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1.
Objective
To determine the current cost impact and financial outcomes of transoral robotic surgery in Otolaryngology.Data sources
A narrative review of the literature with a defined search strategy using Pubmed, MEDLINE, CINAHL, and Web of Science.Review methods
Using keywords ENT or otolaryngology, cost or economic, transoral robotic surgery or TORs, searches were performed in Pubmed, MEDLINE, CINAHL, and Web of Science and reviewed by the authors for inclusion and analysis.Results
Six total papers were deemed appropriate for analysis. All addressed cost impact of transoral robotic surgery (TORs) as compared to open surgical methods in treating oropharyngeal cancer and/or the identification of the primary tumor within unknown primary squamous cell carcinoma. Results showed TORs to be cost-effective.Conclusion
Transoral robotic surgery is currently largely cost effective for both treatment and diagnostic procedures. However, further studies are needed to qualify long-term data. 相似文献2.
Bernar Tan Wen Sheng Patrick Wong Constance Teo Ee Hoon 《American journal of otolaryngology》2018,39(3):355-358
Introduction
Recurrent respiratory papillomatosis results in hoarseness, stridor and airway obstruction. Management is surgical, with most surgeons using microdebrider or laser. Transoral robotic surgery (TORS) has been successfully utilised for the excision of oropharyngeal malignancies and paediatric airway surgery. This is the first case report of TORS being used for the excision of laryngeal papillomas.Case report
A 36?year old Chinese female was diagnosed with juvenile onset recurrent respiratory papillomatosis. She had 4 previous laryngeal surgeries. She was pregnant in her 2nd trimester and experienced rapid progression of her disease, leading to impending airway compromise. At her latest surgery (2?years ago), poor laryngeal exposure was encountered during laryngoscopy which made the surgery technically challenging. Thus, a flexible robotic system (Flex® Robotic System, Medrobotics Corporation, Raynham, Massachusetts, USA) was utilised with the aim of providing better surgical exposure. During surgery, laryngeal intubation was not possible and her airway was secured with needle cricothyroidotomy followed by tracheotomy. Transoral robotic excision of laryngeal papillomas was performed successfully. Complete excision of obstructing papillomas was achieved with postoperative restoration of airway and voice.Discussion
Utilisation of TORS improved visualisation, dexterity and access. Drawbacks include cost, set up time, requirement for special equipment and advanced training. TORS approach can be considered as an alternative to the usual laryngoscopic technique, especially in cases where difficult anatomy and poor laryngeal exposure is anticipated. 相似文献3.
Kirkland N. Lozada Muhammed S. Qazi Azita S. Khorsandi Raymond L. Chai 《American journal of otolaryngology》2018,39(2):242-246
Importance
Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses.Observation
An 84-year-old male presented with a blue mass on the left cheek. This mass started as a small bump and grew significantly over one year. His primary care physician monitored its growth and ultimately referred to an otolaryngologist. Imaging findings revealed a multi-lobular solid and cystic left buccal lesion. FNA was suggestive of low grade mucoepidermoid carcinoma.Intervention
Patient underwent surgical excision with primary closure of the defect. Frozen section was consistent with low grade salivary malignancy. Final pathology revealed primary mucinous eccrine carcinoma of the skin.Conclusions and relevance
Mucinous eccrine carcinoma is a rare entity commonly seen in the head and neck region. Mucinous deposits to the skin from primaries elsewhere in the body are much more common than primary lesions of the skin. Histology is a key component of the diagnosis but full oncologic workup is required. Treatment typically includes wide local excision with possible adjuvant chemotherapy or radiation for high risk features. 相似文献4.
Jay Agarwal Sameep Kadakia Abbas Agaimy Anna Ogadzanov Azita Khorsandi Raymond L. Chai 《American journal of otolaryngology》2017,38(4):505-507
Background
Pleomorphic liposarcoma (PL) is an exceedingly rare tumor of the head and neck. This aggressive liposarcoma variant portends a poorer prognosis compared to more typical sarcomatous tumors.Methods
Multi-institutional study including two cases of PL, the first case occurring in the post-auricular region and the second in the cheek with later recurrence within the parotid bed.Results
Both patients were treated surgically with wide local excision. One patient required reoperation to obtain negative margins. The other patient underwent a total parotidectomy with neck dissection for recurrent intraparotid nodal disease. Both patients underwent adjuvant radiotherapy. No patient had evidence of recurrent disease with minimum one year follow-up.Conclusion
Although the literature is sparse on this disease, wide surgical extirpation with negative margins and adjuvant radiation is recommended. Increased reports of this pathology can be helpful in providing practitioners with experienced-based information that can aid in early detection and treatment. We present the first case series of PL of the head and neck in the literature. 相似文献5.
Giuseppe Spriano Giuseppe Mercante Giovanni Cristalli Raul Pellini Fabio Ferreli 《American journal of otolaryngology》2017,38(5):598-602
Introduction
The supracricoid partial laryngectomy has been described for the treatment of T3 laryngeal glottic and supraglottic tumors as well as upfront and salvage surgery. Good oncological and functional outcomes are expected, while the post-operative rehabilitation can be quite difficult for the patient. Early and late complications can occur especially in salvage surgery. Neck dissection according to the T stage is often associated with the resection of the primary tumor.Objective
To verify the feasibility of a minimally invasive procedure for supracricoid partial laryngectomy by adopting the lateral cervical approach.Methods/results
A 61-year old man affected by a cT3N0 glottic cancer already treated 10 years prior with radiotherapy for oropharyngeal cancer underwent supracricoid laryngectomy using the lateral approach. The key point of the procedure was a subfascial dissection with the harvesting of anterior cervical flap including skin, fat, platysma, fascia superficialis, anterior jugular veins, homo- and sterno-hyoid muscles.Conclusion
Supracricoid laryngectomy by a lateral approach is feasible and safe; it allows to perform a simultaneous neck dissection and the removal of the entire laryngeal specimen preserving ample healthy tissue compared to the classic anterior approach. 相似文献6.
Daniel A. Carlton Enrique E. Perez Eric E. Smouha 《American journal of otolaryngology》2018,39(1):41-45
Importance
Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.Objective
Determine if there has been a shift in the microbiology and outcomes of MEO.Design
A retrospective case series at a tertiary care institution.Setting
Inpatient and outpatient tertiary care hospital.Participants
12 cases of recent MEO were reviewed.Main Outcomes and measures
The primary outcome was progression of disease. Secondary outcomes were drug resistance and complications of MEO.Results
Only 4 patients were cured of MEO. Four patients expired during the study period and at least one of these deaths was a direct result of the MEO. 7 patients developed Cranial nerve palsies, and 3 patients developed abscesses.Conclusions
Select cases of MEO now require multi-drug and long-term parenteral antibiotic therapy with extended hospital stays. 相似文献7.
Nathan Cass Alan Kominsky Cristina Cabrera-Muffly 《American journal of otolaryngology》2017,38(2):139-142
Purpose
(1) Ascertain the most important concepts and topics for otolaryngology resident education in sleep medicine and surgery, as determined by faculty who teach sleep medicine to otolaryngology residents. (2) Create learning objectives within the area of otolaryngologic sleep medicine in order to design a sleep medicine curriculum for otolaryngology residents.Materials and methods
Two web-based surveys were sent to 163 academic otolaryngologists who teach sleep medicine. The first survey determined the topics, and their relative importance, considered most vital to learn during otolaryngology training. Using the Delphi method, the second clarified questions regarding topics determined by the first survey. Sleep medicine learning objectives for residents were ascertained from responses.Results
The response rate of first and second surveys were 24.5% and 19%, respectively. Topics ranked most important for resident education included upper airway anatomy, polysomnogram interpretation, and understanding the range of medical and surgical therapies used to treat sleep disorders. Respondents listed surgical therapy as the most critical topic that most residents do not understand well. The second survey clarified the specific anatomic features, surgical techniques, and polysomnography data points deemed most critical for resident learning.Conclusions
Academic otolaryngology sleep experts hold opinions regarding relative value of different topics for teaching sleep medicine, which is useful in creating a curriculum for otolaryngology residents. Otolaryngology learning objectives related to sleep medicine identified during this study are being used to create an online curriculum to supplement resident education. 相似文献8.
Objective
Eagle syndrome, a spectrum of disease resulting from an elongated styloid process and/or calcified stylohyoid ligament, lacks standardized recommendations regarding indications for surgical intervention and approach.Study design
Retrospective cohort study.Setting
Single tertiary care institution.Subjects
Patients treated surgically for Eagle syndrome between January 2011 and June 2017.Methods
Patients were diagnosed with Eagle syndrome based on thorough clinical workup and assessment. The primary outcome was improvement in pain severity following surgery, with complete resolution of pain being considered clinically meaningful. Wilcoxon rank-sum tests and Fisher's exact were used to compare numerical and categorical variables, respectively.Results
Twenty-one patients were diagnosed with Eagle syndrome and underwent surgical resection of the styloid process. Patients most often complained of neck pain (81%), throat pain (62%), and ear pain (48%). Among these patients, 57% of procedures featured a transcervical approach, while the remaining 43% were transoral. The vast majority (90%) of patients experienced improvement in pain severity from a median of 6.0 before surgery to 0.0 afterwards (p?<?0.01) as 62% experienced complete resolution. Using multivariable linear regression to model changes in pain severity, neck pain (β?=??1.69, p?<?0.01) and jaw pain (β?=??0.93, p?=?0.03) predicted greater relief, while headache (β?=?0.82, p?=?0.04) predicted an inferior response. Adverse events were uncommon and typically resolved within three months, with 24% experiencing first bite syndrome and 19% reporting numbness.Conclusions
Transcervical and transoral styloidectomy are effective treatments for Eagle syndrome with minimal adverse effects. Patients with classic symptoms of neck or jaw pain benefit most from surgery. 相似文献9.
Intraoperative imaging during minimally invasive transoral robotic surgery using near-infrared light
Purpose
The purpose of this study was to determine if the use of the FIREFLY imaging system could be an asset in transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC). The system uses indocyanine green dye (ICG), which fluoresces when illuminated by near-infrared light from the Da Vinci robot. The system may improve visualization of tumor margins, highlight important vascular structures, and help identify the location of tumors and unknown primary head and neck cancers.Methods
Six patients with OPSCC were enrolled in the study. Two of these cases were unknown primaries, one was base of tongue, and three were palatine tonsils. Each patient was given two 3 ml doses of ICG, one at the beginning of the surgical case and one during resection of the tumor. The oropharynx was then visualized using the near-infrared light of the Da Vinci robot for a minute after injection.Results
The FIREFLY system was unable to detect gross tumors, positive margins, unknown primaries, or vascular structures in any of the six subjects in the study. In addition, there were no adverse events or side effects in any of the subjects.Conclusion
The use of the FIREFLY system with indocyanine green fluorescence did not identify tumor boundaries, unknown primary head and neck cancers, or vascular structures in the oropharynx. 相似文献10.
Andrew J. Bowen Amy S. Nowacki Michael S. Benninger Eric D. Lamarre Paul C. Bryson 《American journal of otolaryngology》2018,39(2):97-100
Objective
A recent study reported decreasing trends in tracheotomy procedures by its otolaryngology service. We set out to determine whether the previously reported decrease in otolaryngology performed tracheotomies by one institution is a local or generalizable phenomenon.Design
Retrospective cohort study from 2010 to 2015.Setting
Tertiary care hospital and affiliated regional hospitals.Subject and methods
All patients who received tracheotomy during the period of analysis were included. Performing specialty, surgical technique, and procedure location were recorded. Procedures were stratified by year and specialty to generate incidence rate ratios for otolaryngologists and non-otolaryngologists. Incidence rate ratios were estimated with negative binomial regression across services.Results
The otolaryngology service demonstrated a yearly decrease of 3.4% in the total number of tracheotomies (95% CI ? 7.9% to + 1.4, P = 0.17). While the thoracic service remained constant (+ 0.3%, 95% CI ? 2.6% to + 3.3%, p = 0.83), general surgery demonstrated the greatest increase in procedures (+ 4.4%, 95% CI ? 6.0% to + 15.8%, P = 0.42). Thoracic and general surgery both dramatically increased the number of percutaneous tracheotomies performed, with general surgery also performing a greater number of bedside procedures.Conclusions and relevance
We observed a similar decline in the number of tracheotomies otolaryngology over six years. Our trend is likely due to changes in consultations patterns, increasing use of the percutaneous method, and an increase in adjunctive gastrostomy tube placements. Investigations on the impact of a greater number of non-otolaryngology performed tracheotomies on follow up care is warranted. 相似文献11.
12.
Sameer K. Singh Stanley Liu Robson Capasso Robert C. Kern Christopher J. Gouveia 《American journal of otolaryngology》2018,39(4):378-382
Purpose
Assess the quality of information on obstructive sleep apnea (OSA) presented on YouTube for patients.Materials and methods
“Obstructive sleep apnea” was entered into the YouTube search. Two independent reviewers categorized and analyzed videos utilizing a customized scoring-system along with search position, likes, and views.Results
Forty-eight videos were analyzed. Most were educational (52.1%). Educational and news videos had significantly higher scores, but had no significant differences in search position, likes/day, or views/day. Most videos mentioned positive airway pressure (65%), and nearly half (44%) mentioned mandibular devices in the management of OSA. Few videos discussed surgery (13%) or otolaryngology (15%).Conclusion
YouTube is a promising source of information for OSA patients. Educational and news videos are of highest quality. General quality measures like search position, views, and likes are not correlated with formally scored value. Sleep surgery and otolaryngologists are minimally mentioned, representing an opportunity for improvement. 相似文献13.
Objectives
The utility of topical mitomycin C (MMC) as an adjuvant treatment in the management of laryngeal and tracheal stenosis has been studied; however, the ideal timing of MMC application has not been fully elucidated. There is a paucity of studies evaluating the timing of MMC application after surgical airway intervention for stenosis. The purpose of this study is to describe a novel technique for MMC application that allows for delayed application in the unsedated, office-based setting, approximately one week following endoscopic airway dilation.Methods
A technique for retrograde transtracheal application of MMC was developed and utilized in 3 tracheostomy-dependent patients with subglottic stenosis and glottic stenosis with bilateral vocal fold immobility. After administration of topical anesthesia, a MMC (0.4?mg/ml) coated pledget was advanced via a transtracheal approach and directed to the area of stenosis in retrograde fashion using endoscopic frontal sinus instruments. Appropriate positioning of the pledget was confirmed via transnasal flexible fiberoptic laryngoscopy.Results
All 3 patients underwent successful in-office retrograde application of MMC onto the area of laryngeal stenosis 7–9?days after their preceding surgery. There were no complications. Two patients achieved decannulation while the third patient's management was interrupted due to cancer treatment.Conclusions
We present a novel and well tolerated technique for delayed in-office application of MMC in tracheostomy-dependent patients with laryngeal stenosis. This approach can facilitate the study of the ideal timing of topical MMC use in airway stenosis. 相似文献14.
Mark J. Ringstrom Jay Christian Matthew L. Bush Jeffrey E. Levy Bin Huang T.J. Gal 《American journal of otolaryngology》2018,39(5):575-581
Objectives
The objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting.Methods
6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables.Results
Patients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p?=?0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p?=?0.03). Proximity to otolaryngology care was not significant.Conclusion
Increased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed. 相似文献15.
Jia Hui Jang Hiang Khoon Tan N. Gopalakrishna Iyer Khee Chee Soo Ngian Chye Tan 《American journal of otolaryngology》2017,38(1):82-86
Background
Nasopharyngectomy for excision of nasopharyngeal tumors is challenging, as access to the nasopharynx is difficult. Recently our institution embarked on two new approaches – robotic nasopharyngectomy and open nasopharyngectomy with operating microscope (NOM) via maxillary swing approach. This article proposes that the novel approach of NOM via maxillary swing aids visualization for resection of locally invasive nasopharyngeal tumors.Methods
Over a thirteen-month period, eight patients required nasopharyngectomy in our single Asian institution. Four underwent robotic nasopharyngectomy and four underwent NOM via maxillary swing approach. The latter four were retrospectively reviewed, and their clinical characteristics and surgical outcomes reported. Tips and pearls for operative setup and patient selection were also discussed.Results
All four patients who underwent NOM had negative intraoperative frozen sections with subsequent negative paraffin sections. All patients remained disease free post-salvage surgery.Conclusion
NOM via maxillary swing allows better visualization and aids in augmentation of open nasopharyngectomy. This enables achievement of adequate resection margins and fewer surgical complications in locally invasive nasopharyngeal tumors. 相似文献16.
Francesco Chu Marta Tagliabue Gioacchino Giugliano Luca Calabrese Lorenzo Preda Mohssen Ansarin 《American journal of otolaryngology》2017,38(4):375-379
Purpose
Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck masses. Surgery remains the standard treatment for most cases, including different approaches (cervical approach, parotidectomy, mandibulotomy, transoral/robotic). We report our experience in the management of PPS tumors, aiming to create a surgical algorithm on the base of tumor's radiological and clinical characteristics.Materials and methods
Critical retrospective analysis of patients with PPS neoplasms who underwent surgery at our Institute. Data were collected on patient age and sex, tumor location and size, preoperative investigations, surgical approaches, histopathology, complications and outcomes.Results
Between January 2000 and July 2015, 53 patients were treated at our Institute. Salivary gland tumors were the most common neoplasms followed by neurogenic tumors. CT scan/MRI were the most used preoperative imaging studies. The cervical approach with or without parotidectomy is the most used, providing the best compromise between the need for radicality and low risk of damage to the neurovascular structures. Mandibulotomy is used whenever the mass extends to the cranial base, assuming a higher morbidity, a slower functional recovery and the need for tracheotomy. Recently, TORS has been used for tumors of the PPS with promising outcomes.Conclusions
PPS surgery includes a wide spectrum of approaches but it is still a matter of debate which one guarantees better functional and oncological outcomes. We report a surgical algorithm based on surgical invasiveness and tumor characteristics to standardize PPS tumors management. We also highlight the upcoming role of TORS in this field. 相似文献17.
Purpose
Functional outcomes and complication rates after open surgery for advanced-stage oropharyngeal cancers are rarely reported. These measures are critical for choice of treatment modality and patient counseling. We describe the long term functional outcomes and associated complications of primary surgical management of T4 oropharyngeal cancers reconstructed with radial forearm free flaps.Materials and methods
A retrospective review was performed of 40 patients with T4 oropharyngeal cancers treated between 2005 and 2015 at a tertiary care center.Results
Forty patients with T4 oropharyngeal cancers underwent open surgical resection and radial forearm free flap reconstruction at the time of surgery. Mandibulotomy was required in 33 (82.5%) cases. Thirty-five (87.5%) patients received adjuvant radiation or combined chemotherapy and radiation. Tracheostomy was performed in all patients, but every patient was eventually decannulated. Twenty (57.1%) patients required gastrostomy tube placement at some point during treatment; however, 91.4% were on a completely oral diet with a mean FOSS score of 1.6 by 1 year after completion of treatment. The addition of adjuvant treatment was the only factor significantly associated with poorer FOSS scores. The overall rates of short and long-term complications were 60.0% and 57.1% respectively. The most common short and long-term complications were infection (30.0%) and velopharyngeal insufficiency (25.7%) respectively.Conclusions
Traditional open surgical approaches to large tumors of the oropharynx carry higher complication rates than more recent advanced transoral approaches. However, they can still be utilized with excellent long-term functional results in certain cases of advance oropharyngeal cancers not amenable to transoral approaches. With careful reconstruction of oropharyngeal defects, over 90% of patients can achieve a completely oral diet. 相似文献18.
Cameron C. Wick Rod P. Rezaee Tammy Wang Andrea M. Garcia-Jarchow Chad A. Zender Michael Gibson Min Yao Pierre Lavertu 《American journal of otolaryngology》2017,38(1):72-76
Hypothesis
Patients with advanced laryngeal cancer sometimes desire organ preservation protocols even if it portends a worse outcome.Background
To assess outcomes of patients with T4 laryngeal cancer treated with chemoradiation therapy.Methods
Case series with chart review at a tertiary university hospital. Twenty-four patients with T4 laryngeal cancer all declined total laryngectomy with adjuvant radiation as the primary treatment modality and alternatively received concurrent chemoradiation therapy. The primary outcome was overall survival. Secondary outcomes were rates of tracheotomy dependence, gastric tube dependence, and need for salvage laryngectomy.Results
All patients had T4 laryngeal disease, 71% had cartilage invasion and 59% had regional metastasis to the neck. Kaplan–Meier analysis determined 2-year and 5-year overall survival to be 64% and 59% respectively. The locoregional recurrence rate was 25%. The distant metastasis rate was 21%. The rate of salvage laryngectomy was 17%, which occurred at a mean of 56.5 months after the original diagnosis. The rate of tracheotomy dependence was 33% while gastric tube dependence was 25%.Conclusion
Advanced T4 laryngeal cancer, particularly with cartilage invasion, remains a surgical disease best treated with total laryngectomy and adjuvant radiation. This data may help guide patients and practitioners considering concurrent chemoradiation therapy for definitive treatment of advanced laryngeal cancer. 相似文献19.
Eliza H. Dewey Ansley M. Roche Cathy L. Lazarus Mark L. Urken 《American journal of otolaryngology》2017,38(5):618-625
Background
The management of large chin and lower lip defects is challenging due to this facial subunit's tremendous functional and aesthetic importance. Specific methods for total lower lip and mentum reconstruction are not well chronicled. Aesthetic and functional goals of this reconstruction include restoration of oral competence by maintaining lower lip height, vermilion reestablishment, color-matched skin introduction to the chin, sensation restoration, and ideally restoration of dynamic activity to the lower lip.Methods
Literature review performed.Results
Presentation of novel, two-stage technique for lower lip and chin reconstruction with a submental flap and a radial forearm free flap, suspension of the lower lip and chin with a tensor fascia lata graft, and vermilion reconstruction with a buccal mucosal flap.Conclusions
This procedure meets all goals of total lower lip reconstruction with the exception of the introduction of dynamic tissue and represents a novel solution to a challenging reconstructive problem. 相似文献20.
Anthony M. Tolisano Sungjin A. Song Douglas S. Ruhl Philip D. Littlefield 《American journal of otolaryngology》2017,38(4):401-404