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OBJECTIVE: To report outcomes of a large cohort of patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for resection of a pituitary adenoma with subsequent Resorb-X plate (RXP) sellar reconstruction. METHODS: A retrospective review of 620 EETS operations performed at a single academic center between 2005 and 2020 was conducted. RESULTS: A total of 215 EETS operations of 208 patients were identified between 2012 and 2020 who underwent reconstruction with the RXP after EETS for pituitary tumor resection with a final pathologic diagnosis of pituitary adenoma. Analysis of pooled data revealed a mean preoperative tumor volume of 6.8 cm3 (range: 0.038-51.03 cm3). Postoperative cerebrospinal fluid leak occurred in 2 patients (0.93%). Postoperative meningitis occurred in 1 patient (0.47%). There were no cases of RXP extrusion. CONCLUSIONS: The rate of postoperative CSF leak and meningitis after use of the RXP for sellar reconstruction compares favorably to other methods, including use of autologous grafts and flaps. Use of RXP during EETS is a safe and efficacious method of sellar reconstruction and may obviate the need for autologous tissue reconstruction after pituitary adenoma resection.
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Meningitis , Neoplasias Hipofisarias , Humanos , Neoplasias Hipofisarias/cirugía , Implantes Absorbibles , Endoscopía/métodos , Colgajos Quirúrgicos , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/cirugía , Complicaciones Posoperatorias , Meningitis/etiología , Estudios RetrospectivosRESUMEN
Transnasal flexible laryngoscopy is considered an aerosol generating procedure. A negative pressure face shield (NPFS) was developed to control aerosol from the patient during laryngoscopy. The purpose of this study was to determine the effectiveness of the NPFS at controlling virus aerosol compared to a standard disposable plastic face shield. The face shields were placed on a simulated patient coughing machine. MS2 bacteriophage was used as a surrogate for SARS-CoV-2 and was aerosolized using the coughing machine. The aerosolized virus was sampled on the inside and outside of the face shields. The virus aerosol concentration was not significantly different between the inside and outside of the traditional plastic face shield (p = 0.12). However, the particle concentrations across all particle sizes measured were significantly decreased outside the face shield. The virus and particle concentrations were significantly decreased (p < 0.01) outside the NPFS operating at a flow rate of 38.6 L per minute (LPM). When the NPFS was operated at 10 LPM, virus concentrations were not significantly different (p = 0.09) across the face shield. However, the number particle concentrations across all particle sizes measured were significantly different (p < 0.05).
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COVID-19 , Humanos , COVID-19/prevención & control , SARS-CoV-2 , Aerosoles y Gotitas Respiratorias , Tos , LaringoscopíaRESUMEN
OBJECTIVE: To evaluate the historical descriptive origins of the extracranial transnasal transsphenoidal route to the sphenoid sinus and sella turcica focusing on the works of two otolaryngologists: Markus Hajek (1861-1941) and Oskar Hirsch (1877-1965). DATA SOURCES: A collection of primary references of author publications, and contemporary references and textbooks. REVIEW METHODS: Primary references were reviewed with specific focus on surgical routes to the sphenoid sinus and sella turcica. Chronology was cross-referenced with contemporary publications by contemporaries. Translations from German were conducted by author AM when necessary. RESULTS: Markus Hajek elegantly described the surgical approach to the posterior ethmoids and sphenoid sinus in 1904 using a transnasal route. Building on this foundation, Oskar Hirsch described the fully extracranial endonasal transethmoid transsphenoidal approach in 1909. He was first to describe surgical entrance to the sella using this exclusively unilateral endonasal route, which he demonstrated on a cadaver. He reports performing this procedure on a live patient in April, 1910, under local anesthesia in stages over 5 weeks. For better exposure, Hirsch consolidated his method with Killian's submucosal window resection of the posterior nasal septum allowing for bilateral access to the sphenoid sinus and sella, and completed a single stage procedure on a patient in June 1910. CONCLUSION: Oskar Hirsch was the first to describe and perform a stepwise surgical approach to the sella using an exclusively extracranial, endonasal, transethmoid, and transsphenoidal approach. He built upon his mentor Markus Hajek's approaches to the posterior ethmoid cells and sphenoid sinus. LEVEL OF EVIDENCE: NA: Background information, synthesis from multiple sources emphasizing factual information Laryngoscope, 133:807-813, 2023.
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Otolaringología , Enfermedades de la Hipófisis , Neoplasias Hipofisarias , Masculino , Humanos , Neoplasias Hipofisarias/cirugía , Hipófisis/cirugía , Silla Turca/cirugíaRESUMEN
OBJECTIVE: Endoscopic repair of skull base defects is required following resection of intracranial pathology via the endoscopic endonasal approach (EEA). Many closure techniques have been described, but choosing between techniques remains controversial. We report outcomes of 560 EEA procedures of skull base reconstruction performed on 508 patients over a 15-year-period. Halfway through this period, we adopted the use of a rigid, bioabsorbable extrasellar plate for reconstruction, enabling a comparison between this technique and those used previously. METHODS: All patients undergoing EEA from 2005 to 2019 at our institution were retrospectively reviewed. Demographic information, surgical pathology, tumor dimensions and radiographic features, reconstructive technique, and patient-related outcomes were collected and analyzed with univariate and multivariate statistical modeling. RESULTS: Five-hundred sixty procedures were performed on 508 patients. The series complication rate was 8.2%. Overall, cerebrospinal fluid (CSF) leak rate was 5.0% but varied significantly across closure techniques (p < 0.001). Critically, the CSF leak rate in the 272 cases prior to our 2013 adoption of the Resorb-X Plate (RXP) was 8.5%, whereas leak rate in the subsequent 288 cases was 1.7%. RXP was protective against CSF leak (p = 0.001), whereas gross total resection (GTR) correlated with increased leak rate (p = 0.001). Patient BMI was significantly associated with risk of leak (p = 0.047). Other variables did not impact leak risk. CONCLUSION: Reconstructive technique, extent of resection, and patient BMI significantly contributed to CSF leak rate. GTR was associated with increased leak risk while the RXP was protective. The bioabsorbable RXP is an effective option for rigid skull base repair with comparatively few complications. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:1092-1098, 2023.
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Procedimientos de Cirugía Plástica , Neoplasias de la Base del Cráneo , Humanos , Colgajos Quirúrgicos/cirugía , Neoplasias de la Base del Cráneo/patología , Estudios Retrospectivos , Implantes Absorbibles , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Endoscopía/métodos , Base del Cráneo/cirugía , Base del Cráneo/patología , Pérdida de Líquido Cefalorraquídeo/etiología , Pérdida de Líquido Cefalorraquídeo/cirugíaRESUMEN
Objective Anterior skull base meningiomas include olfactory groove, planum sphenoidale, and tuberculum sellae lesions. Traditionally, standard craniotomy approaches have been used to access meningiomas in these locations. More recently, minimally invasive techniques including supraorbital and endonasal endoscopic approaches have gained favor; however there are limited published series comparing the use of these two techniques for these meningiomas. Using our patent database, we identified patients who underwent these two approaches, and conducted a retrospective chart review to compare outcomes between these two techniques. Methods A total of 32 patients who underwent minimally invasive approaches were identified: 20 supraorbital and 11 endoscopic endonasal. Radiographic images, presenting complaints and outcomes, were analyzed retrospectively. The safety of each approach was evaluated. Results The mean extent of resection through a supraorbital approach was significantly greater than that of the endoscopic endonasal approach, 88.1 vs. 57.9%, respectively ( p = 0.016). Overall, preoperative visual acuity and anopsia deficits were more frequent in the endonasal group that persisted postoperatively (visual acuity: p = 0.004; anopsia: p = 0.011). No major complications including cerebrospinal fluid (CSF) leaks or wound-related complications were identified in the supraorbital craniotomy group, while the endonasal group had two CSF leaks requiring lumbar drain placement. Length of stay was shorter in the supraorbital group (3.4 vs. 6.1 days, p < 0.001). Conclusion Anterior skull base meningiomas can be successfully managed by both supraorbital and endoscopic endonasal approaches. Both approaches provide excellent direct access to tumor in carefully selected patients and are safe and efficient, but patient factors and symptoms should dictate the approach selected.
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BACKGROUND: Non-squamous cell carcinoma sinonasal malignancies (NSCCSM) are relatively rare. Neoadjuvant radiotherapy and/or chemotherapy (NTx) have been proposed to improve outcomes compared to surgery alone. In this study, we aim to examine the prevalence of NTx utilization and associated outcomes. METHODS: A retrospective study utilizing the National Cancer Database, 2004 to 2015. The study population included adult patients diagnosed with primary NSCCSM. RESULTS: A total of 574 patients were included. The mean age of the study population was 61.7 ± 16.5 years. The median follow-up time was 40.4 months (interquartile range: 15.3-81.3 months). The histopathological diagnoses identified included: (i) 37.0% adenocarcinoma, (ii) 22.8% adenoid cystic carcinoma, (iii) 20.0% mucosal melanoma, (iv) 11.9% esthesioneuroblastoma, and (v) 8.2% sinonasal undifferentiated carcinoma (SNUC). NTx was utilized in 70 (12.20%) of the study population. Patients who received NTx were more likely to have SNUC or esthesioneuroblastoma (P < .01 each) and to have stage III or IV disease (P < .01 each). NTx was most likely to be administrated in a high-volume center [OR: 3.94, 95%CI: (1.47, 10.53), P = .006]. Patients who received NTx had a significantly lower prevalence of positive margin postoperatively [OR: 0.48, 95%CI: (0.26, 0.87), P = .016]. In patients with NSCCSM, negative margin was associated with improved overall survival [HR: 0.55, 95%CI: (0.36, 0.82), P = .004]. CONCLUSIONS: This study provides an epidemiological perspective regarding NSCCSM and related practice patterns and survival outcomes. Neoadjuvant radiotherapy and/or chemotherapy is likely to decrease the risk of positive margin which ultimately could improve survival in this population.
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Carcinoma/epidemiología , Estesioneuroblastoma Olfatorio/epidemiología , Melanoma/epidemiología , Neoplasias Nasales/epidemiología , Neoplasias Nasales/terapia , Adolescente , Adulto , Anciano , Carcinoma/diagnóstico , Carcinoma/terapia , Terapia Combinada , Bases de Datos Factuales , Estesioneuroblastoma Olfatorio/diagnóstico , Estesioneuroblastoma Olfatorio/terapia , Femenino , Humanos , Masculino , Márgenes de Escisión , Melanoma/diagnóstico , Melanoma/terapia , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Nasales/diagnóstico , Estudios Retrospectivos , Tasa de Supervivencia , Estados Unidos , Adulto JovenRESUMEN
Objective: To evaluate a negative pressure microenvironment designed to contain laser plume during flexible transnasal laryngoscopy. Methods: The Negative Pressure Face Shield (NPFS) was previously reported as well tolerated with initial use on 30 patients. Diagnostic transnasal laryngoscopy was performed on an additional 108 consecutive patients who were evaluated by questionnaires and sequential pulse oximetry. Further study addressed operative transnasal potassium-titanyl-phosphate (KTP) laser laryngoscopy with biopsy done on four patients employing the NPFS. Results: The previously described NPFS version 3 (v.3), a transparent acrylic barrier with two anterior instrumentation ports, was modified by repositioning the side suction port closer to the level of the nose and deepening the lateral sides, squaring off the lower projection. A post-procedure questionnaire employing a 5-point Likert scale ranging from no symptoms (rating of 1) to intolerable (rating of 5) identified excellent patient tolerance of the new design (v.4), among 22 patients evaluated and similar in the comparison to the 116 patients using version 3. Among the 138 patients analyzed, only one patient rated the experience as greater than "mild claustrophobia." 100% of patients answered either "none" or "mild" to the pain and shortness of breath questions. The NPFS (v.4) was then successfully used in four patients for laser laryngoscopy with biopsy of laryngeal papilloma (3/4) and hemorrhagic polyp (1/4). Post-procedure questionnaire identified no shortness of breath (4/4), no claustrophobia (4/4), no pain (4/4) and no significant changes in pulse oximetry during use. Conclusion: Extensive experience in performing diagnostic laryngoscopy with the NPFS directed design changes leading to successful use for transnasal flexible laser laryngoscopy with biopsy in a negative pressure microenvironment. Level of Evidence: Level 2b (Cohort Study).
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OBJECTIVE: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. METHODS: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. RESULTS: The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. CONCLUSION: Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care. LEVEL OF EVIDENCE: NA.
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OBJECTIVE: Introduce novel methods and materials to limit microdroplet spread when performing transnasal aerosol generating procedures in the COVID-19 era. METHODS: Prototypes of a negative pressure face shield (NPFS) were tested then used clinically to create a suction-clearing negative pressure microenvironment with controlled access to the nose and mouth. Air pressure measurements within prototypes were followed by prospective evaluation of 30 consecutive patients treated with the device assessed through questionnaires and monitoring oximetry. RESULTS: The NPFS is a transparent acrylic barrier with two anterior instrumentation ports and a side port to which continuous suction is applied. It is positioned on a stand and employs a disposable antimicrobial wrap to secure an enclosure around the head. This assembly was successfully used to complete transnasal laryngoscopy in all 30 patients studied. Tolerance of the design was excellent, with postprocedure questionnaire identifying no shortness of breath (27/30), no claustrophobia (27/30), no pain (29/30), and no significant changes in pulse oximetry. CONCLUSION: Diagnostic laryngoscopy was successfully performed in a negative pressure microenvironment created to limit dispersion of aerosols. Further application of the NPFS device is targeted for use with transnasal laryngeal laser and biopsy procedures to be followed by additional modification to enable intranasal and intraoral procedures in a similar protected environment. LEVEL OF EVIDENCE: Level 2b (Cohort Study).
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BACKGROUND: examine presentation and outcomes of sinonasal squamous cell carcinoma (SCC). METHODS: A retrospective study utilizing the National Cancer Database, 2004 to 2015. The study population included adult patients diagnosed with primary sinonasal SCC. RESULTS: A total of 537 patients were included. The mean age of the study population was 62.6 ± 12.7 years. The median follow-up time was 35.6 months (interquartile range: 8.6-55.9). The histological variants identified are: (i) 66.7% keratinizing SCC, (ii) 21.6% non-keratinizing SCC, (iii) 8.0% papillary SCC, and (iv) 3.7% spindle cell carcinoma. Stage at presentation was: (i) 33.3% T1-2, N0, (ii) 31.8% T3-4a, N0, (iii) 13.8% T1-4a, N+, (iv) 17.0% T4b,N0-3, (v) 4.1% M1. Human papilloma virus (HPV) status was available for 96 patients and tested positive in 24 (25.0%) patients. By histological variants, 5-year survival was lowest for spindle cell carcinoma (40.0%), and highest for papillary SCC (70.1%). HPV negative tumors had a 5-year survival of 26.4%, while HPV positive tumors had a 5-year survival of 57.1% (P = <.001). Of the 255 patients with T1-4a, N0-3, M0 who had surgery of the primary site, 31 (12.2%) patients underwent endoscopic approach. The risk of positive postsurgical margins was not significantly different comparing endoscopic to open approach (23.8% vs 24.1%, P >.99). CONCLUSIONS: Sinonasal SCC could present at advanced stages in two-thirds of the population and exhibit a variety of histological subtypes. Like other sites of head and neck, HPV positive tumors are associated with a favorable prognosis. Endoscopic approach is comparable to open approach in terms of post-surgical margins.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Endoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias de los Senos Paranasales/epidemiología , Pronóstico , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To examine clinical profile and outcomes of elderly patients (65-90 years) undergoing head and neck surgeries in the United States. STUDY DESIGN: A retrospective cross-sectional analysis. SETTING: The Nationwide Readmissions Database, 2010 to 2015. SUBJECTS AND METHODS: Adult (≥18 years) patients who underwent head and neck surgeries. Analysis included χ2 test and logistic analysis. RESULTS: A total of 113,602 and 32,580 patients <65 and ≥65 years old, respectively, were included. Patients ≥65 years old were more likely to have multiple comorbidities (62.8% vs 32.6%, P < .001) and to present with head and neck cancer (19.8% vs 11.4%, P < .001). The most common comorbidity was diabetes (21.0%). The most common cancer types by site were mouth (29.12%), thyroid (28.08%), and nonmelanoma skin cancer (13.22%). The percentage of geriatric patients who underwent head and neck surgeries increased from 21.8% in 2010 to 25.0% in 2015 (P < .001). A total of 5450 (16.85%) patients developed postoperative complications, and the most common complications were pulmonary related (10.55%), bleeding (6.96%), acute renal failure (6.01%), and infection (3.97%). Blood transfusion was required in 3.53% of the patients. Readmission prevalence was 0.32%, and mortality risk was twice as likely (odds ratio, 2.05; 95% confidence interval, 1.77-2.38; P < .001). Independent risk factors of mortality were older age, multiple comorbidities, type of surgery, blood transfusion, and tracheostomy (P < .05, each). CONCLUSION: Elderly patients currently represent 25% of patients admitted for head and neck surgery. This population should be provided with a different level of care due to a higher risk of complications and mortality.
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Neoplasias de Cabeza y Cuello/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVES/HYPOTHESIS: To examine the risk and prevalence of accidental intraoperative injury reported during head and neck surgeries and the associated outcomes. STUDY DESIGN: Retrospective cross-sectional analysis. METHODS: An analysis utilizing the Nationwide Readmissions Database, 2010 to 2014. Adult patients with a reported accidental intraoperative injury were compared to controls without such injuries. RESULTS: A total of 173 cases and 105,659 controls were included. Most cases were reported in surgeries of the mouth/tonsils (29.4%) and maxillofacial bones/mandible (22.5%). The remaining cases were reported in surgeries of the pharynx/larynx (17.5%), nose/paranasal sinuses (15.4%), salivary glands and ducts (6.2%), thyroid/parathyroid (5.2%), and ear (3.8%). The multivariate logistic regression model demonstrated that surgeries of the pharynx/larynx were associated with the highest risk of injuries compared to other site surgeries (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.49, 4.25, P < .001]. Concomitant neck dissection was also independently associated with the risk of injury (OR: 4.07, 95% CI: 2.05, 8.09, P < .001]. Compared to controls, cases were not associated with an increased risk of mortality (P = .63) or readmission (P = .29); however, those cases had a significantly longer hospital stay on average by 3.64 ± 0.95 days/case (P < .001) and a higher cost of treatment on average by $13,478 ± 119.42/case (P < .001). CONCLUSIONS: This study reports on the prevalence and outcomes of accidental intraoperative injuries reported in head and neck surgeries. The prevalence is relatively low, and the annual trend appears stable; however, it is associated with a significant burden on the health system. LEVEL OF EVIDENCE: NA Laryngoscope, 130:918-924, 2020.
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Cabeza/cirugía , Enfermedad Iatrogénica/epidemiología , Errores Médicos/estadística & datos numéricos , Cuello/cirugía , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES/HYPOTHESIS: Examine the prevalence and outcomes of head and neck surgeries in patients with a history of organ transplantation. STUDY DESIGN: A retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010 to 2014. METHODS: The study population included adults patients who underwent head and neck surgeries. Patients with a reported history of solid organ transplantation were compared to patients with no such history. RESULTS: The study population included 322 transplant patients (76.4% kidney, 8.7% liver, 8.4% heart, 3.0% kidney/pancreas, 2.3% lung, 0.9% kidney/liver, 0.4% pancreas) and 120,401 controls who underwent comparable procedures. Main surgeries that were performed in cases included 37.8% parathyroid, 17.7% thyroid, 11.2% major salivary gland, 10.6% major mouth/tonsil, and 9.6% major nose/paranasal sinuses. Encountering transplant patients in otolaryngology practice has been increasing annually by three patients for every 10,000 procedures performed in the United States. There was no difference in the overall postoperative complications risk (12.5% vs. 10.1%, P = .26); however, cases had a higher risk of acute renal failure (5.4% vs. 1.1%, P < .001) and shock state (0.3% vs. 0.02%, P < .001). Readmission risk was higher for cases (6.8% vs. 3.4%, P = .003). There was no reported in-hospital mortality among cases. CONCLUSIONS: Transplant patients are increasingly encountered in otolaryngology practices. The most common transplanted organ is kidney, and the most commonly performed procedure is parathyroidectomy. LEVEL OF EVIDENCE: NA Laryngoscope, 130:E89-E97, 2020.
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Trasplante de Órganos/estadística & datos numéricos , Otolaringología/estadística & datos numéricos , Procedimientos Quirúrgicos Otorrinolaringológicos/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Procedimientos Quirúrgicos Otorrinolaringológicos/efectos adversos , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To examine trend, prevalence, and outcomes of surgical site infection (SSI) in head and neck surgery. STUDY DESIGN: Retrospective cross-sectional analysis. SETTING: The Nationwide Readmissions Database (2010-2014), which represents 56.6% of all US hospitalization. SUBJECTS: Adult patients (≥18 years) who underwent head and neck surgery. Patients with SSI were compared with controls. METHODS: Analysis included chi-square test and multivariate logistic and linear regression models. RESULTS: A total of 427 cases and 116,921 controls were identified. SSI prevalence among patients who underwent head and neck surgery was 0.37%, of which 41.0% was reported within the initial admission while the remaining 59.0% was reported on readmission within 30 days of first surgery. SSI was associated with a higher mortality risk (odds ratio, 3.95; 95% CI, 1.25-12.50; P = .019). Multivariate analysis demonstrated that a higher risk of SSI was associated with major surgery of the ear, nose and paranasal sinuses, mouth and tonsil, salivary glands and ducts, maxillofacial bones and mandible, and pharynx and larynx (P < .05 each). However, a lower risk of SSI was reported in thyroid and parathyroid and nonmajor procedures (P < .05 each). Other factors associated with a higher risk of SSI included multiple comorbidities, smoking, cancer diagnosis, concomitant neck dissection, and tracheostomy (P < .05 each). SSI was associated with a mean ± SE additional hospital stay of 8.1 ± 0.8 days per case (P < .001) and an additional cost on the health system of $20,953.00 ± $186.3 per case (P < .001). CONCLUSIONS: SSI is associated with a significant mortality risk and burden on the health system. More than half of SSI cases were identified on readmission.
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Enfermedades Otorrinolaringológicas/cirugía , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Costos de la Atención en Salud , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/mortalidad , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Venous thromboembolism (VTE) can complicate major surgeries. This study examines the risk and outcomes of VTE in patients who underwent head and neck surgeries. METHODS: Retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database (2010-2014). Study population included adults (≥18 year) patients who underwent head and neck surgeries. RESULTS: A total 386 VTE patients and 116 450 controls included. VTE risk was 0.37%, postoperative mortality was 4.87%. Of VTE, 57.02% identified within the initial admission for surgery, while the rest required readmission within 90 days. VTE high-risk surgeries included: major ear/skull base surgeries, major nose/paranasal sinuses surgeries, major mouth/tonsil surgeries, major salivary glands/ducts surgeries, major maxillofacial bones/mandible surgeries, and major and nonmajor pharynx and larynx surgeries (P < .05). Those same surgeries were also associated with a high risk of readmission (P < .05). CONCLUSIONS: VTE is associated with a significant mortality risk. Surgeries that involve the pharynx and larynx have the highest risk of VTE and readmission.
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Neoplasias de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Otorrinolaringológicos/efectos adversos , Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/epidemiología , Tromboembolia Venosa/epidemiología , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Estudios Retrospectivos , Estados Unidos , Adulto JovenAsunto(s)
Osteocondrodisplasias/diagnóstico , Trastornos Respiratorios/etiología , Enfermedades de la Tráquea/diagnóstico , Femenino , Humanos , Laringe/diagnóstico por imagen , Laringe/patología , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Osteocondrodisplasias/complicaciones , Tomografía Computarizada por Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos X , Tráquea/patología , Enfermedades de la Tráquea/complicacionesRESUMEN
BACKGROUND: Patients with primary antibody deficiencies have an increased frequency of sinonasal and pulmonary infections. Immunoglobulin (Ig) replacement is a standard therapy for common variable immunodeficiency (CVID) and other antibody deficiency diseases. Although there is convincing evidence that Ig replacement reduces pulmonary infections, there is little evidence that it reduces sinus infections or abates chronic rhinosinusitis (CRS). This study aims to identify the impact of Ig replacement on CRS in antibody deficiencies. METHODS: A single-center, retrospective chart review of adult patients from 1995 to 2015 was performed. Inclusion criteria were diagnosis of CVID or specific antibody deficiency (SAD), history of CRS requiring medical and/or surgical management within the year prior to presentation, treatment with Ig replacement therapy, and follow-up interval of at least 1 year after initiating Ig replacement. Patients with secondary immune deficiencies were excluded. Thirty-one patients met criteria. Data collected included pretreatment and posttreatment Lund-Mackay scores, and frequency of sinusitis and pulmonary infections requiring rescue antibiotics. Statistical analysis was performed using Wilcoxon signed-rank tests. RESULTS: A significant decline in the Lund-Mackay score was evidenced from pretreatment to posttreatment (p < 0.01). Treatment also resulted in significantly lower rates of sinusitis (p < 0.01) and pulmonary infections (p < 0.01). Additionally, 56% of patients who were on prophylactic antibiotics prior to Ig replacement were able to discontinue their use. CONCLUSION: We present objective evidence showing that Ig replacement therapy has a positive impact on the frequency of sinusitis and confirm its positive impact on pulmonary infections in adult patients with CVID and SAD.
Asunto(s)
Disgammaglobulinemia/tratamiento farmacológico , Inmunoglobulinas/uso terapéutico , Rinitis/prevención & control , Sinusitis/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Enfermedad Crónica , Disgammaglobulinemia/complicaciones , Disgammaglobulinemia/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Senos Paranasales/diagnóstico por imagen , Infecciones del Sistema Respiratorio/diagnóstico por imagen , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/prevención & control , Rinitis/diagnóstico por imagen , Rinitis/tratamiento farmacológico , Rinitis/etiología , Sinusitis/diagnóstico por imagen , Sinusitis/tratamiento farmacológico , Sinusitis/etiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Premalignant oral lesions have a high incidence of recurrence and progression to malignant disease and, although studies have shown the contribution of transforming growth factor ß (TGF-ß) to cancer progression, none have been conducted with premalignant oral lesion cells to determine the impact of TGF-ß in stimulating properties that are characteristic of more invasive cells. The present study focused on TGF-ß-modulation of paxillin and the serine/threonine protein phosphatase PP-1, and the impact on cellular motility. These studies show that TGF-ß stimulates premalignant lesion cell motility and up regulates expression of paxillin, as well as its co-localization with PP-1, while concurrently diminishing the level of paxillin serine phosphorylation. The TGF-ß-mediated up regulation of paxillin and co-localization with actin, as well as the TGF-ß-stimulated motility of premalignant lesion cells, were all blocked by inhibiting PP-1, indicating their dependence on PP-1 activity. These studies suggest interplay between TGF-ß and PP-1 in promoting a more malignant phenotype in premalignant oral lesion cells.