Laryngoscope最新文献

Objective: Conventional grading scales and static image assessments may not capture dynamic facial movement in facial paralysis. We developed a video-based, dynamic, artificial intelligence (AI) application, DynaFace, to objectively quantify facial metrics and determine which measures correspond with patient-reported appearance, function, and psychosocial outcomes, providing insight into how objective dynamics relate to subjective patient experience.

Methods: DynaFace automatically extracted dynamic facial metrics (facial asymmetry index [FAI], bilateral palpebral fissure, and oral commissure excursion [OCE]) at rest and during smile, laughter, and pucker. Multivariable linear regression, controlling for paralysis duration and baseline trait emotional intelligence, assessed associations between objective metrics and patient-reported outcomes from FACE-Q subsets.

Results: Greater asymmetry (higher FAI) during smile and laugh was associated with poorer perceived facial (β = smile: -2.82/laugh: -3.01, p < 0.05), eye (β = -3.99/-3.12, p < 0.05), and smile appearance (β = -4.40/-4.80, p < 0.01), as well as lower overall facial function (β = -3.05/-3.60, p < 0.05) and self-esteem (β = -2.93/-3.12, p < 0.05). In contrast, greater ratio of OCE change (affected to unaffected hemiface) during smile predicted better perceived facial appearance (β = 0.88, p < 0.01), smile appearance (β = 0.69, p < 0.05), and higher self-esteem (β = 0.62, p < 0.05). Greater ratio of OCE change during both smile and laugh predicted improved social function (β = 0.48/0.44, p < 0.05). Palpebral fissure asymmetry was associated with only eye appearance.

Conclusions: Dynamic AI-derived facial metrics from DynaFace align with patient perceptions, showing that greater symmetry in movement enhance satisfaction and function. These findings highlight the clinical potential of DynaFace to bridge objective and patient-reported measures in facial paralysis assessment.

Level of evidence: 4:

This study presents a case of undiagnosed HIV presenting with Kaposi sarcoma (KS) of the head and neck with acute upper airway obstruction (UAO) and provides an updated scoping literature review to examine the patient characteristics, lesion characteristics, interventions, and outcomes of KS cases with UAO from the pharynx, larynx, and/or trachea.

Objective: Prior studies have demonstrated the feasibility of fluorescently labeled tilmanocept for sentinel lymph node biopsy (SLNB) in the oral cavity. We evaluated the added value of fluorescently labeled tilmanocept in sentinel lymph node biopsy (SLNB) of the oral cavity compared to gamma probe.

Methods: Healthy male New Zealand white rabbits received oral cavity injections of radioactive (Technetium 99m) and fluorescently (IRDye800) conjugated tilmanocept followed by either fluorescence guided (n = 14) or gamma probe guided (n = 14) SLNB performed 1 h, 48 h, or 5 days postinjection. Duration of the SLNB performed by two individuals was measured and compared using the two methods.

Results: Fluorescence guidance resulted in a 1.8-fold reduction in time of SLN removal (median 104 vs. 191 s, p = 0.05). For the fluorescence guided SLNB, 7.1% (1 of 14) had nonsentinel node tissue removed prior to the correct identification of the SLN, whereas gamma probe/radioactivity guided SLNB had 28.6% (4 of 14). When comparing operation time between attending and resident surgeon, time to identification of first SLN was not significantly different for fluorescence guided surgery (82 vs. 107 s, respectively) or with gamma probe (158 vs. 204 s); however, median times using the gamma probe were nearly double for both operators. We additionally show the durability of fluorescence signal up to 5 days and clear visualization of proposed tracer with commercially available intraoperative imagers.

Conclusion: The use of fluorescent labeled tilmanocept decreases operative time needed for SLNB as well as reduces the amount of nonsentinel tissue removed.

Level of evidence: N/A.

Objectives: While standard treatments for mandibular osteoradionecrosis (MORN) exist for mild/superficial and severe/full thickness disease, there is no consensus on treatment for advanced, partial thickness disease. In this niche, the anterolateral thigh fascia lata (ALTFL) "rescue" flap has managed MORN successfully. This study aimed to compare ALTFL with fibula free flap (FFF) reconstruction to determine differences in outcomes, complications, and postoperative logistics.

Methods: A retrospective chart review of patients undergoing ALTFL or FFF for MORN between 2008 and 2024 was carried out.

Results: Fifty-one patients with Grade III (n = 26) or IV (n = 25) MORN underwent FFF (n = 22) or ALTFL (n = 29). ALTFL patients were older but did not differ in preoperative MORN treatment or risk factors compared to FFF. Median operative time for ALTFL was significantly less than FFF in both Grade III (298 min vs. 516 min) and IV (298 min vs. 599 min), without differences in subsites of mandible involved. Hospitalization for ALTFL was significantly shorter than FFF for both Grade III (2 days vs. 7 days) and IV (4.5 days vs. 7 days) without differences in peri-operative complications, flap failure or MORN resolution. Tracheotomy was performed more often for patients undergoing FFF for Grade III MORN. Patients who underwent ALTFL were more likely to return to a diet beyond soft within the follow-up period.

Conclusions: The ALTFL rescue flap offers reduced morbidity and improved resource allocation compared to FFF for the treatment of advanced, partial thickness MORN with similar outcomes.

Level of evidence: 4:

Objectives: To evaluate the prognostic importance of impaired vocal cord mobility (VCM) in T2N0 glottic cancer.

Methods: All patients with T2N0 glottic cancer treated with partial laryngeal IMRT in 2009-2021 in our institution were retrospectively reviewed. For comparison, cohorts with T1N0 and T3N0 disease were also included. Locoregional failure (LRF), disease-free survival (DFS), and overall survival (OS) were compared among T1N0, T2N0 with normal VCM (T2-Normal-VCM), T2N0 with impaired VCM (T2-Impaired-VCM), and T3N0 groups. Multivariable analysis (MVA) assessed the prognostic value of VCM within the T2N0 group.

Results: A total of 642 cases were included: 288 T1N0, 224 T2N0 (147 T2-Normal-VCM, 77 T2-Impaired-VCM), and 130 T3N0. Median follow-up was 5.0 years (IQR 3.4-6.2). Five-year LRF for T1N0, T2-Normal-VCM, T2-Impaired-VCM, and T3N0 were 4% (95% CI 2-6), 9% (5-15), 27% (17-38), and 35% (27-44), respectively. Corresponding DFS was 83% (78-88), 80% (73-87), 55% (45-68), and 50% (41-60), while OS was 85% (80-90), 86% (80-92), 71% (61-83), and 59% (50-69), respectively. In T2N0, MVA confirmed that impaired VCM was associated with higher LRF (aHR 3.72 [95% CI 1.79-7.71], p < 0.001), lower DFS (aHR 2.74 [1.68-4.45], p < 0.001), and lower OS (aHR 2.07 [1.17-3.67], p = 0.013).

Conclusions: In this contemporary cohort, LRF rates increased stepwise from T1N0 to T2-Normal-VCM, T2-Impaired-VCM, and T3N0 glottic cancer. Within T2N0 disease, impaired VCM is an adverse prognostic factor, supporting subdivision into T2a (normal VCM) and T2b (impaired VCM) in future TNM revisions. Prospective studies are warranted to assess whether treatment intensification can improve outcomes for T2-Impaired-VCM disease.

Level of evidence: 3:

Objectives: Percutaneous dilatational tracheostomy (PDT) is increasingly preferred in intensive care due to its procedural efficiency. Standard approaches typically rely on real-time bronchoscopic or ultrasound guidance, which may be unavailable in resource-limited settings. We evaluated the feasibility, safety, and learning curve of landmark-guided PDT performed without adjunctive visualization.

Methods: We retrospectively analyzed 71 consecutive adult patients who underwent landmark-guided PDT without bronchoscopic or ultrasound guidance between August 2024 and June 2025. All procedures were performed by a head and neck surgeon newly trained in PDT. Outcomes included procedure duration, complication rates, and patient-specific predictors of procedural difficulty. The learning curve was assessed using correlation and linear regression, and independent predictors of prolonged procedure time were identified through multivariable linear modeling.

Results: The median procedure time was 7.0 (3.0-54.0) min, and a significant learning curve was observed (r = -0.41; p < 0.001). Complications occurred in 14.1% of patients, with major events being limited to one bleeding episode and two pneumothoraces. In multivariable analyses, prior cerebrovascular accident and increased cricoid-manubrium distance independently predicted prolonged procedure times.

Conclusion: Landmark-guided PDT without real-time visualization was feasible and safe following a brief learning phase. With appropriate patient selection and operator training, this technique may represent a practical alternative in settings where visualization adjuncts are unavailable.

Level of evidence: 4:

Objective: To evaluate perioperative changes in olfactory bulb volume (OBV) and olfactory function in patients with eosinophilic chronic rhinosinusitis (ECRS) using 3T magnetic resonance imaging (MRI) with fast imaging employing steady-state acquisition (FIESTA) sequence and to assess their associations.

Methods: This single-center, retrospective observational study included 32 patients with ECRS who underwent functional endoscopic sinus surgery. Olfactory function was assessed pre- and postoperatively using the Alinamin test, T&T olfactometer, Open Essence (OE), Odor Stick Identification Test for Japanese (OSIT-J), Visual Analog Scale (VAS), and Self-Assessment Olfactory Questionnaire (SAOQ). OBV was manually measured from FIESTA images. Logistic regression was used to identify preoperative predictors of OBV change.

Results: Postoperative OE, OSIT-J, VAS, and SAOQ scores improved significantly. Mean OBV increased by 10.3% postoperatively, although not statistically significant (p = 0.095). OBV change correlated with improvements in olfactory identification (OE: r = 0.404, p = 0.022; OSIT-J: r = 0.402, p = 0.022), which should be interpreted as exploratory. Multivariate analysis revealed that longer odor duration on the Alinamin test (≥ 50 s) and higher SAOQ scores predicted smaller OBV increases.

Conclusion: OBV measurement using 3T MRI with FIESTA may provide a structural correlate of olfactory changes in ECRS. The observed correlation between OBV changes and olfactory identification suggests a potential relationship with postoperative functional recovery.

Level of evidence: 4:

Objectives: While maxillary sinus fungal balls (MSFB) can be associated with odontogenic conditions (MSFBO), MSFBO clinical and dental features have not been compared to odontogenic sinusitis (ODS). This multicenter study aimed to compare characteristics of MSFB, MSFBO, and ODS.

Methods: A multicenter international retrospective cohort study was conducted on adults with MSFBs and ODS who underwent sinus surgery. First in MSFBs, it was determined whether different dental conditions were more likely in FB versus non-FB sides. Second, clinical features and dental pathologies were compared between MSFBO and ODS. For analyses, dental conditions were considered individually and as two groups: infectious pathologies and dental/oral procedures with indwelling metallic materials.

Results: After exclusions, there were 203 MSFBs and 163 ODS. Among MSFBs, 141 were MSFBOs. FB sides were associated with sinus protrusion of root canal treatment (RCT) materials (p = 0.040) and dental implants (p = 0.040). Compared to MSFBO, ODS patients were younger, more likely to have MS purulence (OR = 40.9, p < 0.010), more likely associated with apical periodontitis (OR = 2.59, p = 0.010) and oroantral fistulas (OR = 6.94, p = 0.020), and less likely associated with extruded RCT materials (OR = 0.01, p = 0.010) and protruded midface screws (OR < 0.01, p = 0.010). Comparing purulent MSFBO and ODS, ODS was more associated with infectious dental pathologies (p < 0.009).

Conclusion: Compared to MSFBs, MSFBOs were associated with RCT extrusion and implant protrusion. Compared to MSFBOs, ODS was more likely purulent and associated with infectious dental pathologies. While ODS is often distinct from MSFBO, the two conditions can coexist, and surgeons must determine whether patients have infectious dental pathology requiring treatment with both conditions.

Level of evidence: 4:

Objective: Transverse cordotomy with medial arytenoidectomy (TCMA) for bilateral vocal fold immobility (BVFI) can optimize a patient's respiratory status and promote tracheostomy decannulation, but has the potential to adversely affect voice and swallow function. We present the largest cohort to date evaluating the procedure's effectiveness and compare functional outcomes by etiology of BVFI.

Methods: Retrospective case series of consecutive patients treated at a tertiary care center from April 2014 to 2024. All patients who underwent TCMA for posterior glottic stenosis (PGS) or bilateral vocal fold paralysis (BVFP) were included. Exclusion criteria were multi-level stenosis and prior airway resection or reconstruction. We assessed rate of decannulation, Voice handicap index (VHI), dyspnea index (DI), eating assessment tool (EAT-10), and cough severity index (CSI) scores and compared outcomes by surgical indication.

Results: Forty-five patients were included and the majority had PGS (64%). Seventy six percent of tracheostomy dependent patients were decannulated. Surgical indication did not impact time to decannulation or number of interventions required for decannulation. DI was improved at 1-month post-operation and last clinic visit (p < 0.0001). DI was slightly improved for the PGS cohort at last clinic visit, compared to the BVFP cohort (p = 0.04). There were no differences in VHI, EAT-10, or CSI after surgery compared with baseline, or differences based on BVFI etiology.

Conclusions: TCMA is an effective surgical intervention for BVFI that provides a reliable rate of decannulation and improves respiratory function without compromising voice or swallowing outcomes, regardless of the BVFI etiology.

Level of evidence: 4: