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Αλέξανδρος Γ. Σφακιανάκης

Thursday, September 9, 2021

Efficacy of the pretreatment geriatric nutritional risk index for predicting severe adverse events in patients with head and neck cancer treated with chemoradiotherapy: Efficacy of the pretreatment Geriatric Nutritional Risk Index for predicting severe adverse events

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Publication date: Available online 9 September 2021

Source: Auris Nasus Larynx

Author(s): Masahiro Nakayama, Kayoko Ohnishi, Masahiro Adachi, Rieko Ii, Shin Matsumoto, Masatoshi Nakamura, Hidetaka Miyamoto, Yuki Hirose, Bungo Nishimura, Shuho Tanaka, Tetsuro Wada, Keiji Tabuchi

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Bench testing of tracheostomy tube-related insults using an instrumented manikin

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Eur Arch Otorhinolaryngol. 2021 Sep 9. doi: 10.1007/s00405-021-07054-3. Online ahead of print.

ABSTRACT

PURPOSE: Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury.

METHODS: We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin.

RESULTS: Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models.

CONCLUSION: Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury.

LEVEL OF EVIDENCE: Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.

PMID:34499203 | DOI:10.1007/s00405-021-07054-3

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SARS-CoV-2 vaccine-induced subacute thyroiditis

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Publication date: Available online 9 September 2021

Source: American Journal of Otolaryngology

Author(s): Krupa R. Patel, Mary E. Cunnane, Daniel G. Deschler

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Submental Flap in the Reconstruction of Palatal Defects

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Abstract

Amongst oral cancers, malignancies of the palate and the upper gingivo-buccal complex are relatively uncommon. Following resection, defects in the palate lead to a nasal speech and nasal regurgitation on swallowing. This is best overcome with a prosthetic obturator which occludes the palatal defect and has dentures for the upper alveolus. It may not be possible to fit a prosthetic obturator in edentulous patients and in patients with trismus. Microvascular free flaps though commonly used for such defects, are time consuming, expensive and require a specialised setup. This study assesses the submental flap for its feasibility to repair palatal defects, the sturdiness of the flap, its functional outcome and the oncological safety in using the flap. This is a retrospective analysis of 46 patients, where palatal defects for oral cancers were reconstructed with the submental flap. Oncological safety was studied in 41 patients with a median follow-up of 34.5 month s. 20 patients were studied for their functional outcomes using the parameters, adopted from the University of Washington-Quality of Life questionnaire. Complete flap loss was seen in 4 (8.7%) patients while 2 (4.35%) patients had minor dehiscence. No donor site morbidity was reported. Locoregional Recurrences and distant metastasis were noted in 13 of the 41 patients studied. The mean score was highest for speech at 95.5% while the lowest mean score was for mouth opening at 42.5%. The submental flap is an effective and reliable alternative for the reconstruction of palatal defects.

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Recurrent Giant Mucoepidermoid Carcinoma of the Parotid: A Case Report and Review of Literature

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Abstract

Mucoepidermoid carcinoma is the most common salivary gland malignancy and about one third occurs in the parotid gland. The peak incidence is commonly seen between the third and fifth decades of life. It routinely presents as a fixed, painless mass below the ear. However, its presentation as a giant mass is exceedingly rare. Here, we report a case of a recurrent giant exophytic mucoepidermoid carcinoma in a young male. He underwent Revision Total Parotidectomy with Modified Radical neck dissection with Sural nerve grafting and an Anterolateral thigh flap reconstruction followed by Adjuvant radiotherapy. The rarity of the clinical presentation and the management challenges faced in a young male are being discussed in this case report.

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Is Revision Surgery Necessary for Patients With High Risk of Recurrence After Parotidectomy? A Multicenter Retrospective Study

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Ann Otol Rhinol Laryngol. 2021 Sep 8:34894211045269. doi: 10.1177/00034894211045269. Online ahead of print.

ABSTRACT

OBJECTIVES: Close margin is a frequent situation after parotidectomy. The need for systematic prophylactic revision surgery is a question that arises regularly for malignant tumors, as it exposes to a high risk of facial palsy, while oncological benefits are unclear.

STUDY DESIGN: retrospective study.

SETTING: Multicentric.

SUBJECTS AND METHO DS: We included all patients operated for systematic revision surgery in case of close margins after parotidectomy for a malignant tumor and analyzed the rate of tumor residue and its risk factors.

RESULTS: A tumor residue was identified in 43.5% of 23 cases, but none in case of initial complete excision with supra-millimetric margins. Invaded lymph nodes were identified in 6 cases, but none in case of low-grade tumors.

CONCLUSIONS: Systematic revision seems mandatory in case of infra-millimetric margins and high-grade tumors or positive lymph node; further studies are needed to confirm whether it can be spared for T1-T2/N0 low-grade tumors, with close margins but complete initial excision.

PMID:34496666 | DOI:10.1177/00034894211045269

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Neck Mass in an Adolescent

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Neck Mass in an Adolescent
Saikrishna C. Gourishetti, MD1; Jamie Hittman, MD2; Kevin D. Pereira, MD, MS1,3
Author Affiliations
1Department of Otorhinolaryngology–Head and Neck Surgery, University of Maryland School of Medicine, Baltimore
2Department of Pathology, University of Maryland School of Medicine, Baltimore
3Department of Pediatrics, University of Maryland School of Medicine, Baltimore
JAMA Otolaryngol Head Neck Surg. Published online September 9, 2021. doi:10.1001/jamaoto.2021.2314

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Text
A 13-year-old male presented to the pediatric otolaryngology clinic with a 2-year history of a right neck mass that had slowly increased in size. He denied any associated symptoms of pain, fevers, chills, malaise, night sweats, unintentional weight loss, prior history of neck masses, recent upper respiratory tract infections, or skin lesions. He was the product of a full-term pregnancy with up-to-date immunizations. Physical examination revealed a 2.5-cm firm, ovoid, mobile, and nontender mass at the apex of the posterior triangle of the right neck without any associated overlying skin changes. The remainder of the head and neck examination was unremarkable. Doppler ultrasonography revealed a 1.9 × 1.8 × 0.9-cm hypoechoic mass, and subsequent fine-needle aspirates demonstrated cells with elongated nuclei and eccentric blue cytoplasm in a background of myxoid stroma. The mass was excised in entirety without issue. At the time of surgery, the deep surface of the mass was foun d to be adherent to the sternocleidomastoid muscle. The lesion was resected with a cuff of muscle and sent for permanent histopathological examination. This revealed proliferation of bland spindle cells with plump nuclei and eosinophilic cytoplasm arranged as loose fascicles in a background of myxoid stroma (Figure 1). These cells were positive for mucin 4 (MUC4), epithelial membrane antigen (EMA), and transducing-like enhancer of split 1 (TLE1) immunohistochemical stains. Fluorescence in situ hybridization (FISH) revealed a positive FUS (16p11) gene rearrangement.

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This case report describes a 13-year-old male who presented with a 2-year history of a right neck mass that had slowly increased in size. What is your diagnosis?
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