World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Objective: Sinonasal squamous cell carcinoma (SNSCC) is rare in the general population. No clear and consistent etiologic correlation between human papillomavirus (HPV) and SNSCC has yet been delineated in the literature. p16 is a tumor suppressor protein used as a surrogate marker for HPV. This study aims to evaluate the relationship between p16 overexpression in SNSCC and its role in prognosis and survival.

Methods: A population-based retrospective analysis was performed using prospectively collected data from the Northern Alberta Head and Neck Tumour Board, the Alberta Cancer Registry, and the Alberta Cancer Research Biobank. p16 overexpression was analyzed from pathologic samples of patients meeting study criteria, and participants were dichotomized by status. Subsequently, nonparametric analysis of demographics, initial staging, and initial treatment were performed, and a Kapan-Meier curve was developed to assess differences in survival.

Results: Sixteen patients were included in the analysis. p16 overexpression was seen in 68.8% of patients. p16 positive and negative groups were comparable for age, gender, smoking status, stage, and treatment. A statistically significant 5-year survival advantage was observed in patients with p16 positive SNSCC (P = 0.013).

Conclusions: This is the first Canadian study to demonstrate a high prevalence of p16 positivity in SNSCC and its presence denoting a statistically significant survival advantage. Results demonstrate a previously unconfirmed role of oncogenic HPV in SNSCC.

The diagnosis and staging of head and neck tumors requires proper clinical, endoscopic, and radiological evaluation. Currently, imaging techniques such as Magnetic Resonance Imagining (MRI) and Computed Tomography (CT) are used for head and neck tumors but are limited in showing involvement of different hypopharyngeal sub-compartments. Several maneuvers have been developed to improve visualization of the head and neck area; however, they demonstrated minimal benefit. In this case series, patients with tumors involving the hypopharynx are studied. A laryngeal mask airway was used to stent the hypopharynx to assess the extent of the disease by creating real space between mucosal surfaces. This case series aims to describe the impact of using laryngeal mask airway on the evaluation of cancers involving the hypopharynx.

Background: Thyroid carcinoma (TC) accounts for almost 0.5%-1% of total malignancies. Its incidence is increasing rapidly worldwide. Several studies have drawn up the epidemiological profile of TC and its clinical and pathological features. However, to date, no similar studies have been conducted in Tunisia.

Aims: To establish an epidemiological profile of TC in a Tunisian health care institute and to analyze its clinical and histopathological characteristics in our institute.

Materials and methods: We present a retrospective study reviewing the cases of TC diagnosed in our institution in a 4-year period.

Results: We collected a sample of 192 cases of TC. It consisted of 31 males and 161 females (83.8%) with a sex-ratio M/F of 0.19. The mean age was 46.4 years. Papillary thyroid carcinoma was the most frequent histological subtype. The multifocality rate was 33.8%. The mean size of TC was 2.2 ± 1.9 cm. 60.9% of TC were staged pT1 and 20.3% had nodal involvement. Papillary thyroid microcarcinomas were noted in 37.5% of cases.

Conclusion: Our results were consistent with those of the literature. A high proportion of pT1 and pN0 tumors were noted in our series, suggesting that TC's diagnosis and management was performed at an early stage of the disease in our institution. In addition, our study enabled us to notice the impact of the Coronavirus disease 19 crisis on the management of TC in our institution. Further studies are needed to establish the epidemiological profile of TC in Tunisia and to assess its clinical and pathological features.

Objectives: Postoperative pain medications and aspirin before undergoing functional endoscopic sinus surgery (FESS) are managed carefully due to concern for bleeding. Little is known regarding the increase in the risk of bleeding for patients unable to stop aspirin as trials are limited in this area. We compared outcomes for patients undergoing FESS who were managed postoperatively with nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids. We also determined the epistaxis rate for patients on aspirin at the time of surgery compared to those who were not on aspirin.

Data source: Retrospective analysis of patients undergoing FESS using the TriNetX database.

Methods: Patients were propensity-matched, and the odds of bleeding complications between the patients prescribed postoperative NSAIDs were compared to those prescribed opioids. We also compared postoperative odds of bleeding in patients unable to halt aspirin use at the time of surgery to those who were not on aspirin before surgery.

Results: A total of 51,361 patients received opioids after FESS compared to 1923 patients who received NSAIDs. After propensity matching, 1918 patients were in each group and odds of epistaxis were similar between the NSAID group and the opioid group (odds ratio [OR]: 1.32, 95% confidence interval (CI): 0.90-1.94); 7.67% of the NSAID group required rescue opioids. Patients on aspirin who were unable to hold aspirin at surgery showed bleeding rates of 14.67% compared to 9.00% in propensity-matched controls who were not on aspirin (OR: 1.74, 95%CI: 1.20-2.51).

Conclusions: NSAID use appears to be a safe alternative to opioids for patients without pre-existing risk factors for bleeding. Patients who remained on aspirin in the week before FESS had an increased risk of postoperative epistaxis.

Background: Oroantral fistula (OAF) is a pathological channel formed between the oral cavity and the maxillary sinus. A large size of OAF (≥5 mm) increases the risk of surgical failure, and an optimal surgical approach should be cautiously selected.

Objective: This study aims to characterize the application of nasal endoscopy and buccal fat pad (BFP) flaps to repair large OAFs in patients with odontogenic maxillary sinusitis (OMS).

Methods: A total of 32 patients with large OAF combined with OMS after dental extraction who were treated in the Department of Otorhinolaryngology, Nanjing Renpin ENT Hospital from 2018 to 2022, were retrospectively recruited. A thorough preoperative evaluation was performed and all patients were first treated with nasal endoscopy, followed by the repair of OAFs using BFP flaps under general anesthesia. The cure rate and postoperative pain score were used as outcome indicators to evaluate the effectiveness of the procedure.

Results: All patients completed a 12-month follow-up. The results showed that OFAs were cured in 25 (32 in total, 78.1%) patients by the second postoperative week. OFAs were healed in all patients at week 8 postoperatively. OMS was healed in 25 (32 in total, 78.1%) patients at the first postoperative week and all patients were healed by the disappearance of symptoms associated with OMS at week 8 postoperatively. At the second postoperative week, complete relief of pain symptoms was obtained in 18 (32 in total, 56.3%) patients (visual analog scale = 0 score), in 25 (32 in total, 78.1%) patients at the fourth postoperative week, and by the eighth postoperative week, all patients had complete resolution of pain symptoms.

Conclusions: Secondary maxillary sinusitis is not a contraindication to the treatment of large OAFs. Large OAFs can be effectively closed using BFP flaps combined with endoscopic maxillary sinus drainage.

Introduction: Medication-related osteonecrosis of the temporal bone is rare and has been reported to be associated with the use of anti-resorptive and biologic agents. Here, we present the first case of tyrosine-kinase inhibitor-related external auditory canal (EAC) osteonecrosis as well as two cases related to anti-resorptive therapies.

Methods: A retrospective case series.

Results: Case one: an 84-year-old female presented with chronic otitis externa and osteonecrosis of EACs bilaterally. She had a history of osteoporosis treated with denosumab and risedronic acid. She successfully underwent left EAC reconstruction using an inferiorly-based pedicle periosteal flap while the right ear canal was managed conservatively. Case two: a 69-year-old male presented with osteonecrosis of the right EAC. He had a history of osteoporosis treated with alendronic acid and zoledronic acid. His osteonecrosis is conservatively managed with local debridement and antibiotic application. Case three: a 60-year-old male presented with osteonecrosis of the right inferior EAC. He had a history of chronic myelogenous leukemia treated with a tyrosine-kinase inhibitor, imatinib. After failing conservative therapy, he underwent right ear canal reconstruction using a periosteal vascular pedicle flap without complication and experienced complete resolution to his symptoms.

Conclusion: Anti-resorptive agents and/or tyrosine kinase inhibitors may lead to dysregulation of bone remodeling and result in rare cases of temporal bone osteonecrosis. When a local debridement and antibiotic therapy fail, definitive surgical excision of necrotic bone with subsequent reconstruction of the EAC may offer patients a possible resolution in symptoms.