Laryngoscope最新文献

Objective: Tranexamic acid is a potential rhytidectomy adjunct; however, its route of administration, benefits, and safety remain a topic of debate. The purpose of this study is to analyze the effects of topical and subcutaneous TXA during rhytidectomy.

Methods: This is a retrospective, 3-arm analysis of a single surgeon's practice from Aug. 2019 to Nov. 2023. 175 consecutive patients underwent rhytidectomy; 55 did not receive TXA (8/2019-12/2020), 65 received intraoperative topical 25 mg/mL TXA (1/2021-7/2022), and 55 received subcutaneous 5 mg/mL TXA (7/2022-11/2023). Measured outcomes included drain output, bruising, operative time, estimated blood loss, and complications.

Results: Subcutaneous and topical TXA had similar drain outputs (11.32 mL vs. 12.98 mL, respectively) and bruising scores (20.93 vs. 22.12, respectively). These were significantly less than the control group (24.05 mL, p < 0.001 and 36.28, p < 0.001, respectively). The subcutaneous group operative time (196.13 min) was less than the topical and control groups (212.72 min, p = 0.01; 207.90 min, p = 0.037, respectively) in patients who underwent rhytidectomy with platysmaplasty. EBL and seroma formation in the subcutaneous TXA group were significantly less than the control (23.92 mL vs. 31.67 mL, p = 0.011; 3.60% vs. 18.18%, p = 0.03, respectively). Hematoma, epidermolysis, and infection rates were similar between all groups.

Conclusion: Both topical and subcutaneous TXA use during rhytidectomy are associated with reduced postoperative drain output and bruising without an increased risk of complications. Subcutaneous TXA has the added associated benefit of decreasing operative time, EBL, and seroma formation.

Level of evidence: III Laryngoscope, 2024.

Introduction: The risk of fire during laser microlaryngoscopy is well known. However, limited information is available about fire risk with the novel TruBlue laser. This study systematically evaluates its interactions with common surgical supplies, offering valuable insights into safety considerations for surgeons.

Material and methods: We used experimental conditions to test the extent to which TruBlue laser energy produces smoke, perforation, or fire in Rüsch®, Medtronic™ and microlaryngeal endotracheal tubes and in surgical pledgets.

Results: Only the Microlaryngeal Tube (MLT) caught fire. Notably, it happened only when the laser fiber shifted on the tube's surface. Smoke emerged solely from the laser fiber applied to the Medtronic™ shaft and only during continuous contact mode. Cuff perforation and smoke emanating from the shaft occurred in three-quarters of the Rüsch® trials. The pledgets' radiopaque segment exhibited a greater combustibility than other segments (p < 0.01). In many of the pledget trials, faster smoke emission occurred with shorter laser-to-target distances (p < 0.05). Water-soaked pledgets displayed a reduced rate of smoke production (p < 0.01) and string division.

Conclusion: The Medtronic™ tube assures remarkable safety with a nonignitable shaft and low cuff ignition. The MLT poses the highest ignition risk. Cuff perforation risk is mitigated by maintaining a 0.3-cm distance from the laser fiber tip. Pledget fire risk is mitigated by positioning the radiopaque part away from the laser beam and by soaking the pledget with water. Laser division of the pledgets' string was common.

Level of evidence: NA Laryngoscope, 2024.

Surgical access to tumors involving the infratemporal fossa (ITF) and adjacent regions can be challenging, and there is a continued need for novel approaches to complex tumors in this region. In this manuscript, we present a unique anatomical approach that allows contiguous exposure of the ITF and buccal space with mobilization of the lateral maxillary buttress. Laryngoscope, 2024.

Objectives: To evaluate temporal trends and identify patient characteristics associated with otitis media (OM) surgery.

Methods: A retrospective cohort study performed using electronic health record data from seven large pediatric medical networks from January 1, 2009, to December 31, 2022. Children <6 months old cohort entrance time and OM history were included and followed longitudinally.

Results: The database included 1,448,390 children entering at age <6 months of which 5.3% underwent tympanostomy tube insertion (TTI). Inclusion criteria was met by 454,924 children. Age at first OM was 1.6 years (standard deviation [SD]: 1.1), with mean follow-up of 6.3 years (SD 3.7), and 249,818 (54.9%) were male. Among children with OM 64,950 (14.3%) underwent only TTI, and 13,188 (2.9%) had TTI with adenoidectomy (TTI-A). Over time, TTI only rates exhibited seasonal fluctuations with a drop in 2020, TTI-A rates were flat. The following patient characteristics greatly increased TTI: sensorineural hearing loss (adjusted hazard ratio, aHR 4.0, [95% confidence interval, CI] 3.9-4.1), chronic adenoiditis (aHR 3.4 [95% CI 3.0-3.5]), and cleft palate (aHR 1.9 [95% CI 1.8-2.0]). Children 4-8 years old (aHR >11.7 [95% CI 10.6-16.4]), history of chronic adenoiditis (aHR 6.4 [95% CI 5.4-7.7]), or sleep disorders (aHR 4.9 [95% CI 4.7-5.2]) greatly increased TTI-A odds.

Conclusions: Overall TTI rate was 5.3%, which increased to approximately 20% in children with OM. Aside from the COVID-19 pandemic, surgical rates have been stable. Though multiple characteristics increase the risk of TTI, sensorineural hearing loss for TTI only, and older age in the TTI-A subset carried the highest risk.

Level of evidence: 3 Laryngoscope, 2024.

Objective: Transoral robotic surgery (TORS) has shown promising results in treating human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), and there has been increasing interest in incorporating neoadjuvant chemotherapy (NCT) prior to TORS. This study aimed to assess the feasibility and safety of sparing adjuvant RT following NCT and TORS.

Methods: A retrospective cohort study included consecutive patients with HPV-positive OPSCC who underwent NCT followed by TORS without adjuvant RT. Disease-free survival (DFS) was the primary outcome. Pattern of recurrence (local, regional, and distant), salvage treatment outcomes, and predictors of tumor recurrence were also assessed.

Results: A total of 84 patients were included in the analysis. No patients died during the study period. DFS rates (95% Confidence Interval, CI) at 1, 2, and 3 years were 92.8% (87.4-98.5), 87.0% (79.7-94.9), and 84.4% (76.0-93.8), respectively. Local, regional, and distant recurrence rates were 7.0%, 9.5%, and 3.6%, respectively. Salvage treatment achieved a 100% salvage rate. Predictors of tumor recurrence included the number of positive lymph nodes (hazard ratio: 2.66; 95% CI: 1.19-5.92) and clinical stage III at diagnosis (hazard ratio: 7.65; 95% CI: 1.97-29.7).

Conclusions: Recommendation of adjuvant treatment based on pathologic adverse features appears to be associated with favorable outcomes in selected HPV-positive OPSCC cases treated with NCT and TORS. Future studies should focus on refining criteria for recommending adjuvant RT to further reduce recurrence rates and minimize treatment-related toxicity, contributing to personalized treatment strategies for HPV-related OPSCC.

Level of evidence: 4 Laryngoscope, 2024.

Background: This study analyzes nasopharyngeal carcinoma (NPC) from 1990 to 2021 across 204 countries, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs). It examines gender disparities, regional variations, age dynamics, and temporal trends to provide insights for health policy and resource allocation.

Methods: We used the Global Burden of Disease (GBD) approach to assess NPC's health burden, including incidence, prevalence, mortality, and DALYs. Trends from 1990 to 2021 were illustrated using estimated annual percent change (EAPC). Subgroup analysis revealed variations by gender, age, Socio-Demographic Index (SDI), GBD classification, and country. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models predicted future trends.

Results: In 2021, there were 118,878 new NPC cases globally (1.38 per 100,000), with a prevalence of 525,219 cases (6.14 per 100,000), 75,359 deaths (0.87 per 100,000), and 249,019 DALYs (28.91 per 100,000). Males had higher rates across all metrics. Incidence peaked at ages 50-54, mortality at 70-74, and DALYs at 50-54. High SDI regions, especially East and Southeast Asia, showed higher burdens. Despite decreasing age-standardized incidence rates, absolute cases are rising, necessitating improved prevention and treatment strategies.

Conclusions: NPC prevalence has increased due to better diagnosis and aging populations, despite decreasing age-adjusted incidence rates. Lower mortality rates indicate improved treatment. Males, especially in East and Southeast Asia, bear a higher NPC burden. These findings highlight the need for targeted interventions and tailored public health policies in high-risk regions.

Level of evidence: III Laryngoscope, 2024.

Objectives: This systemic review with meta-analysis evaluated the effect of intranasal BTX-A turbinate injection on chronic rhinitis-related symptoms.

Data sources: PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases.

Review methods: We reviewed studies retrieved from databases up to Aug 2024. The studies evaluating the degree of change of rhinitis-related symptom scores and quality of life before and after BTX-A injection were analyzed. Standard mean differences were used to calculate effect sizes.

Results: A total of 269 patients from 7 studies were analyzed. BTX-A injection showed a significant improvement in rhinitis-related symptoms (congestion: 2.5416, 95% CI 1.0927-3.9905, I² = 94.4%, itching: 1.2553, 95% CI 0.6660-1.8446; I² = 70.8%, rhinorrhea: 1.8451, 95% CI 1.0468-2.6435, I² = 89.7%, and sneezing: 1.3580, 95% CI 0.5194-2.1967; I² = 90.7%), total nasal symptom score (2.4020, 95% CI 1.4161-3.3879, I² = 86.1%), and quality of life (1.5256, 95% CI 1.0760-1.9752; I² = 0.0%) throughout the follow-up period (4 months). However, 3 months after injection, although symptom improvement remained, there was no statistical significance. Allergic rhinitis (AR) patients showed a significant improvement in rhinitis-related symptoms compared with nonallergic rhinitis (NAR) patients.

Conclusions: Nasal symptoms and quality of life scores related to rhinitis were decreased after BTX-A injection. In particular, this treatment showed better efficacy in AR and could be more beneficial for the symptoms of nasal congestion and rhinorrhea at the early periods of treatment. However, the effects lasted for a relatively short period of only 2-3 months. Laryngoscope, 2024.

Objectives: To investigate the incidence, laryngeal distribution, management, and postoperative clinical course of patients with newly diagnosed adult-onset recurrent respiratory papillomatosis (RRP) in Japan.

Methods: An initial brief questionnaire was sent to 782 institutions, including all 101 core and 627 collaborating institutions providing board certification programs accredited by the Japanese Society of Otorhinolaryngology-Head and Neck Surgery. A detailed questionnaire regarding patient age, sex, Derkay's score, surgery, and postoperative clinical course was sent to 196 institutions caring for patients with either newly or previously diagnosed RRP.

Results: A total of 186 patients with newly diagnosed adult-onset RRP from 78 institutions were identified during the present study period (2018-2019), suggesting an annual incidence of 0.20 per 100,000 population in Japan. The true vocal folds were the most frequently affected subsites in the larynx, followed by the false vocal folds, anterior commissure, and laryngeal surface of the epiglottis. The use of cold instruments was the most preferred surgical approach, followed by the carbon dioxide laser and microdebrider. A significant difference in recurrence-free period after the initial surgery was observed between patients with lesions in a single region and those with lesions in multiple regions (p = 0.001).

Conclusion: Here, we estimated the annual incidence of adult-onset RRP for the first time in Japan. To the best of our knowledge, the present study is the largest to identify the laryngeal distribution of lesions, as well as postoperative outcomes after initial surgery in newly diagnosed adult-onset RRP patients.

Level of evidence: 4 Laryngoscope, 2024.

Endoscopic nasopharyngectomy in the context of recurrent nasopharyngeal carcinoma may require reconstruction with strongly vascularized flaps. This is fundamental to address the volumetric deficit and prevent complications such as carotid blowout syndrome. The submental island flap is well suited for this purpose. Laryngoscope, 2024.