Recommendations For Surgical Intervention Research Articles

Refusal of Surgical Treatment for Advanced Oral Squamous Cell Carcinoma in a Long-Term Naswar Consumer: A Case Report

Introduction: Oral squamous cell carcinoma (OSCC) is a significant global health concern, primarily associated with tobacco use, including naswar—a smokeless tobacco mixture widely used in South Asia. Naswar is composed of ground tobacco leaves, slaked lime, and occasionally flavoring agents. When mixed with saliva, it releases carcinogenic nitrosamines, nicotine, and other harmful toxins. Despite the well-documented risks, including oral cancer, naswar continues to be used by many. Its harmful effects extend beyond oral health, contributing to heart disease, gastrointestinal issues, and reproductive health problems. It is also associated with mouth lesions, gum disease, and an elevated risk of oral cancers. This study emphasizes the urgent need for targeted global strategies to address naswar-related oral cancers. Case Presentation: This article details the case of a 62-year-old woman with a 40-year history of naswar consumption, who was diagnosed with advanced oral squamous cell carcinoma (SCC) affecting the right side of her face. She was referred to the Maxillofacial Surgery Department of Zahedan University of Medical Sciences. Despite recommendations for surgical intervention, the patient declined treatment following comprehensive consultations with medical professionals. This case highlights the complexities of managing advanced oral SCC in chronic naswar users and underscores the role of patient autonomy in treatment decisions. Conclusions: This case illustrates the challenges in treating advanced oral SCC in long-term naswar users and emphasizes the critical importance of respecting patient autonomy in treatment decision-making.

Preoperative risk factors and recommendations for surgical intervention in cN0 papillary thyroid microcarcinoma.

The evaluation and management of papillary thyroid microcarcinoma (PTMC) have always been challenging and controversial. Our retrospective study aimed to investigate the metastatic trend and risk factors of cN0 papillary thyroid microcarcinoma patients and provide advice for surgical strategies. The clinicopathological features of 556 cN0 PTMC patients undergoing thyroidectomy combined with central compartment dissection (CCD) were compared by the χ2 test and risk factors were identified by binary logistic regression analysis. Numbers of dissected lymph nodes (DLN) and metastatic lymph nodes (MLN) were analyzed using the Mann-Whitney U test to compare metastatic trends between different lobes. Male gender, tumor maximum diameter (TMD) larger than 5 mm, multifocality, and capsular/extracapsular invasion were metastatic risk factors of central compartment metastasis (CCM) (p<0.05). The number of DLN in the right level VI was larger than in the left (p<0.05), while the number of MLN was similar (p>0.05). The chance of CCM was higher when the number of DLN was larger than 5 (p<0.05). After identified metastatic trends and risk factors, we recommend surgery for patients deciding on aggressive treatment, especially for cases where a combination of risk factors is present. And to ensure no residual metastatic lymph nodes and reduce secondary surgery rates, adequate lymphadenectomy on the diseased side would be a better choice considering the standard of care.

Recommendations for Surgical Interventions during COVID-19 Pandemic

Recommendations for Surgical Interventions during COVID-19 Pandemic

P3364Cardiac damage in a real-world severe aortic stenosis population

Abstract Introduction The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren't considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017, a new staging echo classification was presented to accurately describe them. Purpose To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real–world setting. Methods Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG) ≥40 mmHg or a peak transvalvular velocity (PTV) ≥4.0 m/s), examined between January 2014 and December 2016. Pts were classified according to the new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization. Results 212 pts with SAS were included (age 76.1±9.1 years, 31.6% men; aortic valve area 0.69±0.21cm2; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%). 19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4. Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p&lt;0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (table 1). Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p&lt;0.005; Figure 1). Table 1. Predictors of the outcome Variables Adjusted HR (95% CI) p-value Sex* 1.86 (1.01–3.44) 0.047 eGFR* 0.99 (0.98–1.01) 0.201 AVR* 8.97 (3.85–20.90) 0.0001 Classification* – 0.031 Stage 0 0.19 (0.02–1.537) 0.120 Stage 1 0.28 (0.08–1.01) 0.052 Stage 2 0.36 (0.17–0.74) 0,006 Stage 3 0.81 (0.30–2.19) 0.675 Stage 4 1 – *Variables with p&lt;0.05 in univariate analysis. Figure 1. Survival of SAS pts with no AVR Conclusion In a real-world experience, the new staging echo classification showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.

A systematic review of surgical treatment for supraglottic exercise-induced laryngeal obstruction.

ObjectivesExercise‐induced laryngeal obstruction (EILO) is a condition causing breathing difficulties and stridor during exercise. The condition has in severe cases been treated surgically with supraglottoplasty. The purpose of this systematic review is to assess the evidence and recommendations for surgical intervention in treating patients with EILO.MethodsA systematic search was performed in PubMed and Embase to identify relevant studies describing surgical treatment of patients diagnosed with severe EILO. According to eligibility criteria, data were independently extracted by two reviewers. To assess the risk of bias of each included study, the Newcastle‐Ottawa scale (NOS) was used.ResultsThe screening process identified 11 observational studies with a total of 75 patients. Findings indicated that many beneficial outcomes are to be found in surgical treatment for EILO. These indications were found both on visual verification of improvement of the laryngeal obstruction during exercise and patient self‐reported symptom severity. The average NOS score (4.3) indicated low level of evidence in the included studies.ConclusionStudies reporting effects of surgical treatment of EILO have shown promising results in patients with laryngeal obstruction. However, the heterogeneity of study methodologies and the level of evidence precludes definitive recommendations for or against supraglottoplasty at this time; prospective and methodologically robust studies are now needed.Level of Evidence4

Late reconstruction of brachial plexus birth palsy.

Brachial plexus birth palsy (BPBP) presents to the physician on a clinical spectrum, and may substantially impair the child. Potential interventions to improve function for the child with BPBP include physical therapy, microsurgical nerve reconstruction and nerve transfers, soft-tissue balancing and reconstruction with musculotendinous transfers, and osteotomies. Some interventions, such as nerve reconstruction, are best performed in infancy; others, such as muscle transfers and osteotomies, are performed to treat manifestations of this condition that appear later in childhood. Although controversy continues to exist regarding the natural history and surgical management of these patients, recent literature has improved our understanding of surgical indications, anticipated outcomes, and potential complications. On the basis of current evidence, we present here the recommendations for surgical intervention in the upper extremity of children with BPBP, and encourage early referral to a brachial plexus specialist to establish care.

Interrater and Intrarater Reliability of the Kuntz et al New Deformity Classification System

Kuntz et al recently introduced a new system for classifying spinal deformities. This classification of spinal deformity was developed from age-dependent deviations from the neutral upright spinal alignment. To determine the interobserver and intraobserver reliabilities of the new Kuntz et al system for classifying scoliosis. Fifty consecutive patients were evaluated. Three observers independently assigned a major structural curve, minor structural curve, curve type, apical vertebral rotation, spinal balance, and pelvic alignment to each curve following the guidelines described by Kuntz et al. Assignment of the curves was repeated 4 weeks later, with the curves presented in a different blinded order. The Kendall W and Holsti agreement coefficients were used to determine the interobserver and intraobserver agreement. The intraobserver value of agreement for all parameters was 0.85 (range, 0.28-1.0), and the mean Kendall W coefficient was 0.89 (range, 0.5-0.97), demonstrating perfect reliability. The interobserver agreement averaged 0.7 (range, 0.251-1.0). The mean Kendall W coefficient was 0.67 (range, 0.19-1.0), demonstrating substantial reliability. The average time for classification of 1 curve was approximately 8.4 minutes. The new Kuntz et al deformity classification system is comparable to the Lenke et al system in terms of reliability. However, the Kuntz et al classification system provides no recommendations for surgical interventions. It is more complex and time-consuming and therefore may be of limited value in daily clinical practice.

Orbital Floor Fractures: A Retrospective Review of 45 Cases at a Tertiary Health Care Center

The purpose of this retrospective study was to investigate treatment options for orbital floor fractures at a Level 1 Trauma Center in Southern California. A review of 45 cases of isolated orbital floor fractures treated at the University of California at Irvine between February 2004 and April 2007 was done. Patients were retrospectively analyzed for gender, age, mechanism of injury, associated facial injuries, presenting symptoms, method of treatment, and postoperative complications. Thirty-six male patients and nine female patients were treated. Motor vehicle collision (26/45) was the most common cause of injury, and the mean age of the patients was 35.5 years (range: 15-81 years). Ecchymosis surrounding the orbital tissue was the most common presentation (38/45). Diplopia was present in 8 of 45 patients, with 1 patient requiring urgent decompression for retrobulbar hematoma. Forty-three patients underwent surgical repair; 40 underwent transconjunctival approach with lateral canthotomy; 17 underwent reconstruction with porous polyethylene Medpor (Porex Surgical, Inc., College Park, GA.); and 26 underwent reconstruction with a titanium mesh plate. Immediate postoperative complications included 12 patients with infraorbital numbness, 3 with diplopia, 1 with cellulitis, and 1 with ectropion with a subcilliary approach. Average timing of surgery of our study was 4.94 days (range, 1-20 days). Orbital floor fracture management has changed significantly over the past few decades with the introduction of new internal fixation methods and new materials for reconstructing orbital floor defects. Recommendations for surgical intervention on orbital floor fractures mostly depend on clinical examination and imaging studies. Consequences of inadequate repair of orbital floor fractures can lead to significant facial asymmetry and visual problems. Both porous polyethylene and titanium plates are effective tools for reconstructing the orbital floor. Our review demonstrates that orbital floor fractures can be repaired safely with minimal postoperative complications and confirms that transconjunctival approach to orbital floor is an effective way for exposure and prevention of ectropion that can be seen with other techniques.

Diagnosis of Acute and Chronic Anterior Cruciate Ligament Tears

The diagnosis of acute and chronic injuries of the ACL has been reviewed. Attention has been given to the history, physical examination, and other diagnostic tools available for evaluation of the ligamentous injury. Clinical correlations have been highlighted. Finally, our recommendations for surgical intervention have been presented.