European Archives of Oto-Rhino-Laryngology最新文献

Introduction: It is debatable whether neck dissection is necessary in patients with advanced laryngeal carcinoma who are clinically node-negative (cN0). We assessed the effect of neck dissection on overall survival in patients with cN0 undergoing primary or salvage laryngectomy.

Materials and methods: A retrospective evaluation of cN0 patients who underwent primary or salvage total/pharyngolaryngectomy at a French tertiary facility in 2008-2018, with or without neck dissection, was carried out. Patients were divided into two groups: primary (n = 65) and salvage (n = 84).

Results: Comparing subglottic (HR = 3.978; p = 0.023) and hypopharyngeal (HR = 2.958; p = 0.018) malignancies to other tumor subsites, the mortality rates were greater. The primary group had a greater rate of occult metastases (23.07% vs. 14.28%; p = 0.089) than the salvage. The average lymph node ratio was significantly different between the treatment groups (0.05 ± 0.04 vs. 0.17 ± 0.33; p = 0.004). If LNR > 0.05, we found poor survival rates (p < 0.001). Although performing a neck dissection during the primary treatment increased the 5-year OS rate (Yes 89.5% vs. No 83.3%; p = 0.062), there was no discernible difference in the salvage group (Yes 80.3% vs. No 78.6%; p = 0.806; Log-rank p > 0.05). For the predicted survival variables, no significant relationships were detected in the Cox regression analysis (all p-values > 0.05).

Conclusion: Although the primary group had a greater frequency of occult metastases, neither the primary group's survival outcomes nor those of the salvage laryngectomy cases were significantly affected by neck dissection. LNR and the location of the tumor were important variables that could affect survival and the choice to do a neck dissection.

Objective: This study aimed to summarise the clinical features and management strategies concerning auditory canal duplication anomalies in children with congenital first branchial cleft anomalies (CFBCAs), and to provide guidance for precise treatment.

Methods: We retrospectively analysed 84 children with CFBCAs who had complete data, diagnosed between December 2018 and February 2024.

Results: All the lesions identified were located around the external auditory canal or near the mandibular angle, manifested as pinhead-sized perforations in 10 cases, painless masses in 18 cases, recurrent swelling and pain with purulent discharge in 52 cases, and otorrhea in 4 cases. Otoscopy examinations revealed external auditory canal swelling in seven children, fistulas within the auditory canal in four children, and a myringa web in three children. Fifty-six children had a preoperative history of infection. Using Work's classification system, Work I and II in 70 (87.5%) and 14 (12.5%) children, respectively. Intraoperatively, 80 (95.2%) children had auditory canal duplication anomalies at the base of the lesion, closely associated with the cartilage of the inferior wall of external auditory canal(EAC), We then classified auditory canal duplication anomalies into three types: Type A (duplication anomalies of epithelial tissue structure between the skin of the EAC and the cartilage of the inferior wall, n = 16 children), Type B (duplication anomalies of the epithelial and/or skin tissue structure, sharing a wall with the cartilage of the inferior wall, n = 40), and Type C (duplication anomalies of the skin and cartilage tissue structure, connected to the cartilage of the inferior wall of EAC, n = 24). Sixty-eight children had lesions superficial to the facial nerve, 12 had lesions deep to the facial nerve, and four had lesions between branches. There were two cases of transient postoperative facial paralysis, three cases of CFBCA recurrence, and two cases of transient auditory canal stenosis.

Conclusion: Auditory canal duplication anomalies are an important feature of first branchial cleft anomalies in children. Precise staging and accurate identification of the base of the lesion facilitate complete removal, thereby increasing the cure rate.

Objective: This retrospective multicenter study aimed to evaluate surgical versus conservative treatment in patients with hypopharyngeal and laryngeal cancer under real world conditions.

Methods: This study included 2307 patients diagnosed with hypopharyngeal or laryngeal squamous cell carcinoma (SCC) in five German tertiary head and neck centers between 01/2004 and 12/2014. Overall, 783 patients with advanced SCC consecutively underwent laryng(opharyng)ectomy (L(P)E). Patient chart data regarding age, sex, tumor location, TNM status, grading, indication for L(P)E, treatment modalities, R status, postoperative complications, and hospitalization time were analyzed. Patients with lacking data and incomplete staging and those who refused treatment or did not comply with the recommended treatment were excluded from survival analysis.

Results: A slight but significant increase was observed in L(P)E, referring to an increasing rate of tumor recurrence. While T1/2N0M0 laryngeal and hypopharyngeal cancer patients showed comparable overall survival (OS) for surgical and conservative treatment, surgery showed significantly better OS in lymph node-positive individuals and locally advanced tumor stages. Tumor recurrence occurred in more than one-third of the cases. In particular, in early glottic cancer recurrence, L(P)E represents a curative and safe treatment option, whereas in supraglottic and hypopharyngeal cancer, L(P)E was associated with reduced survival rates. Notably, 36% of patients with supraglottic cancer and 59% of patients with hypopharyngeal cancer recurrence could only be treated with palliative care.

Conclusion: Comparable survival rates were demonstrated for cT1/2N0M0 laryngeal and hypopharyngeal SCC compared with primary chemo-/radiotherapy and larynx-preserving surgery. Better OS was achieved after surgery in nodal-positive patients and in those with locally advanced disease. Tumor recurrence should be anticipated in up to 39% of cases. Glottic cancer recurrence can be successfully and safely treated with L(P)E, whereas OS is reduced in hypopharyngeal cancer and possibly in supraglottic cancer.

Purpose: Total laryngectomy (TL) is a referral procedure useful in case of locally advanced laryngeal cancer but is difficult to train during residency. The objective of this work was to assess the dead porcine model for training in TL by studying its face, content, and construct validity.

Methods: Young residents (postgraduate year (PGY) 1 to 3), experienced residents (PGY-4 to 6) and senior surgeons (SS) trained TL on dead swine. Face and content validity were assessed by questioning the perception of realism and the interest of this model for teaching. Construct validity was assessed by comparing the mean Ottawa Surgical Competency Operating Room Evaluation (O-SCORE), obtained during the simulation sessions, and the mean modified Objective Structured Assessment of Technical Skills (OSATS) score, obtained by independent blind video analysis, between PGY1-3, PGY4-6 and SS groups.

Results: Twenty-three individuals trained TL on dead swine. The mean OSATS score were 11.3, 14.9 and 22 for young residents, experienced residents and SS respectively (p < 0.05). The mean O-SCORE were 3 for young residents, 3.8 for experienced residents and 4.95 for SS (p < 0.05). 89% of the participants agreed or strongly agreed that the steps resembled those of a TL in humans. SS strongly agreed that the model was a useful training tool, may improve performance and should be used to train students.

Conclusion: Dead swine is a valid option to train TL steps as it offers strong face, content, and construct validity.

Purpose: The relationship between seasonal variations and the incidence of benign paroxysmal positional vertigo (BPPV) has been widely studied, but the findings remain inconsistent. This systematic review and meta-analysis aimed to evaluate whether BPPV demonstrates seasonal variation.

Methods: A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and CNKI databases for studies on the monthly or seasonal incidence of BPPV from their inception up to August 2024. Pooled monthly or seasonal incidence rates, risk ratios (RRs) for one season versus another and 95% confidence intervals (CIs) were combined using the random-effects model. This meta-analysis has been registered at International Prospective Register of Systematic Reviews (PROSPERO) (NO. CRD42024583513).

Results: Ten eligible studies were included, comprising 5,063 subjects. Pooled BPPV incidence was highest in winter (28%) and lowest in summer (21%). Additionally, the pooled monthly incidence was highest in December (12.6%) and lowest in July (7.4%). The overall RRs and 95% CIs are as follows: winter versus summer (1.30 [1.07,1.59]); winter versus spring (1.01 [0.88,1.17]); winter versus autumn (1.11[0.95,1.30]); spring versus autumn (1.09 [0.91,1.31]); spring versus summer (1.29 [1.00,1.66]); autumn versus summer (1.17 [0.97,1.42]).

Conclusion: Our meta-analysis suggests that there may be seasonal variation in the incidence of BPPV. The finding of seasonal patterns provides a new perspective to our understanding of BPPV, suggesting environmental factors may play a potential role in its pathophysiology. However, larger cohort studies and multicenter datasets are warranted to validate these findings in future research.

Objective: The use of the endoscope has brought major changes in skull base surgery in the last decades. In the cerebellopontine angle (CPA), it has shown few advantages over microscopic surgery alone, evolving towards a full-endoscopic surgery for neurovascular conflicts and tumors. This review aims to systematically analyze the literature about the use of the endoscope in the cerebellopontine angle tumors.

Methods: Pubmed/Medline and Embase databases were investigated applying PRISMA guidelines without time restrictions to find all adult patients affected by an extra-axial cerebellopontine angle tumor (vestibular schwannoma, meningioma, epidermoid tumor, or other extra-axial lesions) treated using only the endoscope (full-endoscopic, FE or endoscopic-controlled, EC) or with endoscopic assistance (EA).

Results: After article selection, a total of 2489 patients have been treated for a CPA lesion using the endoscope: 2054 vestibular schwannomas (VS), 368 epidermoid tumors (ET), 41 meningiomas and 26 among other pathologies. The retrosigmoid approach was the most frequently employed surgical corridor, irrespective of lesion type, for both full-endoscopic and endoscopic-assisted procedures. Although a great heterogeneity should be highlighted among the selected series of VS (1539), a weighted average of 92.5% of gross total resection (GTR) was obtained and 90% out of 1332 showed a good facial nerve outcome when comparable. Advantages in term of recognition of residuals have been described for the CPA meningiomas and multicompartmental epidermoid tumors with origin from CPA cistern, without increasing the risk of complications.

Conclusions: Despite different accepted advantages, the number of tumors in which the endoscope has been included among the surgical armamentarium is still limited compared to the number of the full-microscopic resections. After almost 30 years since its value was recognized, the number of prospective and case-control studies is still scarce to affirm a real benefit leading to its routinary use.

Objective: This systematic review aims to determine whether patients with obstructive sleep apnea (OSA) undergoing Ear, Nose, and Throat (ENT) surgery have an increased risk of postoperative complications.

Methods: The review followed the Preferred Reporting Items of Systematic Reviews guidelines. A comprehensive search was conducted in Medline, EMBASE, Cochrane CENTRAL, CINAHL, and Google Scholar. The search was performed and updated the on 27th of August 2024 and included all studies involving adults diagnosed with obstructive sleep apnea (OSA) undergoing ENT surgery. Studies focused on OSA-specific surgeries were excluded. The ROBINS-I tool was used to assess the risk of bias for the included studies. The primary outcome was all reported postoperative complications.

Results: The search identified 18,487 articles, with 88 full-text articles reviewed. Three studies, encompassing 1,071 patients, were finally included. The complications reported were desaturation, postoperative hypertension, and infections. All three studies had a serious risk of bias.

Conclusion: This review finds an increased risk of specific complications, including desaturation, hypertension, and infection, in OSA patients undergoing ENT surgery. However, the current body of evidence is significantly limited by the small sample sizes, heterogeneity in study design, variability in diagnostic methods, and inconsistent outcome reporting across the included studies. These limitations hinder the ability to draw definitive conclusions or establish clear recommendations regarding the perioperative management of OSA patients in ENT settings, including whether routine postoperative admission is warranted. The findings emphasize the urgent need for more rigorous, high-quality research to guide clinical decision-making.

Purpose: Obtaining negative margins in primary tumor resection is essential to decreasing recurrence and mortality. Fluorescence imaging may aid in complete tumor removal. As fluorescent agents are still under clinical trial investigation for use in head and neck cancer (HNC), their effectiveness in intraoperative margin assessment (IMA) remains unclear. This scoping review examines the use of fluorescent-guided surgery (FGS) in the treatment of HNC, highlighting significant opportunities in this nascent field.

Methods: PubMed, Scopus, CINAHL, and Cochrane Library were searched from inception through March 22, 2024. This study was conducted under PRISMA-ScR guidelines. Data on study characteristics, fluorescence and imaging techniques, imaging efficacy, and diagnostic accuracy were extracted.

Results: Twenty-seven prospective studies from 2013 to 2024 on intraoperative FGS in HNC, involving 455 patients from six countries, were included. Studies ranged from preclinical to phase II trials, applying various fluorescent techniques, predominantly indocyanine green and IRDye800CW, to enhance surgical precision. Imaging assessments were conducted in-vivo, ex-vivo, or both, using a wide range of devices and taking an additional 0 to 30 min intraoperatively. Quantitative measures like signal-to-background ratio and mean fluorescent intensity suggested variable diagnostic accuracy across studies. FGS shows great potential in improving IMA, although standardization in methodologies and reporting is needed.

Conclusion: This scoping review highlights the potential of intraoperative FGS to enhance treatment accuracy in solid HNC, though variability in diagnostic efficacy and a lack of standardized methodologies persist. Advancements in fluorophore technology and uniform procedural protocols are essential to optimize surgical outcomes and move towards personalized HNC interventions.

Purpose: This article aims to review techniques and applications for using double flaps (both free and pedicled, and their combinations) in reconstructing defects from total pharyngolaryngectomies (TPL) or pharyngolaryngo-esophagectomies.

Methods: This systematic review followed PRISMA 2020 guidelines. Three authors screened articles, selecting and extracting data on malignancy characteristics, reconstructive techniques, outcomes and complications.

Results: Eleven articles were reviewed, involving 176 oncologic patients. Most patients (39.8%) had defects in the larynx, hypopharynx and cervical skin, while in 31.8% the double flaps were used to restore the pharynx and protect the visceral anastomosis. In most studies included, preoperative treatments were administered, including radiotherapy (RT), concurrent chemoradiotherapy (CRT), and surgery, either alone or in combination. A wide variety of pedicled and free flaps were described. The most common pedicled flap is the pectoralis flap (81 patients, 46%), while the most used free flap is the jejunum flap (124 patients, 70%). 19 patients (10.8%) manifested partial necrosis or encountered minor complications postoperatively. 5 patients necessitated a surgical revision of the flap.

Conclusion: The literature on surgical reconstructions following TPL or pharyngolaryngo-esophagectomies using double flaps is limited. The use of double flap is indicated in cases of TPL with extensive skin defect but is also recommended in case of salvage TPL without skin defect.

Purpose: To evaluate the aesthetic outcomes of primary closure of auricle lacerations in the emergency department.

Methods: In this prospective case study in our tertiary referral center we included all patients with an auricular laceration without complete avulsion. Wound treatment involved thorough cleaning and primary closure. Photos of the auricle were taken at various stages for evaluation. To evaluate the achieved results after 3 months, a success classification system with four classes was developed: (1) full success, no irregularities, (2) partial success, only minor irregularities, (3a) unsuccessful, major irregularities or (3b) unsuccessful, (partial) necrosis.

Results: Most patients demonstrated successful outcomes (60.7% full success and 32.1% partial success), with helical involvement being associated with inferior results. The interobserver percent agreement of the classification system was 88%. The Fleiss' kappa coefficient was 0.570, p < 0.001.

Conclusion: Primary closure of ear lacerations results in a high success rate. We have introduced a revised classification system to qualify the success of treatment of the auricle laceration. Involvement of the helix is correlated with inferior surgical results three months after surgical closure. Trial registration number and date of registration: reference number W21_387 # 21.432, September 9, 2021.