination and investigate their respective ability to predict outcomes of hypoglossal nerve stimulation (HGNS). Study Design Retrospective cohort study at a US medical center. Methods Subjects were adults with apnea‐hypopnea index (AHI) >15 events/hr who underwent HGNS according to standard indications. Eligible subjects had diagnostic preoperative sleep studies, full‐night efficacy postoperative studies, as well as postoperative video recordings of transoral examination and awake endoscopy. Recordings were independently scored by two blinded reviewers. Cohen's κ coefficient, Student t test, and χ2 analyses were performed. Results Fifty‐seven patients met all inclusion criteria. On average, patients were Caucasian, middle aged, and overweight. The mean preoperative AHI was 36.7 events/hr, which improved significantly to 18.3 events/hr following HGNS (P < .01). Overall, the response rate (defined as AHI reduction >50% and AHI < 20 events/hr) was 49%. There was slight correlation between transoral tongue protrusion and endoscopic tongue base movement (κ = 0.10). On transoral examination, patients with minimal/moderate tongue motion achieved a greater mean AHI reduction than patients with full motion (26.0 ± 18.0 vs. 12.8 ± 24.1, P = .02). In contrast, on awake endoscopy, patients with minimal/moderate tongue motion achieved a lesser mean AHI reduction than patients with full motion (8.7 ± 19.9 vs. 22.1 ± 22.7, P = .04). Conclusions Transoral tongue protrusion bears an inverse relationship to HGNS success and correlates poorly with endoscopic tongue base movement. Endoscopic tongue base motion appears reflective of response to HGNS, with greater motion corresponding to greater AHI reduction. Level of Evidence 4 Laryngoscope, 131:675–679, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly

xlomafota13 shared this article with you from Inoreader Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases Via The Laryngoscope Objective To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA‐CS). Methods Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA‐CS at a tertiary care center between August 2013 and January 2020. An age‐matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. Results Cochlear implant surgery under LA‐CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA‐CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake‐up from anesthesia was required in one patient (1%) from the LA‐CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA‐CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA‐CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). Conclusion Cochlear implant surgery under LA‐CS offers many benefits and is a safe, feasible, and cost‐effective alternative to GA when performed by experienced CI surgeons. Level of Evidence 3 Laryngoscope, 131:E946–E951, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Practical Guide for Identification of Internal Carotid Artery During Endoscopic Nasopharyngectomy

xlomafota13 shared this article with you from Inoreader Practical Guide for Identification of Internal Carotid Artery During Endoscopic Nasopharyngectomy Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Application of the Spider Limb Positioner to Subscapular System Free Flaps

xlomafota13 shared this article with you from Inoreader Application of the Spider Limb Positioner to Subscapular System Free Flaps Via The Laryngoscope Objective To demonstrate the application and surgical time savings of the Spider Limb Positioner for subscapular system free flaps in head and neck reconstructive surgery. Methods Single institution retrospective chart review and analysis of patients between 2011 and 2019 that underwent a subscapular system free flap either with or without use of the Spider Limb Positioner. One hundred five patients in total were reviewed with 53 patients in the Spider group. The surgical times were compared between the two groups. Patient‐specific information regarding average age, laterality of donor site, recipient site, gender, and flap type were reviewed. Results Forty‐one patients in both groups underwent a latissimus free flap. Twelve of 53 in the Spider group and 11/52 in the control group underwent a scapula free flap. The average age in the Spider group at the time of surgery was 64 years. The recipient sites for the Spider groups were reviewed. The free flap was ipsilateral to the defect in 81% of cases. The mean surgical time for the 105 patients without the Spider was 568 minutes versus 486 minutes with a Spider P‐value of .003478. Conclusion Use of the Spider Limb Positioner allows for a simultaneous two‐team approach during free flap elevation of the subscapular system, which eliminates both dependence on an assistant to support the arm and time consuming positioning changes during flap elevation. Level of Evidence 3 Laryngoscope, 131:525–528, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery

xlomafota13 shared this article with you from Inoreader Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery Via The Laryngoscope Objective Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. Study Design Case Series. Methods The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. Results A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m2. Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO2 was 50 mmHg, and median minimum SpO2 was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO2 of 0.844 mmHg/min of apneic time. Conclusions THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non‐laser surgery in appropriately selected patients. To ensure safety, back‐up plans such as jet ventilation and microlaryngeal ETT should be available. Level of Evidence 4 Laryngoscope, 131:587–591, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy

xlomafota13 shared this article with you from Inoreader In Reference to Chronic Cerebrospinal Venous Insufficiency and Meniere's Disease: Interventional Versus Medical Therapy Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Fetoscopic Balloon Dilation and Cricotracheal Resection for Laryngeal Atresia in CHAOS

xlomafota13 shared this article with you from Inoreader Fetoscopic Balloon Dilation and Cricotracheal Resection for Laryngeal Atresia in CHAOS Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.