Ear, nose, & throat journal最新文献

Amputations of the earlobe after a human bite are rare. But when they appear, they present a challenge for the plastic surgeon, due to its reconstruction since the earlobe is anatomically built only from skin and cartilage. In these cases, the retro auricular flap represents a perfect solution for reconstruction. We will present a 25-year-old man with amputation of the lower half of the earlobe, caused after a human bite injury. We have decided to reconstruct the amputated part of the auricle in 3 (acts) with a retro auricular flap. The skin is removed from the amputated part of the auricle and the (cartilage part) is implanted in the pocket created in the retro auricular region. Then in the second act, the retro auricular flap is raised with the previously implanted cartilage graft. By contrast, in the third act, the retro auricular flap is separated and the auricle defect is closed. The second defect is covered with a full skin graft. The reconstruction in 3 acts, delay procedure, of the auricle defects with retro auricular flap represents a satisfactory and very acceptable solution for the patient, not only from the reconstructive aspect but also from the aesthetic aspect.

Objective: As skull base defects become increasingly complex, necessitating more extensive repairs, alternative strategies are needed to address challenging reconstructions and rescue cases of failed primary reconstruction. In this study, we aimed to validate the surgical technique and assess the feasibility of using the platysma myocutaneous flap for skull base reconstruction, using cadaveric specimens in a preclinical setting. Materials and Methods: This descriptive anatomical study was conducted on 2 fresh human cadavers (4 sides). The study assessed the flap's size, range of rotation, suitability for covering the skull base, and the corridor technique for transferring the flap to the skull base. Results: The technique was applied to 2 cadavers, with 4 flaps raised. The average flap length was approximately 15 cm, providing adequate coverage of the ipsilateral carotid artery and anterior skull base, extending from the planum sphenoidale to the cribriform plate and frontal recess. Conclusion: Harvesting a platysma myocutaneous flap is a feasible option for skull base reconstruction, providing adequate coverage for the ipsilateral carotid artery and anterior skull base.

Paragangliomas are rare neuroendocrine tumors originating from the paraganglia. They are mostly benign, slow-growing, and non-secretory. This report describes a rare case of a catecholamine-secreting paraganglioma located in the pterygopalatine fossa. A 45-year-old man presented with severe hypertension, occipital headache, and facial pain. Imaging revealed a large pterygopalatine mass, initially misdiagnosed as chondrosarcoma. Gamma knife stereotactic radiosurgery was performed, followed by surgical resection via a maxillary swing approach. Histological examination confirmed the zellballen pattern typical of paraganglioma. Post-surgery, the patient's blood pressure normalized immediately and subsequently. This case highlights the diagnostic challenges of head and neck paragangliomas in atypical locations and underscores the importance of surgical intervention for catecholamine-secreting tumors. Future studies should focus on refining diagnostic protocols and comparing the efficacy of radiosurgery versus surgical resection for these tumors.

Nasal hemangiomas most commonly occur in the anterior part of the nose, including the Little's area of the nasal septum, the anterior tip of the inferior nasal turbinate, and the vestibule. They rarely develop in the posterior part of the inferior nasal turbinate and meatus. Here, we report a case of cavernous hemangioma at the posterior aspect of the left inferior meatus in a 79-year-old man who presented with epistaxis and progressive nasal obstruction for 4 months after blowing his nose forcefully and review the relevant literature. An endoscopic evaluation revealed a dark red mass in the posterior part of the left inferior meatus that did not extend to the posterior choana or nasopharynx. The tumor was removed with endoscopic surgery under general anesthesia. No recurrence was observed during a 2-year follow-up. Our experience suggests that forceful nose blowing is a traumatic stimulus that can lead to hemangiomas arising in the posterior nasal cavity in rare instances.

The posterior transverse cordotomy (PTC) can be performed for posterior glottic stenosis (PGS) in the operating room through suspension laryngoscopy. This procedure requires adequate exposure of the vocal cords. An alternative PTC approach was carried out on a 56-year-old man without a view of the vocal cords during suspension laryngoscopy. After anteriorizing the hypertrophic tongue with a glide scope, the surgeon reached the vocal folds through a flexible nasofibroscopy with an operative channel. The adequate exposure of the posterior part of the vocal cords allowed the blue laser PTC through the operative channel in the cut setting. The postoperative outcomes were adequate in the follow-up period. This paper describes an alternative approach to PTC in a patient with PGS and several unsuccessful laryngeal exposures.

Objectives: Descending necrotizing mediastinitis (DNM) is a serious infection with a high-mortality rate. However, large-scale studies analyzing the clinical characteristics and risk factors of mortality in DNM are rare. This study aimed to clarify the risk factors and some clinical characteristics of mortality of DNM in our hospital. Methods: We retrospectively analyzed the data, including clinical characteristics and mortality, of 181 patients diagnosed with DNM between 2008 and 2022 to clarify the mortality-related risk factors. Results: A total of 181 patients were evaluated, and the mortality rate was 21.55% (39/181 patients). Endo classification type IIB; advanced age; higher white blood cell count, neutrophil percentage, C-reactive protein (CRP) level on admission; and the incidence of septic shock, sepsis, hypoalbuminemia, and electrolyte disorders were significantly related to mortality. Logistic analysis showed that age (≥55 years old), Endo classification type IIB on computed tomography (CT), septic shock, and high CRP level on admission were independent risk factors of mortality. Conclusion: Old age and high CRP levels on admission increase the risk of mortality in DNM patients. Further, Endo classification type IIB on CT and septic shock were associated with poor prognosis.

Objective: To examine the accuracy, engagement, and quality of otolaryngology-related educational videos produced by health care providers on Instagram. Methods: A systematic search on Instagram was conducted to identify the top 150 video posts using the hashtags #Otolaryngology, #Otolaryngologist, and #ENTeducation, ranging from September 2020 to January 2024. Posts not related to otolaryngology medical education were excluded from analysis. Engagement metrics such as likes, comments, shares, views, and video duration were used to quantify the reach of the content. The Patient Education Materials Assessment Tool for Audiovisual Materials was utilized to evaluate the understandability and actionability of medical educational videos. Results: 54 Instagram videos were analyzed and categorized by content type based on their primary topic-ear (n = 15), nose (n = 20), and throat (n = 19). Overall, 85% of the content was completely accurate, 13% was incomplete/misleading, and 2% was completely inaccurate. The average understandability was high at 89%, and the average actionability was low at 39%. 78% of the videos were created by otolaryngologists, 7% by plastic surgeons, and 15% by other health care providers. Conclusions: Most of the top otolaryngology-related educational content on Instagram was accurate with some misleading and inaccurate content. Although the inaccurate video is small in comparison, the moderate user engagement reveals that even a single inaccurate video can adversely reach and influence many people.

Objective: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is characterized by type 2 inflammation, and studies have shown that conventional therapy usually yields unsatisfactory results. While recent studies have indicated the potential effect of vitamin D on allergic and inflammatory diseases, including CRSwNP. Therefore, this study aimed to investigate the relationship between serum vitamin D levels and the severity of CRSwNP using endoscopic evaluations, imaging, patient-reported outcome measures, absolute eosinophilic count, and serum vitamin D levels and determine the prevalence of vitamin D deficiency in patients with CRSwNP. Methods: Serum vitamin D levels were measured in 104 patients with uncontrolled CRSwNP, who failed maximum medical management and were scheduled for functional endoscopic sinus surgery. Vitamin D levels were compared between patients using the Lund- Mackay (LM) score, Sinonasal Outcome Test-22 (SNOT-22), total nasal polyp scores, and absolute eosinophil counts. Results: The 104 included patients had an average age of 42.09 ± 13.3 years, and 63.5% of them were male. Mean value of vitamin D was 57.9 ± 31.2 nmol/L. The average SNOT-22 score was 65.49 ± 21.3. The mean LM score was 14.48 ± 6.64. The total nasal polyp score was 4.3 ± 2.08. Vitamin D levels were negatively correlated with LM score (r = -.210, P = .032) and polyp grade (r = -.264, P = .007), but did not correlate with other variables. Conclusions: Our study indicates that vitamin D deficiency or insufficiency is common in patients with CRSwNP. We found that low serum vitamin D levels were negatively correlated with the Lund-Mackay score and the total nasal polyp score, providing additional support for an association between low vitamin D levels and a greater severity of CRSwNP.

Background: Bell's palsy is a common peripheral facial nerve disorder that manifests as sudden unilateral facial paralysis. The condition, believed to be caused by viral infections and ischemic processes, affects a significant portion of the population and is associated with various systemic comorbidities. This study aimed to analyze the clinical characteristics, risk factors, and prognosis in primary and recurrent Bell's palsy to identify factors associated with recurrence and outcomes. Methods: A retrospective study was conducted on patients diagnosed with Bell's palsy at tertiary hospital between 2018 and 2024. Data collected included demographic information, comorbid conditions, clinical features, and recovery outcomes. Statistical analyses were performed to determine the significance of various factors in the recurrence of Bell's palsy. Results: The study included 254 patients. Recurrence was observed in 20.9% of cases. Significant risk factors for recurrence included diabetes (33.3%), hypertension (41.0%), hypothyroidism (56.1%), autoimmune disorders (54.2%), and a family history of Bell's palsy (48.6%). The severity of initial paralysis also influenced recurrence rates. Complete recovery from the initial episode was achieved by 66.9% of patients, whereas prolonged recovery times were noted in recurrent cases. Conclusion: The study highlights the significant role of systemic comorbidities and the severity of initial presentation in the recurrence of Bell's palsy.