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

Purpose of review: Innovations in biomedical engineering have been instrumental in advancing skull base and head and neck surgical care. This review highlights the current state of the art of engineering in head and neck and skull base surgery and sheds light on future advances that will continue to revolutionize surgical care.

Recent findings: Recent impacts of biomedical engineering include 3D virtual planning, custom prosthetics, reconstruction with inert polymers or metals, and biosynthesis for reconstructive surgery. 3D virtual planning has revolutionized the surgical management of oral cavity squamous cell carcinoma, with preoperative simulation leading to decreased operative time and improved patient-centered outcomes. The field of prosthetics has also benefited greatly from the customization gained with patient tailored, 3D printed prosthetics. Other facets of biomedical engineering, such as tissue engineering, have great potential to aid in complex reconstruction with limited resources.

Summary: The intimate anatomy of the head and neck leads to unique reconstructive needs that require creative solutions. As one example, 3D surgical planning is becoming the mainstay for osteocutaneous resections and reconstructions, particularly for oral cavity cancer. With patient-centered thinking, there are numerous opportunities for the use of evolving technology to improve patient outcomes.

Purpose of review: To review literature on telehealth and digital applications in the field of pediatric otolaryngology in the last 18 months.

Recent findings: Eleven new papers were identified as adding information in this field. Recent studies exploring service level benefits continue to demonstrate that asynchronous telehealth service models support early intervention, alternative access, and improved monitoring for patients in rural and remote areas. However, policy changes and reimbursement rules need to support these models of care. Effective, reliable remote diagnoses for patients have been achieved using live video-otoscopy, hearing evaluation via telehealth, and artificial-intelligence driven models. Successful telehealth and digital application models for remote rehabilitation, education, and support for children and caregivers are described in the growing evidence-base.

Summary: Telehealth and broader digital modalities continue to expand within the field of pediatric otolaryngology, improving equity of access for children to healthcare. Although challenges and limitations exist, evidence continues to support the benefits of technology-assisted care within clinical practice. High quality research and ongoing technological improvements will continue to drive advancements in this field. Health policy needs to continue to support the advancement of digitally enhanced health services to optimize services and enhance patient-centered care.

Purpose of review: This review evaluates current evidence on outcomes following supraglottoplasty in children with laryngomalacia. Emphasis is placed on surgical indications, perioperative care, and short-term and long-term functional outcomes.

Recent findings: Contemporary studies confirm that supraglottoplasty significantly improves respiratory obstruction, feeding, and sleep-related symptoms for moderate-to-severe laryngomalacia. Patient selection remains critical, with prematurity, neurologic comorbidities, and swallowing dysfunction associated with higher revision and complication rates. Adjunctive investigations such as polysomnography and drug-induced sleep endoscopy increasingly guide tailored intervention strategies.

Summary: Supraglottoplasty remains the cornerstone of surgical management for severe laryngomalacia, with high success rates and generally low complication profiles. Surgical techniques, comorbidity profiles, and preoperative evaluation methods continue to evolve to optimize outcomes and minimize revision surgery.

Purpose of review: This review explores the current understanding and clinical considerations of ossiculoplasty in pediatric patients, focusing on ossicular chain reconstruction associated with congenital or acquired cholesteatoma. The goals of this review are to review the current literature on diagnostic approaches, surgical timing and techniques of pediatric ossiculoplasty.

Recent findings: Current literature suggests that pediatric cholesteatoma tends to be more aggressive than in adults, often necessitating staged ossiculoplasty for better long-term outcomes. Diffusion-weighted MRI, particularly nonecho planar imaging (non-EPI DWI), is a valuable surveillance tool, though its diagnostic accuracy in children remains lower than in adults. The choice of prosthesis - total vs. partial ossicular replacement and titanium vs. autologous materials - significantly influences outcomes. Additionally, endoscopic ossiculoplasty has emerged as a viable and often preferable alternative to microscopic approaches, offering comparable audiologic outcomes with fewer complications.

Summary: The success of pediatric ossiculoplasty after treatment of cholesteatoma depends on several factors including timing of surgery, prosthesis type, and middle ear status. Because cholesteatoma can be more aggressive in children, a tailored and staged approach, combined with advances in imaging and endoscopic techniques, is essential for optimal management. Future directions point toward personalized solutions using 3D modeling and biocompatible implants to further enhance outcomes.

Purpose of review: Chronic rhinosinusitis in pediatric patients is commonly managed with medical therapy; however, there are a significant number of patients who will require endoscopic sinus surgery for refractory disease. In this review, we aim to elucidate the best practices for postoperative care in this patient population.

Recent findings: Overall, there is limited data in the pediatric patient population to direct all aspects of postoperative care and many recommendations have been developed from older literature or extrapolated from adult studies. Nasal saline rinses and topical nasal steroid sprays are cornerstones of management following surgery. The use of steroid impregnated saline is gaining more traction in the adult world but it has not been adequately studied among pediatric patients and should be carefully considered. Routine postsurgical antibiotics and second look endoscopy are not widely recommended but can be implemented on a case by case basis.

Summary: The use of saline irrigation and topical steroids sprays are safe and effective measures to maximize healing after sinus surgery and to help prevent recurrence of symptoms. More research is needed to understand the implications and indications for systemic steroids, antibiotics, and debridement after sinus surgery.

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.