World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Objective: The aim of this study is to compare the clinical characteristics and surgical outcomes of patients with traumatic and nontraumatic cerebrospinal fluid (CSF) rhinorrhea.

Methods: CSF rhinorrhea patients admitted between January 2007 and December 2022 were recruited and categorized into traumatic and nontraumatic groups. The clinical characteristics and surgical outcomes of the two groups were compared.

Results: A total of 94 patients with traumatic and 49 patients with nontraumatic CSF rhinorrhea were included. The prevalence of meningitis was significantly higher in traumatic CSF rhinorrhea patients (p = 0.012). Multifocal defects were more frequent in the traumatic group, while sphenoidal defects were significantly correlated with nontraumatic CSF rhinorrhea. Frontal defects were commonly identified in CSF rhinorrhea patients with meningitis than in those without, though no statistical significance was reported. Multivariate logistic regression revealed that male sex, iatrogenic traumatic CSF leak, and pneumonitis are independent factors for development of meningitis. An endoscopic approach combined with an external incision was performed in one patient and 24 patients in nontraumatic and traumatic groups, respectively (p = 0.001). Combined vascularized grafts were more commonly used in patients with traumatic CSF rhinorrhea (p < 0.05). No statistical difference in the success rate (100% vs. 97.9%) was documented between the two groups.

Conclusions: Multifocal defects and meningitis were more prevalent in traumatic CSF rhinorrhea patients, leading to increased complexity in treatment management. Iatrogenic rather than accidental traumatic CSF rhinorrhea is an independent risk factor for development of meningitis. The endoscopic combined coronal extradural approach, in conjunction with various vascularized flaps, can effectively supplement skull base reconstruction, especially for complex traumatic CSF rhinorrhea.

Objectives: To gain a comprehensive understanding of the vocal repercussions experienced by mild COVID-19 infection, as well as the duration and underlying factors contributing to these effects.

Methods: Ten participants with mild COVID-19 infection were included as the experimental group to evaluate the voice metrics changes at 15 days (D15), 30 days (D30), and 60 days (D60) after mild COVID-19 infection, and 10 healthy people were taken as the normal control group. Self-assessment and objective measures were taken at each time point, including questionnaires for voice handicap index (VHI) and reflux symptom index (RSI), as well as acoustic and aerodynamic indicators such as fundamental frequency (F0), Jitter, Shimmer, noise-to-harmonics ratio, sound pressure level (SPL), phonation threshold pressure (PTP), phonation threshold flow, aerodynamic resistance(AR), aerodynamic efficiency, mean expiration airflow, maximum phonation time, and maximum loudest phonation time.

Results: Notable elevations in RSI and VHI were observed during the D15 assessment, but by D60, these levels had returned to normal. At D60, Shimmer, PTP, and PTF significantly increased compared to the control group, while HNR and AR significantly decreased (p < 0.05). F0, SPL, and PTP significantly increased compared to 15 days (p < 0.05), while other acoustic and aerodynamic indicators showed no significant changes in intra-group and inter-group comparisons.

Conclusions: Our study demonstrated that COVID-19 infection has a detrimental effect on voice production. Although subjective discomfort may gradually subside within 2 months after onset, alterations in phonation mode can be delayed. It is essential for healthcare professionals to remain vigilant in preventing any organic changes that may arise due to COVID-19-related voice disorders, such as muscle tension dysphonia.

The incidence of juvenile-onset recurrent respiratory papillomatosis (JORRP) varies worldwide, and the lack of well-adopted guidelines for use in China suggests that patients with JORRP do not receive optimal care. In America, where data are available, pediatric patients undergo an average of 4 surgeries annually and a total of >40 surgeries in their lifetimes primarily due to this condition. It is widely accepted that timely diagnosis and implementation of scientifically sound and effective interventions can prevent JORRP progression and mitigate serious complications. Notably, evidence-based guidelines to coordinate care are lacking, and there is a need to standardize clinical practice to improve outcomes for patients. The International Pediatric Otolaryngology Group issued guidelines in 2020 to improve care for patients with JORRP. However, this guideline was majorly tailored to the healthcare system in Europe and America, posing a challenge to its adoption in China. To this effect, we assembled a guideline development working group to formulate guidelines for the diagnosis and treatment of JORRP tailored to the Chinese context. The working group consisting of multidisciplinary experts with experience in managing patients with JORRP undertook qualitative and quantitative studies, conducted two rounds of Delphi consensus, and carried out multiple systematic reviews/meta-analyses to provide 24 key recommendations to 12 questions of clinical interest. We anticipate that healthcare workers, including primary care physicians and specialists managing JORRP, will find the guidelines useful, and their utilization will translate to improved outcomes for patients with the disease.

Objective: The "July effect," a theory that the beginning of the academic year has worse operative outcomes and complication rates, remains controversial. We evaluated the "July effect" as a risk factor for negative operative outcomes in head and neck microvascular reconstruction.

Methods: Multi-institutional retrospective review at three academic tertiary care centers from January 2010 to August 2021. Free flaps were stratified by the academic quarter. Patient factors, operative variables, length of stay (LOS), flap failures, and postoperative complications and adverse events were compared between academic quarters 1 and 4.

Results: We identified 2897 free flaps: 749 quarter 1 (Q1), 693 quarter 2 (Q2), 770 quarter 3 (Q3), and 685 quarter 4 (Q4). Overall flap failure rate was 4.9% (n = 143), and the most common postoperative complications were wound infection (12.8%, n = 370) and dehiscence (7.6%, n = 221). There were no significant differences between quarters in overall complication rate, flap failures, partial flap necrosis, wound infection, fistula, or hematoma (p > 0.05). There were also no significant differences in LOS or rates of 30-day readmission or reoperation (p > 0.05). Q1 had significantly more dehiscences (p = 0.04) and longer operative times (p = 0.001) than Q4.

Conclusion: Although Q1 surgeries had significantly longer operative times and higher dehiscence rates, we found no other differences in postoperative complications, flap failures, or adverse events by the academic quarter. While a "July effect" may exist due to the integration of new trainees into the surgical workflow, this effect does not translate into meaningful differences in overall free flap or patient outcomes.

Objectives: Appropriate scenarios of lumbar drain (LD) use in endonasal skull base surgery is an active area of investigation. However, existing data is limited. The purpose of this study is to evaluate the robustness of the NSQIP database to characterize morbidity and complications associated with LD usage concurrent to minimally invasive resection of pituitary tumors.

Methods: A cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program database was used to query patients undergoing transnasal resection of pituitary tumor. Patients were stratified by concurrent perioperative use of LD and outcomes were compared.

Results: A total of 1714 patients underwent minimally invasive endonasal (microscopic or endoscopic) pituitary tumor resection, of which LD was concurrently placed in 98 (5.7%) cases. Operative time was significantly longer for patients who had LD placed compared to those without (176.5 min (IQR 114.8-229.5) vs. 137 min [IQR 100-185]), (p < 0.001) with a significantly longer length of stay (5 days [IQR 4-6] vs. 3 days [IQR 2-5]), (p < 0.001). Multivariate regression demonstrated LD placement was an independent predictor of postoperative medical complication (OR 2.41, 95% CI 1.15-5.03, p = 0.020) and unplanned readmission (OR 2.06, 95% CI 1.02-4.16, p = 0.044), but not CSF leak (OR 2.30, 95% CI 0.51-10.26; p = 0.276). Temporal analysis during the study period demonstrated a decrease in LD use from 8% to 5% (R ² = 0.60; p = 0.025).

Conclusions: The NSQIP database provides a large patient population for examining LD use in endoscopic pituitary adenoma resection. LD use for minimally invasive pituitary surgery is associated with postoperative medical complications and unplanned readmissions, with no apparent impact on reconstructive outcomes, and there is overall decreasing usage. Clinical judgment should be exercised in selecting appropriate scenarios for use.

Objectives: This study evaluates the influence of facility volume and type on the treatment and outcomes of pituitary adenoma (PA).

Methods: The 2004-2016 National Cancer Database was queried for patients with PA receiving definitive treatment. Tumor size represented the largest diameter of the primary tumor.

Results: A total of 89,863 patients (53.8% female) with a mean age and tumor size of (51.0 ± 18.0) years (Mean ± SD, later the same) and (19.5 ± 13.2) mm, respectively, were included. Patients were managed at 1,241 unique facilities, categorized into 1057 low-volume (treating approximately <10 patients annually), 142 intermediate-volume (treating approximately 10-30 patients annually), and 42 high-volume facilities (treating approximately 31-105 patients annually). Increasing facility volume and academic centers were both associated with higher rates of surgical treatment as well as lower rates of radiotherapy and shorter postoperative length of hospitalization (all p < 0.001). Kaplan-Meier log-rank analysis showed that increasing facility volume and academic centers were both significantly associated with improved overall survival (p < 0.001). On multivariate Cox-regression analysis after adjusting for age, gender, Charlson-Deyo comorbidity index, tumor size, treatment type, and facility type, treatment at intermediate-volume (HR 1.238, 95% CI 1.155-1.329, p < 0.001) and low-volume facilities (HR = 1.413, 95% CI 1.306-1.528, p < 0.001) were independent risk factors of all-cause mortality, while facility type was not independently associated with overall survival.

Conclusion: Management and outcomes of PA appear to be dependent on the treatment facility volume, with high-volume facilities, but not necessarily facility type, being associated with improved outcomes overall.

Objectives: Traditional resection of second branchial cleft fistulas (SBCFs) involves a transcervical incision in the neck, which leaves a prominent scar; therefore, endoscope-assisted excision of SBCFs through the anterior chest approach has been proposed. To introduce endoscope-assisted excision of SBCFs via the anterior chest approach and to evaluate its feasibility, validity, safety, and clinical results.

Methods: This was a study of four patients with SBCFs who underwent surgical resection with the assistance of endoscopy via the anterior chest approach between May 2012 and May 2018.

Results: All procedures were successfully performed with endoscope-assisted surgery via the anterior chest approach. The volume of blood loss ranged from 5 to 10 mL (median 6 ml). The operating time ranged from 45 to 67 min (median 50 min). No patients presented evidence of long-term complications or recurrence during the median follow-up period of 72-144 months (median 99 months). All patients were satisfied with the cosmetic outcomes.

Conclusions: Endoscope-assisted resection of SBCFs via the anterior chest approach is feasible, effective, and safe and has better esthetic effects. Therefore, SBCF surgery via the anterior chest approach could be a novel and superior treatment option for patients with SBCFs.

Objective: Laryngocele is a rare condition, which can be congenital or acquired, characterized by an abnormal dilatation of the laryngeal ventricle filled with air. A correlation between laryngocele formation and increased intralaryngeal pressure has been postulated, as much as a frequent coexistence with laryngeal carcinoma. Despite this, systematic research on its potential etiology is still limited up to date.

Methods: We carried out a systematic an electronic search on the MEDLINE, Embase, Web of Science, Cochrane Library, Scopus, and ClinicalTrials.gov databases for all articles related to laryngocele or laryngopyocele. The authors performed a PRISMA-compliant systematic review across multiple databases including all studies published until February 7, 2023, focusing on laryngocele etiology. Case reports and articles in languages other than English were excluded. The authors recorded etiology, age of patients, male-to-female ratio, history of smoking, symptoms, management, and overall follow-up.

Results: The majority of publications related to laryngocele are case reports and case series. We found a total of 10 articles correctly reporting etiologies, the majority of which included only a limited number of patients. Most case series explored the association of laryngocele and laryngeal cancer. Other reported etiologies were wind instruments' playing, cricohyoidoepiglottopexy's execution, amyloidosis, and chronic constipation. Some cases of congenital laryngocele were also reported.

Conclusions: Actual knowledge concerning laryngocele etiology appears-based on literature studies-inferential at best. The association between laryngocele and laryngeal cancer is, on the other hand, well-established and must be taken into account when evaluating patients with this condition. Wider and prospective data collections should allow further insight into this condition and its pathogenesis.