Cause of death in patients with well-differentiated thyroid carcinoma

OBJECTIVES: The aim of this study is to examine in detail patients dying of well-differentiated thyroid carcinoma. STUDY DESIGN: A retrospective chart review with follow-up. METHODS: Data were collected from 522 consecutive cases of differentiated thyroid carcinoma treated by one endocrinologist and four surgeons at Mount Sinai Hospital, Toronto, Ontario, Canada, from 1964 to 1999. RESULTS: Ten patients died as a direct result of thyroid carcinoma; 19 other deaths were unrelated. Five of 102 patients were men (5%) and 5 of 420 were women (1%); the median age at diagnosis was 68.5 years (range, 49-82 y). No cases were stage I; three, stage II; two, stage III; and five, stage IV. Pathologically papillary carcinoma was found in six of the patients who died, follicular carcinoma in three patients, and Hurtle cell carcinoma in one patient. The causes of death were local invasion or compression of the trachea in two cases and distant metastases in eight patients. Median survival was 3.5 years (range, 1 mo-20 y). CONCLUSIONS: All patients dying of well-differentiated thyroid carcinoma had neck nodes, extrathyroidal spread, or distant metastases at presentation and were older than 49 years of age. Many presented because of their distant metastases. Death resulting from local disease was unusual, with most patients dying of distant metastases.     

The pathogenesis of tracheal stenosis following thyroidectomy (author's transl)

The frequency of trachealmalacia or stenoses following operations for struma or recurrent struma initiated our study of the pathogenesis of such changes. This study revealed that mechanical factors, such as compression of the trachea and the like, had been reported in the literature as the causative factors. The present paper investigates to what extent disturbances in the blood supply of the trachea, particularly after ligature of the inferior thyroid artery during thyroidectomy, influence changes in the tracheal mucosa, the connective tissue, and the adjacent cartilage. In twelve experiments on domestic pigs, the blood supply of the cervical trachea was interrupted. After varying periods of survival time, the animals were sacrificed and the tracheas histologically examined. In all cases, ischemic changes in the tracheal mucosa and cartilage could be found in addition to inflammatory reactions with scar formation. It seems justified to conclude that both mechanical factors and disturbances in local blood supply can cause tracheal tissue changes after thyroidectomy. The inferior thyroid artery and its branches also seem to play a central role in the success or failure of tracheal reconstructions following end-to-end anastomoses after stenosis resections. As a consequence, this paper also deals comprehensively with the detailed anatomy of this vessel.     

Extraosseous osteosarcoma of the thyroid gland

Extraosseous osteosarcomas are very rare malignant neoplasms that have been published in 300 cases so far. Manifestation within the thyroid gland was described in 6 cases only. We report a 69 year old female who suffered from enlarged recurrent struma after primary resection and radiotherapy 5 years ago. Histology revealed a high grade extraosseous osteosarcoma. Presenting the patient's clinical, radiological and histological findings the therapeutical options of this rare tumor entity are discussed.     

Trends in intraoperative neural monitoring for thyroid and parathyroid surgery amongst otolaryngologists and general surgeons

The role of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery remains a controversial subject for surgeons regardless of surgical training and background. This study aims to compare usage patterns and motivations behind IONM among otolaryngologist-head and neck surgeons (OTO-HNS) and general surgeons (GS) performing thyroid and parathyroid surgery. The study is a multi-institution survey of 103 otolaryngology and affiliated 103 GS programs in the US. 206 surveys were sent to OTO-HNS and GS academic program directors with a response rate of 44.7 %. Of those who performed thyroid surgery, 80.6 % of OTO-HNS and 48.0 % of GS surgeons reported using IONM. 44.3 % of OTO-HNS and 30.8 % of GS respondents used IONM in all thyroid cases. For thyroid surgery, as surgical volume increased, surgeons were more likely to use IONM more frequently. Fourteen percent (14 %) of the OTO-HNS and 41.7 % of the GS respondents used IONM primarily to locate the RLN. Forty percent (40 %) of the OTO-HNS and 8.3 % of the GS used IONM for medicolegal reasons. The majority of OTO-HNS programs use IONM for thyroid and parathyroid surgery, whereas less than half of GS programs regularly use IONM for these surgeries. Thyroid surgeons, with larger thyroid surgery volume, regardless of discipline, tend to use IONM more. The motivations for using IONM differ significantly between OTO-HNS and general surgeons in that more GS use it for locating the RLN, and more OTO-HNS use it for continuous monitoring of the nerve during resection and for medicolegal purposes.     

Malignant melanoma of the nose

Absract  Malignant Melanoma of the nose is a rare neoplasm, with primary mucosal melanoma being more aggressive than its cutaneous counterpart (Land,1982). The presentation is often not as dramatic as compared to its progression. While cutaneous melanomas typically present with obvious and consistent features, melanomas of the mucosal form are often diagonised late due to their hidden location and relatively non-specific features. This tumour can metasiasise by lymphasies or bloodsream. Moreover the tumour is often quite resistent to complete cure especially due to reccurence and metastotis. We wish to empahsize that early diagonisis with a high index of suspicion is essential for the management of this condition, by means of two case reports of patients who attended the ENT clinic at Southend Hospital, UK, both of whom were being treated for nasal polyposis in whom the diagonisis susbsequently turned out to be malignant melanoma.     

How we do it: Changes in thyroid and salivary gland surgery since 1989: who's doing it and what are they doing?

? The aim of this study was to identify changes in the provision of parotid, submandibular and thyroid gland surgery between surgical specialties since 1989, as well as changes in surgical practice. ? Data from the Department of Health's Hospital Episode Statistics (HES) was extracted from 1989/1990 and 2003/2004 records by operation and surgical specialty in England. ? The data reveals a considerable decline in the amount of parotid and submandibular surgery performed by General surgeons; with the majority of this surgery currently being performed by ENT surgeons, and to a lesser extent, Oral and Maxillo‐Facial surgeons. ? Thyroid surgery has undergone less radical change, with General surgeons continuing to perform the majority of cases; however, an increasing proportion is now provided by ENT surgeons. ? There also seems to be changes in the types of thyroid operation being performed; with large increases in total thyroidectomy and reductions in subtotal thyroidectomies.     

Early postoperative complications and their measures after skull base reconstruction: A study from the standpoint of plastic and reconstructive surgeons

ObjectiveIn skull base surgery, postoperative complications may be lethal and it is important to know how to deal with these. There are several reports on complications after skull base reconstruction, but it is difficult to understand which are important for plastic surgeons in charge of reconstruction. The objective of this study is to clarify the early postoperative survival-related complications after skull base reconstruction of which plastic surgeons should participate in treatment.MethodsOne hundred and seventy-seven patients who underwent skull base reconstruction at our department over the last 12 years were retrospectively surveyed. The cases of early complications in which plastic surgeons were actively involved in treatment were investigated and the preventive measures actually taken at our facility are examined in addition to treatment methods after development.ResultsPlastic surgical complications were wound infection in seven patients, impaired blood flow in transplanted tissue in two patients, cerebrospinal fluid leakage in five patients, and intracranial compression in three patients. Total number of postoperative complications were seventeen and the total complication rate was 9.6%. Complication rates tended to be higher in anterior-middle skull base cases than in anterior or middle alone cases and higher with free tissue transfer than with locoregional flap. Multivariate analysis revealed that operation time was a significantly higher risk factor (p=0.012) and preoperative chemotherapy was a significantly lower risk factor (p=0.033) for the development of complications. It was also found that the hospitalization length was significantly longer when complications occurred (p<0.0001). Wound infection was treated with removal of the cause, sufficient drainage, and irrigation. Regarding preventive measures, it is necessary to pay attention especially to intracranial contamination with epithelial components. Rapid surgical measures were necessary when blood flow of the transplanted tissue was impaired. For pedicle flaps, conservation of the feeding vessel is needed, and for free flaps, reliable vascular anastomosis is needed as preventive measures. Plastic surgeons play a role in reducing the risk of cerebrospinal fluid leakage through covering the repaired dura mater with tissue with favorable blood flow, especially in reoperation after development of leakage. Skull base reconstruction with soft tissue may cause intracranial compression, and sometimes, it is not resolved by conservative treatment and reoperation is selected.ConclusionPlastic surgical postoperative complications were clarified, and treatment methods and preventive measures for them were examined. Careful consideration of blood flow, placement, and volume of the transplanted flap is important to prevent complications.     

Antroscopy: current practice--a survey of UK otolaryngologists

The use of antroscopy by otolaryngologists in the UK was assessed by means of a postal questionnaire. A response of 70 per cent was obtained. Thirty-three per cent of otolaryngologists currently perform antroscopy; the principal reason for not using the technique being lack of suitable equipment. Twenty-four per cent of non-users believed that antroscopy would not alter their management of patients, and 19 per cent of all responders thought that antroscopy had no proven clinical role. Few surgeons recognized a role for antroscopy in the treatment of antral disease. Antroscopists preferred to operate on in-patients (73 per cent), under a general anaesthetic (60 per cent) and via the inferior meatus (66 per cent); 76 per cent consider that morbidity is insignificant. There is clearly a need for studies clarifying the role of antroscopy in clinical practice and to establish the cost-effectiveness of the technique.     

Complications of midline‐open tracheotomy in adults

Objectives/Hypothesis:

Percutaneous tracheotomy is progressively replacing open tracheotomy as a consequence of promising results of comparative studies. However, this comparison has four considerable weaknesses: 1) selected indications (high‐risk patients excluded for percutaneous tracheotomy); 2) varying spectra of complications included in different studies; 3) varying operative settings (experienced surgeons exclusively, surgeons in training, or both); and 4) missing differentiation between different surgical techniques. Our study was performed to collect complete datasets of unselected patients who all underwent a tracheotomy in a uniform technique in an academic teaching hospital setting.

Methods:

Retrospective evaluation of all complications following 303 consecutive surgical tracheotomies (midline‐open technique) performed by different surgeons and surgeons in training at one academic institution. Complications were classified and compared to results in the literature.

Results:

Rates of 21.5% minor and 1.0% major complications and 0% tracheotomy‐related mortality were registered. The most prevalent complications were local wound infections (10.9%), intra‐ and postoperative hemorrhages (4.2%), and cartilage damage (1.7%). No significant difference was found for high‐risk patients and emergency tracheotomies.

Conclusions:

Our study demonstrates that open tracheotomy is a safe procedure, particularly if performed in high‐risk patients even by inexperienced surgeons. Therefore, we emphasize the advantages of the midline‐open tracheotomy in an academic teaching hospital setting. Laryngoscope, 2010     

Learning curve of septomeatoplasty

Objective

To determine the time for us to train a well-trained surgeon to perform septomeatoplasty.

Material and methods

From July 1, 2003 to June 30, 2007, we included 75 patients with nasal septal deviation and chronic hypertrophic rhinitis received septomeatoplasty into this study. All the procedures were performed by four surgeons trained in the same tertiary referral center. We stratified the patients into groups according to the surgeon level at the time of the operations performed. We analyzed the operation time, surgical complications and hospital stay length of these patients.

Results

We stratified the patients according to surgeon years, from year two to year five. The surgical or operation time of the 3rd, the 4th and the 5th year surgeons was statistically shorter than that of the 2nd year surgeons. The operation time of the 4th and 5th year surgeons was statistically shorter than that of the 3rd year surgeons and the operation time of the 5th was also statistically shorter than that of the 4th year surgeons. The hospital stay length of the 4th and the 5th year surgeons was significantly shorter than that of the 3rd year surgeons. No significant difference was noted between that of the 4th and the 5th surgeons. There was no difference on surgical complication among all year group.

Conclusion

Surgeon's years of experience could make the difference on the speed of operation and may also shorten hospital stay length. We conclude that it takes at least five years for us to train a well-trained surgeon for septomeatoplasty.     

Survey of the use of suction drains in head and neck surgery and analysis of their biomechanical properties

BACKGROUND: Closed suction drains have an important role in surgical wound healing. Although most surgeons use them routinely, indications for use and their postoperative management (emptying, removal) vary. The purpose of this study was to assess drain use by head and neck surgeons in Canada, to conduct a biomechanical analysis of the drains in a laboratory setting, and to make recommendations for drain use and management. METHODS: A survey was mailed to 343 active members of the Canadian Society of Otolaryngology. Three sets of experimental trials were conducted on the most commonly used drains to assess the effect of increased reservoir filling on suction generated through (1) incrementally increasing the amount of fluid within the reservoir, (2) compression of the reservoir with no fluid within, and (3) compression with the reservoirs while filled to 25% capacity with fluid. RESULTS: A 41% response rate was obtained. It was found that the majority of head and neck surgeons in Canada use Hemovac and Jackson-Pratt drainage systems routinely. There is considerable variability in practice with regard to drain emptying and timing of removal. Experimental results indicate that as filling of the reservoir increases, suction generated decreases sharply, to between 13 and 20% of initial values at 50% capacity. CONCLUSION: Postoperative drain management has important implications in surgical wound healing. Drain reservoirs should be monitored frequently to ensure adequate compression, particularly in the first 24 hours after insertion. Anticipated volume of drainage should dictate in part which reservoir is chosen. A larger reservoir is preferable in most cases. Drains should be removed promptly to decrease the risk of wound contamination.     

Emerging trends in the performance of parathyroid surgery

OBJECTIVE: The management of hyperparathyroidism has evolved rapidly in the past decade with the introduction of intraoperative parathyroid hormone testing, radioguided surgery, and endoscopic surgery. Not surprisingly, there is a corresponding movement toward specialization of surgeons providing increasingly sophisticated treatments for head and neck endocrine disorders. We sought to identify trends in the disciplines performing parathyroid surgery. DESIGN: Nonrandomized, controlled comparison of surgical caseloads and publication volumes. METHODS AND MATERIALS: Two metrics designed to reflect the proportion of parathyroidectomies being performed by otolaryngologist-head and neck surgeons (OHNS) and general surgeons (GS) were chosen: the operative case logs of graduates from American training programs in OHNS and GS from 1996 through 2005 and the number of scientific papers published relating to parathyroid surgery during two timeframes (1991-1995 and 2001-2005). RESULTS: There was a gradual increase in the mean number of parathyroid surgeries performed by GS residents from 6.0 in 1996 to a peak of 9.2 in 2004; this volume has begun to decline (to 8.5 in 2005). During the same timeframe, the mean number of parathyroidectomies performed by OHNS residents rose sharply and steadily from 1.8 in 1996 to 10.9 in 2005. The number of American GS parathyroid publications from 1991 to 1995 was 41, compared with 108 in the period 2001 to 2005. During the same timeframe, the number of American OHNS parathyroid papers increased from 1 to 27. The relative proportion of parathyroid publications authored by American otolaryngologists rose from 2.4% to 20.0% (P = .006). CONCLUSIONS: Increasingly, otolaryngologists are the primary surgeons in parathyroid operations as indicated by two surrogate metrics. Graduating chief residents in otolaryngology now perform more parathyroid procedures than chief residents in general surgery, and a growing proportion of parathyroid publications are being authored by otolaryngologists.     

The organization and activity of the otolaryngological institutions in Warsaw in the second half of the 19th century and at the beginning of the 20th century

The importance of various otolaryngological institutions: hospital wards, outpatient clinics, infirmaries and consulting rooms in the formation of the new specialization, otolaryngology, is described in this paper. An important role of surgery in the first period of the development of otolaryngology is mentioned. At that time all major otolaryngological operations were performed by general surgeons. The necessity to create new separate hospital otolaryngological wards became evident. The attainment of general surgical education and management of suitable post-operation treatment by otolaryngologists as well as creation of autonomous operating rooms were also evident. Poor state of Warsaw otolaryngological outpatient clinics is described in detail. The state of otolaryngological institutions in Europe, in the United States of North America and in the Kingdom of Poland is described briefly.     

Association between surgeon volume and hospitalisation costs for patients with oral cancer: a nationwide population base study in Taiwan

Clin. Otolaryngol. 2010, 35 , 46–52. Objective: Oral cancer leads to a considerable use of and expenditure on health care. Wide resection of the tumour and reconstruction with a pedicle flap/free flap is widely used. This study was conducted to explore the relationship between hospitalisation costs and surgeon case volume when this operation was performed. Setting: A population-based study. Design: This study uses data for the years 2005–2006 obtained from the National Health Insurance Research Database published in the Taiwanese National Health Research Institute. Participants: From this population-based data, the authors selected a total of 2663 oral cancer patients who underwent tumour resection and reconstruction. Main outcome measures: Case volume relationships were based on the following criteria; low-, medium-, high-, very high-volume surgeons were defined by ≤ 9, 10–29, 30–55, ≥ 56 resections with reconstruction, respectively. Hierarchical linear regression analysis was subsequently performed to explore the relationship between surgeon case volume and the cost and length of hospitalisation. Results: The mean hospitalisation cost among the 2663 patients was US$ 9528 (all costs are given in US dollars). After adjusting for physician, hospital, and patient characteristics in a hierarchical linear regression model, the cost per patient for low-volume surgeons was found to be US$ 741 (P = 0.012) higher than that for medium-volume surgeons, US$ 1546 (P < 0.001) higher than that for high-volume surgeons, and US$ 1820 (P < 0.001) higher than that for very-high-volume surgeons. After adjustment for physician, hospital, and patient characteristics, the hierarchical linear regression model revealed that the mean length of stay per patient for low-volume surgeons was the highest (P < 0.001). Conclusions: After adjustment for physician, hospital, and patient characteristics, low-volume surgeons performing wide excision with reconstructive surgery in oral cancer patients incurred significantly higher costs and longer hospital stays per patient than did other surgeons. Treatment strategies adopted by high- and very-high-volume surgeons should be analysed further and utilised more widely.     

Variants of papillary thyroid carcinoma: association with histopathological prognostic factors

Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial.ObjectiveTo present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors.MethodRetrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years.ResultsWe included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion.ConclusionA small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases.     

Submental flap practice patterns and perceived outcomes: A survey of 212 AHNS surgeons

ObjectivesTo describe American Head and Neck Society (AHNS) surgeon submental flap (SMF) practice patterns and to evaluate variables associated with SMF complications.MethodsThe design is a cross-sectional study. An online survey was distributed to 782 AHNS surgeons between 11/11/16 and 12/31/16. Surgeon demographics, training, practice patterns and techniques were characterized and evaluated for associations with frequency of SMF complications.ResultsAmong 212 AHNS surgeons, 108 (50.9%) reported performing SMFs, of whom 86 provided complete responses. Most surgeons who performed the SMF routinely reconstructed oral cavity defects with the flap (86.1%, n = 74). Thirty-seven surgeons (43.0%) experienced “very few” complications with the SMF. Surgeons who practiced in the United States versus internationally (p = 0.003), performed more total career SMFs (p = 0.02), and routinely reconstructed parotid and oropharyngeal defects (p = 0.04 and p < 0.001) with SMFs were more frequently perceived to have “very few” complications. SMF surgeons reported more perceived complications with the SMF compared to pectoralis major (p = 0.001) and radial forearm free flaps (p = 0.01). However, similar perceived complications were reported between all three flaps when surgeons performed >30 SMF. Among 94 surgeons not performing SMFs, 71.3% had interest in a SMF training course.ConclusionsPractice patterns of surgeons performing SMFs are diverse, although most use the flap for oral cavity reconstruction. While 43% of surgeons performing the SMF reported “very few” complications, overall complication rates with the SMF were higher compared to other flaps, potentially due to limited experience with the SMF. Increased training opportunities in SMF harvest and inset are indicated.     

Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma

Objectives

Ultrasound‐guided aspiration cytology (US‐FNAC) was previously used to diagnose lymph node metastasis of papillary thyroid carcinoma (PTC). Combined US‐FNAC with nodal thyroglobulin (LN‐FNA‐Tg) significantly improved the diagnostic rate. However, diagnostic accuracy depends on proper node selection. Therefore, it is crucial to choose the nodes with reliable sonographic features to guide clinician for confirmation.

Design and Setting

Retrospective cohort study was carried out in one medical centre from 2011 to 2014.

Participants

A total of 148 patients with PTC, being treated by total thyroidectomy and radioiodine, were assessed for potential nodal metastases by ultrasound.

Main outcome measures

Lymph nodes with cystic content, peripheral hypervascularity, calcification, hyperechoic content, the absence of hilum and Solbiati index < 2 indicated risk of malignancy. US‐FNAC and LN‐FNA‐Tg were both performed. Positive nodal metastasis was further confirmed by dissection. Risk impact of these sonographic features on LN‐FNA‐Tg to diagnose nodal metastasis was tested by logistic regression analysis based on the significance in both univariate and multivariate models.

Results

Overall, 49 lymph nodes were documented as recurrent nodal metastasis. LN‐FNA‐Tg greater than serum thyroglobulin and higher than 1 ng/mL achieved 100% of diagnostic rate for recurrent nodal metastasis. The malignant sonographic features that significantly cohered with positive LN‐FNA‐Tg were cystic and hyperechoic content and lack hilum, in sequence.

Conclusions

LN‐FNA‐Tg is an excellent tool to quantitatively diagnose nodal metastasis. To achieve ideal diagnosis, the most reliable sonographic features were cystic content, hyperechoic content and the absence of hilum in lymph nodes, but not calcification or Solbiati index < 2.     

The Warsaw otolaryngology in the end of the 19th century and the beginning of the 20th century

Main professional and scientific centries in otolaryngology were the Varsovian hospitals. The origin of several otolaryngological institutions in Warsaw (laryngological ward at St. Roch Hospital, founded in 1881 by Teodor Heryng (1847-1925), otological ward at Ujazdowski Hospital, founded also in 1881 by Teodor Heiman (1848-1917), laryngological out-patient ward at St. Spirit Hospital, founded in 1883 by Alfred M. Soko?owski is described. The origin of otolaryngological ward at Orthodox Jew Hospital, the first otolaryngological ward in Warsaw, founded in 1903 by Leopold Lubliner (1863-1937) is also mentioned. The major otolaryngological operations were performed also at surgical wards. The achievements of such surgeons as W?adys?aw Matlakowski (1851-1895), W?adys?aw Stankiewicz (1838-1929), W?adys?aw Krajewski (1855-1907), Franciszek Kijewski (1851-1919), Franciszek Jawdyński (1851-1896), Bronis?aw Sawicki (1860-1931) were very important for the development of otolaryngology in the Polish territories. Jawdyński is shown as a pioneer of radical neck dissection on account of cancer of neck. Operations performed by Warsaw surgeons and by surgeons in other countries was similar. Above-mentioned Warsaw physicians were good teachers of a great number of distinguished laryngologists, although at Warsaw University otolaryngology were not lectured.     

Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study

ObjectiveTo determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy.MethodsAll member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia.ResultsA total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist.ConclusionsUsing a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.     

Value of multimedia educational software in training of the paranasal sinus surgeon

BACKGROUND: When starting sinus surgery, every surgeon has to pass through an individual learning curve. To avoid complications, costly, time-consuming surveillance is necessary. We wanted to analyse the impact of multimedial teaching software on the learning curve. METHODS: A total of 1104 operations performed by four surgeons were evaluated. The first consecutive 200 operations by each surgeon were analyzed according to their complications. After revaluating the general phases of surgical development, we compared the first 90 operations by another group of four surgeons who had undergone training with the teaching program. RESULTS: Cauterization of the anterior ethmoidal anterior was nearly the same in both groups (10/8). Injuries of the dura dropped from 5 to 2, and periorbital lesions were reduced significantly from 20 to 5 (p < 0.001). CONCLUSIONS: Multimedial learning programs can reduce complications effectively and form a valuable part training.