Oto-Rhino-Laryngology

Correction to: Compare two surgical interventions for otitis media with effusion in young children In the original publication, Table 5 and 6 were interchanged by mistake. The correct tables are given here.

“Barbed snore surgery” simulator: a low-cost surgical model Abstract Background “Barbed snore surgery” (BSS) represents one of the last innovation for obstructive sleep apnea syndrome (OSAS) surgical management. Although this technique represents an effective and minimally invasive surgery, it is not still widespread in many ENT centers. The aim of our study was to develop an inexpensive surgical simulator useful to expedite the surgical learning curve for BSS in untrained ENT surgeons. Model assembly The simulator is a simple model composed of a manually shaped silicone palate (3 × 4 × 1 cm) fixed on a resin skeleton (21 × 16 × 12 cm) using a transparent silicon rubber. The mandible is fixed bilaterally with the aid of two screws allowing for modular inter-incisive distance. Simulation Barbed anterior pharyngoplasty (BAPh) was readily performed on the simulator to show the feasibility of this BSS model. All surgical steps were carried out determining a lift and a shortening of the palate as in real surgery. Conclusions This is the first surgical model that provides a realistic, easily repeatable training in the performance of BSS. Our BSS surgical model is very inexpensive with a cost of approximately 19.25$ dollars and it is manufactured to facilitate a worldwide diffusion of this promising palatal surgery for OSAS.

It is time to take action to prevent cardiovascular disease in postirradiation head and neck cancer patients

Vocal fold scars: a common classification proposal by the American Laryngological Association and European Laryngological Society Abstract Purpose Vocal fold scar is one the most challenging benign laryngeal pathologies. The purpose of this paper is to propose a classification that will allow for a common description of this entity between laryngologists, prevent discrepancies in interpretation, allow for comparison of related studies, and offer a training tool for young laryngologists. Methods/Results Based on the depth and laterality of scarring, we propose 4 types: type I, characterized by atrophy of lamina propria with/without affected epithelium; type II, where the epithelium, lamina propria, and muscle are affected; type III, where the scar is located on the anterior commissure; type IV, which includes extended scar formation in both anteroposterior and rostro-caudal axis with significant loss of vocal fold mass. Conclusion We believe that our proposal is comprehensive and encompasses all existing iatrogenic and non-iatrogenic etiologies in a simple and concise manner. It also serves its purpose as a descriptive, comparative, and training tool.

Fascia lata graft closure of an enlarged tracheoesophageal puncture (TEP) after laryngectomy/laryngopharyngectomy Abstract Enlargement of tracheoesophageal puncture (TEP) is seen in 1–29% of laryngectomee/laryngopharyngectomee using tracheoesophageal voice. It predisposes patient for recurrent aspiration pneumonia. Surgical closure of TEP is required in 30–67% of patients not responding to conservative measures. Surgical closure of an enlarged TEP using a flap may be time consuming, complex, and logistically challenging to organize. A novel technique of Fascia lata graft closure of an enlarged TEP is presented here. This technique can be useful in carefully selected patients with an enlarged TEP.

Balsa wood for precise intra-operative bone contouring in fibula free-flap mandible reconstruction Abstract Objective To report a simple and novel method for intra-operative planning of fibula free flap reconstruction by means of a balsa wood (BW) model. Study design Retrospective chart review. Methods Between 2010 and 2015, 29 patients underwent mandibular reconstruction by a BW osteotomy design in which a single BW beam (US$4) is cut into segments to match the plate. The segments are then assembled together in a three-dimensional (3D) fashion to conform to the contour of the defect and the angles of attachment. Osteotomies are then performed according to the BW segment lengths and angles. Outcomes were retrospectively analyzed for number of procedures, operative times, and complications between the balsa wood method and more standard techniques, e.g., conventional 3D models. Results The length of the average mandibular defect was 9.62 cm (4–19), and the mean number of fibula segments was 2.03 ± 0.92 (range 1–4). Only one case (3.4%) necessitated revision surgery. Three patients (10.3%) had minor complications. Comparison of the results of the 13 patients reconstructed solely by BW to the 16 reconstructed by both BW and a 3D-printed model revealed that the use of BW alone did not significantly alter the average number of segments [2.31 (BW) vs 1.69 (combined); P = 0.07] or ischemia time (173 min vs 171 min, respectively, P = 0.938). Conclusion The use of balsa wood as a model for intra-operative planning of fibula free flap osteotomies is an effective, inexpensive, and safe technique.

Paranasal sinus volumes and headache: is there a relation? Abstract Purpose The aim of the study is to investigate the relation between paranasal sinus volumes and headache in patients with no other rhinologic causes. Methods Two hundred patients with chronic headache and 99 subjects with no headache or facial pain history in the last 6 months were included in the study. Paranasal computed tomography (CT) scans of both patient and control groups were evaluated. Sixty one patients were excluded from the study due to possible rhinogenic headache CT findings such as secretions and contact points. Sinus volume index (SVI) formula created by Barghouth et al. in 2002 was used to calculate paranasal sinus volumes: SVI = ½. A × B × C. Mann–Whitney U test was used to compare an independent continuous variable and a continuous variable with non-normal distribution. Results In the patient group, the total sinus, frontal sinus, and maxillary sinus volumes were found to be significantly lower than those of the control group (p < 0.001). Although the total sphenoid sinus volume was found to be lower in the patient group, there was no significant difference between the two groups (p = 0.013). Conclusion Although rhinogenic findings are often related to secondary headache, the relation between paranasal sinus volume and headache is scarcely investigated in the literature. Our study showed that paranasal sinus volumes might have a role in secondary headaches. Furthermore, in contrast to the literature, our study showed a significant relation between headache and smaller paranasal sinus volumes.

How we improve the transoral resection for oral and oropharyngeal cancer: the CO 2 waveguide laser Abstract Purpose The main aim of this study was to evaluate the CO2 waveguide laser (CO2 WGL) with flexible fiber (Lumenis, Santa Clara, CA) in the treatment of oral and oropharyngeal cancers specifically focusing on the lateral thermal damage (LTD) induced by this instrument and therefore on the reliability of the analysis of frozen sections collected during margin mapping. Methods A total of 48 patients with oral and oropharyngeal cancers from T1 to T4a were prospectively enrolled in the study. We collected data about LTD, pathologic tumor and node stage (pTNM), surgical intervention, kind of reconstruction (no flap, local vs free flap), need for tracheotomy and time of removal, postoperative complications (such as bleeding, mucosal dehiscence, and fistula), need for feeding tube and time of removal. Results Mean LTD was 164.7 ± 92.4 μm. Comparing frozen section histology before and after formalin embedding we found 5 true positives, 170 true negatives, 4 false positives and 4 false negatives, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 55.6%, 98%, 55.6%, 98%, and 96.1%, respectively. Conclusion CO2 WGL is a very manageable tool, which allows a precise cut. However, its high costs, the inability to re-use the fibers and its low coagulation capability must be considered.

Dizziness handicap and clinical characteristics of posterior and lateral canal BPPV Abstract Purpose Benign paroxysmal positional vertigo (BPPV) is diagnosed and divided into subtypes based on positioning vertigo and nystagmus. Whether these subtypes entail any significant differences in patient-reported symptoms; is yet not known. Such differences may have clinical and therapeutic consequences. Our aim was to assess dizziness handicap and clinical characteristics of posterior and lateral canal BPPV. Methods This prospective observational multicentre study analysed consecutive patients with BPPV, confirmed by standardized procedures including videonystagmography under diagnostic manoeuvres in a biaxial rotational chair. Patients were screened for other neurological and otological disorders. Outcomes Dizziness handicap inventory (DHI), posterior vs. lateral canal involvement. Factors: age, gender, positional nystagmus intensity (maximum slow-phase velocity), symptom duration, 25-hydroxyvitamin D-level and traumatic aetiology. Results 132 patients aged 27–90 (mean 57, SD 13) years were included. Higher DHI scores were associated with lateral canal BPPV [95% CI (1.59–13.95), p = 0.01] and female gender [95% CI (0.74–15.52), p = 0.03]. Lateral canal BPPV was associated with longer symptom duration [OR 1.10, CI (1.03–1.17), p = 0.01] and lower 25-hydroxyvitamin D-levels [OR 0.80, CI (0.67–0.95), p = 0.03]. There was no correlation between DHI scores and nystagmus intensity. Conclusions This study suggests that patients with lateral canal BPPV have increased patient-perceived disability, lower vitamin D-levels and longer duration of symptoms. This subtype might therefore require closer follow-up. Patient-perceived disability is not related to positional nystagmus intensity.

Quality of life in patients after reconstruction with the supraclavicular artery island flap (SCAIF) versus the radial free forearm flap (RFFF) Abstract Purpose Gold-standard for defect reconstruction in the head and neck region is the radial free forearm flap (RFFF). The supraclavicular artery island flap (SCAIF) gained popularity due to its versatility. Our objective was to compare functional advantages between both modalities. Methods A retrospective analysis of 24 consecutive cases with advanced-stage squamous cell cancer of the oral cavity and oropharynx after cancer defect reconstruction with two modalities (12 SCAIF; 12 RFFF) was conducted. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, Quality of Life Questionnaire-Core 30-questions (QLQ-C30) and Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (QLQ-H&N35). Results Mean follow-up was 22.2 ± 9.5 months. Comparison of quality of life (QOL) showed significant differences only in speech and problems with the senses in favor of the SCAIF. Conclusion Patients report satisfactory QOL results after oncologic surgery and reconstruction with preliminary no significant differences in most aspects comparing the two modalities. Therefore, the SCAIF appears as a viable alternative to the gold standard, the RFFF.