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

Purpose of review: Auricular avulsion injuries present complex reconstructive challenges due to the intricate three-dimensional (3D) structure and vascular supply of the ear. This review examines traditional and emerging techniques in auricular trauma repair, including microsurgical advancements, digital planning, tissue engineering, and 3D bioprinting, highlighting their impact on reconstructive outcomes.

Recent findings: Traditional techniques, such as multilayer closure and microsurgical reattachment, remain foundational in auricular reconstruction. However, recent studies suggest that subtotal amputations with small vascular pedicles may survive without microvascular anastomosis. Microsurgical refinements, including digital planning and customized surgical guides, enhance precision in reconstruction. Tissue engineering innovations, such as 3D bioprinting with biomimetic scaffolds and magnetoresponsive hydrogels, show promise for auricular cartilage regeneration. Additionally, postoperative adjuncts like antipressure alarm systems and bioactive hydrogels seeded with stem cells improve healing and long-term outcomes.

Summary: Auricular trauma repair is evolving through a combination of established and innovative techniques. Digital planning, microsurgical advancements, and tissue engineering are shaping a new era of patient-specific reconstruction. Future research should focus on refining these technologies, evaluating long-term efficacy, and addressing economic feasibility to optimize patient outcomes.

Purpose of review: Maxillomandibular fixation (MMF) is essential for many surgeries on the bony middle and lower face. MMF techniques have multiplied in recent years, each with unique benefits and drawbacks. This review catalogs MMF trends and evidence for and against the most prevalent MMF methods.

Recent findings: Traditional Erich arch bars remain the most robust technique in establishing MMF, particularly for comminuted/complicated fractures. Drawbacks are increased operative time required, wire stick injuries, poor oral hygiene, and gingival trauma. Screw-based techniques save considerable time but cannot stabilize comminuted fractures as adequately and risk tooth root and nerve damage. Embrasure wires offer time and cost savings but are solely for intraoperative use and uncomplicated fractures. Similarly, dental occlusion ties provide the benefits of reduced time and wire sticks, with the added capability of postoperative use, but require adequate dentition and minimally displaced fractures. Recent studies show decreased use of wire-based techniques, with increased adoption of hybrid systems and dental occlusion ties.

Summary: MMF techniques each have unique advantages and weaknesses. Selection should depend on surgical goals, including the severity of fractures, the need to maintain occlusion postoperatively, application/removal time, safety, and patient comfort.

Purpose of review: Wounds within the face, head, and neck region can have devastating aesthetic, functional, and potentially fatal outcomes for patients and often require multimodality treatment. Here we discuss the role of hyperbaric oxygen for a variety of wounds within the head and neck region and the clinically associated outcomes.

Recent findings: Hyperbaric oxygen (HBO) treatment can be useful in the management of wounds and infections within the head and neck region. While there are few randomized controlled clinical trials evaluating the effectiveness of HBO therapy, there is a large amount of retrospective literature supporting its adjunctive role in the treatment of radiation associated head and neck wounds, compromised grafts and flaps, and necrotizing soft tissue infections. The most common treatment protocols are typically initiated at 2-2.4 atmosphere absolute (ATA) at 100% oxygen for 90 min for 30 daily sessions, though this varies significantly in the available literature. In the setting of osteoradionecrosis (ORN) and medication-induced osteonecrosis of the jaw (MRONJ), however, emerging treatments such as the Potentiation by Clodronate (PENTOCLO) protocol may provide more effective treatment that HBO therapy.

Summary: Hyperbaric oxygen therapy should be considered as an adjuvant therapy for head and neck wounds involving radiated soft tissue, compromised local and free flaps, filler-induced soft tissue necrosis or blindness, and for necrotizing soft tissue infection; however, more randomized controlled trials are needed to better evaluate both their clinical impact as well as better establish treatment protocols, particularly in the setting of ORN and MRONJ.

Purpose of review: Mandibular plate fracture (MPF) is a serious complication of mandibular reconstruction, leading to postoperative morbidity and potential revision surgeries. Recently, there has been an increased utilization of virtual surgical planning (VSP) with patient-specific reconstruction plates to decrease operative time and improve postoperative outcomes. It is critical for surgeons performing mandibular reconstruction to have a comprehensive understanding of the contributing factors and strategies for minimizing the likelihood of MPF.

Recent findings: This review examines the patient-related and surgical factors contributing to MPF. The literature highlights that patient-related factors include younger age and degree of occlusion, while surgical factors include lateral mandibular defects, the absence of coronoidectomy, and the use of bridging plates without bony reconstruction. Notably, recent studies suggest a reduction in MPFs with the implementation of VSP and patient-specific reconstruction plates.

Summary: This review aims to inform surgeons about patients who are at increased risk of MPF following mandibular reconstruction, emphasizing the need for close monitoring. Furthermore, it underscores the additional benefits of VSP and patient-specific reconstruction plates in improving postoperative outcomes. However, further research is required to assess the long-term efficacy of these reconstruction plates.

Purpose of review: This review describes recent innovations in craniofacial imaging, focusing on emerging techniques such as 3D photogrammetry, smartphone-based scanning, and artificial intelligence applied to cephalometric assessments in facial plastic and reconstructive surgery.

Recent findings: Traditional methods like occipitofrontal circumference and cephalic index remain widely used, but newer, more precise technologies have recently emerged. 3D photogrammetry is a reproducible, safe, and noninvasive alternative, offering detailed cranial modeling using external landmarks. The integration of smartphone technologies has further democratized craniofacial imaging by enabling accurate 3D scans with minimal cost and radiation exposure. Despite variability in certain facial regions, these technologies have shown promising accuracy for clinical use. Furthermore, AI-driven approaches enhance diagnostic precision by generating synthetic data and improving landmark detection in complex cranial morphologies.

Summary: Recent technological advances are reshaping craniofacial imaging and optimizing preoperative and postoperative care in facial plastic and reconstructive surgery. 3D imaging and AI applications offer significant improvements over traditional methods and allow for more precise and reliable methods for operative planning and longitudinal assessments. As these tools develop, they are bound to become the new standards for clinical evaluation of craniofacial anomalies.

Purpose of review: Sleep complaints are exceedingly common in children and are associated with cognitive and psychosocial impairment. Obstructive sleep apnea (OSA) accounts for only a small percentage of pediatric sleep problems. A comprehensive understanding of nonbreathing-related sleep disorders in pediatric patients is, therefore, needed to adequately assess and treat pediatric patients presenting with sleep concerns.

Recent findings: The review below summarizes the most common non-OSA sleep disorders in pediatric patients, focusing on comprehensive evaluation and evidence-based treatment recommendations. We also describe and review the literature on the newest pediatric sleep disorder, restless sleep disorder (RSD).

Summary: Pediatric otolaryngologists should be equipped to take a concise yet thorough sleep history, identify features of non-OSA sleep disorders, counsel patients and families regarding key sleep hygiene measures, and appropriately refer patients with suspected non-OSA sleep disorders such as circadian rhythm disorders, parasomnias, and/or narcolepsy for additional sleep medicine evaluation, testing and/or treatment whenever indicated.

Purpose of review: This review aims to explore the integration of artificial intelligence (AI) in laryngology, with specific focus on the barriers preventing translation from pilot studies into routine clinical practice and strategies for successful implementation.

Recent findings: Laryngology has seen an increasing number of pilot and proof-of-concept studies demonstrating AI's ability to enhance diagnostics, treatment planning, and patient outcomes. Despite these advancements, few tools have been successfully adopted in clinical settings. Effective implementation requires the application of established implementation science frameworks early in the design phase. Additional factors required for the successful integration of AI applications include addressing specific clinical needs, fostering diverse and interdisciplinary teams, and ensuring scalability without compromising model performance. Governance, epistemic, and ethical considerations must also be continuously incorporated throughout the project lifecycle to ensure the safe, responsible, and equitable use of AI technologies.

Summary: While AI hold significant promise for advancing laryngology, its implementation in clinical practice remains limited. Achieving meaningful integration will require a shift toward practical solutions that prioritize clinicians' and patients' needs, usability, sustainability, and alignment with clinical workflows.