Laryngoscope最新文献

This article reviews the current literature on the use of pentoxifylline and tocopherol for the medical management of osteoradionecrosis of the mandible after head and neck radiotherapy.

Objective: Thyroglossal duct cyst (TGDC) or fistula is a prevalent congenital mass in the neck region. The objective of this study was to introduce a transoral submandibular surgical technique that has not been previously described in the literature. This technique was compared to the classic Sistrunk procedure and the vestibular approach, which is preferred in endoscope-robot-assisted methods.

Method: The present study encompasses a cohort of 12 patients diagnosed with TGDC between 2011 and 2022, who underwent surgical intervention utilizing the transoral submandibular approach technique. The transoral submandibular technique is described in detail and compared with the classical transcervical technique and other transoral approach techniques. These comparisons are discussed in the light of current literature.

Results: The total number of patients included in the study was 12, with ages ranging from 4 to 17 years. The duration of symptoms ranged from 6 to 120 months. The surgical duration ranged from 80 to 180 min, with an average of 102 ± 14.5 min. No intraoperative complications were observed in any of the patients.

Conclusion: The development of minimally invasive techniques has emerged as a response to the external incision scar problem associated with the Sistrunk procedure, the prevailing treatment for TGDC. These techniques hold considerable promise, yet the optimal technique remains elusive. It is hypothesized that the transoral submandibular approach for thyroglossal duct cyst excision will make a positive contribution to the literature in this context.

Level of evidence: 4:

Objective: Alginate therapies are a promising option for managing gastroesophageal reflux (GERD), but most treatments are not recommended during pregnancy. This scoping review aimed to summarize the current outcomes research on the use of alginate therapy for treating GERD during pregnancy.

Data sources: EMBASE, MEDLINE, CINAHL, and Web of Science were searched from database inception to November 1, 2024. Reference lists of included studies were also searched.

Review methods: We included randomized controlled trials (RCTs) and non-randomized studies evaluating alginate use in pregnant individuals with GERD. Screening and data extraction were performed by three reviewers in duplicate. Extracted data included study design, location, population, study group allocation, and clinical outcomes. Descriptive statistics were calculated using Microsoft Excel.

Results: Two RCTs and two prospective cohort studies met the inclusion criteria. Of the two RCTs identified, one evaluated an alginate formulation against a proton pump inhibitor (PPI), and the other against a magnesium-aluminum antacid. Cohort studies reported investigator- and patient-rated treatment success at 89.7% and 90.0%, respectively, with 92.2% of participants having symptom relief within 20 min. Similar improvements in heartburn intensity and frequency were found when comparing alginates and antacids. Few maternal adverse effects were reported, and no fetal or neonatal outcomes were related to treatment. Safety profiles of alginates were comparable to PPIs and antacids.

Conclusion: Current literature on alginate therapy in pregnant women may suggest potential for symptom relief and favorable tolerability, but current evidence is limited by the few available prospective studies.

Level of evidence: N/A.

Obstructive sleep apnea (OSA) affects nearly one billion people worldwide. Natural sleep endoscopy (NSE) is the ideal standard for evaluating airway collapse under physiological sleep but has been unfeasible due to practical limitations. This study evaluates the feasibility of home-based sleep endoscopy during natural sleep using a novel endoscope system.

Objectives: Oral potentially malignant disorders (OPMDs) are local and systemic conditions that can result in oral malignancies. We have had an OPMD surveillance program for 25 years covering over 30% of our state's population. More recent electronic health record search techniques have allowed us to analyze over 1500 patients in over a 10-year period, approximately 20% of total referrals.

Methods: Electronic health record (EHR) information was queried for 24 International Classification of Disease (ICD) 9 and 10 codes to generate a de-identified data set. Charts within this data set were cross-referenced against 79 ICD9/10 codes corresponding to oral and oropharyngeal cancers. The time course of conversion and frequencies of precancerous and cancerous lesions was assessed.

Results: Of 4496 unique patients seen, 1535 patient records met inclusion criteria. Seventy two patients showed cancerous conversion (4.69%), with 55 (3.58%) before 5 years, and 17 (1.11%) after a 5-year surveillance period. Leukoplakia and OLP patients constituted 34.7% of conversions, though other lesions/diseases of the tongue/oral mucosa showed conversion. Tongue cancers were the most represented carcinomas, followed by carcinomas of the oropharynx.

Conclusion: We discovered overall rates of malignant conversion within the broad range reported in the world literature (0%-60%). Importantly, this living data set can be repeatedly queried over time to discover significant malignant conversions, potentially over decades. With significant conversions occurring after 5 years, OPMD conditions likely require longer-term surveillance like colon, breast, or other cancers.

Level of evidence: 3:

Objectives: While prior studies have demonstrated favorable aesthetic outcomes using skin grafted free flaps to improve recipient site color match (Epithelial Preservation Including Dermal Resection Microvascular technique: EPIDERM technique), the clinical safety of this approach has not been established. Manipulation of the skin paddle potentially impairs free tissue monitoring and therefore may affect success rates. This study aims to compare perioperative outcomes in patients undergoing head and neck free flap reconstruction with and without the EPIDERM technique.

Methods: A retrospective 1:1 matched cohort study was conducted involving 138 patients who underwent free flap reconstruction between January 2022 and December 2024 at a single tertiary care center. Patients were matched by flap type to control for variations in reconstructive technique and defect site. Data collected included demographics, defect characteristics, flap type, operative time, perioperative complications, reoperations, and hospital length of stay.

Results: Defect distribution differed between groups, with scalp defects more common in the EPIDERM group (p = 0.05) and oropharyngeal and mandibular defects more frequent in the standard group (p < 0.01, p = 0.02). Despite these differences in defect distribution, no significant differences were observed in flap viability, wound complications, reoperation rates, hospital readmissions, or length of hospital stay between the color match and non-color match groups.

Conclusion: The EPIDERM technique represents a safe adjunct to head and neck free flap reconstruction, offering the potential for improved aesthetic outcomes with no apparent increase in perioperative risk or morbidity.

Level of evidence: 3:

This case report describes the novel use of adjunctive mepolizumab, a monoclonal antibody, in the management of a Pott's Puffy Tumor (PPT) in a 62-year-old male with chronic rhinosinusitis with nasal polyps (CRSwNP). Following extensive surgery to establish drainage, mepolizumab was administered postoperatively to mitigate the risk of bony restenosis and polyp recurrence. Two years after the surgery, the patient showed sustained symptom relief and a patent frontal sinus drainage pathway, suggesting that this therapy may be a valuable addition for complex CRSwNP cases complicated by PPT.