Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation

xlomafota13 shared this article with you from Inoreader Neuromonitoring of the cochlear nerve during vestibular schwannoma resection and simultaneous cochlear implantation Via hno HNO. 2021 May 21. doi: 10.1007/s00106-021-00997-3. Online ahead of print. ABSTRACT Vestibular schwannomas (VS) are benign tumors that originate from the nerve sheath of one of the two vestibular nerves. VS can have a severe impact on everyday life of the patient and may lead to symptoms such as vertigo, hearing loss (e.g., as sudden deafness), deafness, and tinnitus. Treatment concepts include observational waiting with regular imaging control ("wait and scan"), radiotherapy , or surgical resection. Depending on the size of the tumor and status of functional hearing, the surgical approach may be retrosigmoidal, transtemporal, retrolabyrinthine, or translabyrinthine. The translabyrinthine approach always results in complete deafness due to opening of the bony labyrinth. If the nerve structure of the cochlear nerve is preserved, hearing rehabilitation with a cochlear implant (CI) may be successful. In this article the surgical technique for microsurgical resection of VS using a translabyrinthine approach with simultaneous cochlear implantation under intraoperative monitoring of the cochlear nerve by electrical stimulation is presented. PMID:34019139 | DOI:10.1007/s00106-021-00997-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Salvage laryngectomy after primary radio- and radiochemotherapy : A retrospective study

xlomafota13 shared this article with you from Inoreader Salvage laryngectomy after primary radio- and radiochemotherapy : A retrospective study Via hno HNO. 2021 May 21. doi: 10.1007/s00106-021-01030-3. Online ahead of print. ABSTRACT BACKGROUND: Recurrent and residual laryngeal cancer after organ-preserving radio- or radiochemotherapy is associated with a poor prognosis. Salvage surgery is the most important therapeutic option in these cases. OBJECTIVE: The study assessed rates of recurrence and residual tumor as well as survival and complication rates after salvage laryngectomy at the authors' academic cancer center . MATERIALS AND METHODS: A retrospective examination of all patients receiving laryngectomy between 2001 and 2019 due to tumor residuals or recurrence after primary radio- and radiochemotherapy was conducted. RESULTS: A total of 33 salvage procedures were performed. Defect reconstruction was performed by free flap surgery in 30.3% (n = 10) and regional flap surgery in 15.2% (n = 5) . One patient received regional flap surgery and free flap surgery simultaneously. Overall survival after 1, 2, and 5 years was 68.7, 47.9, and 24.2%, and disease-free survival was 81.6, 47.8, and 24.2%, respectively, with 48.5% (n = 16) postoperative tumor recurrences overall. Disease-free survival was significantly shorter for tumor extension into or onto the hypopharynx (p = 0.041). Postoperatively, 72.7% of patients developed a pharyngocutaneous fistula, of which 24.2% required surgical treatment. The hospital stay was 28.0 ± 16.1 days. CONCLUSION: Salvage laryngectomy is associated with a high rate of treatable complications and high morbidity. Nevertheless, considering the advanced tumor stages treated, it allows for respectable oncological results. PMID:34019140 | DOI:10.1007/s00106-021-01030-3 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization?

xlomafota13 shared this article with you from Inoreader How reliable is anamnestic data in predicting the clinical relevance of house dust mite sensitization? Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 May 21. doi: 10.1007/s00405-021-06862-x. Online ahead of print. ABSTRACT PURPOSE: For perennial inhalant allergens such as house dust mite (HDM), the German guideline on allergen-specific immunotherapy explicitly recommends provocation testing. This procedure is time-consuming, expensive, and potentially dangerous for the patient. Recently it has been discussed whether provocation tests are really necessary for diagnosing allergy to Dermatophagoides species. Thus, our study aimed to analyze the concordance between nasal provocation tests with Dermatophagoides species and anamnestic data. METHODS: We retrospectively analyzed the concordance between patients' histories including self-reported symptom scores and the results of provocation testing in 471 individuals with proven sensitization to Dermatophagoides species. RESULTS: 248 patients had a positive nasal provocation test (NPT) result to D ermatophagoides species and 223 individuals a negative NPT result. Patients allergic to HSM suffered significantly more often from atopic dermatitis (14% vs. 7%, p = 0.046) and more from asthma (20% vs. 19%, p = 0.851). Moreover, individuals with clinically silent sensitization complained less about nasal secretion (37% vs. 45%, p = 0.244) but significantly more about nasal dryness (46% vs. 34%, p = 0.046) whereas rates of nasal airway obstruction, ocular complaints and sleep quality were comparable in both groups. Allergic patients reported more often perennial (34% vs. 30%, p = 0.374) and location-dependent (39% vs. 31%, p = 0.090) symptoms. However, the discrepant prevalence of atopic dermatitis was the only statistically significant difference between both groups. CONCLUSION: Despite slight differences between both patient groups, clinical data are not sufficient to distinguish between silent sensitization and clinically relevant allergic rhinitis to HDM. Therefore, nasal provocation testing remains the gold standard for assessing clinical relevance in patients sensitized to Dermatophagoides species. PMID:34019148 | DOI:10.1007/s00405-021-06862-x View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Palliative care in metastatic head and neck cancer

xlomafota13 shared this article with you from Inoreader Palliative care in metastatic head and neck cancer Via Head & Neck Abstract Background Due to inherent impact on quality of life, metastatic head and neck cancer patients are well-suited to benefit from palliative care (PC). Our objective was to examine factors that shape PC utilization and implications for overall survival in stage IVc head and neck cancer patients. Methods A retrospective study of patients with stage IVc head and neck cancer in the National Cancer Database from 2004 and 2015 was conducted. Results 7794 cases met inclusion criteria, of which 19.3% received PC. PC use was associated with more recent years of diagnosis, Northeast facility geography, and non-private insurances (p < 0.05). Compared to no PC, "interventional" PC, defined as palliative surgery, radiation, and/or chemotherapy, and "pain management only" PC were associated with lower overall survival (p < 0.05). Conclusions PC use increased over time and was associated with demographic and clinical factors. There remains opportunity for improvement in optimal implementation of palliative care. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The significance of regional metastasis location in head and neck cutaneous squamous cell carcinoma

xlomafota13 shared this article with you from Inoreader The significance of regional metastasis location in head and neck cutaneous squamous cell carcinoma Via Head & Neck Abstract Background Regional metastasis of head and neck cutaneous squamous cell carcinoma (HNcSCC) can be seen in either parotid and/or cervical lymph nodes. The aim of this study was to assess whether there was a difference in prognosis between parotid and cervical nodal metastases. Methods Patients with regional metastasis from HNcSCC were identified from an institutional database. Disease-specific (DSS) and overall survival (OS) were calculated using the Kaplan–Meier method and Cox proportional hazards models. Results Five hundred and thirty-five patients were identified with median follow-up of 26.4 months (3–255 months). Two hundred and thirty-five patients had parotid metastasis, 96 patients had neck metastasis, and 204 patients had both. On multivariable analysis, any regional metastasis to the neck when compared to parotid alone conferred worse DSS (HR 1.8, p = 0.007) and OS (HR 1.3, p = 0.024). Conclusion Regional metastasis of HNcSCC to the neck confers worse outcomes compared to metastasis to the parotid alone. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Laryngeal Chondrometaplasia

xlomafota13 shared this article with you from Inoreader Laryngeal Chondrometaplasia Via Otolaryngology Indian Abstract Laryngeal chondrometaplasia (LCM) is a rare clinically asymptomatic entity with reported incidence in autopsy studies of 1–2% only. Foci of metaplastic cartilage seen on histology need to be distinguished from other benign cartilaginous tumours of larynx. We present a case of LCM in an elderly male adequately managed by microlaryngeal surgery (MLS). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Simple methods to test the accuracy of MRgFUS robotic systems

xlomafota13 shared this article with you from Inoreader Simple methods to test the accuracy of MRgFUS robotic systems Via The International Journal of Medical Robotics and Computer Assisted Surgery ABSTRACT Background Robotic-assisted diagnostic and therapeutic modalities require a highly accurate performance to be certified for clinical application. In this paper, three simple methods for assessing the accuracy of motion of Magnetic Resonance-guided Focused Ultrasound (MRgFUS) robotic systems are presented. Methods The accuracy of motion of a 4 degrees of freedom (DOF) robotic system intended for preclinical use of MRgFUS was evaluated by caliper-based and Magnetic Resonance Imaging (MRI) methods, as well as visually by performing multiple ablations on a plastic film. Results The benchtop results confirmed a highly accurate motion in all axes of operation. The spatial positioning errors estimated by MRI evaluation were defined by the size of the imaging pixels. Lesions arrangement in discrete and overlapping patterns confirmed satisfactory alignment of motion trajectories. Conclusions We believe the methods presented here should serve as a standard for evaluating the accuracy of motion of MRgFUS robotic systems. This article is protected by copyright. All rights reserved. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Aberrant internal carotid artery in the oropharynx space poses a life-threatening risk of surgery

xlomafota13 shared this article with you from Inoreader Aberrant internal carotid artery in the oropharynx space poses a life-threatening risk of surgery Via radiol anat Surg Radiol Anat. 2021 May 21. doi: 10.1007/s00276-021-02771-0. Online ahead of print. ABSTRACT BACKGROUND: Tortuosity of the internal carotid artery (ICA) is not a rare condition, but its clinical impact is underestimated. The differences in the course and shape of the ICA in the oropharynx just beneath the mucosa were investigated to determine the possible fatal bleeding for both major oropharyngeal tumor resection and less extensive procedures. We report two cases to reve al that the awareness of such an anatomical variation before performing oropharyngeal procedures. METHODS AND RESULTS: We report two different pathologies of retropharyngeal ICAs, which presented with otolaryngological symptoms. Case 1 Retropharyngeal right ICA. The vessel's minimum distance to the pharyngeal wall was 1 mm (very high risk of vascular injury) with a tortuous pathway. Case 2 Retropharyngeal right ICA. A tortuous ICA was in contact with the posterior pharyngeal wall (very high risk of vascular injury). CONCLUSION: The otolaryngologists surgeons must use caution in evaluating patients with masses in the pharynx and augment a careful and complete head and neck examination with appropriate imaging studies before operating. PMID:34021391 | DOI:10.1007/s00276-021-02771-0 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cadaveric study of arterial renal anatomy and its surgical implications in partial nephrectomy

xlomafota13 shared this article with you from Inoreader Cadaveric study of arterial renal anatomy and its surgical implications in partial nephrectomy Via radiol anat Surg Radiol Anat. 2021 May 22. doi: 10.1007/s00276-021-02769-8. Online ahead of print. ABSTRACT PURPOSE: Partial nephrectomy is gaining, nowadays, more interest in oncologic kidney surgery. This type of surgery requires the good knowledge of vascular renal anatomy to make it safe and to guarantee good functional and oncological outcomes. This paper exposes the clinical implication of the arterial renal anatomy in nephron-sparing surgery. METHODS: This is a cadaveric st udy of 71 human kidneys performed at Charles Nicolle mortuary. The right and left kidneys with surrounding tissues were removed en bloc with the adjacent part of the aorta and inferior vena cava, cleared and studied. Colored resin was injected in each artery, vein, and urinary ducts, with a specific color code for each structure. Corrosion technique was used to eliminate the surrounding tissue, leaving only the colored resin matrix. The Ternon anatomic classification of the inferior polar artery, based on its emergence point was used. RESULTS: Multiple renal arteries were noted in 9.85% of casts. Anterior and posterior division of main renal artery was found in 95.7% of cases. Posterior segmental artery crossed posteriorly the upper caliceal infundibulum and the renal pelvis in 93% of cases. The upper renal pole was vascularized by an apical segmental artery in 16.9% of cases and a superior polar artery in one case (1.4%). The mid pole of the kidney was supplied by a unique an terior branch and a single posterior branch in 40% of cases. Inferior polar artery was found in 52 casts (73.23%). Type I of Ternon was found in 6 casts (11.53%), Type II in 25 cases (48.07%), Type III in 19 cases (36.53%), Type IV in 2 cases (3.84%), and type V in 13 casts (25%). CONCLUSION: Renal vascular anatomy presents large variations. Good knowledge of the segmental arterial anatomy of the kidney is a primordial to a safe partial nephrectomy. Good preoperative vascular mapping can be of great help for the surgeon. PMID:34021803 | DOI:10.1007/s00276-021-02769-8 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Association between duration of peripheral facial palsy, severity, and age of the patient, and psychological distress

xlomafota13 shared this article with you from Inoreader Association between duration of peripheral facial palsy, severity, and age of the patient, and psychological distress Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 18:S1748-6815(21)00196-0. doi: 10.1016/j.bjps.2021.03.092. Online ahead of print. ABSTRACT BACKGROUND: Peripheral facial palsy (PFP) (paralysis) can be a devastating condition that has been shown to have associations with increased depression and worse quality of life. The aim of the present study is to better understand the complex association of psychological distress with the duration, severity, and age of patients with PFP. We hypothesize that a shorter duration of PFP is associated with higher levels of psychological distress. METHODS: Fifty-nine patients with PFP that existed longer than 3 months were included in this study. The Hospital Anxiety and Depression Scale (HADS) was used to assess the presence and severity of anxiety and depressions. Spearman's correlation analysis was used to determine correlation between psychological distress, duration, severity of the PFP, and age. < p>RESULTS: Fifty-nine patients were included in this study, of whom 22 were male and 37 were female. The mean age was 55.6 ± 14.6 years and mean duration of PFP from onset ranged from 3 months to 35 years (with a mean duration of 5.39 ± 6.06 years). Twenty-eight patients had left-sided PFP, 30 patients had right-sided PFP, and one patient had bilateral PFP. The majority were caused by Bell's palsy (50.8%). In the group with a duration less than 5 years, there were five (12.8%) patients having a score between 11 and 15 (on HADS) compared to two (10%) patients in the group with a duration of 5 years or more(p = 0.04). CONCLUSION: There seems to be an association between moderate depression and duration of the PFP. Further studies need to substantiate our findings. PMID:34020901 | DOI:10.1016/j.bjps.2021.03.092 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The sternohyoid muscle flap for new dynamic facial reanimation technique: Anatomical study and clinical results

xlomafota13 shared this article with you from Inoreader The sternohyoid muscle flap for new dynamic facial reanimation technique: Anatomical study and clinical results Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 20:S1748-6815(21)00188-1. doi: 10.1016/j.bjps.2021.03.085. Online ahead of print. ABSTRACT BACKGROUND: Long-term facial nerve palsy has a highly negative impact on patients' quality of life. In 2016, Alam reported one case of facial reanimation with the sternohyoid muscle after publishing a preclinical study in 2013. Despite the potentially ideal characteristics of this muscle for reanimation of facial palsy, this technique is still not widely used. The objective of our description of cases was to present the clinical results obtained with the surgical procedure and the study on cadavers to confirm the anatomical findings. METHODS: This work describes the anatomical study of the vascular and nervous pedicle of the sternohyoid muscle compared with clinical results from a series of patients with long-term facial paralysis who underwent facial reanimation between June 2016 and September 2019, through the insertion of the sternohyoid muscle into the masseteric nerve. RESULTS: The anatomical study was conducted in eight human hemi-necks. In five cases (62%), the vascular pedicle was provided by the superior thyroid artery, and the entrance of the ansa cervicalis to the muscle was constant 1.8 cm from the distal insertion. This series included ten patients who underwent the surgery technique of facial reanimation using the sternohyoid muscle, with a 90% (n = 9) of reinnervation; 100% (n = 10) of flaps were viable, and none of the patients showed complications in the donor area. CONCLUSIONS: The sternohyoid muscle showed itself as a reliable muscle as a free flap in facial reanimation, and alternative to the gracilis flap. The surgical technique was safe, without any complications, with excellent excursion, recovery, and aesthetic results. PMID:34020902 | DOI:10.1016/j.bjps.2021.03.085 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.