Neck Surgery Research Articles

Factors Associated With Attrition Among Otolaryngology-Head and Neck Surgery Residents: A 10-Year Analysis.

To identify the risk factors for Otolaryngology-Head and Neck Surgery (OHNS) resident attrition. Retrospective cohort study. Annual Graduate Medical Education track survey. We conducted a retrospective analysis of OHNS residents who matriculated between 2006 and 2015. Variables analyzed included age at matriculation, sex, race/ethnicity, medical degree type, program location, attrition status, and matriculation year period (2006-2010, 2011-2015). A logistic regression model was used to determine factors predictive of attrition, with a significance level set at P < .05. A total of 3073 residents were analyzed. The overall attrition rate was 3.7%. Multivariable regression showed older residents (≥30 years) had a 2.1 times higher risk of attrition compared to younger residents (≤29 years) (adjusted odds ratio [aOR]: 2.1; 95% confidence interval, CI [1.383-3.316], P < .001). Underrepresented minorities in medicine (URiM) residents had a 3.5 times higher risk of attrition compared to whites (aOR: 3.5; 95% CI [1.823-6.806], P < .001). Southern US programs had a 2.5 times higher risk of attrition compared to northeastern programs (aOR: 2.5; 95% CI [1.480-4.315], P < .001). There was no statistically significant difference in attrition based on sex, medical degree type, or matriculation year period. A higher risk of attrition was found among OHNS trainees who were older, self-identified as URiM, and in the southern US programs. There was no significant difference in attrition risk based on gender, medical degree type, or matriculation period. Further research is needed to understand the reasons for attrition and to develop strategies to promote inclusion and diversity in OHNS.

Feasibility of Using Inertial Measurement Units (IMUs) to Augment Cadaveric Temporal Training.

Insertional speed of cochlear implant electrode arrays (EA) during surgery is correlated with force. Low insertional speed, and therefore force, may allow for preservation of intracochlear structures leading to improved outcomes. Given the importance of low insertional speeds, we investigate the feasibility of using inertial sensors for kinematic analysis during EA insertion to augment otolaryngology-head and neck surgery training. Practicing otolaryngology surgeons were recruited and inertial measurement units (IMU; Metamotions+, MBIENTLAB Inc, San Jose, CA) consisting of accelerometers were used to measure hand speed during EA (Cochlear™Nucleus®CI522 cochlear implant with Slim Straight electrode, Cochlear Limited, Sydney, Australia) insertion into a cadaveric cochlea. A mixed regression model was utilized to determine differences in speed across trials within a surgeon. A total of nine trials were performed by three surgeons. The highest mean ± SD speed obtained was 8.4 ± 1.7 mm/s, and the highest speed was 22.5 mm/s. Mean speed was not significantly different across trials within surgeons (p > 0.05). IMUs are relatively inexpensive and relatively easy to use sensors that provide information on variables that may be of interest for otolaryngology resident training. The use of IMUs as part of advanced temporal training for cochlear electrode insertion can provide insight into hand speed, thereby allowing residents to train with specific regard to this variable. Future randomized-controlled trials can be carried out to determine whether IMUs are conducive to lower insertional speeds. NA Laryngoscope, 2024.

3D printed sodium alginate/gelatin/tannic acid/calcium chloride scaffolds laden bone marrow mesenchymal stem cells to repair defective thyroid cartilage plate.

Due to the absence of blood vessels, cartilage exhibits extremely limited self-repair capacity. Currently, repairing laryngeal cartilage defects, resulting from conditions such as laryngeal tumors, injury, and congenital structural abnormalities, remains a significant challenge in the Department of Otolaryngology, Head and Neck Surgery. Previous research has often focused on enhancing the mechanical properties of synthetic materials. However, their low biological activity and weak cell adhesion necessitate compensatory measures. This study aims to capitalize on the advantages of natural materials in cartilage tissue engineering. Sodium alginate, gelatin, tannic acid, and calcium chloride were utilized to prepare bioinks through cross-linking for application in 3D printing cartilage scaffolds. Bone marrow mesenchymal stem cells with multidirectional differentiation potential were chosen as seed cells, with appropriate growth factors incorporated to promote their differentiation into cartilage during in vitro culture. The scaffold laden cells was subsequently implanted into rabbit thyroid cartilage plate defects at the appropriate time. HE staining, toluidine blue staining, Masson staining, and collagen type II staining were employed to assess cartilage defect repair at 4, 8, and 12 weeks, respectively. Results demonstrated that scaffolds made from natural materials could emulate the mechanical properties of fresh cartilage with commendable biocompatibility. Stained sections further confirmed the efficacy of the composite hydrogel scaffolds identified in this study in promoting rabbit thyroid cartilage plate restoration. In summary, this study successfully fabricated a natural material scaffold for rabbit laryngeal cartilage tissue engineering, thereby furnishing a new idea and experience for the clinical application of laryngeal cartilage defect reconstruction.

Urban-rural geographic distribution of Otorhinolaryngologist, Head and Neck surgeons in Aotearoa New Zealand.

We identified geographic distribution of Otorhinolaryngologist, Head and Neck surgeons in Aotearoa New Zealand. To identify the future workforce pipeline, we explored trainee intentions for specialist practice. A survey was distributed to all New Zealand Society of Otolaryngology, Head and Neck Surgery (NZSOHNS) members and all current New Zealand Otolaryngology, Head and Neck surgery trainees. Data were gathered on work location and patterns of work, including on-call commitments and full-time equivalent hours worked. Trainees were asked about future career plans. An 88% response rate was achieved encompassing senior medical officers (SMOs) and trainees. A total of 64.8% (68) of respondents reported primarily working in a metropolitan hospital and 26.7% (28) reported working in a regional centre. Rates of internationally trained surgeons were significantly higher in regional centres compared to metropolitan hospitals (64.3% vs 32.4%, p<0.05). Regional respondents had higher after hours on-call burden, a higher full-time equivalent (FTE) worked and higher average hours worked per week. Retirement intentions within the next 10 years were high in both groups (64% regional and 52.9% metropolitan, p<0.05). The regional workforce in ORLHNS work longer hours, are older and are reliant on internationally trained surgeons. Current training of ORLHNS surgeons is unlikely to keep pace with expected retirements.

Feasibility of transoral robotic surgery using the da Vinci Xi system for oropharyngeal cancer and obstructive sleep apnea in low-volume center.

Transoral robotic surgery (TORS) has become a common surgical approach for the treatment of both benign and malignant conditions of the oropharynx. While the newer da Vinci Xi platform has largely replaced the previous Si model in many institutions, the reported outcomes with this system in head and neck surgery are limited. We report the feasibility of using the da Vinci Xi platform for managing oropharyngeal cancer and obstructive sleep apnea in a low-volume center. This retrospective review from a consecutive case series includes demographic, procedural, and outcome data from all patients who underwent TORS using the da Vinci Xi platform at a single institution over a 5-year period from 2019 to 2023. Thirty-five patients (19 males and 16 females) underwent TORS for a variety of indications. No patients were excluded from the study. There were no mortalities, readmissions, or severe complications directly related to the primary surgery. Our case series demonstrates that TORS is feasible with the da Vinci Xi system even in low-volume centers and supports the existing data suggesting that the Xi platform has an acceptable safety profile.

Utilization of Artificial Intelligence in the Creation of Patient Information on Laryngology Topics.

To evaluate and compare the readability and quality of patient information generated by Chat-Generative Pre-Trained Transformer-3.5 (ChatGPT) and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using validated instruments including Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, DISCERN, and Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). ENTHealth.org and ChatGPT-3.5 were queried for patient information on laryngology topics. ChatGPT-3.5 was queried twice for a given topic to evaluate for reliability. This generated three de-identified text documents for each topic: one from AAO-HNS and two from ChatGPT (ChatGPT Output 1, ChatGPT Output 2). Grade level and reading ease were compared between the three sources using a one-way analysis of variance and Tukey's post hoc test. Independent t-tests were used to compare DISCERN and PEMAT understandability and actionability scores between AAO-HNS and ChatGPT Output 1. Material generated from ChatGPT Output 1 and ChatGPT Output 2 were at least two reading grade levels higher than that of material from AAO-HNS (p < 0.001). Regarding reading ease, ChatGPT Output 1 and ChatGPT Output 2 documents had significantly lower mean scores compared to AAO-HNS (p < 0.001). Moreover, ChatGPT Output 1 material on vocal cord paralysis had a lower PEMAT-P understandability compared to that of AAO-HNS material (p > 0.05). Patient information on the ENTHealth.org website for select laryngology topics was, on average, of a lower grade level and higher reading ease compared to that produced by ChatGPT, but interestingly with largely no difference in the quality of information provided. NA Laryngoscope, 2024.

Analysis of Adherence to AAO-HNSF Clinical Practice Guidelines for Sudden Hearing Loss.

To assess adherence to the 2019 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) guidelines for the diagnosis and management of sudden hearing loss (SHL) and sudden sensorineural hearing loss (SSNHL). Retrospective cohort. TriNetX, a de-identified healthcare database. Evaluation focused on the percentage of patients undergoing proper guideline-adherent workup and treatment for SHL. Key measures include audiogram testing within 2 weeks for distinguishing SSNHL from CHL. For SSNHL patients, MRI or auditory brainstem response (ABR) testing should be obtained, and steroids and/or hyperbaric oxygen may be offered within 2 weeks. There were 24,203 SHL patients, 59.1% (n = 14,309) of whom underwent recommended audiogram testing, with 35.8% (n = 8,674) completing it within 2 weeks. Overall, 3,107 were diagnosed with unilateral SSNHL, 104 with unilateral conductive hearing loss (CHL), 121 with mixed hearing loss, and 10,977 were lost to follow-up. Among 3,107 SSNHL cases, just 25.5% (n = 791) obtained MRI/ABR within 1 month, and vestibular schwannoma was diagnosed in 3.5% (n = 28). Additionally, steroids were prescribed to 54.5% (n = 1,692), and <0.3% (n ≤ 10) received hyperbaric oxygen. In accordance with strong recommendations against or insufficient evidence to support the following diagnostics and treatments, 2.0% (n = 63) underwent a CT scan, less than 0.3% (n ≤ 10) were prescribed vasodilators or thrombolytics, and 3.5% (n = 108) were on antivirals. There is a significant opportunity for improvement in evaluating patients with SHL, specifically SSNHL. Proper adherence to guidelines may improve screening, detection, and management of neurotologic pathologies, including vestibular schwannoma.

Content and development of pharyngology and laryngology

Pharyngology and laryngology is an important subspecialty of Otolaryngology Head and Neck Surgery. It involves congenital diseases, trauma and foreign bodies, inflammatory diseases, obstructive sleep apnea, benign lesions, laryngeal nerve and cricoarytenoid joint diseases, swallowing disorders, laryngopharyngeal reflux diseases, voice medicine, as well as laryngeal microsurgery and endoscopic surgical treatment of benign and malignant tumors of this area. The disease spectrum is wide and involves many surgical techniques and methods.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Application of electronic laryngoscope combined with narrow band imaging endoscope and its classification in the diagnosis of vocal cord leukoplakia

Objective:To investigate the clinical value of electronic laryngoscope combined with narrow band imaging（NBI） endoscope and its classification in the diagnosis of vocal cord leukoplakia. Methods:A retrospective analysis was performed on 115 cases of patients treated in the Department of Otolaryngology, Head and Neck Surgery, Nanjing Drum Tower Hospital from September 2020 to November 2022. All 115 cases were diagnosed with vocal cord leukogramma using the electronic laryngoscopy and narrow band imaging endoscopy, followed by pathological examination in the outpatient tissue biopsy. The morphological characteristics of vocal cord leukoplakia and the correlation between narrow band imaging classification and pathological results were investigated. Results:Among 115 cases of vocal cord leukoplakia, 46 cases（40.00%） were diagnosed as benign lesions. Low grade intraepithelial neoplasia occurred in 29 cases（25.22%）. High-grade intraepithelial neoplasia（including carcinoma in situ） occurred in 22 cases（19.13%）. Invasive carcinoma（including suspected invasive carcinoma） was found in 18 cases（15.65%）. There were no statistical differences in the unilateral and bilateral distribution of vocal cord leukoplakia and pathological results（P>0.05）, but there were statistical differences in the size, thickness, lesion uniformity, clear boundary, pre-invasion commissure, symmetry,age over 55 years old, morphological classification, NBI classification and pathological results distribution（P<0.05）. The two-by-two comparison among the three groups of morphological classification（flat type, raised type, rough type） showed that P<0.017 was only compared between flat type and rough type, and P>0.017 was compared between the other two groups. The pairwise comparison among the three groups of NBI classification（Ⅲ, Ⅳ, Ⅴ） was statistically significant（P<0.017）. There was a high correlation between NBI classification and pathological diagnosis, and the correlation coefficient was 0.705（P<0.05）. The risk of high intraepithelial neoplasia and cancerization in type Ⅳ was 9.125 times higher than that in type Ⅲ, and the risk of high intraepithelial neoplasia and cancerization in type Ⅴ was 271.078 times higher than that in type Ⅲ. The area under the curve of morphological classification and NBI classification were 0.672 and 0.896, respectively. Conclusion:There is a high match and correlation between NBI classification and pathological diagnosis. Electronic laryngoscope combined with narrow band imaging endoscope has a high diagnostic value for vocal cord leukoplakia, and a strong predictive ability for malignant leukoplakia.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically. Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021. Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Sinonasal Ringertz Tumor

Abstract Inverted papilloma is a benign epithelial tumor characterized by ingrowth into the ectodermal Schneiderian membrane in the nasal cavity and the paranasal sinuses. A 35-year-old male patient presented to our Otorhinolaryngology and Head and Neck Surgery Outpatient Department with complaints of left-sided nasal obstruction for 4 years. Histopathological examination was reported as inverted papilloma. The patient recovered well without any evidence of residual lesion.

Virtual Reality for Postoperative Pain Management: A Review of Current Evidence.

With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures. Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting.

Development of a risk index for cognitive decline predicted by adverse radiation events and diet in older oral cancer patients

Professor Norimasa Ogama, Faculty of Nursing, Soka University, is interested in how symptoms such as dry mouth and changes in taste in elderly oral cancer patients could predict the risk of decline in cognitive function with the use of different sensory food experiences. He is developing an index to predict this. While previously at the Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Ogama saw a range of problems among patients caused by radiation and chemotherapy, including reduced eating and swallowing function, changes in body image and ongoing issues with being able to eat and speak. He began to consider how it might be possible to improve quality of life for such patients, including the ability to enjoy food. This inspired him to work to develop an oral rehabilitation programme that takes into account post-operative life evaluation and its influencing factors in order to significantly increase patientsâ–™ life satisfaction. Ogama and the team are developing a risk index for cognitive decline predicted by the adverse events of radiation and the diet of elderly patients with oral cancer. The goal is to accurately determine the risk of cognitive decline early based on changes to eating preferences and the taste of food, as well as worsening of oral mucositis and symptoms of dry mouth due to radiation therapy. This will be done through the concept of ‘eating deliciously’, based on personal preferences and characteristics.

Utilizing Artificial Intelligence to Increase the Readability of Patient Education Materials in Pediatric Otolaryngology.

Objectives: To identify the reading levels of existing patient education materials in pediatric otolaryngology and to utilize natural language processing artificial intelligence (AI) to reduce the reading level of patient education materials. Methods: Patient education materials for pediatric conditions were identified from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) website. Patient education materials about the same conditions, if available, were identified and selected from the websites of 7 children's hospitals. The readability of the patient materials was scored before and after using AI with the Flesch-Kincaid calculator. ChatGPT version 3.5 was used to convert the materials to a fifth-grade reading level. Results: On average, AAO-HNS pediatric education material was written at a 10.71 ± 0.71 grade level. After requesting the reduction of those materials to a fifth-grade reading level, ChatGPT converted the same materials to an average grade level of 7.9 ± 1.18 (P < .01). When comparing the published materials from AAO-HNS and the 7 institutions, the average grade level was 9.32 ± 1.82, and ChatGPT was able to reduce the average level to 7.68 ± 1.12 (P = .0598). Of the 7 children's hospitals, only 1 institution had an average grade level below the recommended sixth-grade level. Conclusions: Patient education materials in pediatric otolaryngology were consistently above recommended reading levels. In its current state, AI can reduce the reading levels of education materials. However, it did not possess the capability to reduce all materials to be below the recommended reading level.

Impact of Weight Loss on Olfaction in Patients Undergoing Bariatric Surgery.

Olfaction plays a vital role in regulating nutrition, avoiding potentially dangerous situations, and modulating behavior along with interpersonal relationships. Many common disorders can have a negative impact on olfaction; one of these is obesity. Bariatric surgery induces weight loss, and current evidence suggests that it can cause improvement in olfaction. However, more information is needed regarding this topic. One hundred eighty-five patients who underwent bariatric surgery and 184 age- and gender-matched control group who did not undergo any surgery have completed a questionnaire including items from the validated Self-Reported Mini Olfactory Questionnaire. Final analysis was based on 369 patients. There was a statistically significant difference between patients before and after surgery (p < 0.05). However, there was a statistically significant difference between people who underwent surgery with < 50% excess body weight loss and the control group but none with those > 50% excess body weight loss. No significant differences were found when comparing people with and without chronic illnesses, head and neck surgery, anti-allergy drug use, and COVID-19. Before surgery, there were statistically significant differences between patients with allergic rhinitis and polyps and those without, but no significant differences were observed after surgery. Patients had significantly improved olfactory scores post-surgery compared to before surgery. Patients who had > 50% excess body weight loss after surgery showed olfactory function as good as the general population represented by the control group. However, those with < 50% excess body weight loss had significantly worse olfactory scores compared to the general population.

Association of Tobacco With Neck Node Metastasis In Supra-Glottic Carcinoma of Larynx

Background: Carcinoma larynx is one of the most common cancers in the head neck region. Mortality and morbidity in this disease is still high in spite of modern treatment modalities. Smoking and Alcohol is recognized as common predisposing factor for carcinoma larynx. Neck node metastasis increases the mortality twice than the primary alone. Most of the Laryngeal carcinoma patient with neck node metastasis are smoker in our country. Stopping the consumption of tobacco may reduce both mortality and morbidity of carcinoma larynx. Metastasis is more common in supra-glottic carcinoma of larynx. This study is carried to observe the association of tobacco with lymph node metastasis in supra-glottic carcinoma of larynx. Materials and Methods: This cross sectional study was conducted in Otolaryngology and head Neck surgery department of Dhaka Medical College and Mitford Hospital of Dhaka, Bangladesh from June 2013 to June2015 .212 cases of supra-glottic carcinoma age ranging from 35 year to 90 years (mean age 63.6 ±11.65) was included in this study. Results: Sixty two percent patients were diagnosed with cervical lymph node metastasis. 83.28% patients with nodal metastasis were above 60 years of age and 75.67% patients were manual worker.100% node positive patients were smoker. Smoking for longer period (&gt;30yrs) and higher in number (&gt;30 sticks/day) were found in advanced stage. Significant association was found between site, size, macroscopic features, cellular differentiation and demographic factors of patient with neck node metastasis in supra-glottic carcinoma larynx. Conclusion: As neck node metastasis significantly reduces prognosis so we must be more attentive towards factors that increase the chance of nodal metastasis to avoid the advancement of the disease. J Dhaka Med Coll. 2023; 32(1) : 51-56

Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.

Deep neck infections mortal complications: Intrathoracic complications and necrotising fasciitis.

We planned this study considering that complications of deep neck infections can be seriously life threatening. To raise awareness that introthoracic complications and necrotizing fasciitis are causes of serious mortality and morbidity. This study was carried out with the participation of 188 patients who were treated at Mersin University Department of Otorhinolaryngology and Head and Neck Surgery at January 1, 2024. When the patient files were retrospectively examined, 16 of 188 patients (8.5%) were included in the study because they were observed to have necrotizing fasciitis and/or intrathoracic complications. There were a total of 16 patients in this study, 9 males (56.25%) and 7 females (43.75%). All patients were adults (> 18 years) and the mean age was 50.37 years ± 15.37 years. Female patients had a mean age of 40.42 years ±13.38 years, whereas for male patients was 58.11 years ± 12.44 years. Patients with necrotizing fasciitis and/or intrathoracic complications require more complicated and serious surgeries, intensive care unit monitoring, and mechanical ventilator support. Higher rates of morbidity and mortality should be expected in these patients who are hospitalized for longer periods of time.

Postoperative Bleeding Risk in Thyroid Surgery: Differences between Conventional and Endoscopic Video-Assisted Neck Surgery Methods.

Postoperative bleeding is a potentially life-threatening complication following thyroidectomy, but the risk factors and timing remain insufficiently understood. The bleeding rate for endoscopic surgery, specifically video-assisted neck surgery (VANS), also remains unclear in Japan. We conducted a retrospective case-control study of postoperative bleeding requiring readmission to the operating room. The overall postoperative bleeding rate was 1.85%. Multivariate analysis revealed that postoperative bleeding was independently associated with antithrombotic therapy (odds ratio 2.95; 95% confidence interval 1.15-7.59) and dialysis (odds ratio 6.53; 95% confidence interval 1.75-24.2). Among patients with postoperative bleeding, the complication developed within 6 h in 56.1% and within 24 h in 93.0%. The postoperative bleeding rate in endoscopic surgery was 1.6%. The most common site of bleeding was around the thyroid in conventional surgery and around the flap in endoscopic surgery. Post-thyroidectomy bleeding is associated with antithrombotic therapy or dialysis. While the bleeding rate in endoscopic surgery is similar to that in conventional surgery, the bleeding site differs.