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Esophageal motility disorder - has Chicago classification v4.0 simplified our management? 食管运动障碍-芝加哥分类v4.0是否简化了我们的管理?
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-10-04 DOI: 10.1097/MOO.0000000000000936
Francis Edeani, Benson Massey

Review purpose: Addressing dysphagia is vital due to its prevalence and impact on healthcare expenditure. While high resolution manometry (HRM) effectively evaluates esophageal dysphagia, its role in oropharyngeal dysphagia and upper esophageal sphincter (UES) dysfunction remains debated. The fourth iteration of the Chicago classification (CC) offers an algorithmic approach for diagnosing abnormal motor patterns via HRM. This review assesses the CC's impact on dysphagia management.

Recent insights: The Chicago classification version 4.0 emphasizes auxiliary and provocative techniques when the algorithm falls short of a conclusive diagnosis. It introduces stricter criteria for previously ambiguous conditions like ineffective motility and esophagogastric junction outflow obstruction. This version also introduces the concept of conclusive and inconclusive classifications based on symptoms, provocation maneuvers, and supportive testing minimizing ambiguity.

Summary: The Chicago classification v4.0 remains a useful tool for the diagnosis of well characterized esophageal motility disorders. However, major limitations include reliance on HRM and a focus on distal esophagus contractile characteristics without considering proximal esophagus or upper esophageal sphincter, both of which can sometimes be the only evident abnormality in patients with dysphagia. Despite efforts to reduce ambiguity, diagnostic challenges persist. These limitations can be addressed in future updates.

综述目的:由于吞咽困难的普遍性和对医疗支出的影响,解决吞咽困难至关重要。虽然高分辨率测压法(HRM)能有效评估食管吞咽困难,但其在口咽吞咽困难和上食管括约肌(UES)功能障碍中的作用仍存在争议。芝加哥分类(CC)的第四次迭代提供了一种通过HRM诊断异常运动模式的算法方法。本综述评估了CC对吞咽困难管理的影响。最近的见解:芝加哥分类4.0版强调在算法无法得出结论性诊断时使用辅助和挑衅性技术。它为以前不明确的情况引入了更严格的标准,如运动无效和食管胃交界处流出道梗阻。该版本还引入了基于症状、挑衅策略和支持性测试的结论性和非结论性分类的概念,以最大限度地减少歧义。综述:Chicago分类v4.0仍然是诊断特征明确的食管运动障碍的有用工具。然而,主要的局限性包括对HRM的依赖和对食管远端收缩特性的关注,而不考虑食管近端或食管上括约肌,这两者有时可能是吞咽困难患者唯一明显的异常。尽管努力减少歧义,但诊断挑战依然存在。这些限制可以在未来的更新中解决。
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引用次数: 0
Total lower lip reconstruction: a review of recent advances. 全下唇重建术:近期进展综述。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-10-12 DOI: 10.1097/MOO.0000000000000926
Aishwarya Shukla, Kelsey Loy, G Nina Lu

Purpose of review: This review describes the fundamental principles and recent advances in the reconstruction of total lower lip defects to restore peri-oral aesthetic and function.

Recent findings: Modifications to the Abbe flap and visor flap have recently been described. Recent advances to free flap techniques have focused on dynamic restoration of lower lip sling function after reconstruction. This involves the transfer of innervated or noninnervated muscle tissue to reconstruct the lower lip to restore the sphincter function of the lips.

Summary: The reconstructive goals for a full thickness lower lip defect are to restore a functional oral sphincter, replace mucosal and external skin, and maintain a functional size of the oral aperture. Local flap reconstruction of sub-total lower lip defects is possible, but use of local flaps for total lip reconstruction often leads to microstomia. Several static and dynamic free tissue transfer options exist for lower lip reconstruction and have been summarized in this review.

综述目的:本综述介绍了重建全下唇缺损以恢复口周美观和功能的基本原理和最新进展。最近的发现:Abbe皮瓣和面罩皮瓣的修改最近已经被描述。游离皮瓣技术的最新进展集中在重建后下唇吊带功能的动态恢复上。这涉及到转移有神经或无神经的肌肉组织来重建下唇,以恢复嘴唇的括约肌功能。总结:全厚下唇缺损的重建目标是恢复功能性口腔括约肌,更换粘膜和外部皮肤,并保持口腔的功能大小。局部皮瓣重建亚全下唇缺损是可能的,但使用局部皮瓣进行全唇重建往往会导致显微切除。有几种静态和动态的自由组织转移方案可用于下唇重建,本文对此进行了总结。
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引用次数: 0
Large-data contextualizations of social determinant associations in pediatric head and neck cancers. 儿童头颈癌社会决定因素关联的大数据背景分析。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-14 DOI: 10.1097/MOO.0000000000000931
David J Fei-Zhang, Daniel C Chelius, Anthony M Sheyn, Jeff C Rastatter

Purpose of review: Prior investigations in social determinants of health (SDoH) and their impact on pediatric head and neck cancers are limited by the narrow scope of cancer types and SDoH being studied while lacking inquiry on the interrelational contribution of varied SDoH in real-world contexts. The purpose of this review is to discuss the current research tackling these shortcomings of SDoH-based studies in head and neck cancer and to discuss means of applying these findings in prospective initiatives and implementations.

Recent findings: Through leveraging contemporary, large-data analyses measuring diverse social vulnerabilities, several studies have identified comprehensive delineations of which social disparities contribute the largest quantifiable impact on the care of head and neck cancer patients. Progressing from prior SDoH-based research of the decade, these studies contextualize the effect of social vulnerabilities and have laid the foundations to begin addressing these issues in the complex, modern-day environment of interrelatedsocial factors.

Summary: Social determinants of health markedly affect pediatric head and neck cancer care and prognosis in complex and surprising ways. Modern-day tools and analyses derived from large-data techniques have unveiled the quantifiable underpinnings of how SDoH impact these pathologies.

综述目的:先前对健康的社会决定因素(SDoH)及其对儿童头颈癌的影响的研究受到癌症类型和SDoH研究范围狭窄的限制,而缺乏对现实环境中不同SDoH的相互作用的研究。本综述的目的是讨论当前针对基于SDoH的癌症头颈部研究的这些缺点的研究,并讨论将这些发现应用于前瞻性计划和实施的方法。最近的发现:通过利用测量不同社会脆弱性的当代大数据分析,几项研究已经确定了哪些社会差异对癌症头颈部患者的护理产生了最大的可量化影响的全面描述。与过去十年基于SDoH的研究不同,这些研究将社会脆弱性的影响置于背景中,并为在复杂的现代相互关联的社会因素环境中开始解决这些问题奠定了基础。摘要:健康的社会决定因素以复杂和令人惊讶的方式显著影响儿童癌症的治疗和预后。来自大数据技术的现代工具和分析揭示了SDoH如何影响这些病理的可量化基础。
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引用次数: 1
The development of a pediatric skull base team: how, where and why? 儿科颅底团队的发展:如何、在哪里以及为什么?
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-13 DOI: 10.1097/MOO.0000000000000930
Joseph Lee, Jeffrey Leonard, Patrick Walz

Purpose of review: The purpose of this review is to describe the development of pediatric skull base surgical techniques and illustrate the advantages of pediatric endonasal skull base surgery (ESBS) when applied in appropriate settings. Additionally, this manuscript endeavors to define the pediatric skull base team components, highlight circumstances amenable to the development of a pediatric skull base surgery team, and describe the relative advantages of independent pediatric teams versus incorporation with adult skull base practices.

Recent findings: Multiple series published within the last decade have described the application of ESBS to the pediatric population, demonstrating adoption of these interventions in many academic centers. Most series include relatively small numbers of patients, highlighting the relative infrequency of anterior skull base pathology in the pediatric patient. Given the relatively low volume and high technical demands of this skillset, general guidelines for the timing, suggested training, and volume necessary to support a pediatric skull base team are offered.

Summary: The interest in pediatric ESBS continues to expand though case volumes may limit maintenance of skills in lower volume centers. The development of a dedicated pediatric skull base team in areas where sufficient volume exists facilitates concentration of expertise and interdisciplinary relationships necessary to provide the highest level of care. Collaborating with adult skull base teams can enhance the pediatric team experience, increasing exposure to complex surgical planning and radiologic nuances. However, a pediatric-focused skull base team can tailor treatment to meet the specific psychosocial and developmental needs of children.

综述的目的:本综述的目的是描述儿童颅底手术技术的发展,并说明儿童鼻内颅底手术(ESBS)在适当环境中应用的优势。此外,这份手稿试图定义儿科颅底团队的组成部分,强调适合发展儿科颅底手术团队的情况,并描述独立儿科团队与成人颅底实践相结合的相对优势。最近的发现:在过去十年中发表的多个系列文章描述了ESBS在儿科人群中的应用,表明许多学术中心采用了这些干预措施。大多数系列包括相对较少的患者,突出了儿科患者中前颅底病理的相对罕见。鉴于该技能的数量相对较低,技术要求较高,因此提供了支持儿科颅底团队所需的时间、建议培训和数量的一般指南。摘要:尽管病例数量可能会限制低容量中心的技能维持,但对儿科ESBS的兴趣仍在继续扩大。在有足够容量的地区发展一支专门的儿科颅底团队,有助于集中专业知识和跨学科关系,以提供最高水平的护理。与成人颅底团队合作可以增强儿科团队的经验,增加对复杂手术计划和放射学细微差别的了解。然而,一个专注于儿科的颅底团队可以根据儿童的特定心理社会和发育需求进行量身定制的治疗。
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引用次数: 0
Current opinion in otolaryngology and head and neck surgery: the role of the otolaryngologist in the management of pediatric dysphagia. 耳鼻咽喉科和头颈外科的最新观点:耳鼻喉科医生在儿童吞咽困难治疗中的作用。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-10-11 DOI: 10.1097/MOO.0000000000000934
Annie Farrell, Nikhila Raol

Purpose of review: Dysphagia affects at least 1% of the pediatric population. This prevalence further increases in patients who are born prematurely or who have underlying neuromuscular or cardiopulmonary disorders. A multidisciplinary team approach, including an Otolaryngologist, can help promote an expedited diagnosis and therapeutic regimen, ensuring that the patient receives adequate nutrition needed for growth and development.

Recent findings: The development and growth of multidisciplinary aerodigestive clinics have improved outcomes in pediatric patients with dysphagia. If a structural concern is noted on examination, there remain a multitude of medical and surgical options to help improve patient outcomes and swallow. These treatment options are usually multimodality and specific interventions may be employed to target a specific and notable abnormality.

Summary: Pediatric dysphagia is a complex concern. For the otolaryngologist, etiologies with surgical targets may include ankyloglossia, tonsillar hypertrophy, laryngomalacia, laryngo-esophageal cleft, vocal fold movement impairment, and cricopharyngeal achalasia. The development and formalization of a multidisciplinary approach has streamlined and broadened treatment options for these patients. An otolaryngologist is integral as part of the treatment team of these patients.

综述目的:吞咽困难影响至少1%的儿科人群。这种患病率在早产或有潜在神经肌肉或心肺疾病的患者中进一步增加。包括耳鼻喉科医生在内的多学科团队方法可以帮助促进快速诊断和治疗方案,确保患者获得生长发育所需的充足营养。最近的发现:多学科空气消化诊所的发展和壮大改善了儿童吞咽困难患者的预后。如果在检查中发现了结构性问题,那么仍有多种医疗和手术选择可以帮助改善患者的预后和吞咽能力。这些治疗选择通常是多模式的,可以采用特定的干预措施来针对特定和显著的异常。摘要:儿童吞咽困难是一个复杂的问题。对于耳鼻喉科医生来说,有手术靶点的病因可能包括强直性脊柱炎、扁桃体肥大、喉软化症、喉食管裂、声带运动障碍和环咽失弛缓症。多学科方法的发展和正式化简化并拓宽了这些患者的治疗选择。耳鼻喉科医生是这些患者治疗团队不可或缺的一部分。
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引用次数: 0
Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa. 撒哈拉以南非洲地区头颈部游离皮瓣重建的现实和挑战。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-18 DOI: 10.1097/MOO.0000000000000932
Samuel Okerosi, Aslam Nkya, Johan Fagan, Mary Jue Xu

Purpose of review: With an increased need to decentralize and train more head and neck ablative and reconstructive surgeons in sub-Saharan Africa, we assess the realities and challenges of free flap reconstruction in sub-Saharan Africa to provide context of its use as a reconstructive option.

Recent findings: Head and neck free flap reconstruction has been performed by local teams as well as visiting teams in Sub Saharan Africa with good results. Free flap success rates are similar to high income regions at 89% vs. 85-100%. However, flap salvage rates are significantly lower (45% compared to 64.1% reported in high income regions). This has been attributed to resource constraints.

Summary: With increasing efforts to increase free flap reconstructive capacity in sub-Saharan Africa, these efforts need to be in the context of available healthcare resources including infrastructure and workforce outside of the surgical team. As training of head and neck ablative and reconstructive surgeons is expanded, reconstructive training needs take the healthcare resource availability into account.

审查目的:随着撒哈拉以南非洲地区越来越需要分散和培训更多的头颈部消融和重建外科医生,我们评估了撒哈拉以南地区游离皮瓣重建的现实和挑战,以提供其作为重建选择的背景。最近的发现:在撒哈拉以南非洲,当地团队和访问团队都进行了头颈部游离皮瓣重建,取得了良好的效果。游离皮瓣的成功率与高收入地区相似,分别为89%和85-100%。然而,皮瓣打捞率明显较低(45%,而高收入地区报告的打捞率为64.1%)。这归因于资源限制。摘要:随着撒哈拉以南非洲地区越来越多地努力提高游离皮瓣重建能力,这些努力需要在现有医疗资源的背景下进行,包括基础设施和手术团队以外的劳动力。随着头颈部消融和重建外科医生培训的扩大,重建培训需要考虑医疗资源的可用性。
{"title":"Realities and challenges of head and neck free flap reconstruction in sub-Saharan Africa.","authors":"Samuel Okerosi,&nbsp;Aslam Nkya,&nbsp;Johan Fagan,&nbsp;Mary Jue Xu","doi":"10.1097/MOO.0000000000000932","DOIUrl":"10.1097/MOO.0000000000000932","url":null,"abstract":"<p><strong>Purpose of review: </strong>With an increased need to decentralize and train more head and neck ablative and reconstructive surgeons in sub-Saharan Africa, we assess the realities and challenges of free flap reconstruction in sub-Saharan Africa to provide context of its use as a reconstructive option.</p><p><strong>Recent findings: </strong>Head and neck free flap reconstruction has been performed by local teams as well as visiting teams in Sub Saharan Africa with good results. Free flap success rates are similar to high income regions at 89% vs. 85-100%. However, flap salvage rates are significantly lower (45% compared to 64.1% reported in high income regions). This has been attributed to resource constraints.</p><p><strong>Summary: </strong>With increasing efforts to increase free flap reconstructive capacity in sub-Saharan Africa, these efforts need to be in the context of available healthcare resources including infrastructure and workforce outside of the surgical team. As training of head and neck ablative and reconstructive surgeons is expanded, reconstructive training needs take the healthcare resource availability into account.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"438-440"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41220733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population. 儿科人群中颈面部非结核分枝杆菌感染的治疗现状。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-12 DOI: 10.1097/MOO.0000000000000927
Keshav V Shah, Lazaro R Peraza, Joshua P Wiedermann

Purpose of review: The purpose of this review is to analyze and consolidate recently published literature to provide updated guidelines on the diagnosis and management of nontuberculous mycobacterial lymphadenitis (NTM LAD) in the pediatric population and to suggest areas of further research.

Recent findings: Diagnosis of NTM LAD relies on a detailed clinical history, physical examination, laboratory tests, and imaging techniques. Treatment strategies vary widely, with a shift towards complete surgical excision being observed due to its higher cure rate, improved aesthetic outcomes, and lower recurrence rates. However, patient-specific factors must be considered. The role of genetic factors, such as Mendelian susceptibility to mycobacterial disease (MSMD), is being increasingly recognized and could lead to targeted therapies.

Summary: Despite strides in the understanding and management of NTM LAD, substantial gaps remain in key areas such as the role of diagnostic imaging, optimal treatment parameters, postoperative care, and surveillance strategies. In this article, we explain our approach to NTM using the most relevant evidence-based medicine while offering directions for future work.

综述目的:本综述的目的是分析和整合最近发表的文献,为儿科人群中非结核分枝杆菌性淋巴结炎(NTM-LAD)的诊断和治疗提供最新指南,并提出进一步研究的领域。最近的发现:NTM-LAD的诊断依赖于详细的临床病史、身体检查、实验室测试和成像技术。治疗策略差异很大,由于治愈率更高、美观效果改善和复发率更低,观察到向完全手术切除的转变。但是,必须考虑患者的具体因素。遗传因素的作用,如孟德尔对分枝杆菌病(MSMD)的易感性,正在得到越来越多的认识,并可能导致靶向治疗。摘要:尽管在NTM-LAD的理解和管理方面取得了进展,但在诊断成像的作用、最佳治疗参数、术后护理和监测策略等关键领域仍存在巨大差距。在这篇文章中,我们解释了我们使用最相关的循证医学进行NTM的方法,同时为未来的工作提供了方向。
{"title":"Current management of cervicofacial nontuberculous mycobacterial infections in the pediatric population.","authors":"Keshav V Shah,&nbsp;Lazaro R Peraza,&nbsp;Joshua P Wiedermann","doi":"10.1097/MOO.0000000000000927","DOIUrl":"10.1097/MOO.0000000000000927","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to analyze and consolidate recently published literature to provide updated guidelines on the diagnosis and management of nontuberculous mycobacterial lymphadenitis (NTM LAD) in the pediatric population and to suggest areas of further research.</p><p><strong>Recent findings: </strong>Diagnosis of NTM LAD relies on a detailed clinical history, physical examination, laboratory tests, and imaging techniques. Treatment strategies vary widely, with a shift towards complete surgical excision being observed due to its higher cure rate, improved aesthetic outcomes, and lower recurrence rates. However, patient-specific factors must be considered. The role of genetic factors, such as Mendelian susceptibility to mycobacterial disease (MSMD), is being increasingly recognized and could lead to targeted therapies.</p><p><strong>Summary: </strong>Despite strides in the understanding and management of NTM LAD, substantial gaps remain in key areas such as the role of diagnostic imaging, optimal treatment parameters, postoperative care, and surveillance strategies. In this article, we explain our approach to NTM using the most relevant evidence-based medicine while offering directions for future work.</p>","PeriodicalId":55195,"journal":{"name":"Current Opinion in Otolaryngology & Head and Neck Surgery","volume":" ","pages":"388-396"},"PeriodicalIF":1.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dysphagia and dementia: a 'double dilemma'. 吞咽困难和痴呆:“双重困境”。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-08-02 DOI: 10.1097/MOO.0000000000000912
Rebecca Leonard

Purpose of review: Dementia and its variants, including Alzheimer's disease, become more prevalent with age. Dysphagia, that is, difficulty swallowing, also occurs with aging, and is often associated with dementia. Currently, there is no cure for dementia, and dysphagia, unrecognized or untreated, can have life-altering, even fatal consequences. Prolonged ability to eat safely and effectively could contribute to improved quality of life in a fragile population. In this review, difficulties associated with the management of dysphagia in individuals with dementia, as well as promising possibilities for continued investigation, will be discussed.

Recent findings: Recent reports point to unique problems related to understanding the comorbidities of dysphagia and dementia. These include delays in identifying dysphagia in affected individuals, as well as a lack of prevalence data for dysphagia in types and stages of dementia, or according to setting, for example, residential center, hospital. Emphasis on new tools, and new applications of existing tools, are needed.

Summary: New evidence not only underscores complexities and shortcomings of our understanding of dysphagia in dementia but also points to existing applications with potential for improving the situation, and new investigational directions that may elaborate our further understanding of these comorbidities.

综述目的:痴呆症及其变体,包括阿尔茨海默病,随着年龄的增长而变得更加普遍。吞咽困难,即吞咽困难,也会随着年龄的增长而发生,通常与痴呆症有关。目前,痴呆症还没有治愈方法,未经识别或治疗的吞咽困难可能会改变生活,甚至致命。延长安全有效饮食的能力有助于提高脆弱人群的生活质量。在这篇综述中,将讨论与痴呆症患者吞咽困难管理相关的困难,以及继续研究的可能性。最近的发现:最近的报告指出了与理解吞咽困难和痴呆合并症相关的独特问题。其中包括识别受影响个体吞咽困难的延迟,以及缺乏痴呆症类型和阶段的吞咽困难患病率数据,或根据居住中心、医院等环境的患病率数据。需要强调新工具和现有工具的新应用。摘要:新的证据不仅强调了我们对痴呆症吞咽困难理解的复杂性和不足,还指出了现有的应用程序,这些应用程序有可能改善这种情况,以及新的研究方向,这些研究方向可能会详细阐述我们对这些共病的进一步理解。
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引用次数: 0
Pediatric tracheostomy decannulation: what's the evidence? 儿童气管造口拔管:有什么证据?
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-09-26 DOI: 10.1097/MOO.0000000000000929
Tiffany Raynor, Joshua Bedwell

Purpose of review: Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate.

Recent findings: Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay.

Summary: Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.

综述的目的:儿童拔管失败可能与高发病率和死亡率有关,但目前还没有发表儿童气管造口术拔管的循证指南。气管造口术经常在医学复杂的儿童中进行,他们很难预测何时以及如何安全地拔管。最近的发现:已发表的关于儿科拔管的研究仅限于单个机构的综述和病例系列,这些机构的人群、气管造口术的适应症和机构资源各不相同。本文将对过去10年中公布的拔管方案进行综述 年。插管前需要进行内窥镜气道评估,以评估气道的通畅性并解决任何气道阻塞。在已发表的方案中,气管造口管的修改存在相当大的差异,尽管大多数人支持进行加盖试验和缩小气管造口管以便于加盖。大多数方案包括在拔管前在监测环境中过夜加盖,观察范围为24至48 拔管后h。关于哪些患者应该在拔管前进行多导睡眠描记术(PSG),存在争议,因为这种检查是资源密集型的,可能不广泛。拔管后常见持续性气管皮瘘。经二次手术治愈的瘘管切除术报告的手术时间、总并发症发生率和术后住院时间较低。总结:小儿拔管应分阶段进行。理想的拔管方案应该是安全和方便的,不需要使用过多的医疗资源。基于患者群体或机构资源,协议可能存在差异,但每个机构内明确描述的协议对于长期持续的护理和质量改进至关重要。需要进一步的研究来确定拔管前谁将从PSG中受益最大的选择标准,以指导这一有限资源的分配。
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引用次数: 0
Intracapsular tonsillectomy: setting a new standard. 扁桃体囊内摘除术:树立新标准。
IF 1.6 4区 医学 Q2 OTORHINOLARYNGOLOGY Pub Date : 2023-12-01 Epub Date: 2023-10-09 DOI: 10.1097/MOO.0000000000000935
Ethan Bassett

Purpose of review: Tonsillectomy is one of the most common surgical procedures performed on children in the United States. Since 2002, the intracapsular technique has been studied as a safer and less painful alternative to total tonsillectomy. Concerns have been raised, however, as to the potential for regrowth and long-term outcomes regarding this technique.

Recent findings: Studies support the use of intracapsular tonsillectomy in the management of sleep disordered breathing, including in syndromic populations, as well as for tonsillitis. In addition, safety profiles continue to be improved over that of extracapsular dissection. While the incidence of regrowth ranges depending on the study and duration of follow up, it remains acceptably low. The most consistent independent risk factor for revision surgery includes young age.

Summary: While total tonsillectomy is more thoroughly studied historically, an important absence in the literature is a definitive superiority over the intracapsular technique. With continued high-level studies, as well as additional examination of long-term outcomes, we should continue to see greater acceptance of intracapsular tonsillectomy as a standard of practice in a vulnerable population.

综述目的:扁桃体切除术是美国最常见的儿童手术之一。自2002年以来,囊内技术已被研究为一种更安全、疼痛更小的替代全扁桃体切除术的方法。然而,人们对这项技术的再生潜力和长期结果表示担忧。最近的发现:研究支持使用囊内扁桃体切除术治疗睡眠呼吸障碍,包括综合征人群,以及扁桃体炎。此外,与囊外剥离相比,安全性仍在不断提高。虽然再生的发生率取决于研究和随访的持续时间,但仍处于可接受的低水平。翻修手术最一致的独立风险因素包括年轻人。总结:虽然全扁桃体切除术在历史上得到了更彻底的研究,但文献中一个重要的缺失是它明显优于囊内技术。随着持续的高水平研究,以及对长期结果的额外检查,我们应该继续看到更大程度上接受囊内扁桃体切除术作为弱势人群的标准做法。
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引用次数: 0
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Current Opinion in Otolaryngology & Head and Neck Surgery
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