Current Opinion in Otolaryngology & Head and Neck Surgery最新文献

Purpose of review: Climate change is an urgent public health crisis that significantly impacts disease development, health outcomes, and access to care. The major approaches to climate change are mitigation and adaptation. The purpose of this review is to discuss the effects of climate change on health and health disparities, review the carbon footprint of surgical care and discuss strategies for surgeons to reduce emissions and advocate for sustainability.

Recent findings: Recent studies increasingly demonstrate the direct and indirect health effects of climate change, including the relationship between climate and otolaryngologic disease. Within the domain of otolaryngology, we summarize findings related to climate change and health and healthcare delivery; health disparities; healthcare-associated emissions; and the role of otolaryngologists in mitigating and adapting to the climate crisis. There are many recent studies that identify impactful sustainability opportunities and initiatives for healthcare providers. Climate solutions may also reduce cost and have potential clinical benefits.

Summary: Climate change and air pollution directly impact disease burden in otolaryngology patients and are underrecognized social determinants of health. Surgeons can lead on climate change by implementing sustainability initiatives in the operating room and engaging in research and advocacy.

Purpose of review: The philosophy of preservation rhinoplasty originated 100 years ago. Many variations have appeared in the last 10 years, with different opinions emerging in the literature and scientific meetings.

Recent findings: New technological devices (piezo and diamond burs), new anatomical concepts (W and E-points, lateral and dorsal keystone area), and many new surgical strategies have led to a recent revolution in rhinoplasty.

Summary: Preservation rhinoplasty is a surgical strategy/philosophy that has gained popularity among rhinoplasty surgeons. Dorsal preservation rhinoplasty is the 'queen' of preservation rhinoplasty, and an array of surgeons' variations have come about. Ferreira et al. have proposed a classification for dorsal preservation rhinoplasty that splits it into foundation techniques and surface techniques. Foundation techniques are all techniques with impaction osteotomies - push or letdown; in this group, there is always a more minor or significant disruption between the skull and the nasal pyramid. Surface techniques are techniques that work on the surface of the nose (like the traditional structured approaches); in this group, there are no impaction osteotomies, so there is no disruption between the skull and the nose.

Purpose of review: Velopharyngeal insufficiency (VPI) refers to a structural defect resulting in incomplete closure between the soft palate and posterior pharyngeal wall, leading to inadequate speech and deglutition. Traditional surgical options for VPI include sphincter pharyngoplasty, pharyngeal flaps and palatoplasty. Although these procedures have been successfully used over the past several decades, they are associated with complications such as pain, bleeding, infection and obstructive sleep apnoea. They also require postoperative admission. Injection augmentation pharyngoplasty (IAP) is increasingly being viewed as a viable, less invasive surgical option for patients with mild to moderate VPI.

Recent findings: Both autologous fat and alloplastic synthetics have been used as injectable materials, with low morbidity and good speech outcomes. However, given the overall lack of standardization across studies, no single material has shown clear superiority.

Summary: IAP is a promising alternative to more invasive surgeries in the treatment of patients with mild to moderate VPI. The purpose of this review is to provide an overview of this approach, with an emphasis on its safety and efficacy.

Purpose of review: To review the evolving role of selective neurectomy in the management of patients with synkinesis including the history of selective neurectomy, operative techniques, and clinical outcomes.

Recent findings: Modified selective neurectomy alone or in conjunction with other procedures achieves more durable outcomes based on objective measures such as time to recurrence of symptoms and units of botulinum toxin required postoperatively. This is also reflected on patient reported quality of life outcome measures. Regarding operative technique, lower rates of oral incompetence are reported with division of an average of 6.7 nerve branches as opposed to more branches.

Summary: Chemodenervation has long been the mainstay of treatment in facial synkinesis, but in recent years, the paradigm has begun to shift in favor of incorporating interventions with more durable outcomes such as modified selective neurectomy. Modified selective neurectomy is often performed with other simultaneous surgeries such as nerve transfer, rhytidectomy, lid surgery and static facial reanimation primarily to address periocular synkinesis and synkinetic smile. The outcomes have been favorable with improvement in quality-of-life measures and a decrease in botulinum toxin requirements.

Purpose of review: Congenital ear deformities are characterized by distorted, but still present, landmarks of the auricle. Interventions include early treatment with ear molding or delayed surgical treatment. The purpose of this review is to provide an update on the latest information related to ear molding for congenital ear deformities.

Recent findings: Various ear molding techniques date back to the 1980s, but with the availability of commercially available molding systems, interest and use has blossomed in recent years. As more longitudinal research results are obtained, ear molding has been proven to be a highly effective treatment, although the best technique and length of treatment remains unclear.

Summary: While it is clear that earlier intervention is ideal, due to lack of public awareness, patients often present later, and it remains controversial what age to offer ear molding interventions to and still expect success. Ear molding interventions are becoming increasingly covered by insurance due to evidence of preventing long-term psychological morbidities and the need for future surgical interventions.

Purpose of review: Although tranexamic acid is commonly used in surgical fields such as obstetrics, orthopedics, and trauma, its utilization in facial plastic surgery is a recently emerging concept, and studies examining its potential impact have been few. This review highlights how tranexamic acid may be employed during facial plastic procedures and the promising impact it may have.

Recent findings: Tranexamic acid is primarily being studied in rhinoplasties and rhytidectomies, with intravenous administration and local infiltration being the most common routs of application, respectively. During rhinoplasties, tranexamic acid has the potential to improve the visualization of the surgical field by decreasing blood loss and to improve postoperative edema and ecchymosis. For rhytidectomies, on the contrary, it may shorten time to attain hemostasis, lessen the rate of hematoma formation, and lead to lower surgical drain output. Its efficacy is preserved at low doses, and significant medication side effects have not been reported after facial plastic procedures.

Summary: Altogether, tranexamic acid may present a valuable adjuvant to facial plastic surgery, as it could increase both surgeon and patient satisfaction while exhibiting a benign safety profile.

The purpose of this review is to provide an in-depth look at the current perioperative and intraoperative practices for unilateral cleft lip repair. The contemporary literature reveals trends towards incorporation of curvilinear and geometric hybrid lip repairs. Perioperative practices are trending in new directions as well with the use of enhanced recovery after surgery (ERAS) protocols to reduce morbidity and length of stay, continued use of nasoalveolar molding, and a tendency to favor outpatient repair with more utilization of same day surgery centers. There is much room for growth, with new and exciting technologies on the horizon to improve upon cosmesis, functionality, and the operative experience.

Purpose of review: The current United States opioid epidemic resulted from the overprescribing of opioids by physicians and surgeons in response to deceptive and unlawful marketing campaigns by pharmaceutical companies seeking to profit from opioid sales. Surgeons have a moral obligation to employ evidence-based opioid-sparing analgesia protocols for management of perioperative pain.

Recent findings: Recent evidence strongly supports the use of NSAIDs in perioperative pain management, with large studies demonstrating no increased risk of postoperative hemorrhage or renal insult.

Summary: We present an evidence-based approach for opioid-sparing perioperative pain management, including multimodal analgesia guidelines used at our center for patients undergoing free flap facial reanimation procedures.

Purpose of review: To discuss the principles of auricular reconstruction and review recently published literature in the field.

Recent findings: Auricular reconstruction poses several challenges to the surgeon aiming to restore form and function following skin cancer resection. Various techniques have been described in the literature with many modifications also reported to address their shortcomings. An algorithmic approach based on the location and composition of the defect is recommended. In many instances, more than one technique can be used, and the operating surgeon should be familiar with these to determine the optimal approach for the individual patient.

Summary: This review highlights the updates in well established techniques as well as modern modifications. Furthermore, a framework for decision-making in auricular reconstruction is presented.