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

Purpose of review: Septorhinoplasty is considered a complex procedure as it aims at addressing the functional and aesthetic issues of the nose. An integral part of the procedure is the utilization of grafting materials and techniques to achieve these goals.In this review article, authors explore the various grafting materials available including autologous, allogenic, and synthetic options, emphasizing their indications, advantages, limitations, and potential complications with emphasis on their experience on choice of materials for Middle-Eastern patients.

Recent findings: This review delves into recent grafting techniques including dorsal, septal and lower third grafts. There is special emphasis on dorsal grafts highlighting the latest surgical techniques and dorsal grafting constructs.

Summary: By providing a comprehensive overview, this review aims to guide surgeons in making decision regarding graft selection and application, optimizing patient outcomes in septorhinoplasty.

Purpose of review: The purpose of this review is to share the implementation of an integrated care systems approach for head and neck cancer speech and language therapy services. Facilitating factors and barriers to change are highlighted and links to relevant literature are indicated. The intention is that this paper will provide a 'non blueprint' for others embarking on large scale integrative change.

Recent findings: Integrating health and social care provision across organizations is necessary for improving outcomes for people, reducing health inequalities and improving efficiencies in care. Whilst recognizing this intention, the current structure for providing care in NHS organizations does not foster cross-organizational working.

Summary: Integration enhances patient centred care, however implementation of change across organizations is challenging. Managerial support is pivotal and differences in organizational culture need to be acknowledged, respected and overcome. A clearly defined vision, to which all staff are committed provides an anchor in challenging situations. Transformational change is iterative and cannot always be predetermined. Success is possible; tenacity, flexibility and agility are key.

Purpose of review: The aim of this review was to evaluate the current information available on the provision of rhinological services in sub-Saharan Africa and discuss the challenges and opportunities for improving care.

Recent findings: We found that there were very little data available. Some information had been gathered as part of ENT surveys and there were some local and regional reports looking at rhinological care.

Summary: Despite the lack of data, it is clear that specialist rhinological services in sub-Saharan Africa are generally very poor, particularly in rural areas. There are exceptions in some major cities but there exists a huge unmet need in this part of the world. We discussed the importance of the availability of endoscopy for evaluation and management of diseases of the nose and sinuses. We also look at ways of providing training. Partnership and collaboration with high income countries offer benefits for all. Fellowships are particularly valuable in developing specialist services. The availability of the internet provides a powerful way of imparting knowledge through lectures, guidance, courses and educational material such as open access journals and books. It is incumbent on high income countries to help develop healthcare services in areas of greatest need.

Purpose of review: The purpose of this study was to review epistaxis management in Nigeria in the context of current global rhinology practice. It aimed to identify the current strengths in practice that require consolidation and the gaps that require recommendations.

Recent findings: The consistent predominance of otolaryngological interventions in tertiary hospitals reflects the paucity of specialists and lack of equipment for the optimal management of epistaxis in primary and secondary healthcare facilities in Nigeria. Endoscopic intervention was apparent in the most recent publications, but it is still a key limitation, given that it is not widely available in all facilities. The commencement of rhinology fellowships and the emergence of interventional radiology is a ray of hope for an imminent, excellent practice.

Summary: Management of nosebleeds in Nigeria is safe despite limited resources. We believe that there has been progress in endoscopic management; however, this is not widely available. Therefore, there is a need for inclusive advancement. Moreover, local management guidelines would be an excellent tool for unified practice in the advent of rhinology fellowships and evolving interventional radiology. It is vital to fortify primary and secondary health systems.

Purpose of review: An overview of research exploring communication rehabilitation published between 2022 and 2024. There is limited research in the field so this timely review offers the clinician an insight into the available literature and the gaps that exist.

Recent findings: The review identified four main themes related to communication and speech rehabilitation; articulation and intelligibility, measures of function following surgical interventions, therapeutic interventions and their variability and quality of life outcomes.

Summary: Clinicians may benefit from identifying organizational, institutional, cultural, practical and data driven influences on their clinical interventions and capacity to provide person-centred communication rehabilitation. There is an ongoing need to move beyond measurement of compromise and impairment-based interventions, to explore how enhancing communicative competence using multiple rehabilitative interventions from the Speech and Language Therapist may improve holistic outcomes for people with head and neck cancer.

Purpose of review: To review the pros and cons of treating supraglottic laryngeal cancer with transoral laser microsurgery (TOLM) or transoral robotic surgery (TORS).

Recent findings: The use of TORS is limited by the cost and the availability of the robots despite a faster learning curve than TOLM. The laryngeal exposure difficulty, the use of long instruments, and the restricted view of the surgical field consist of the primary limitations of TOLM, which are addressed in TORS technology through a 30° view of surgical fields, and the 180° amplitude of the instruments. The indications of TOLM and TORS are similar and include cT1-T2 and some selected cT3 with moderate invasion of the preepiglottic space. The rates of positive margins in TORS-SGL are lower than those of TOLM-supraglottic laryngectomy (SGL), while both approaches report similar duration of hospital stays. Patients treated with TORS report higher rates of percutaneous gastrostomy and temporary tracheotomy compared to TOLM. The feeding tube and oral diet re-start appear comparable between both groups. The overall survival, disease-free survival, local, regional, and relapse-free survival rates of TORS are reported to be higher than those found for TOLM SGL.

Summary: TORS and TOLM SGL are well tolerated and effective approaches for cT1, cT2, and some selected cT3 LSCC. The functional and surgical outcomes appear comparable. TORS could have superior survival and loco-regional outcomes than TOLM, which could be attributed to the fastest TORS learning curve, and its superiority in terms of tumor/operating field visualization, and instrument movements.

Purpose of review: Carotid body tumors (CBTs) are rare neuroendocrine tumors with an annual incidence of 1 : 30 000. Bilateral carotid body tumors (BCBTs) account for 3-5% of all CBTs and are more frequently linked to familial syndromes and potential malignancy. BCBT management is still not universally standardized and depends on multiple factors, including patient's age, risk of malignancy, location, growth rate, size, and related Shamblin and Mehanna classifications.

Recent findings: Options of treatment include active surveillance, external beam radiation, and surgery. Surgery is the first-choice treatment, but it may not always be performed especially in elderly patients. Simultaneous BCBT resection is not suggested due to high intra-operative and postoperative risks. The decision to operate on the larger or smaller tumor first is still debated. Whenever feasible, treatment of the larger tumor first to reduce the tumor burden should be preferred but with higher risks of neurovascular injury. Conversely, starting with the smaller tumor first offers a lower risk at initial surgery but may complicate the management of the larger tumor later.

Summary: Surgery for BCBTs, whenever feasible, remains the most indicated treatment but poses a significant risk of neurovascular complications. Resection of the larger, often more symptomatic, and potentially problematic or malignant tumor, reduces the overall disease burden and mitigates risks of rapid progression but involves a higher immediate complication hazard. Multidisciplinary evaluation is essential for balancing surgical risks and long-term outcomes, prioritizing neurovascular preservation and reducing morbidity.

Purpose of review: The rate of distant metastases in patients with head and neck squamous cell carcinoma (HNSCC) ranges between 4 and 26%. Their appearance marks a critical stage in disease progression, significantly reducing survival rates. Treatment options require a multidisciplinary approach and differ based on the number and extension of distant metastases. The aim of this narrative review is to provide a comprehensive and updated overview of the current state of the art in management of such a clinical scenario.

Recent findings: Accurate detection and staging of distant metastases are essential to determine prognosis and guide therapeutic strategies. Oligometastatic condition refers to patients with only a few distant metastases (up to 5). Surgery or stereotactic body radiotherapy are the best curative treatment options for oligometastatic. However, the majority of HNSCC has a polymetastatic disease, not amenable to curative approach. Therefore, systemic therapies, including chemotherapy (CHT) or target molecular therapy and/or best supportive care, are usually reserved to these patients. Rarely, head and neck region, in particular supraclavicular cervical lymph nodes, may be a site of distant metastases from non-head and neck cancer, particularly from the genitourinary and gastrointestinal tracts.

Summary: The occurrence of distant metastases in HNSCC represents a pivotal point in the disease progression, lowering survival rates. Pattern of distant metastases has been related to survival outcomes. Patients with distant metastases from an HNSCC always require a multidisciplinary approach and an accurate selection is necessary to individualize the best treatment strategy.