Increased salvage rates with early reexploration: A retrospective analysis of 547 free flap cases

xlomafota13 shared this article with you from Inoreader Increased salvage rates with early reexploration: A retrospective analysis of 547 free flap cases Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 19:S1748-6815(21)00089-9. doi: 10.1016/j.bjps.2021.03.001. Online ahead of print. ABSTRACT BACKGROUND: Free flap complications are generally rare, but not negligible since they may exert paramount impact on both patients and care providers. The aim of the study was to identify risk factors for reexploration and assess predictors associated with increased salvage rates. METHODS: A retrospective cohort study was conducted for free flaps performed between 2006 and 2015. Patient demographics, indications and flap types were analyzed together with complications and time to reexploration. RESULTS: Among 547 consecutive free flaps, 11.5% required acute reexploration. Hematoma together with vascular compromise was the main cause (41.9%) for reexploration, followed by hematoma only (19.4%), venous (16.1%) and arterial (6.5%) thrombosis. Hematoma was associated with an increased risk for concom itant vascular complication (p < 0.02). The incidence of total and partial flap necrosis was 3.5% and 3.7% respectively. There was an overall 71.4% salvage rate. The median time from detection of a compromised flap to reexploration was 3.0 h. Significantly higher salvage rates were observed for cases reexplored within (82.4%) compared to after (57.1%) 3.0 h (OR 3.50 (95% CI 1.10 to 11.13, p = 0.034)). CONCLUSIONS: The current study highlights the importance of early intervention, including evacuation of hematomas that may lead to vascular compromise. Adequate monitoring of venous outflow was found necessary to improve flap salvage rates, whereas arterial complications were mainly related to persistent arterial injury in traumatized extremities with reduced salvage rates. Free flap surgery requires trained staff and immediate access to operating facilities to ensure high flap survival rates. PMID:33879412 | DOI:10.1016/j.bjps.2021.03.001 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A longitudinal assessment of the surgical treatment of symptomatic neuromas and their surgical management in the American College of Surgeons National Surgical Quality Improvement Program database

xlomafota13 shared this article with you from Inoreader A longitudinal assessment of the surgical treatment of symptomatic neuromas and their surgical management in the American College of Surgeons National Surgical Quality Improvement Program database Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Mar 28:S1748-6815(21)00108-X. doi: 10.1016/j.bjps.2021.03.018. Online ahead of print. NO ABSTRACT PMID:33879414 | DOI:10.1016/j.bjps.2021.03.018 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hypotony Without Globe Rupture During Orbital Fracture Repair

xlomafota13 shared this article with you from Inoreader Hypotony Without Globe Rupture During Orbital Fracture Repair Via The Laryngoscope Abstract A 29‐year‐old male presented to the emergency department with an orbital fracture. He denied ocular symptoms and CT showed bilateral fracture of nasal bones, left medial orbital wall, and left orbital floor, with herniation of orbital fat and minimal retrobulbar hematoma. Pre‐operative ophthalmic exam was unremarkable. Intra‐operatively, intraocular pressure of the left eye was 5 mm Hg, a significant change from 17 mm Hg preoperatively. Globe exploration revealed no injury. Post‐operatively, IOP normalized. With these findings it was felt that ocular manipulation related to the orbital fracture repair placed significant and intermittent pressure on the globe, thereby lowering IOP. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta‐Analysis

xlomafota13 shared this article with you from Inoreader Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta‐Analysis Via The Laryngoscope Objectives/Hypothesis The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs). Study Design Systematic review with meta analysis. Methods Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta‐analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed. Results Five studies describing 393 TTMPs were included in the quantitative meta‐analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04–1.21). Conclusions TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone. Level of Evidence N/A Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study

xlomafota13 shared this article with you from Inoreader Prediction of Speech, Swallowing, and Quality of Life in Oral Cavity Cancer Patients: A Pilot Study Via The Laryngoscope Objectives/Hypothesis To investigate the impact of specific treatment‐related variables on functional and quality of life outcomes in oral cavity cancer (OCC) patients. Study Design Retrospective Cohort. Methods Patients with primary OCC at least 6 months after resection and adjuvant therapy were included. Patients completed surveys including the Speech Handicap Index (SHI), M.D. Anderson Dysphagia Inventory (MDADI), and Functional Assessment of Cancer Therapy‐Head and Neck (FACT‐HN). Performance Status Scale (PSS) and tongue mobility scale were completed to allow provider‐rated assessment of speech and tongue mobility, respectively. Additional details regarding treatment were also collected. These data were used to generate a predictive model using linear regression. Results Fifty‐three patients with oral tongue and/or floor of mouth (FOM) resection were included in our study. In multivariable analysis, greater postoperative tongue range of motion (ROM) and time since treatment improved SHI. Flap reconstruction and greater postoperative tongue ROM increased MDADI and PSS (eating and speech). A larger volume of resected tissue was inversely correlated with PSS (diet and speech). Tumor site was an important predictor of PSS (all sections). There were no statistically significant predictors of FACT‐HN. Conclusions In this pilot study, we propose a battery of tools to assess function in OCC patients treated with surgery. Using the battery of tools we propose, our results show that a surgical endpoint that preserves tongue mobility and employs flap reconstruction resulted in better outcomes, whereas those with greater volume of tissue resected and FOM involvement resulted in poorer outcomes. Larger prospective studies are needed to validate our findings. Level of Evidence 3 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy

xlomafota13 shared this article with you from Inoreader Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy Via The Laryngoscope Objectives/Hypothesis Patients' eligibility for bilateral selective laryngeal reinnervation surgery is evaluated by suspension microlaryngoscopy (SML) examination with laryngeal electromyography (LEMG). Maintaining spontaneous ventilation, with remifentanil sedation/analgesia without endotracheal tube, to allow the patient to phonate with the surgeon during awake, LEMG is a major challenge for the anesthesiologist and the otorhinololaryngologist. The objective of this study was to evaluate the safety and efficacy of a novel anesthesia protocol to manage airway access during awake tubeless SML. Study Design Retrospective study. Methods Anesthesia records of patients undergoing awake SML with LEMG were retrospectively analyzed. Procedures were performed with remifentanil sedation/analgesia with targeted controlled infusion (TCI) in combination with local anesthesia. The main outcome was the failure rate of the anesthesia protocol during the procedure. Secondary outcomes were as follows: rate of apnea requiring ventilation, airway bleeding, regurgitation, hemodynamic data as well as vasopressor use, complications, and surgeon satisfaction with the procedure. Results Data were obtained for 39 patients between November 2017 and September 2019, the mean age was 52 years and 29 (74%) were female. All procedures were completed without complications (0% [0–9]). Three patients (8% [1.6–20.8]) had an intraoperative episode of hypoxemia requiring mask reventilation. There was no airway bleeding, no regurgitation, and no hypotensive episode. Three patients (8% [1.6–20.8]) had noninvasive ventilation for respiratory distress after the end of the procedure. Conclusions Our results show that awake tubeless SML allowing phonation during LEMG can be realized under sedation and local anesthesia. However, further data are needed concerning the intraoperative and postoperative safety of the procedure. Level of Evidence 4. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis

xlomafota13 shared this article with you from Inoreader The Prevalence of Incidental Mastoid Opacification and the Need for Intervention: A Meta‐Analysis Via The Laryngoscope Objectives/Hypothesis The increasing use of cross‐sectional imaging has led to the predicament of incidental mastoid opacification (IMO). We investigated the prevalence of IMO and the clinical need for ENT assessment or intervention when identified. Study Design Systematic review and meta‐analysis. Methods The PRISMA statement standards were used to search electronic databases including Medline, Embase, PubMed, and Web of Science. The selection criteria were mastoid opacification found on computed tomography (CT) or magnetic resonance imaging (MRI) as incidental findings. Results A total of 16 studies were identified for qualitative analysis and 15 for quantitative analysis, mainly retrospective. The pooled prevalence of IMO in 246,288 patients was 8.4% (95% CI 5.5–12.0). The prevalence of IMO was significantly higher in studies with children (17.2%, 95% CI 10.9–24.6) than those with adults (6.1%, 95% CI 3.3–9.6); smaller sample size studies (12.4%, 95% CI 8.1–17.3) compared to larger sample size studies (4.1%, 95% CI 1.5–7.8); and when IMO was detected by viewing images (14.5%, 95% CI 9.9–19.8) compared to reading reports (3.5%, 95% CI 1.3–6.6). Imaging modality was not a significant moderator due to similar IMO rate on CT (8.6%, 95% CI 1.8–19.7) and MRI (10.4%, 95% CI 4.9–17.6). Nine studies reported on clinical outcomes of patients with IMO, and none reliably reported any cases of clinical mastoiditis. Conclusions The term "mastoiditis" on radiology reports based on IMO does not indicate a clinical diagnosis of mastoiditis, although the current body of evidence is limited. Otolaryngology review is suggested if clinical correlation detects otological signs or symptoms. Level of Evidence NA. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The clinical significance of fHIT in migraine patient without vertigo symptom

xlomafota13 shared this article with you from Inoreader The clinical significance of fHIT in migraine patient without vertigo symptom 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 Apr 21. doi: 10.1007/s00405-021-06811-8. Online ahead of print. ABSTRACT OBJECTIVE: The aim of this study was to assess the functional head impulse test on migraine patients without vertigo. fHIT is a new vestibular test which evaluates the ability to see and read clearly during head movement as a functional measurement of the vestibulo-ocular reflex. MATERIALS AND METHODS: The study included 20 patients suffering from migraine without vertigo between the ages of 20 and 30-years-old who were diagnosed by a neurologist and 20 individuals with non-migraine headaches (control group), with similar demographic characteristics. The functional head impulse test was applied to both groups, and the migraine disability assessment test was applied to migraine patients. RESULTS: There was no statistically significant difference in the general fHIT results between the migraine group and the control group (p > 0.05). However, a statistically significant decrease was obtained in migraine patients in the left lateral (p = 0.018) and right posterior (p = 0.029) semicircular canals at 4000 Hz and the right anterior semicircular canal at 6000 Hz (p = 0.019). When compared by the degree of migraine disability assessment test, no significant difference in the fHIT results were observed (p > 0.05). CONCLUSION: The semicircular canals may be affected at high head acceleration (4000-6000 Hz) in migraine patients without a history of vertigo. It should be considered that fHIT results between 4000 and 6000 Hz in migraine patients without vertigo can be pathologic. PMID:33881576 | DOI:10.1007/s00405-021-06811-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Elective open 'Shield Tracheostomy' in patients with COVID-19

xlomafota13 shared this article with you from Inoreader Elective open "Shield Tracheostomy" in patients with COVID-19 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 Apr 21. doi: 10.1007/s00405-021-06820-7. Online ahead of print. ABSTRACT PURPOSE: To prevent the consequences of long-term endotracheal intubation, patients undergo tracheostomies. However, as COVID-19 is highly contagious, its existence has made the tracheostomy a high-risk procedure. Tracheostomy procedures must, therefore, be adjusted for safety reasons. The aim is to present the adjustments that should be made to the surgical technique. METHODS: Both the medical charts and surgical reports of patients with COVID-19 who were subjected to elective open tracheostomies were reviewed. RESULTS: The retrospective study included 25 patients. Our adjustments include the timing of tracheostomies, ideally putting them at 21 days after the onset of COVID-19, the advancement of an endotracheal tube to 26-28 cm from the upper-alveolar ridge, surgery being carried out in the intensive care unit with app ropriately modified positions of the patient and providers, tracheo-cutaneous sutures, and intentionally making the small tracheal flap and the tracheal window the same shape as a medieval shield. CONCLUSIONS: A tracheostomy performed in this way is now referred to as the Shield Tracheostomy. Further improvements to the surgical technique are expected in the future. PMID:33881578 | DOI:10.1007/s00405-021-06820-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pneumolabyrinth: a systematic review

xlomafota13 shared this article with you from Inoreader Pneumolabyrinth: 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 Apr 21. doi: 10.1007/s00405-021-06827-0. Online ahead of print. ABSTRACT PURPOSE: The aim of this study is to provide a systematic review of the literature about the etiology, clinical and radiological presentation, surgical management, and outcomes of pneumolabyrinth (PNL). METHODS: A systematic review of the literature was performed including studies published up to September 2020 in electronic databases (PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus). The PRISMA standard was applied to identify English, Italian, or French-language studies mentioning PNL. Full texts lacking information on the etiology were excluded. Data concerning the cause, site of air bubbles/fistula, clinical presentation, treatment, and outcome were collected. A qualitative synthesis of the results was performed. RESULTS: Seventy-eight articles were eventually included; 132 patients were involved in the qualitat ive synthesis. The most common causes were: stapes surgery (24/132, 18.2%), temporal bone fracture (42/132, 31.8%), head trauma without temporal bone fracture (19/132, 14.4%), penetrating trauma (21/132, 15.9%), and barotrauma (15/132, 11.4%). The site most commonly involved was the vestibule (102/107, 95.3%), followed by cochlea (43/107, 40.2%) and semicircular canals (25/107, 23.4%). CONCLUSION: The etiopathogenesis of PNL can be summarized in traumatic, iatrogenic, or inflammatory/infective. Its management consists in exploratory tympanotomy and sealing the fistula, but also conservative treatments can be attempted. Vestibular symptoms disappear in the majority of cases. Instead, the prognosis of hearing function is widely variable, and complete recovery is less probable. The certainty of evidence is still too low to make it useful for clinical decision-making. PMID:33881577 | DOI:10.1007/s00405-021-06827-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Functional and oncological outcomes of salvage transoral robotic surgery: a comparative study

xlomafota13 shared this article with you from Inoreader Functional and oncological outcomes of salvage transoral robotic surgery: a comparative 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 Apr 20. doi: 10.1007/s00405-021-06812-7. Online ahead of print. ABSTRACT PURPOSE: Transoral robotic surgery (TORS) as a first-line therapy has been well-documented but evidence is missing regarding salvage therapy. The aim of this study is to compare the oncological and functional outcomes of TORS as a primary and salvage therapy. METHODS: This retrospective monocentric study included 74 patients operated by a single surgeon and sorted out into two groups: primary treatment (PT) or Salvage treatment (ST) in case of previous history of radiation therapy. Patients were further stratified by tumour location: larynx and pharynx (lST vs lPT and pST vs pPT). RESULTS: Forty-eight patients were included in PT group (64.9%) and 26 in ST group (35.1%). ST patients had more frequent cTis/T1 tumours (57.7% vs 29.2%, p = 0.0164) and no clinical lymph disease (3.8% vs 37.5%, p = 0.0016). Tracheostomy was m ore often performed in the ST group (57.7% vs 16.7%, p = 0.0003) and the lST subgroup (88.9% vs 9.1%, p < 0.0001). Gastric feeding tube placement was more frequent in the ST group (76.9% vs 33.3%, p = 0.0003), the pST subgroup (64.7% vs 15.4%, p = 0.0009) and the lST subgroup (100% vs 54.5%, p = 0.0297). We observed a trend for more postoperative complications in the ST group (69.2% vs 47.9%, p = 0.0783). The overall survival was lower in the ST group (p = 0.0004), and in the pST subgroup (p < 0.0001). The disease-free survival rate was lower in the ST group (p = 0.0001), the pST subgroup (p = 0.0002) and the lST subgroup (p = 0.0328). CONCLUSION: This study confirms that survival and functional outcomes after salvage TORS are worse than in first line surgery. PMID:33880636 | DOI:10.1007/s00405-021-06812-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.