Laryngoscope最新文献

Objective: Repositioning and fixation of the posterior septal angle (PSA) relative to the anterior nasal spine (ANS) is a well-known maneuver performed during rhinoplasty. Suture techniques through the periosteum along with transosseous drilling through the spine are the two most common fixation methods. We report on how nasal airway patency varies as a function of technique and patient demographic factors.

Methods: A retrospective analysis was performed on patients who underwent PSA repositioning and stabilization during rhinoplasty due to caudal septal deformities. Nasal Obstruction Symptom Evaluation (NOSE) scales were measured pre- and post-operation to evaluate functional outcomes.

Results: 207 patients with either mobile or immobile PSA underwent ANS fixation secured with either a suture passed through the periosteum of the ANS or with the creation of a drill hole through the ANS. In all patients regardless of clinical or demographic groupings, postoperative NOSE scores were significantly decreased when compared to preoperative scores (p < 0.05). Preoperative NOSE score, fixation method, sex, functional versus cosmetic, age, follow-up period, and graft site did not independently affect the postoperative NOSE score. Though the differences between primary and revision outcomes were statistically significant, patients in both groups reported significant improvements in postoperative NOSE scores that deescalated their symptoms from "severe" to "mild."

Conclusion: Repositioning and fixation of the PSA improve patient outcomes. However, there is no significant difference between fixation methods on final NOSE scores. Septal fixation with consideration for patient anatomy allows for effective treatment.

Level of evidence: 4 Laryngoscope, 2024.

In endoscopic endonasal surgery for anterior skull base lesions, maximizing the anterior sphenoidotomy in the superior part is crucial for direct visualization and creating a wide working corridor. Here, we describe a technique we devised that maximizes upper anterior sphenoidotomy while preserving the olfactory mucosa. Laryngoscope, 2024.

Introduction: There is increasing prevalence of single-use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls).

Methods: The ISO 14040 standardized Life Cycle Assessment (LCAs) was utilized to estimate the environmental footprint of SUD-L and R-L. Product and packaging material composition, energy and water consumption, and high-level disinfection products were tabulated from on-site observation, manufacturer data, and the Ecoinvent database. Global warming impacts were defined by greenhouse gas emissions (GHGs) quantified by kilograms of carbon dioxide equivalents (kgCO₂-eq) and analyzed using the US EPA's TRACI and SimaPro software. Monte Carlo sensitivity analyses were additionally performed.

Results: Assuming a 6-year lifespan and 218 laryngoscopies/year, the R-L saves 804 kgCO₂-eq compared to SUD-L (1816 vs 2619 kgCO₂-eq). Notably 63% of the R-L total GHGs were due to personal protective equipment (PPE) production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, a R-L produces fewer lifespan GHGs than SUD-Ls after 82 uses.

Conclusion: Reusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation. Providers should assess laryngoscope use frequency, site of use, and available resources to balance the environmental consequences. Further areas of sustainable optimization include reducing disposable PPE used in R-L reprocessing.

Level of evidence: N/A Laryngoscope, 2024.

Objectives: To compare longitudinal improvement in nasal obstruction quality-of-life outcomes between medial flap turbinoplasty (MFT) and inferior turbinate submucous resection (SMR) concurrently performed with functional septorhinoplasty.

Methods: Retrospective review of a prospectively collected cohort of patients undergoing functional septorhinoplasty between 2015 and 2022 at a tertiary academic center. Outcomes were assessed using the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire preoperatively and over 12 months postoperatively.

Results: 373 patients were analyzed with longitudinal NOSE questionnaires. Of these, 298 underwent SMR and 75 underwent MFT. The proportion of concurrent intraoperative techniques including rim graft, spreader graft, auto-spreader graft, intradomal sutures, interdomal sutures, and alar spanning sutures were not significantly different between the two cohorts. Patients in all surgical groups had a statistically and clinically significant improvement in NOSE scores between their preoperative and postoperative follow-up visits (p < 0.001). MFT patients had higher NOSE scores 1 month postoperatively (40.0 ± 30.5 vs. 31.0 ± 27.97; p = 0.017), but lower scores after 10 months (15.2 ± 13.3 vs. 25.4 ± 23.5; p = 0.036). Similarly, patients in the MFT cohort in primary rhinoplasty procedures reported higher scores initially but lower after 10 months (p = 0.024). Men in the MFT cohort reported significantly better NOSE outcomes than the SMR cohort as early as 4 months post-surgery and sustained this improvement longitudinally throughout the follow-up period (10.6 ± 12.3 vs. 22.6 ± 21.4; p = 0.012).

Conclusion: MFT and SMR offer beneficial long-term nasal breathing outcomes among patients undergoing functional rhinoplasty, though further study in appropriate patient selection is indicated.

Level of evidence: 3 Laryngoscope, 2024.

Background: Objective, controlled eye-tracking measurement of gaze patterns during layperson evaluation of facial attractiveness is currently lacking.

Objectives: To objectively investigate (1) where on the face laypeople direct their attention when assessing attractiveness compared with a control group, and (2) whether increased fixation on certain facial regions is associated with high attractiveness ratings.

Methods: Lay observers viewed a cohort of 40 faces with a diverse age, sex, and racial distribution. Observers were either allowed to free-gaze without a specific task or rate facial attractiveness for 10 seconds per face while their gaze was recorded by an eye-tracking system.

Results: Forty-seven observers assessed facial attractiveness (mean age 35.1 years (range 21-76), 62% female) and 57 observers free-gazed at the facial photos without a specific task (mean age 35.5 years (range 22-66), 54% female). Preliminary analysis showed that sex of both the face and observer substantially influence gaze-attractiveness associations (p < 0.05). Mixed effects analysis suggests that when males assessed female facial attractiveness, increased fixation time at the mouth correlated most strongly with high attractiveness (p = 0.001), whereas when females assessed male faces, increased fixation at the eyes (p < 0.001) and hair (p = 0.002) were most strongly associated with high ratings of attractiveness.

Conclusions: Increased gaze at the mouth in females and eyes and hair in males is associated with significantly higher ratings of attractiveness by observers of the opposite sex. Practitioners may want to pay special attention to these areas when designing an evidence-based aesthetic treatment plan.

Level of evidence: NA Laryngoscope, 2024.

Objectives: Cochlear implant array malpositioning is associated with impaired speech perception, vertigo, and facial nerve stimulation. Tip fold-over is a subset of malpositioning that occurs more often with perimodiolar electrodes, but historically it has not been characterized due to lack of knowledge regarding electrode movements of the electrode within the cochlea. The aim of this study was to characterize the mechanics of tip fold-over events and their associated insertion pressure profiles.

Methods: Cadaveric human heads were surgically prepared with a mastoidectomy and facial recess. Fiberoptic pressure sensors were inserted into the scala vestibuli and tympani to measure intracochlear pressures. Perimodiolar CI electrodes (Cochlear Slim-Modiolar, CI532) were inserted via round window under fluoroscopy.

Results: Three types of tip fold-over events were observed: anterior-posterior C-shaped, medial-lateral C-shaped, and S-shaped roll-overs. The largest transient pressures occurred with anterior-posterior and S-type roll-over, and were associated with rotation or twisting inside the cochlea.

Conclusions: Results demonstrate at least three subtypes of tip fold-overs. Elevated pressure transients were noted before and during the tip fold-over event related to electrode twisting. The characterization of tip fold-over into subtypes is novel and may aid identification of tip fold-over events intraoperatively in the future. It remains important to identify tip fold-over events, and they should be recognized early using a multimodal verification system. Further investigation is still required to determine the significance of these changes and other possible patterns of intracochlear electrode movement.

Level of evidence: N/A: Cadaver study Laryngoscope, 2024.

Objectives: To investigate the characteristics of the vascular pedicle of the nasoseptal flap (NSF) and its perfusion patterns using intraoperative indocyanine green (ICG) angiography during endoscopic skull base surgery (ESBS), and examine the correlation between ICG perfusion patterns and clinical outcomes, including postoperative cerebrospinal fluid (CSF) leak and flap necrosis.

Methods: This study enrolled patients undergoing ESBS between January 2017 and December 2021. Intraoperative ICG angiography was performed to visualize the arterial supply of the nasal septum and evaluate NSF perfusion. Postoperative CT scans and clinical follow-ups were conducted to assess flap outcomes.

Results: A total of 126 patients were included in the study. The posterior septal artery (PSA) was most commonly identified in the middle third of the sphenoidal rostrum (63.5% right, 60.3% left). Three branching patterns were observed: single-branch (58.7% right, 64.3% left), double-branch (12.7% right, 11.1% left), and reticular-branch (26.6% right, 24.6% left). Among 72 patients who underwent NSF placement, ICG angiography showed full enhancement in 37 patients (51.4%), partial enhancement in 27 patients (37.5%), and no enhancement in eight patients (11.1%). Postoperative CSF leak occurred in eight patients (11.1%), with no significant correlation to ICG enhancement patterns (p = 0.07). Flap necrosis occurred in five patients (6.9%), all of whom had shown no ICG enhancement beyond the pedicle (p < 0.01).

Conclusions: ICG angiography is a valuable tool for visualizing the vascular supply of NSF during ESBS. While it does not correlate with postoperative CSF leak, ICG enhancement pattern showed a significant association with flap necrosis. This technique may contribute to improved surgical outcomes and reduced complications in NSF reconstructions.

Level of evidence: 3 Laryngoscope, 2024.

Objective: The goal of this study was to describe lacerations of the head and neck sustained among ice hockey players in the US.

Methods: Data on adult (20-65 years) ice hockey injuries were collected from the 2003-2022 National Electronic Injury Surveillance System (NEISS) database. Injuries of the head, neck, face, mouth, and ears were included, while those sustained as a spectator, coach, or on a non-ice surface were excluded. Frequencies and means were calculated. A one-way ANOVA and chi-squared tests were performed, with p < 0.05 indicating statistical significance.

Results: Five hundred ninety-three patients were included; 578 (97.5%) male, 15 (2.5%) female. Mean age was 31.3 (95% CI 30.5-32.2) years. Lacerations occurred on the face (N = 422, 71.2%), mouth (N = 124, 20.9%), head (N = 23, 3.9%), ear (N = 22, 3.7%), and neck (N = 2, 0.3%). One patient (0.17%) was admitted due to closed head injury; there were no deaths. Pucks were the primary cause of lacerations (N = 210, 35.4%), followed by sticks (N = 135, 22.8%), collisions (N = 56, 9.4%), and falls (N = 51, 8.6%). 3.4% (N = 20) of patients experienced a laceration caused by a skate blade, most often on the face (N = 17/20, 85.0%).

Conclusion: Hockey pucks are the primary cause of lacerations in the head, face, and mouth, with neck lacerations being rare in this cohort. Full face protective gear would reduce the number of adult ice hockey head and neck lacerations.

Level of evidence: IV Laryngoscope, 2024.