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Αλέξανδρος Γ. Σφακιανάκης

Thursday, May 13, 2021

Novel Concept, Design and Feasibility Test of Hybrid Temporal Bone and Sheep Head Holder

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Abstract

We present a first feasibility and usability assessment of a novel commercial hybrid temporal and sheep head holder. Feasibility tests were conducted on human cadaveric and sheep temporal bone based on common otologic procedures. Overall practicality of using this device for cadaveric temporal bone dissections was evaluated. Beneficial aspects included ease of usage, handling, fixing and stability, inbuilt irrigation system, compartments for instrument placement, ergonomics and overall satisfaction. The novel hybrid Temporal and sheep bone holder bears the potential to provide benefits for cadaveric and sheep bone dissections.

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Endoscopic Transnasal Management of Giant Paediatric Sinonasal Ossifying Fibroma

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Abstract

The ossifying fibroma is a rare fibro-osseous benign lesion of bone in the head and neck region. The mandible is the most common site reported followed by maxilla and other bones of the skull. A paediatric male presented with protrusion of the right eyeball for one-month duration. Further evaluation by diagnostic nasal endoscopy revealed a smooth mass confined to the superior and middle meatus on the right side. Computed tomography of paranasal sinus showed a large heterogenous bony lesion involving the ethmoid and sphenoid sinus and extending laterally into the orbit and superiorly into anterior skull base. Endoscopic biopsy was suggestive of ossifying fibroma. Transnasal endoscopic excision of the lesion was done and the patient is currently on follow-up. This case is reported for the rarity of presentation and the difficulties in management.

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Performance of a Closed Set Picture Identification Test in Tamil for Children with Cochlear Implant

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Abstract

The study attempted to assess the closed set word identification abilities in children with cochlear implant (CI) with a picture identification test developed in Tamil. The test was validated on typically developing children with normal hearing (NH) to build a reference for comparison. Participants for the study included 205 children with NH between the age range of 3–6 years and 45 children with cochlear implant within the age range of 3–11 years. The picture identification test was developed using bisyllabic words with corresponding pictures in Tamil. Two lists were created with 25 words each and administered to the children with NH and CI. The scores of both the groups were analysed. The results indicated that the mean scores improved as age increased for children in the NH group. Also, there was no significant difference in performance between the two-word lists. Significant difference in scores was noted between the CI and the NH group (p < ; 0.01). However, the mean scores in the CI group increased as the experience with CI increased. The picture identification test in Tamil is deemed appropriate to elicit closed set word identification responses for children with CI between the age of 3–6 years. The test will provide supplemental information for mapping and to plan habilitation for children with CI.

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A longitudinal study of changes of congenital auricular deformity regarding self-correction

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J Plast Reconstr Aesthet Surg. 2021 Mar 28:S1748-6815(21)00113-3. doi: 10.1016/j.bjps.2021.03.023. Online ahead of print.

ABSTRACT

This study aimed to investigate the factors associated with congenital auricular deformities and evaluate the long-term frequency of their self-correction. Ninety newborns were enrolled in the study, and data were collected within 2 weeks after birth and at 1 year. The shape of the auricle was classified into seven categories using a digital image. At 2 weeks after birth, several birth-related factors were evaluated in the auricular deformity and normal groups. At 1 year after birth, the images of auricles were compared with the images at birth, and the changes in the auricle shape were investigated. Congenital auricular deformities were observed in 139 out of 180 ears, and the major type noted was helix rim deformity (47 ears), followed by normal ears (41 ears), and cup ears (33 ears). Male sex was found t o have a statistically significant association with the occurrence of auricular deformity. In the longitudinal study, among 43 neonates (86 ears) followed-up 12 months later, the self-correction rate was approximately 50%. The normal auricle and prominent ear increased, helix rim deformity and cup ear decreased significantly. The prognosis of deformity varied depending on the type of deformity. Considering the low self-correction rate in the prominent and cup ears, newborns with these deformities might be recommended to undergo management such as auricle molding technique, as required.

PMID:33972198 | DOI:10.1016/j.bjps.2021.03.023

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BreastImplantAnalyzer: An easy-to-use, validated tool for calculating breast implant volume from MRI data

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J Plast Reconstr Aesthet Surg. 2021 Apr 8:S1748-6815(21)00158-3. doi: 10.1016/j.bjps.2021.03.068. Online ahead of print.

ABSTRACT

BACKGROUND: Given the prevalence of breast augmentation and prosthetic-based breast reconstruction, it is common for the plastic surgeon to see patients presenting for revisional implant surgery. A frequent issue encountered in such procedures is uncertainty of implant size, which presents numerous challenges and may lead to undesired outcomes for both the patient and the surgeon. There is currently no tool available with the purpose of measuring implant volume from magnetic resonance imaging (MRI) data. In this study, such a program was designed and tested.

METHODS: An open-source software was developed that provides volume measurement of a chosen breast implant with minimal interaction from the user, allowing for precision in the planning of breast implant revisional surgery. It was developed to be a s easy to use as possible for clinicians who may not have experience with imaging analysis platforms. The program was tested on patients who underwent revisional implant surgery and had documented implant volumes and pre-operative breast MRIs. Twenty-two implants were tested in total, including saline and both smooth and textured silicone implants.

RESULTS: The software has shown to be highly accurate with an average accuracy of 98.6%. A Spearman correlation coefficient of 0.967 was obtained. The software also performed faster than previously proposed methods.

CONCLUSION: Plastic surgeons can easily calculate breast implant volume pre-operatively using BreastImplantAnalyzer, which is available to download for free from www.BreastImplantAnalyzer.com or as an extension for the popular medical imaging platform 3D Slicer.

PMID:33972201 | DOI:10.1016/j.bjps.2021.03.068

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Indications and Pitfalls of Prepectoral Breast Reconstruction with Braxon Acellular Dermal Matrix (ADM): A preliminary plastic surgical experience

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J Plast Reconstr Aesthet Surg. 2021 Apr 22:S1748-6815(21)00228-X. doi: 10.1016/j.bjps.2021.03.124. Online ahead of print.

NO ABSTRACT

PMID:33972202 | DOI:10.1016/j.bjps.2021.03.124

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The chimeric medial sural artery perforator flap as the ideal for partial tongue reconstruction: A case series and technical refinements

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J Plast Reconstr Aesthet Surg. 2021 Mar 29:S1748-6815(21)00114-5. doi: 10.1016/j.bjps.2021.03.024. Online ahead of print.

ABSTRACT

BACKGROUND: The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction.

METHODS: A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap.

RESULTS: A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8 mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented.

CONCLUSION: The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction.

PMID:33972203 | D OI:10.1016/j.bjps.2021.03.024

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Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ*) into Brazilian Portuguese

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Braz J Otorhinolaryngol. 2021 Apr 20:S1808-8694(21)00068-9. doi: 10.1016/j.bjorl.2021.03.009. Online ahead of print.

ABSTRACT

INTRODUCTION: Obstructive sleep apnea is a frequent entity in childhood that can lead to important consequences for the health and children's quality of live. Polysomnography is the gold-standard exam to diagnose obstructive sleep apnea, but it is expensive, complex, and poorly affordable in Brazil. The pediatric sleep questionnaire has shown to be a valuable screening test for obstructive sleep apnea. It is a simple questionnaire with good sensitivity and specificity compared to polysomnography in the countries where it has been validated.

OBJECTIVE: Translation and cross-cultural adaptation of the pediatric sleep questionnaire (PSQ), into Brazilian Portuguese.

METHODS: The translation of the PSQ into Brazilian Portuguese was carried out in accordance with good practices. The validated and adapted q uestionnaire was applied to parents/caregivers of 60 children (40 of them with obstructive sleep apnea and 20 controls) aged 2-18 years. Retest was applied to 30 children with obstructive sleep apnea. The following tests were performed: internal consistency, test-retest, validation of questionnaire (the latter by ROC curve).

RESULTS: Brazilian PSQ has shown high internal consistency by Cronbach's alpha (0.86 for the total test, 0.83 for subscale "snoring", 0.64 for "sleepiness" and 0.65 for "behavior"). Test-retest presented a correlation of 0.89 for subscale "snoring", 0.93 for "sleepiness" and 0.86 for "behavior". Accuracy by ROC curve was 0.99. Nine was considered the optimal value to discriminate patients with obstructive sleep apnea from controls, with a sensitivity of 0.92 and specificity of 1.0.

CONCLUSION: The translation and cross-cultural adaptation of the PSQ into Brazilian Portuguese proved to be successful. In places with difficult access to polysomnography, PSQ can be a useful tool in screening and follow-up of children with obstructive sleep apnea.

PMID:33972191 | DOI:10.1016/j.bjorl.2021.03.009

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Assessing Agreement between Frequency-Specific Chirp Auditory Steady-State Response and Pure Tone Audiometry in Adults by Intraclass Correlation Coefficient

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Introduction: Chirp auditory steady-state response (ASSR) can be used to assess frequency-specific hearing thresholds. However, its reliability has not been confirmed yet. The purpose of this proposed study is to analyze the agreement of thresholds measured by chirp-ASSR and pure tone audiometry (PTA) to investigate the value of chirp-ASSR in hearing threshold evaluation. Methods: Participants with normal hearing (age: 18–66, 108 ears) and patients with sensorine ural hearing loss (age: 22–82, 75 ears) were tested using PTA and chirp-ASSR at 0.5, 1, 2, and 4 kHz, respectively. Intraclass correlation coefficient (ICC) and Bland-Altman plot were introduced to analyze the agreement between the 2 methods. Results: One-hundred eight participants underwent both chirp-ASSR and PTA to estimate their thresholds. The ICCs yielded by these 2 methods are 0.757, 0.893, 0.883, and 0.921 (p #x3c; 0.001) at 0.5, 1, 2, and 4 kHz carrier frequency, respectively. However, there is a significant difference between the 2 methods at 2 kHz: the mean value of the ASSR thresholds is 5.27 dB HL higher than the value of PTA thresholds. Additionally, the 95% limits of agreement range from −27.48 to 26.66 dB HL at 0.5 kHz, from −18.19 to 17.87 dB HL at 1 kHz, from −12.01 to 22.55 dB HL at 2 kHz, and from −21.29 to 19.17 dB HL at 4 kHz, which are large enough to affect clinical decision-making. Conclusion: In this study, we ha ve confirmed good to excellent correlation between chirp-ASSR and PTA in threshold estimation for adults with and without hearing loss. The degree of correlations is higher for participants with hearing loss and for measurements at high frequencies. However, significant systematic difference and large limits of agreement between the 2 methods have been found. These findings show that chirp-ASSR can be treated as a supplementary method to PTA when evaluating the hearing level, but the 2 methods are not interchangeable due to their systematic difference and large limits of agreement.
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The effect of prior radiation on the success of ventral skull base reconstruction: A systematic review and meta‐analysis

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Abstract

The incidence of cerebrospinal fluid leak after ventral skull base reconstruction is a primary outcome of interest to skull base surgeons. Exposure to pre‐operative radiation may put patients at an increased risk of skull base reconstructive failure. A systematic search identified studies which included patients receiving ventral skull base reconstruction in the setting of pre‐operative radiation. A meta‐analysis using a random effects model was conducted to estimate an odds ratio of cerebrospinal fluid (CSF) leak in patients exposed to pre‐operative radiation. A meta‐analysis of 13 studies demonstrated that the odds ratio of CSF leak was 1.73 (95% CI 0.98–3.05). The majority of studies (77%) used vascularized tissue grafts for reconstruction. We identified an increased incidence of CSF leak among patients undergoing ventral skull base reconstruction after prior radiation therapy, although not of statistical significance. Skull base surgeons should exercise caution whe n planning reconstruction in this population.

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Subacute Thyroiditis in COVID-19 Patients

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Ear Nose Throat J. 2021 May 11:1455613211012114. doi: 10.1177/01455613211012114. Online ahead of print.

ABSTRACT

OBJECTIVE: As a result of the COVID-19 pandemic that occurred in the last year, it has been revealed that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) does not only cause viral respiratory tract infection but can also affect many organs in the short or long term. In our study, we aimed to reveal that COVID-19 infection affects the endocrine system and triggers subacute thyroiditis (SAT) in the acute period.

MATERIAL AND METHOD: In our retrospective study, the ear-nose-throat examination, internal diseases consultation (investigation of COVID-19 symptoms and polymerase chain reaction [PCR] test), routine blood tests, T3, T4, thyroid-stimulating hormone, antithyroglobulin (anti-TG), antithyroid peroxidase (anti-TPO), thyroid scintigraphy, and thyroid ultrasonography results of 5 patients who applied to the otorhinolaryngology clinic due to complaints of neck pain and odynophagia between April 2020 and February 2021 were examined.

FINDINGS: All 5 patients were female patients (30.4 years) with odynophagia and pain in the front lower region of the neck. These patients had no previous history of thyroiditis. COVID-19 PCR tests of the patients diagnosed with SAT were positive, and there were no typical COVID-19 signs and symptoms except odynophagia and neck pain.

RESULT: It comes in view that SARS-COV-2 affects th yroid functions and causes SAT and the main symptoms in patients are pain in the neck and odynophagia.

PMID:33974811 | DOI:10.1177/01455613211012114

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