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

Purpose of review: Bilateral vocal fold paralysis (BVFP) is a complex condition with a range of aetiologies and clinical presentations. Whilst spontaneous improvement may occur in a significant number of cases (48-70%), in the absence of recovery, multiple operations have been used to improve the airway. This review aims to analyse recent literature surrounding the management of BVFP and discuss changes in practice.

Recent findings: Suture lateralization in neonates is an emerging trend and has been recently reported to have good success rates in managing BVFP and preventing tracheostomy. Laryngeal electromyography (L-EMG) may be used to confirm the diagnosis and differentiate from fixation. Corticobulbar motor-evoked potentials (Co-MEPs) is a complimentary technique to L-EMG, which studies the corticobulbar tract and enables visualization of the motor pathway from the brainstem to the peripheral nerves. Currently, there is no reliable method available to predict prognosis. Recent comprehensive reviews of the published literature have described the outcomes for surgical intervention, with no technique proving clearly superior overall.

Summary: The wide range of aetiologies and the variable recovery rates mean standardized management of BVFP is not possible. L-EMG is not a reliable prognostic indicator of recovery. There is an emerging trend of suture lateralization to avoid tracheostomy. Extensive recent reviews have not identified a lateralization procedure that is superior overall. Small numbers of bilateral reinnervation have reported worldwide (n = 26) with some vocal cord recovery reported but relatively low decannulation rates at present (66%).

Purpose of review: With the exception of blood, bone and cartilage grafts are the most common form of transplanted tissue in the world. Many graft materials are available to utilise in head and neck reconstruction with an array of oncologic, traumatic, congenital and cosmetic applications. Accordingly, it is imperative to understand the complications associated with these grafts, especially in relation to specific materials available.

Recent findings: Infection, warping, resorption and donor site morbidity are the most commonly reported complications in the literature. In relation to cartilage grafts, autologous costal cartilage is the preferred material owing to low immunogenicity and ease of harvest. However, with the disadvantage of donor site morbidity, more recent literature has shown comparable complication rates with allogenic fresh frozen and irradiated costal cartilage. Alloplastic grafts have been associated with concern for a higher risk of complications, although there is a lack of high-quality studies to demonstrate this risk. Bone is subject to similar complications with the exception of graft warping. However, bone grafts are typically used to treat more significant and sizeable defects, which can engender more severe complications.

Summary: Complications regarding grafting of cartilaginous and bony material to the head and neck continue to evolve in the literature. Advances in graft material, including the advent of bio-engineered tissue, remain a developing area with auspicious prospects.

Purpose of review: To review the utility of negative pressure wound therapy (NPWT) in the management of head and neck wounds.

Recent findings: NPWT has broad applications in the management of head and neck wounds. NPWT has demonstrated success in the treatment of head and neck fistulas and necrotizing soft tissue infections. Immediate application after free flap reconstruction is also shown to be safe, with benefits of reduced tissue edema and promotion of wound healing. NPWT can further be used to prepare chronic wounds for reconstruction, particularly in patients who have undergone radiotherapy. The addition of intermittent saline instillation and dwell time has shown promise in treating head and neck fistulas.

Summary: NPWT has been shown to improve wound healing times, reduce length of hospital stays, decrease frequency of dressing changes, and lower pain scores compared to conventional wound care. However, existing evidence is largely limited to case reports and retrospective studies, with few prospective comparative studies. Larger prospective studies are needed to further investigate the efficacy and safety of NPWT in the head and neck.

Purpose of review: This review focuses on the recent advancements in the application of the medial sural artery perforator (MSAP) flap for head and neck reconstruction. It highlights key anatomical findings, surgical techniques, comparative outcomes, and future perspectives from the last 1-3 years of research.

Recent findings: The MSAP flap has emerged as a reliable option for head and neck reconstruction due to its thin, pliable nature and minimal donor-site morbidity. Recent anatomical studies have refined understanding of its vascular consistency, with perforators located 8-12 cm distal to the popliteal crease and pedicle lengths averaging 10.1 cm. Functional outcomes demonstrate superiority over bulkier alternatives such as the anterolateral thigh flap, particularly in intraoral reconstructions, while donor-site morbidity remains significantly lower than that of the radial forearm free flap.

Summary: The MSAP flap provides an optimal balance of form and function for complex head and neck reconstructions. Its consistent anatomy and favorable postoperative outcomes underscore its growing role in modern reconstructive surgery. Further multicenter trials are essential to establish standardized protocols and enhance outcomes.

Purpose of review: Zygomaticomaxillary complex (ZMC) fractures pose both functional and aesthetic challenges, requiring careful surgical planning to optimize outcomes while minimizing morbidity. Recent advancements in surgical planning, fixation strategies, and implant technology have refined the approach to ZMC fracture repair. This review highlights these developments and discusses their implications for surgical decision-making, emphasizing strategies that balance reduction accuracy with the least invasive intervention.

Recent findings: Studies suggest that minimizing fixation points in properly selected ZMC fractures does not compromise patient satisfaction or postoperative symmetry. Intraoperative CT is increasingly utilized and has been shown to reduce unnecessary incisions and implants while improving reduction accuracy. Computer aided surgical planning has demonstrated improved surgical precision through preoperative planning, guiding plate placement, and enhancing anatomical symmetry. Additionally, patient specific implants (PSIs) have emerged as valuable tools in complex or revision cases, offering more precise reconstruction with reduced operative time. Augmented reality (AR) is a rapidly emerging technology that holds promise for surgical planning and navigation for ZMC fracture repair.

Summary: Wider adoption of intraoperative CT has improved surgical assessment, while advances in computer aided surgical planning and patient specific implants continue to refine surgical workflows and outcomes. As technology evolves, future research should focus on optimizing cost-effectiveness and further integrating digital planning tools. AR, still in its preliminary stages, may represent a significant innovation in enhancing surgical precision and visualization during ZMC fracture repair.

Purpose of review: This review seeks to describe the current state of virtual surgical planning (VSP) for head and neck free flap reconstruction, highlighting recent advancements, future directions, and outstanding limitations.

Recent findings: Three-dimensional (3D)-printed plates have been shown to confer increased accuracy and lower fracture rate compared to hand-bent plates. Efforts are underway to optimize plate design for load bearing and dental rehabilitation. Preclinical work is investigating bioresorbable plate materials and 3D-bioprinting of composite materials using stem cell and tissue engineering technology. Advances in imaging and artificial intelligence may improve reconstructive planning. Use of robots and augmented reality may increase precision and intraoperative flexibility in the future. Cost of VSP remains a concern, but has shown to be offset by decreased operative time and in-house VSP, and will likely continue to fall as use of VSP increases. While numerous advantages have been shown for VSP, few studies have investigated correlation of VSP to patient-reported outcomes, which is an increasingly important metric.

Summary: In addition to increasing accuracy, decreasing operative time, and facilitating complex reconstructions, VSP has the potential to harness advancements in reconstructive materials, imaging, and artificial intelligence to advance free flap reconstruction and improve patient outcomes.

Purpose of review: The purpose of this manuscript is to review the current literature regarding nonoperative strategies for management of upper airway obstruction (UAO) among infants with Robin sequence (RS). We evaluate and discuss recent advances, benefits, and challenges of preepiglottic baton plate (PEBP) use as an alternative to more invasive surgical interventions for RS in infancy.

Recent findings: Over the last two decades, the use of an orthodontic appliance has become an increasingly popular nonoperative intervention for the treatment of RS in newborns. Among infants with isolated RS, PEBP placement has been proven effective in diminishing signs of upper airway obstruction, avoiding tracheostomy, and facilitating oral feeding. When compared side-by-side to proven surgical interventions, such as mandibular distraction osteogenesis (MDO), at least one study suggests that PEBP may be equally effective in treating infants with moderate UAO. In addition, PEBP utilization may result in improved feeding and growth outcomes compared to those reported among infants who undergo MDO.

Summary: This article summarizes the current landscape of an evolving, nonoperative treatment option for neonatal tongue base obstruction, which, in the appropriate patient population, represents an exciting alternative to surgical management.

Purpose of review: The purpose of this review is to summarize the current management of radiation-induced trismus. It will provide an overview of radiation-induced trismus' pathophysiology, assessment, diagnosis, and treatment, along with directions for future research.

Recent findings: Despite advances in radiation technology, the proximity of head and neck tumours to the masticatory muscles prevents shielding of these critical structures, increasing the risk of trismus. Trismus has been treated using various techniques including stretching and strengthening exercises in the rehabilitation setting that have resulted in improvements in mouth opening, however, the exercise approach in both research and clinical practice rarely accommodates an individual's goals and priorities. The effect of prophylactic trismus exercises during radiation can be challenging to measure, likely due to exercise adherence with the onset of treatment related toxicities. There is limited support from the literature as to its preventive efficacy. Recent papers provide direction for trismus exercises and devices which may offer greater capacity to individualize treatment and optimize both functional and quality of life outcomes.

Summary: The incidence of radiation induced trismus is anticipated to rise along with that of head and neck cancers globally. Trismus carries significant functional and quality of life implications with known limitations and opportunities for optimizing its management.

Purpose of review: Trismus (decreased mouth opening) is frequently associated with oral premalignant/malignant lesions, and also occurs in upto 40% of head neck cancer patients post radiation therapy. Trismus is associated with adverse functional and oncologic outcomes through impact on quality of life and posttreatment disease surveillance. Relevant literature is mostly retrospective and single author/institution- a review of the same would aid management of this complex multifactorial disorder.

Recent findings: Newer innovations aim at obviation of trismus during treatment planning for head neck cancer, including radiological and serologic prediction, surgical/reconstructive modifications, and tailored radiation therapy with emphasis on sparing excessive treatment to masticatory apparatus.Rehabilitation of manifest treatment-associated trismus, on the other hand, begins with accurate assessment of etiology and extent. Treatments range from exercises and device-based interventions, novel reconstructive methods aimed at ensuring maximal interincisal opening while minimizing donor site morbidity, and ensuring compliance through monitored adherence and self-reporting.

Summary: Trismus prevention and rehabilitation in oral cancer is a multistep sustained process necessitating inputs from several specialties. Personalized treatment and rehabilitation regimens should be incorporated at the outset and continued till at least one year post treatment completion, to ensure optimized outcomes.