World Journal of OtorhinolaryngologyHead and Neck Surgery最新文献

Introduction: Choanal atresia (CA) is a congenital narrowing or obliteration of the posterior nasal aperture. The condition is rare with an incidence of approximately 1 in 5000 to 9000 live births.

Objective: The aim of this work was to assess the results of treating this condition at the Otolaryngology Department in Oslo University Hospital-Rikshospitalet.

Methods: Retrospective review of patients treated at Oslo University Hospital-Rikshospitalet between 2005 and 2015 were performed. The review consisted of surgical techniques and outcomes, types of atresia, uses of stent and mitomycin C, age at operation, laterality of atresia, and associated anomalies.

Results: Thirty-one patients with CA were referred to Oslo University Hospital-Rikshospitalet during the mentioned observation period. Nine (29%) of the cases had bilateral CA and 22 (71%) had unilateral CA. Ten patients (32%) had bony atresia, 12 (39%) had membranous and eight (26%) had mixed type of atresia. Twenty-one patients (68%) needed revision surgery because of complete or partial restenosis after primary surgery. Stents were applied in 16 cases (52%) of patients and Mitomycin C was only used in the primary surgery of three patients. In the bilateral group, eight of the nine patients were operated on within the first 9 days of life. Sixteen patients (45%) had associated anomalies.

Conclusions: According to the observations in our sample, the restenosis problem is expected more and may need more revisions in bilateral CA than the unilateral type. The presence of other anomalies is associated with higher incidence of restenosis. Stenting is not essential in preventing restenosis.

Objectives: This study aims to investigate the role of Sirt5 in regulating eosinophil maturation and activation, specifically focusing on primary eosinophils in mice at the genetic level. Additionally, the study aims to elucidate the underlying mechanism of Sirt5 in eosinophilic inflammation metabolism and identify potential drug targets for the treatment of chronic sinusitis. The findings of this study will provide new insights and a solid theoretical basis for the development of novel therapeutic strategies for eosinophilic chronic rhinosinusitis (eCRS).

Methods: Our study investigated the role of Sirt5 gene expression in both non-eCRS and eCRS. We examined the correlation between Sirt5 gene expression and disease severity as well as eosinophil infiltration. Additionally, we utilized a mouse model of eCRS to assess the impact of Sirt5 gene deletion on the disease. To further understand the underlying mechanisms, we conducted experiments at the single-cell level using bone marrow-derived eosinophils. We validated our findings through in vitro culture of eosinophils and intervention experiments. Through these experiments, we aimed to elucidate how Sirt5 regulates target proteins and reshapes their related metabolic pathways.

Results: There is a positive correlation between the severity of eCRS and the expression level of Sirt5 in nasal mucosa. Inhibiting Sirt5 expression can effectively alleviate the abnormal activation of eosinophils and the resulting inflammatory response in eCRS-affected nasal mucosa. Sirt5 exerts its influence on eosinophil metabolism by negatively regulating the succinylation level of pkm2, a critical gene in the amino acid biosynthesis pathway.

Conclusions: The severity of eCRS is closely associated with the expression level of Sirt5. Sirt5 plays a negative regulatory role in the succinylation level of Pkm2 in eosinophils, thereby influencing metabolic remodeling and functional activation in eCRS. Investigating Sirt5 and its downstream metabolic pathways could offer valuable insights into the disease's pathogenesis and facilitate the development of targeted therapeutic strategies. This research holds significant implications for clinical practitioners involved in the diagnosis and treatment of patients with eCRS.

Objective: To assess the incidence of head and neck cancer in patients exposed to Agent Orange and related dioxins.

Methods: Studies were identified through CINAHL, PubMed, and Scopus. Primary studies were identified through April 2023. Articles were included reporting incidence of head and neck cancer and/or deaths due to head and neck cancer in participants exposed to Agent Orange. Meta-analysis of proportions was conducted to calculate incidence and mortality by primary site in those who were exposed to Agent Orange and for control groups. A comparison of proportions was used to compare rates in exposed and control groups.

Results: Of 1530 unique abstracts screened, 13 studies were included in the systematic review. Of the exposed patients with reported subsites, oral cavity (31.2%), and larynx (14%) were the most common. Of the exposed patients with reported deaths and subsites, oropharynx (0.25%) was the most common primary site in patients who died. The most common subsites of those who were not exposed, oropharynx (0.13%), and larynx (0.16%). Head and neck cancer of all subsites was more common in those exposed to Agent Orange than in unexposed controls (difference 0.061%; 95% confidence interval: 0.04%-0.08%, p < 0.0001).

Conclusions: Our findings suggest that head and neck cancer is more common in those who were exposed to Agent Orange than those who were not. Additionally, individuals exposed to Agent Orange were more likely to die from head and neck cancer. Further investigation is warranted to evaluate subsite-specific outcomes given the limitations of our study design.

Objectives: The Da Vinci robotic surgical system was used for head and neck surgery. This study aimed to investigate the feasibility, safety, and effect of postauricular approach on the resection of lateral neck cysts.

Methods: Eleven patients with lateral neck cysts were enrolled in this retrospective study and accepted robot-assisted surgery via a postauricular approach. Data on volume of cervical cysts, length of incision, bleeding volume, mean operating time, and hospitalization time were analyzed. The postoperative esthetic satisfaction of patients was investigated.

Results: In this case series, the average length of the incision was 6.67 cm. Bleeding volumes ranged from 10 to 20 mL. Average operation time was 55 min. Four patients developed postauricular numbness after the operation, and all recovered over 3 months. No other serious adverse events occurred after the operation. Postoperative cosmetic outcomes were satisfactory. During the follow-up median period of 38.2 months, there was no evidence of recurrence or long-term complications.

Conclusion: Robot-assisted resection for lateral neck cysts via a postauricular approach is feasible and safe and yields excellent cosmetic outcomes.

Objective: Coronavirus disease-2019 (COVID-19) can cause not only respiratory symptoms but also facial paralysis. Lianhua Qingwen (LHQW) has been reported to have therapeutic effects on COVID-19 and facial neuritis (FN). We explored the potential mechanism of LHQW in the treatment of COVID-19 and FN through a network-pharmacology approach.

Methods: Active compounds and relevant targets of LHQW were obtained from the databases of Traditional Chinese Medicine Systems Pharmacology Database, HERB, UniProt Knowledge Base, SwissADME, and Swiss Target Prediction. Disease targets of COVID-19 and FN were acquired from Gene Cards. Database For Annotation, Visualization And Integrated Discovery and Metascape were used to search the biological functions of intersecting targets. After identifying the core targets and their corresponding ingredients, KEGG Mapper analyzes the localization of core targets in key pathways. AutoDock were employed to conduct molecular docking of the core targets and their corresponding ingredients.

Results: We obtained four core genes: interleukin (IL)-8, IL-1B, IL-6, and tumor necrosis factor (TNF)-α. Database searching revealed the anti-inflammatory and antiviral effects of LHQW may be related to the action of aleo-emodin, hyperforin, kaempferol, luteolin, and quercetin on these four genes by regulating the pathways of IL-17 and NOD-like receptor. The molecular-docking results of the four core targets and their corresponding active ingredients showed good binding activity between receptors and ligands.

Conclusions: We uncovered the active ingredients, potential targets, and biological pathways of LHQW for COVID-19 and FN coinfection. Our data provide a theoretical basis for further exploration of the mechanism of action of LHQW in treatment of COVID-19 and FN.

Objectives: Documentation and billing are important and time-consuming parts of an otolaryngologist's work. Given advancements in machine learning (ML), we evaluated the ability of ML algorithms to use operative notes to classify rhinology procedures by Current Procedural Terminology (CPT®) code. We aimed to assess the potential for ML to replicate rhinologists' completion of their administrative tasks.

Study design: Retrospective cohort study.

Setting: Urban tertiary hospital.

Methods: A total of 594 operative notes from rhinological procedures across six CPT codes performed from 3/2017 to 4/2022 were collected from 22 otolaryngologists. Text was preprocessed and then vectorized using CountVectorizer (CV), term frequency-inverse document frequency, and Word2Vec. The Decision Tree, Support Vector Machine, Logistic Regression and Naïve Bayes (NB) algorithms were used to train and test models on operative notes. Model-classified CPT codes were compared to codes assigned by operating surgeons. Model performance was evaluated by area under the receiver operating characteristic curve (ROC-AUC), precision, recall, and F1-score.

Results: Performance varied across vectorizers and ML algorithms. Across all performance metrics, CV and NB was most overall the best combination of vectorizer and ML algorithm across CPT codes and produced the single best AUC, 0.984.

Conclusions: In otolaryngology applications, the performance of basic ML algorithms varies depending on the context in which they are used. All algorithms demonstrated their ability to classify CPT codes well as well as the potential for using ML to replicate rhinologists' completion of their administrative tasks.

Objective: Studies have described sleep dysfunction (SD) in patients with chronic rhinosinusitis (CRS). However, there is a paucity of literature describing sleep dysfunction in the context of aspirin-exacerbated respiratory disease (AERD). The purpose of this study was to evaluate the prevalence and severity of SD in patients with AERD relative to CRS.

Methods: This study is a prospective cohort study. Patients diagnosed with CRS without polyposis (CRSsNP, n = 206), CRS with nasal polyposis (CRSwNP, n = 38), and AERD (n = 28) were recruited prospectively in academic center rhinology clinic. SD was assessed using the Neuro-QOL Short Form v1.0-Sleep Disturbance (sleep-QOL), for which severe SD is defined as a score >2.0 standard deviations from the normalized mean. Demographic and patient-reported outcome measures (including SNOT-22 and PHQ-2) were collected to adjust for sleep confounders. Comparisons were made between groups using univariate and multivariate analyses.

Results: The prevalence of severe SD was significantly higher in AERD (57.1%) than in CRSsNP (32.5%) or CRSwNP (34.2%), p = 0.038. After adjusting for sleep confounders, the risk of sleep dysfunction remained higher among patients with AERD (odds ratio [OR] = 2.72 vs. CRSsNP, 95% confidence interval [CI] = 1.18-6.27, p = 0.02; OR = 3.06 vs. CRSwNP, 95% CI = 1.06-8.82, p = 0.04). SNOT-22 total score and the sleep subdomain showed no correlation with sleep-QOL score.

Conclusions: The frequency and severity of SD are greater in AERD patients than in patients with CRS with or without nasal polyposis, independent of confounders of sleep quality. While the putative link between AERD and SD remains elusive, this study suggests that SD in AERD may be greater than previously recognized.

Neurological and psychiatric complications continue to be a public health concern in long coronavirus disease 2019 (COVID-19). This varies from olfactory dysfunctions such as parosmia to cognitive and emotional challenges. Historically, the surge of neurological disorders followed the viral pandemics, for example, the emergence of Encephalitis Lethargica after the outbreak of Spanish Influenza. During and after COVID-19 infection, the problems associated with the sense of smell and the reports of affected olfactory and limbic brain areas are leading to a growing concern about the similarity with the symptoms and the pattern of degeneration observed at the onset of Parkinson's disease and Alzheimer's disease. These reports reveal the essentiality of long-term studies of olfactory and cognitive functions in the post-COVID era and the experiments using animal models to dissect the neural basis of these complications. In this manuscript, we summarize the research reporting the potential correlation between neurological disorders and viral pandemic outbreaks with a historical perspective. Further, we discuss the studies providing evidence of neurodegeneration due to severe acute respiratory syndrome coronavirus 2 infection by focusing on viral Parkinsonism.

Objective: The aim of this study was to assess the feasibility and safety of implanting covered stents in cases of advanced head and neck squamous cell carcinoma (ASCCHN) where the carotid artery was involved.

Methods: A total of 30 patients (29 males and one female) were included in this study, with ages ranging from 40 to 79 years. Among these patients, 28 patients had received radiotherapy and 17 received subsequent adjuvant therapy, while one was receiving treatment for the first time. Eighteen were treated with covered stent implantation in conjunction with surgery, and the remaining 12 received stent implantation alone. The study evaluated and compared the stent implantation's success rate, overall survival (OS), and associated complications.

Results: Successful implantation of covered stents was achieved in all 30 cases. No instances of significant hemorrhage or thromboembolic cerebral infarction occurred during surgery. Of the patients in the salvage surgical group, 15 underwent complete tumor resection with a success rate of 83.3% (15/18), of which four experienced tumor recurrence with a local recurrence rate of 26.7% (4/15). The OS rates at 6 months for all patients, the salvage surgical group, the 15 patients with complete tumor resection, and the nonsurgical group were 64.0%, 66.8%, 75.5%, and 58.6%, respectively. At 12 months, the OS rates were 21.4%, 29.3%, 43.2%, and 11.8%, respectively. Notably, the OS of the 15 patients who underwent complete tumor resection was significantly higher than that of the 12 patients who received stent implantation alone (p = 0.044). All cerebrovascular accidents occurred in patients with radiotherapy history, and subsequent adjuvant therapy had no significant effect on the OS time in the salvage surgical and nonsurgical groups (p = 0.935; p = 0.526).

Conclusion: In cases of ASCCHN involving the carotid artery, the implantation of covered stents is a safe and feasible procedure.