Endoscopic Z‐plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients

xlomafota13 shared this article with you from Inoreader Endoscopic Z‐plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients Via The Laryngoscope Objectives Supraglottic stenosis is a rare type of laryngeal stenosis that is caused by congenital laryngotracheal anomalies, iatrogenic instrumentation injuries, autoimmune disorders, infection, irradiation, chemical or thermal burns, and external blunt or penetrating trauma. The author presents his experience on nine patients using this new endoscopic surgical technique for treatment of supraglottic stenosis. Study Design Individual retrospective cohort study, tertiary referral center, university hospital. Methods All cases of supraglottic laryngeal stenosis treated during a 10‐year period at a tertiary academic medical center were reviewed. Nine patients with supraglottic stenosis treated with endoscopic uni‐ or bilateral z‐plasty technique were determined and presented. The etiology of stenosis was iatrogenic surgical trauma in seven patients, laryngeal fracture in one patient, and systemic lupus erythematosus in the other patient. Main outcome measures were respiratory function test results, absence of dyspnea on exertion, and decannulation if tracheotomy was present preoperatively. Results Seven patients with tracheotomy were decannulated 1 month after surgery. All nine patients had adequate airway and were dyspnea‐free. Their preop respiratory function test results improved significantly postoperatively (P < .05). Conclusion For supraglottic stenosis endoscopic surgery using mucosal flaps in the form of z‐plasty should be considered within the available surgical techniques. Although this type of surgery is highly successful, it is technically difficult to apply. Level of Evidence 4 Laryngoscope, 131:E534–E539, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Improving Mortality Attribution in Otolaryngology – Head and Neck Surgery

xlomafota13 shared this article with you from Inoreader Improving Mortality Attribution in Otolaryngology – Head and Neck Surgery Via The Laryngoscope Objective/Hypothesis Mortality attribution can have significant implications for reimbursement, hospital/department rankings, and perceptions of safety. This work seeks to compare the accuracy of externally assigned diagnosis‐related group (DRG)‐based service line mortality attribution in otolaryngology to an internal review process that assigns mortality to the teams that cared for a patient during hospitalization. Study Design Retrospective case series. Methods Mortality events at Vanderbilt University Medical Center (VUMC) from 2012 to 2018 were compared. Included events were assigned to the otolaryngology service line (OSL) via the following methods: an external agency (Vizient) using DRG, utilization management assignment based on the service that provided care at admission (admission service), discharge (discharge service), or throughout hospitalization (major service line), or through the internal VUMC mortality review committee. Internal review was considered the standard for comparison. Results Of the 28 mortality events assigned to OSL by the DRG‐based external method, nine (32%) were actually attributable to OSL. Of the 23 total mortality events attributable to OSL at our institution, external DRG‐based review captured nine (39%). The designation of major service during hospitalization was correct 95% of the time and captured 87% of mortality events. Differences between external and internal attribution methods were statistically significant (P < .001). Conclusions DRG‐based models are frequently utilized but can be inaccurate when attributing mortality for an individual otolaryngology department. Otolaryngology mortalities appear to be captured and assigned more accurately by assigning deaths to the service that renders the majority of care during hospitalization. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship

xlomafota13 shared this article with you from Inoreader Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship Via The Laryngoscope Objectives/Hypothesis Residency preparation courses (RPCs) have become a widely adopted practice to ease the transition of medical students into residency, but these courses often lack training in skills expected of subspecialty interns. To fill this gap, a simulation‐based curriculum in otolaryngology (ORL) was implemented at the University of Michigan Medical School. The curriculum aimed to improve confidence and perceived ability to perform common ORL skills for graduating students prior to internship. Study Design Cross‐sectional study. Methods Six basic simulations (tracheostomy, flexible laryngoscopy, otomicroscopy, myringotomy and tube insertion, epistaxis and peritonsillar abscess management) were included in the first course in 2019. The course was expanded in 2020 with the addition of three advanced simulations (ear foreign body extraction, tracheostomy complications, and "cannot intubate, cannot ventilate" situations). Pre‐ and postsession surveys were collected to assess individual simulations and the course overall. Results A total of 32 students participated in the ORL simulation curriculum in Spring 2019 and 2020. Paired t‐tests showed significant improvement in self‐perception of ability on every simulation. Qualitative feedback revealed that students particularly valued the opportunity for hands‐on learning. Non‐ORL students rated their baseline abilities significantly lower than ORL students on five stations, but they achieved statistically equivalent postsession ratings on all but the otomicroscopy station. Conclusions An ORL‐specific curriculum is a valuable addition to procedural RPCs. The curriculum resulted in increased confidence and perceived ability in skill performance for both students pursuing ORL residencies, as well as those pursuing other procedural specialties. Level of Evidence 4. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

xlomafota13 shared this article with you from Inoreader Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life Via The Laryngoscope Objectives//Hypothesis To characterize long‐term outcomes in pediatric patients requiring tracheotomy in the first year of life. Study Design Retrospective case series. Methods A retrospective longitudinal registry of tracheostomy patients was queried for patients who underwent tracheotomy from birth to 11 months. Primary outcomes were decannulation and survival. Secondary outcomes included neurocognitive quality of life assessed with the PedsQL Family Impact Module (scored from worst to best, 0 to 100 points). Results The study included 337 children. Thirty (8.90%) were neonates and 307 (91.10%) were infants. The population was 56.08% male (n = 189), and the racial and ethnicity composition were equally distributed (29.97% White, 31.45% Black, and 31.16% Hispanic). Significant differences between neonates and postneonates included birth weight in grams (2,731.40 vs. 1,950.44, P < .05), extreme prematurity (13.33% vs. 38.88%, P = .01), upper airway obstruction (80.00% vs. 42.67%, P < .05), and the need for mechanical ventilation (40.00% vs. 83.71%, P < .05). Despite these differences, long‐term outcomes were similar: decannulation (X 2 = 2.19, P = .14), death (X 2 = 2.63, P = .11), and neurocognitive quality of life (X 2 = 2.63, P = .27). Having a child with a tracheostomy caused the most problems with being physically tired (mean = 75.32 ± 3.90), emotional frustration (mean = 77.31 ± 5.05), and worry (mean standard deviation = 74.23 ± 6.48). Conclusion There were demographic differences between neonatal and infantile tracheostomy patients, but they did not affect long‐term outcomes. The presence of a tracheostomy caused a significant impact on a family's quality of life. Level of Evidence 3. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

xlomafota13 shared this article with you from Inoreader Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review Via The Laryngoscope Objectives/Hypothesis Cerebellopontine angle (CPA) and internal auditory canal (IAC) lipomas are rare, benign tumors comprising 0.08% of all intracranial tumors and can be mistaken for other, more common lesions of the CPA/IAC such as vestibular schwannoma. The purpose of this study was to review the literature and assess the evolution of CPA/IAC lipoma diagnosis and management. In addition, we present 17 new lipomas, matching the largest known case series of this rare tumor. Study Design Retrospective case series and systematic review. Methods Systematic review of the literature was performed using PubMed and Google Scholar. References from identified articles were also reviewed to identify potential additional manuscripts. Manuscripts and abstracts were reviewed to identify unique cases. For the case series, the charts of all CPA/IAC lipoma patients seen at a single institution from 2006–2019 were manually reviewed. Logistic regression and chi‐squared analysis were performed where appropriate. Results A total of 219 unique lipomas have been reported in the literature, including 17 presented in this study. Surgical management has been performed in 46% of cases and has been conducted less often in recent decades, likely due to improved radiographic diagnostic capabilities and understanding of surgical outcomes. Surgical management is associated with worse neurologic outcomes (P = .002) and has become less common in recent decades. Although growth is unlikely, it has been demonstrated in patients into their 30s. Conclusions Accurate radiographic diagnosis is imperative for appropriate patient management, as CPA/IAC lipomas should typically be managed through observation and serial imaging whereas vestibular schwannomas and other CPA/IAC lesions may require microsurgical or radiosurgical intervention depending on growth and symptomatology. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current Protocol for Aesthetic Scar Management in Thyroid Surgery

xlomafota13 shared this article with you from Inoreader Current Protocol for Aesthetic Scar Management in Thyroid Surgery Via The Laryngoscope Objectives/Hypothesis We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol. Study Design We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center. Methods We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non‐ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared. Results Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C. Conclusions Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome. Level of Evidence II Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue

xlomafota13 shared this article with you from Inoreader Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue Via Journal of Voice The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Automatic Classification of Healthy Subjects and Patients With Essential Vocal Tremor Using Probabilistic Source-Filter Model Based Noise Robust Pitch Estimation

xlomafota13 shared this article with you from Inoreader Automatic Classification of Healthy Subjects and Patients With Essential Vocal Tremor Using Probabilistic Source-Filter Model Based Noise Robust Pitch Estimation Via Journal of Voice Essential voice tremor (EVT) is a voice disorder resulting from dyscoordination within the laryngeal musculature. A low-frequency fluctuations of fundamental voice frequency or the strength of excitation amplitude is the main consequence of the disorder. The automatic classification of healthy control and EVT is useful tool for the clinicians. A typical automatic EVT classification involves three steps. The first step is to compute the pitch contour from the speech. The second step is to compute the features from the pitch contour, and the final step is to use a classifier to classify the features into healthy or EVT. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review.

paythelady.612 shared this article with you from Inoreader Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review. Μέσω pubmed: "world j clin cases"... Related Articles Treatment of cervical spine metastasis with minimally invasive cervical spondylectomy: A case report and literature review. World J Clin Cases. 2021 Jan 26;9(3):644-650 Authors: He LM, Ma X, Chen C, Zhang HY Abstract BACKGROUND: Cervical spondylectomy for the treatment of cervical tumors is traumatic, causes bleeding, and is risky. This study reports on the experience with minimally invasive cervical spondylectomy for a cervical metastasis and reviewed the literature on cervical spondylectomy. The purpose was to reduce the risk and trauma of spondylectomy. CASE SUMMARY: A 60-year-old woman presented with cervical pain and radiating pain in the left upper limb for more than 2 mo. Preoperative diagnosis was C4 metastasis of thyroid cancer. Preoperative visual analogue scale score was 5. American Spinal Cord Injury Association (ASIA) grade was E. Tomita classification was 7. Weinstein-Boriani-Biagini (WBB) classification was A-D, 3-9. Tomita score was 5. Modified Tokuhashi score was 9. Spinal instability neoplastic score (SINS) was 13. The patient underwent minimally invasive cervical spondylectomy on September 28, 2017. The operative time was 200 min; the estimated blood loss was 1200 mL. The operation was successful, without complications. The postoperative visual analogue scale score was 0. The patient remained classified as ASIA grade E at the last follow-up. She accepted regular iodine-131 therapy postoperatively. The serum thyroglobulin (Tg) level of this patient was 299.02 ng/mL at 1 mo after the operation and was 13.57 ng/ mL at the last follow-up. There was no local recurrence at the 25-mo follow-up, according to images, single-photon emission computed tomography, and serum Tg levels. Obvious ossification and solid fusion of C3-C5 were found at the last follow-up. CONCLUSION: Minimally invasive cervical spondylectomy with tubular retractor could minimize soft tissue trauma, intraoperative traction injury, and paraspinal muscle injury, accelerating postoperative recovery. This technique requires a rich experience in cervical spine surgery with tubular retractors, so that surgeons can visualize the anatomical structure in a small field. PMID: 33553403 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report.

paythelady.612 shared this article with you from Inoreader Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Radical resection of hepatic polycystic echinococcosis complicated with hepatocellular carcinoma: A case report. World J Clin Cases. 2021 Jan 26;9(3):659-665 Authors: Kalifu B, Meng Y, Maimaitinijiati Y, Ma ZG, Tian GL, Wang JG, Chen X Abstract BACKGROUND: Hepatic cystic echinococcosis (CE) is an infectious zoonotic parasitic disease, and the insidious onset and slow progression of hepatic CE usually contributes to delayed diagnosis and treatment. Hepatocellular carcinoma (HCC) is the fourth most common malignant tumor. Co-existence of CE and HCC is fairly rare in clinical settings and the association between the two is still not well recognized. We report a case of hepatic CE complicated with HCC which are radically resected and raise some questions worth thinking about. CASE SUMMARY: A 70-year-old man presented with upper abdominal pain. On admission, laboratory data showed that, except for hepatitis B surface antigen positivity, other indicators were normal, including alpha-fetoprotein. Computed tomography of the abdomen revealed a huge polycystic lesion in left liver lobe, without reinforcement after enhanced scanning and sized about 16.9 cm × 12.2 cm, which was considered a type II hydatid cyst. Multiple small solid lesions were also found adjacent to it, and thus it was highly suspected as a malignant tumor. After a multidisciplinary team discussion, the diagnosis of co-occurrence of hepatic CE and HCC was made. According to Romic classification, the case belongs to type IIb, and radical left hemi-hepatectomy was performed. Postoperative pathological examination revealed CE co-existence with well-differentiated HCC, consistent with the preoperative diagnosis. CONCLUSION: With the combination of hepatitis B and obvious extrusion by large hydatid, the HCC risk of a patient might be higher. PMID: 33553405 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Pleural lump after paragonimiasis treated by thoracoscopy: A case report.

paythelady.612 shared this article with you from Inoreader Pleural lump after paragonimiasis treated by thoracoscopy: A case report. Μέσω pubmed: "world j clin cases"... Related Articles Pleural lump after paragonimiasis treated by thoracoscopy: A case report. World J Clin Cases. 2021 Jan 26;9(3):666-671 Authors: Xie Y, Luo YR, Chen M, Xie YM, Sun CY, Chen Q Abstract BACKGROUND: Paragonimiasis is a parasitic disease that has multiple symptoms, with pulmonary types being common. According to our clinical practices, the pleural effusion of our patients is full of fibrous contents. Drainage, praziquantel, and triclabendazole are recommended for the treatment, but when fibrous contents are contained in pleural effusion, surgical interventions are necessary. However, no related reports have been noted. Herein, we present a case of pulmonary paragonimiasis treated by thoracoscopy. CASE SUMMARY: A 12-year-old girl presented to our outpatient clinic complaining of shortness of breath after exercise for several days. Enzyme-linked immunosorbent assay revealed positivity for antibodies against Paragonimus westermani, serological test showed eosinophilia, and moderate left pleural effusion and calcification were detected on computed tomography (CT). She was diagnosed with paragonimiasis, and praziquantel was prescribed. However, radiography showed an egg-sized nodule in the left pleural cavity during follow-up. She was then admitted to our hospital again. The serological results were normal except slight eosinophilia. CT scan displayed a cystic-like node in the lower left pleural cavity. The patient underwent a thoracoscopic mass resection. A mass with a size of 6 cm × 4 cm × 3 cm adhered to the pleura was resected. The pathological examination showed that the mass was composed of non-structured necrotic tissue, indicating a granuloma. The patient remaind ed asymptomatic and follow-up X-ray showed complete removal of the mass. CONCLUSION: This case highlights that thoracoscopic intervention is necessary when fibrous contents are present on CT scan or chest roentgenogram to avoid later fibrous lump formation in patients with pulmonary paragonimiasis. PMID: 33553406 [PubMed] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.