Management of the Disrupted Airway in Children

xlomafota13 shared this article with you from Inoreader Management of the Disrupted Airway in Children Via The Laryngoscope Objective Our objective was to gather data that would enable us to suggest more specific guidelines for the management of children with airway disruption. Study Design Retrospective case series with data from five tertiary medical centers. Methods Children younger than 18 years of age with a disrupted airway were enrolled in this series. Data pertaining to age, sex, etiology and location of the disruption, type of injury, previous surgery, presence of air extravasation, management, and outcome were obtained and summarized. Results Twenty children with a mean age of 4.4 years (range 1 day–14.75 years) were included in the study. All were evaluated by flexible endoscopy and/or microlaryngoscopy in the operating room. Twelve (60%) children had tracheal involvement; seven had bronchial involvement; and one had involvement of the cricoid cartilage. Nine children had air extravasation, and all these children required surgical repair. Of the 11 who did not have air extravasation, only one underwent surgical repair. Complete healing of the disrupted airway was seen in all cases. Conclusion This series suggests that if there is no continuous air extravasation demonstrated on imaging studies or clinical examination, nonoperative management may allow for spontaneous healing without sequelae. However, surgical repair may be considered in those patients with continuous air extravasation unless a cuffed tube can be placed distal to the site of injury. For children in whom airway injury occurs in a previously operated area, the risk of extravasation is reduced. This risk is also diminished if positive pressure ventilation can be avoided or minimized. Level of Evidence 4 Laryngoscope, 131:921–924, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea

xlomafota13 shared this article with you from Inoreader Real‐Time, Intraoperative, Ultrasound‐Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea Via The Laryngoscope Objectives/Hypothesis To investigate the lingual artery (LA) position in the tongue base through intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS) and evaluate bleeding complications with or without the assistance of IOU. Study Design Cohort study with historical control. Methods Patients with obstructive sleep apnea (OSA) who underwent TORS for tongue base resection were recruited since 2016. During surgery, ultrasound imaging was employed to identify anatomic parameters of the LA in the tongue base, including distance to the midline and arterial depth and diameter. Results Ninety‐three OSA patients (82 men, 88.2%) were analyzed. Mean age was 42.2 ± 10.0 years and body mass index was 29.2 ± 4.5 kg/m2. Average apnea–hypopnea index (AHI) was 58.1 ± 21.4 events/hour. Overall, 70 patients who underwent TORS with IOU had a shorter operation time (191.7 ± 3.8 vs. 220.1 ± 6.6 minutes), lower total blood loss (11.3 ± 10.8 vs. 19.6 ± 26.7 mL), and higher tongue base reduction volume (7.1 ± 2.5 vs. 3.9 ± 1.6 mL) than 23 patients who underwent TORS without IOU. Significant predictors of arterial depth included higher AHI level during the rapid eye movement sleep (P = .038), larger tonsil size (P = .034), and more elevated Friedman tongue position (P = .012). Postoperative complications associated with LA injury were not found in patients subjected to IOU. Conclusions With the assistance of IOU, surgeons can confidently determine LA position. The use of IOU can maximize efficiency and minimize catastrophic bleeding complications when OSA patients undergo TORS for tongue base resection. Level of Evidence 4 Laryngoscope, 131:E1383–E1390, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Quality of Life After Treatment of Oropharyngeal Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Long‐term Quality of Life After Treatment of Oropharyngeal Squamous Cell Carcinoma Via The Laryngoscope Objectives To analyze the long‐term quality of life (QOL) among oropharyngeal squamous cell carcinoma (OPSCC) survivors. Study Design Retrospective chart analysis and patient response to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ‐C30), Head and Neck Module (EORTC QLQ‐H&N35), and M.D. Anderson Dysphagia Inventory (MDADI) survey questionnaires. Methods All survivors of OPSCC diagnosed and treated between 2000 and 2009 in Finland were included. There were 263 survivors (44.2% of all curatively treated patients), of which a total of 164 participated in this study (62.4%). Median follow‐up was 11.79 years (range = 8.59–18.53 years, interquartile range [IQR] = 4.64 years). The mean age of the participants was 67.9 years (standard deviation = 8.0 years) at QOL follow‐up. Results Most survivors reported a good QOL. The EORTC QLQ‐C30 global health status median was 75.00 (IQR = 31.25). The single modality treatment group had significantly better QOL outcomes than the combined treatment group. Nonsmokers and previous smokers had significantly better QOL outcomes than patients who smoked at the time of diagnosis. A history of heavy alcohol use resulted in significantly worse QOL outcomes. The p16‐positive cancer patients had significantly better QOL outcomes than p16‐negative patients. Percutaneous endoscopic gastrostomy (PEG) tube–dependent patients reported a significantly worse QOL than patients without a PEG tube. Conclusions Long‐term QOL in OPSCC survivors is generally good. In line with previous literature, single modality treatment was superior to combined treatment in long‐term QOL outcomes, and it should be pursued whenever possible. Level of Evidence 4 Laryngoscope, 131:E1172–E1178, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children

xlomafota13 shared this article with you from Inoreader Comparing Caliper versus Computed Tomography Measurements of Cranial Dimensions in Children Via The Laryngoscope Objectives/Hypothesis We have found no study assessing the accuracy of caliper cranium measurements compared to computed tomography (CT) measurements of the head. The objective of this study was to assess the reliability of caliper measurements in comparison to CT measurements. Study Design Retrospective chart review. Methods This study includes all patients evaluated for head shape abnormality between 2010 and 2019 at a single academic medical center. Eighty‐nine patients who had CT head scans were identified, and their caliper measurements of anterior–posterior and transverse head dimensions were documented. Results There was no statistically significant difference between the CT and caliper measurements. Conclusion Caliper measurements are a simple and reliable way to assess cranial vault proportionality with growth after cranial vault reconstruction. Level of Evidence 4 Laryngoscope, 131:773–775, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID‐19 Era

xlomafota13 shared this article with you from Inoreader Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID‐19 Era Via The Laryngoscope Objectives/Hypothesis To determine the prevalence and associated risk factors of voice disorders in healthcare workers of high‐risk hospital care units during the 2019 coronavirus disease (COVID‐19) pandemic. Study Design Cross‐sectional study. Methods Questionnaire survey to healthcare personnel of COVID‐19 high‐risk hospital units was conducted, regarding demographic data, clinical activity, the pattern of usage of personal protective equipment, medical and vocal history, vocal symptoms, and Spanish validated Voice Handicap Index (VHI)‐10 questionnaire. Results A total of 221 healthcare workers answered the survey. Nearly 33% of them reported having trouble with their voice during the last month, and 26.24% had an abnormal score in the Spanish validated VHI‐10 questionnaire. The mean VHI‐10 score was 7.92 (95% confidence interval 6.98–8.85). The number of working hours, the number of hours of mask daily use, simultaneous surgical and self‐filtering mask use, and working in intermediate or intensive care units were independent variables significantly associated with a higher VHI‐10 score. Conclusions Healthcare workers of high‐risk hospital care units during the universal masking COVID‐19 pandemic are at risk of voice disorders. Level of Evidence 3 Laryngoscope, 131:E1227–E1233, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The Effect of Tonsillectomy and Adenoidectomy on Isolated Sleep Associated Hypoventilation in Children

xlomafota13 shared this article with you from Inoreader The Effect of Tonsillectomy and Adenoidectomy on Isolated Sleep Associated Hypoventilation in Children Via The Laryngoscope Objective Sleep associated hypoventilation (SAH) is diagnosed when more than 25% of total sleep time (%TST) is spent with end tidal carbon dioxide (EtCO2) > 50 mmHg. SAH in children occurs as a single entity or combined with obstructive sleep apnea. Outcomes of surgical treatment for isolated SAH in children have not been reported. Methods The medical charts of children who were diagnosed with isolated SAH and did not have OSA at a tertiary children's hospital between January 2013 and December 2019 were reviewed. Data collection included information on history and physical examination, past medical history, polysomnography (PSG) findings, and surgical management. Results Seventeen children (10 male, 7 female, age range: 3–14 years) were diagnosed with isolated SAH. Comorbid conditions included asthma in four children, Down syndrome in one, and seizure in two. Eight children were normal weight, four were overweight, and five were obese. Children did not have obstructive or central sleep apnea. Three children (18%) had persistent SAH as documented by PSG. All normal weight children had resolution of SAH whereas two obese children and one overweight child had residual SAH. %TST with CO2 > 50 mmHg after upper airway surgery (3.4% ± 1.6%) was significantly less than that of before TA (59.1% ± 5.5%) (P < .001). Conclusions The majority of children with isolated SAH had normalization of hypercapnia after TA. Further studies in larger groups of children are needed to identify the risk factors for residual isolated SAH after TA. Level of Evidence 4 Laryngoscope, 131:E1380–E1382, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Is Antral Choanal Polyp Best Managed by an Endoscopic or Caldwell‐Luc Approach?

xlomafota13 shared this article with you from Inoreader Is Antral Choanal Polyp Best Managed by an Endoscopic or Caldwell‐Luc Approach? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery

xlomafota13 shared this article with you from Inoreader Polymicrobial Skull Base Osteomyelitis Related to Chronic Sphenoiditis and Endoscopic Sinus Surgery Via The Laryngoscope Skull base osteomyelitis (SBO) secondary to endoscopic surgery for chronic sinusitis and post‐operative sphenopalatine artery electrocautery has not been previously reported. This case report details an instance of Central SBO with an unusual microbiology profile and highlights the need to readily consider SBO should patients present with persistent headache and cranial nerve palsies following sinus surgery. Laryngoscope, 131:E1086–E1087, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A New Device for Fine‐Needle Aspiration Cytology Consisting of a Vibrating Linear Resonant Actuator

xlomafota13 shared this article with you from Inoreader A New Device for Fine‐Needle Aspiration Cytology Consisting of a Vibrating Linear Resonant Actuator Via The Laryngoscope Objective To evaluate the efficacy of a new device for fine‐needle aspiration cytology (FNAC) consisting of a vibrating linear resonant actuator (LRA). Study Design Prospective clinical study. Methods The LRA frequency was optimized by visualization of the needle motion using a high‐speed camera. The FNAC device consists of a vibrating motor fixed to the stopper of a 5‐ml syringe and piston. Upon insertion of the syringe needle into a thyroid nodule (with the stopper attached to the syringe piston), sufficient negative pressure with 1‐ml suction was maintained. Subsequently, samples were obtained using vibration generated by an LRA or an eccentric rotating mass (ERM). Surgically resected thyroid specimens from 10 patients were evaluated. The number of follicular groups required for adequate diagnosis and the number of larger follicular groups were counted. Next, 254 thyroid nodules from 187 patients were also evaluated by FNAC. The inadequacy rate was determined, and final cytology was classified according to thyroid Bethesda categories. Results The optimized LRA frequency was 155 Hz. Both the LRA and ERM devices resulted in sufficient amounts of diagnostic material and achieved low inadequacy rates. The number of large follicular groups obtained was significantly greater with the LRA device compared with the ERM device. Conclusions The vibrating device using an LRA for thyroid FNAC resulted in sufficient amounts of thyroid follicular groups and achieved low inadequacy rates. In addition, the LRA device allowed for collection of larger follicular groups sufficient to diagnose appropriate thyroid Bethesda categories. Level of Evidence 2 Laryngoscope, 131:E1393–E1399, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma

xlomafota13 shared this article with you from Inoreader Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma Via The Laryngoscope Objectives Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN. Study Design Retrospective study in a tertiary referral university cancer institute. Methods We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared. Results Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P = .015). Only advanced T‐stages were significantly associated with neck recurrences. Conclusion IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory. Level of Evidence 4 Laryngoscope, 131:788–793, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Primary Hyperparathyroidism During Pregnancy Treated With Parathyroidectomy: A Systematic Review

xlomafota13 shared this article with you from Inoreader Primary Hyperparathyroidism During Pregnancy Treated With Parathyroidectomy: A Systematic Review Via The Laryngoscope Objectives/Hypothesis The primary objective of this study was to assess the safety of parathyroidectomy during pregnancy as treatment for hyperparathyroidism (HPTH) in comparison to nonsurgical management plans. Secondary outcomes involved analyzing the safety of surgery in the third trimester and the benefit of operating on asymptomatic pregnant patients. Study Design Systematic review. Methods PRISMA‐guided systematic review of all cases of primary hyperparathyroidism during pregnancy published in peer‐reviewed English journals on PubMed/MEDLINE, EMBASE, and SCOPUS from 1980 to 2020. Results A total of 75 manuscripts were included in this review describing 382 cases of gestational hyperparathyroidism. The median maternal age was 31 years. Overall, 108 cases (28.3%) underwent parathyroidectomy during pregnancy while 274 cases (71.7%) were treated nonsurgically. The majority of surgeries took place during the second trimester (67.6%). Complications and/or deaths were less likely to occur after surgery in the second trimester (4.48%) as compared to surgery in the third trimester (21.1%). Nine surgically treated cases resulted in infant complications and/or death; however, none of these nine cases had any surgical complications. Despite these complications, the overall infant complication rate for patients who underwent surgical treatment remained lower than that of patients treated with conservative therapy (9.1% vs. 38.9%). Conclusions This review suggests that for all pregnant patients with diagnosed HPTH, parathyroidectomy should be considered regardless of symptomatology. Our data suggest that parathyroidectomy is associated with fewer risks than more conservative treatments and results in better fetal outcomes. Surgery during the third trimester is feasible and surgery should be considered in both symptomatic and asymptomatic patients. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Blue, Green, or Radioisotope: Which Modality Is Best for Head and Neck Melanoma SLN Identification?

xlomafota13 shared this article with you from Inoreader Blue, Green, or Radioisotope: Which Modality Is Best for Head and Neck Melanoma SLN Identification? Via The Laryngoscope View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.