Head and neck free-flap salvage

xlomafota13 shared this article with you from Inoreader Head and neck free-flap salvage Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To highlight three clinical arenas in which head and neck free-flap compromise is encountered and acted upon: nonoperative, operative and postoperative realms. Recent findings Time to identification and intervention is paramount to successful free-flap salvage. Surgical microvascular revision remains chief amongst strategies to revert vascular compromise of a free-flap. Adjuncts, such as thrombolytics and systemic anticoagulation have an important role in the complex work of microvascular free tissue care. Venous congestion of free flaps holds favorable for salvage when compared with arterial insufficiency. Summary Vascular compromise of head and neck free flaps is a rare and feared event for microvascular surgeons, with successful transfers rates approaching above 95%. Success in salvage is dependent on prompt identification of tissue compromise and timely, directed interventions to re-establish tissue perfusion. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hearing restoration and the stria vascularis: evidence for the role of the immune system in hearing restoration

xlomafota13 shared this article with you from Inoreader Hearing restoration and the stria vascularis: evidence for the role of the immune system in hearing restoration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This article reviews the current literature regarding the pathogenesis of immune-mediated sensorineural hearing loss, utilizes previously published single-nucleus transcriptional profiles to characterize cytokine and cytokine receptor expression in the adult stria vascularis cell types to support immune system interaction with the stria vascularis and reviews the current literature on immunomodulatory agents currently being used for hearing-restoration treatment. Recent findings The literature review highlights recent studies that elucidate many cytokines and immune markers, which have been linked to various immune-mediated disease processes that have been observed with sensorineural hearing loss within the stria vascularis and highlights recent publications studying therapeutic targets for these pathways. Summary This review highlights the current literature regarding the pathogenesis of immune-mediated hearing loss. The role of cochlear structures in human temporal bones from patients with immune-mediated sensorineural hearing loss are highlighted, and we review cytokine signalling pathways relevant to immune-mediated sensorineural hearing loss and localize genes encoding both cytokine and cytokine receptors involved in these pathways. Finally, we review immunomodulatory therapeutics in light of these findings and point to opportunities for the application of novel therapeutics by targeting these signalling pathways. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sarcopenia and microvascular free flap reconstruction

xlomafota13 shared this article with you from Inoreader Sarcopenia and microvascular free flap reconstruction Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This article reviews the recent literature regarding the impact of sarcopenia on microvascular free flap reconstruction outcomes. Recent findings Malnutrition, and consequent muscle loss, is a prevalent issue among head and neck cancer patients. However, diagnosis remains challenging due to a paucity of reliable objective measures. Traditional markers, such as albumin, have been used in the past to assess nutritional status, but cancer-related inflammation limits their predictive value. Recently, developments in the diagnosis of sarcopenia through the novel use of computed tomography (CT) cross-sectional muscle mass indices to evaluate body composition have proven effective and accessible. Summary Literature shows compelling evidence that sarcopenia is associated with higher rates of surgical complications that delay recovery and increase mortality. The use of CT imaging to quantify muscle loss offers an objective way to evaluate nutritional status, which is predictive of postoperative rates of complications. Research on ways to optimize muscle mass prior to surgery is limited, however, immunonutrition is emerging as a promising intervention that can attenuate sarcopenia-related inflammation to improve outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Understanding the differentiation and epigenetics of cochlear sensory progenitors in pursuit of regeneration

xlomafota13 shared this article with you from Inoreader Understanding the differentiation and epigenetics of cochlear sensory progenitors in pursuit of regeneration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Sensory hair cells (HCs) of the inner ear are responsible for our ability to hear and balance. Loss of these cells results in hearing loss. Stem cell replacement and in situ regeneration have the potential to replace lost HCs. Newly discovered contributions of transcription factor regulatory networks and epigenetic mechanisms in regulating HC differentiation and regeneration are placed into context of the literature. Recent findings A wealth of new data has helped to define cochlear sensory progenitors in their developmental trajectories. This includes transcription factor networks, epigenetic manipulations, and cochlear HC subtype specification. Summary Understanding how sensory progenitors differ and how HC subtypes arise will substantially inform efforts in hearing restoration. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Insights into the molecular mechanisms regulating mammalian hair cell regeneration

xlomafota13 shared this article with you from Inoreader Insights into the molecular mechanisms regulating mammalian hair cell regeneration Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To give an overview of recent advances in mammalian auditory hair cell regeneration. Recent findings Supporting cells act as progenitors to regenerate hair cells in the prehearing mammalian cochlea but not in the mature cochlea. To overcome this developmental obstacle, manipulation of multiple genes and intracellular pathways has been investigated, which has obtained promising data. This review focuses on recent advances in auditory hair cell regeneration, including synergic gene regulation associated with Atoh1 and Notch signaling, epigenetics, and functional recovery of regenerated hair cells. Co-manipulation of genes critical for hair cell development and cell cycle re-entry, including Atoh1, Isl1, Pou4f3, Gata3, Gfi1, P27kip1, RB, Myc, and Notch-signaling genes, has generated hair cell-like cells in the adult cochlea both in vitro and in vivo. The epigenetic mechanism has been studied in hair cell development and regeneration. Regeneration of hair cell function has a very limited progress, which lacks in-vitro and in-vivo electrophysiology data. Summary Regeneration of adult auditory hair cells remains a major challenge. Manipulation of multiple genes and pathways together with epigenetic regulation might potentially regenerate functional hair cells in the adult mammalian cochlea. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Advances in hearing preservation in cochlear implant surgery

xlomafota13 shared this article with you from Inoreader Advances in hearing preservation in cochlear implant surgery Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Advancements in cochlear implant surgical approaches and electrode designs have enabled preservation of residual acoustic hearing. Preservation of low-frequency hearing allows cochlear implant users to benefit from electroacoustic stimulation, which improves performance in complex listening situations, such as music appreciation and speech understanding in noise. Despite the relative high rates of success of hearing preservation, postoperative acoustic hearing outcomes remain unpredictable. Recent findings Thin, flexible, lateral wall arrays are preferred for hearing preservation. Both shortened and thin, lateral wall arrays have shown success with hearing preservation and the optimal implant choice is an issue of ongoing investigation. Electrocochleography can monitor cochlear function during and after insertion of the electrode array. The pathophysiology of hearing loss acutely after cochlear implant may differ from that involved in delayed hearing loss following cochlear implant. Emerging innovations may reduce cochlear trauma and improve hearing preservation. Summary Hearing preservation is possible using soft surgical techniques and electrode arrays designed to minimize cochlear trauma; however, a subset of patients suffer from partial to total loss of acoustic hearing months to years following surgery despite evidence of residual apical hair cell function. Early investigations in robotic-assisted insertion and dexamethasone-eluting implants show promise. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Emerging artificial intelligence applications in otological imaging

xlomafota13 shared this article with you from Inoreader Emerging artificial intelligence applications in otological imaging Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To highlight the recent literature on artificial intelligence (AI) pertaining to otological imaging and to discuss future directions, obstacles and opportunities. Recent findings The main themes in the recent literature centre around automated otoscopic image diagnosis and automated image segmentation for application in virtual reality surgical simulation and planning. Other applications that have been studied include identification of tinnitus MRI biomarkers, facial palsy analysis, intraoperative augmented reality systems, vertigo diagnosis and endolymphatic hydrops ratio calculation in Meniere's disease. Studies are presently at a preclinical, proof-of-concept stage. Summary The recent literature on AI in otological imaging is promising and demonstrates the future potential of this technology in automating certain imaging tasks in a healthcare environment of ever-increasing demand and workload. Some studies have shown equivalence or superiority of the algorithm over physicians, albeit in narrowly defined realms. Future challenges in developing this technology include the compilation of large high quality annotated datasets, fostering strong collaborations between the health and technology sectors, testing the technology within real-world clinical pathways and bolstering trust among patients and physicians in this new method of delivering healthcare. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.