Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation-Description of Technique and Early Case Series

xlomafota13 shared this article with you from Inoreader Compartmentalization: An Open Technique for Frontal Sinus Repair and Preservation-Description of Technique and Early Case Series Via leak of cerebrospinal fluid J Neurol Surg B Skull Base. 2021 Apr;82(2):189-195. doi: 10.1055/s-0039-1696683. Epub 2019 Sep 12. ABSTRACT Background Cranialization or obliteration is widely accepted intervention for traumatic or intentional breach of the frontal sinus. These techniques, however, result in the loss of frontal sinus function and have a persistent risk of cerebrospinal fluid (CSF) leak and mucocele. Compartmentalization is an open technique for repair of the frontal sinus using allograft onlay and a vascularized periosteal flap that allows for preservation of frontal sinus function. Objective The main objective of this article is to describe the technique for compartmentalization of the frontal sinus and demonstrate its efficacy and complication rate with an early patient series. Methods Our technique includes the following key components: harvesting of a pedicled periosteal flap, frontal sinus repair through a bifrontal craniotomy with minimal mucosa removal, ensuring the patency of the nasal frontal outflow tract, and separation of the brain from the frontal sinus with a dual layer of periosteum and allograft. All cases of frontal sinus repair using the compartmentalization technique at our institution were reviewed. Charts were reviewed for CSF leak, mucocele, and other complications. Results Twenty-three patients underwent the described frontal sinus repair technique 17 for tumor and 6 for trauma. There were no CSF leaks and no mucoceles. One patient experienced postoperative anemia and a "parameningeal reaction" that were managed with a short course of antibiotics. Conclusions Compartmentalization, due to its sinus preservation and low complication rate, represents a meaningful step forward in neurosurgical technique for open frontal sinus repair. However, long-term outcomes are necessary to fully evaluate risk of mucocele. PMID:33777633 | PMC:PMC7987381 | DOI:10.1055/s-0039-1696683 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reconstruct the anterior commissure with intralaryngeal mucosal flap

xlomafota13 shared this article with you from Inoreader Reconstruct the anterior commissure with intralaryngeal mucosal flap Via Clinical Otolaryngology Abstract An anterior glottic web formation occurs from either congenital or acquired causes.1 Acquired anterior glottic web is the most common type of glottic web, and can be caused by surgical, iatrogenic, or external trauma. The severity of clinical symptoms, which include dysphonia or dyspnea, varies significantly according to the extent of the web.2,3 The prevention of glottic web formation is extremely important for surgical intervention on the anterior commissure. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Prognostic Variables Affecting the Frontal Sinusotomy Patency Outcome and How to Manage: A Prospective Study

xlomafota13 shared this article with you from Inoreader The Prognostic Variables Affecting the Frontal Sinusotomy Patency Outcome and How to Manage: A Prospective Study Via Clinical Otolaryngology Abstract Objectives The study aimed to assess the factors affecting the frontal sinus patency after endoscopic frontal sinusotomy. Design A prospective cohort study Setting Tertiary centre hospital Main outcome measures Fifty patients with refractory chronic frontal sinusitis (83 operated frontal sinuses) had frontal sinusotomy and followed up for six months. Multiple operative factors were included; the type of the procedure, intraoperative sinus findings, degree of mucosal preservation, and middle turbinate stability. Other factors were also assessed, including smoking, the presence of allergic rhinitis, asthma, gastroesophageal reflux, and other associated medical comorbidities. Results The sinus patency success rate was 75.9%. There was a significant difference regarding the intraoperative anteroposterior sinus ostium diameter (5.36 ± 1.45 mm vs 8.88 ± 2.38 mm, p‐value: .001* in the failed group and the success group, respectively). There was a significant association between the patency outcome and the presence of associated medical comorbidities (P‐value: .001*), the presence of allergic rhinitis (P‐value: .001*), the degree of sinus mucosal preservation (P‐value: .012*), and the degree of middle turbinate stability (P‐value: .001*). The multivariate analysis showed that the intraoperative anteroposterior diameter of the sinus ostium, middle turbinate stability, and presence of allergic rhinitis were significant predictors (P‐value: .012*, .042*, and .013*, respectively). Conclusion Sinuses with anteroposterior ostium diameters less than 5.36 mm are more susceptible to restenosis. The flail middle turbinate increases the risk of postoperative middle meatus synechia and frontal sinus patency failure. The presence of allergic rhinitis has a negative impact on the patency outcome. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intraoperative botulinum toxin injection for superficial partial parotidectomy: A prospective pilot study

xlomafota13 shared this article with you from Inoreader Intraoperative botulinum toxin injection for superficial partial parotidectomy: A prospective pilot study Via Clinical Otolaryngology Abstract Objectives Sialocele and salivary fistula are not serious but troublesome complications after parotidectomy. Various modalities have been introduced to prevent postoperative saliva‐related complications. However, clinical trials assessing the prophylactic use of botulinum toxin (BTX) for parotidectomy has not been conducted yet. Herein, we report a pilot study investigating the safety and efficacy of intraoperative BTX (iBTX) injection in partial superficial parotidectomy (PSP). Participants Patients with benign parotid tumor were prospectively recruited for this clinical trial from 2017 to 2019. The study participants underwent PSP with iBTX injection. We retrospectively reviewed the clinical information of all the consecutive patients who underwent PSP without iBTX from 2013 to 2019. These patients were divided into the two groups: the iBTX group (n = 36) and the control group (n = 54). Results Permanent facial palsy was not observed in either group. None had transient marginal palsy in the iBTX group but 2 patients (3.7%) had it in the control group. The incidence of sialocele was significantly lower in the iBTX group than in the control group (2.8% vs. 20.4%, P<0.05). Although the incidence of salivary fistula was lower in the iBTX group than in the control group (0% vs. 7.4%), no significant difference was determined between the two groups (P=0.147). Total drainage volume was significantly lower in the iBTX group than in the control group (55.0ml vs. 116.6ml, P<0.001). Conclusions iBTX injection may be safe and effective in reducing sialocele and postoperative drainage in PSP. It might be a useful option to prevent saliva‐related complication after PSP. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary Transoral Robotic Surgery +/‐ Adjuvant Therapy for Oropharyngeal Squamous Cell Carcinoma – a large observational single‐centre series from the United Kingdom

xlomafota13 shared this article with you from Inoreader Primary Transoral Robotic Surgery +/‐ Adjuvant Therapy for Oropharyngeal Squamous Cell Carcinoma – a large observational single‐centre series from the United Kingdom Via Clinical Otolaryngology Abstract Objectives To analyse the oncological outcomes following primary Transoral Robotic Surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). Design Observational case series. Setting Tertiary centre; first TORS practice to commence in the UK. Participants All consecutive patients undergoing primary TORS with curative intent, with or without adjuvant treatment. Main outcome measures Descriptive analysis of patient and tumour pathology variables. Survival outcomes: Overall, Disease‐Specific, Progression‐Free, and Locoregional control. Results The cohort comprised of 120 patients undergoing TORS with minimum 12 month follow up data and the following characteristics: mean age 58 years, 91 males (76%), 78 tonsil (65%) and 34 base of tongue primaries (28%), 89% HPV related OPSCC. The surgical pathology revealed 14 (12%) with positive margins, 19 (16%) had close margins < 2mm and 31% with extranodal extension. The treatment was as follows: 39 (33%) treated with TORS alone, 50 (42%) received adjuvant radiotherapy, and 31 (26%) received adjuvant radiotherapy with chemotherapy. There were 15 recurrences. Estimated survival for all patients at 3 years (95% CI): overall 85% (78‐92), disease‐specific 90% (85‐96), progression‐free 86% (79‐92), locoregional control 90% (84‐96). The equivalent survival figures for the HPV‐related cases alone were: overall 88% (82‐94), disease‐specific 93% (87‐98), progression‐free 88% (81‐95), locoregional control 92% (87‐98). Conclusions Whilst TORS has become a common practice in the management of OPSCC in the UK, these are the first reported oncological outcomes. For selected patients, TORS with or without adjuvant therapy is an appropriate treatment modality. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Nasopharyngeal Carcinoma in Dermatomyositis

xlomafota13 shared this article with you from Inoreader Nasopharyngeal Carcinoma in Dermatomyositis Via Clinical Otolaryngology Abstract The most common cancer associated with dermatomyositis in NPC‐endemic populations is NPC. 90% of dermatomyositis patients with NPC were diagnosed with cancer within a year of myositis onset, whereas the most delayed presentation of NPC occurred 22 months after myositis onset. There was a greater proportion of subclinical early‐stage cancer in NPC associated with dermatomyositis compared to general NPC. Dermatomyositis patients with early‐stage NPC have good survival outcomes while those with advanced‐stage NPC appear to have poorer prognosis compared to general NPC patients. Dermatomyositis patients with anti‐transcription intermediary factor (TIF)‐1ƴ antibodies had a 14.5‐fold higher risk of developing associated cancers compared with seronegative dermatomyositis. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Role of PD‐1/PD‐L1 inhibitors in the treatment of recurrent/metastatic head and neck squamous cell carcinoma: a systematic review and meta‐analysis

xlomafota13 shared this article with you from Inoreader Role of PD‐1/PD‐L1 inhibitors in the treatment of recurrent/metastatic head and neck squamous cell carcinoma: a systematic review and meta‐analysis Via Clinical Otolaryngology Abstract Background The use of immunotherapy to treat recurrent/metastatic squamous cell carcinoma of the head and neck has become a popular research topic in recent years, and many clinical trials have been carried out. Objectives To systematically evaluate the efficacy and safety of PD‐1/PD‐L1 inhibitors in the treatment of recurrent/metastatic head and neck squamous cell carcinoma. Methods We searched PubMed, Embase, Cochrane Library and other databases up to 1 November 2019 for publications reporting the use of PD‐1/PD‐L1 inhibitors in the treatment of squamous cell carcinoma of the head and neck. Revman 5.0 was used for combination analysis, and the overall survival (OS), progression‐free survival (PFS), overall response rate (ORR), and adverse events were determined. Results Five articles were included. Compared with other treatment methods, this meta‐analysis showed that treatment with PD‐1/PD‐L1 inhibitors can significantly improve OS (P < 0.0001), but there was no significant improvement in PFS or ORR. The risk of anaemia and nausea was significantly reduced by treatment with PD‐1/PD‐L1 inhibitors. Conclusions and Significance Treatment with PD‐1/PD‐L1 inhibitors alone can improve the overall survival rate for recurrent/metastatic squamous cell carcinoma of the head and neck but there is no obvious advantage in other aspects and adverse events. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.