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Αλέξανδρος Γ. Σφακιανάκης

Thursday, November 18, 2021

Immediate and Short-term Effects of Straw Phonation in Air or Water on Vocal Fold Vibration and Supraglottic Activity of Adult Patients with Voice Disorders Visualized with Strobovideolaryngoscopy: A Pilot Study

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Purpose The first purpose of this study was to investigate and compare the short-term effects after a semi-occluded vocal tract (SOVT) therapy session consisting of straw phonation (SP) in air or water on vocal fold vibration and supraglottic activity of adult patients with voice disorders, visualized with strobovideolaryngoscopy (SVL). The second purpose of this study was to investigate and compare immediate changes in the patients' vocal fold vibration and supraglottic activity during SP in air or water, visualized with SVL.
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Complete Facial Paralysis Caused by Stabbing With a Car Key at the Stylomastoid Foramen

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Ear Nose Throat J. 2021 Nov 18:1455613211056548. doi: 10.1177/01455613211056548. Online ahead of print.

ABSTRACT

Non-iatrogenic traumatic facial paralysis is most common in intratemporal facial nerve injury caused by temporal bone fracture, followed by intraparotid facial nerve branch injury. Facial paralysis caused by injury to the extratemporal trunk of the facial nerve is extremely rare. We present a case of a 60-year-old man suffering from immediate complete left periphe ral facial paralysis due to blunt transection of extratemporal trunk of facial nerve by stabbing with a car key. There was a facial nerve defect about 1 cm in length. The great auricular nerve was grafted to repair the facial nerve. Over 12 months, his facial nerve function improved to a House-Brackmann III/VI.

PMID:34792423 | DOI:10.1177/01455613211056548

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Survival and swallowing function outcome impact factors analysis of surgery-oriented comprehensive treatment for hypopharyngeal cancer in a series of 122 patients

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Ear Nose Throat J. 2021 Nov 18:1455613211058108. doi: 10.1177/01455613211058108. Online ahead of print.

ABSTRACT

OBJECTIVE: Under current standards of treating highly aggressive hypopharyngeal cancer (HPC), oncological control and functional outcome are still unsatisfactory worldwide. This study explored the surgery-oriented comprehensive treatment approach based on 15 years of practice.

METHODS: A retrospective cohort of HPC patients treated by the senior author at Ch inese PLA General Hospital between Nov 2005 and Aug 2012 and Capital Medical University Beijing Friendship Hospital between May 2014 and Nov 2019 was studied. Oncological control, swallowing function, and quality of life (QoL) were assessed.

RESULTS: In total, 122 patients were included in this study, with 11 (9.0%) cases in the early stage and 111 (91.0%) cases in the advanced stage. Five-year overall survival (OS) and disease-free survival (DFS) were 40.0% and 36.1%, respectively. The swallowing outcome was satisfactory in 90 (73.8%) patients. Tracheostomy-free survival was achieved in 55 (45.1%) patients. Multivariate cox regression analysis showed that the size of the surgical defect, local-regional recurrence, and distant metastasis were independent impact factors for OS and DFS (P < .05). Multivariate analysis showed that the logistic regression coefficients (standard error) of pharyngo-cutaneous fistula and local-regional recurrence on swallowing function were 1.274 (.532) and 1.283 (.496), respectively (P < .05). In addition, the logistic regression coefficients (standard error) of the clinical stage, local-regional recurrence, decannulation, and feeding tube on QoL were -7.803 (3.593), -7.699 (3.151), 13.853 (3.494), and -20.243 (3.696), respectively (P < .05).

CONCLUSIONS: Surgery-oriented comprehensive treatment can give rise to good swallowing function without jeopardizing oncological control. The size of the surgical defect, local-regional recurrence, and distant metastasis were independent factors impacting OS and DFS. Pharyngo-cutaneous fistula and local-regional recurrence were independent factors impacting swallowing function. Clinical stage, local-regional recurrence, decannulation, and feeding tube were independent factors impacting QoL.

PMID:34792398 | DOI:10.1177/01455613211058108

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Wednesday, November 17, 2021

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial

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Clin Neurol Neurosurg. 2021 Nov 6;211:107020. doi: 10.1016/j.clineuro.2021.107020. Online ahead of print.

ABSTRACT

OBJECTIVE: We aimed to evaluate the functional recovery of stroke patients with orophyaryngeal dysphagia after treatment with traditional swallowing therapy (TST), neuromuscular electrical stimulation (NMES), and kinesiology taping (KT), by using clinical swallowing assessments and objective fiberoptic endoscopic evaluation of swallowing (FEES).

METHODS: A total of 37 patients were randomized in three groups: those who received TST and NMES as Group 1 (n:12), those who received both TST and KT as Group 2 (n:13), and those who received TST, NMES, and KT together as Group 3 (n:12). Patients were evaluated before treatment, after treatment, and three months after treatment onset with bedside water-swallow test, Eating Assessment Tool (EAT-10), Functional Oral Intake Scale (FOIS), penetration-aspiration scale (PAS), and Nationa l Institute of Health-Swallow Safety Scale (NIH-SSS). FOIS, PAS, and NIS-SSS were completed according to results of fiberoptic endoscopic evaluation of swallowing (FEES).

RESULTS: A statistically significant decrease was observed in bedside water-swallow test, EAT-10, PAS, and NIH-SSS scores in all treatment groups 5 weeks and 3 months after treatment onset compared to pre-treatment scores (p < 0.05). There was a statistically significant increase in FOIS scores 5 weeks and 3 months after treatment compared to pretreatment scores in all treatment groups (p < 0.05). When the pre-treatment, 3-week, and 5-month swallow scale scores of all groups were compared, there was no significant different difference in terms of bedside water-swallow test, EAT-10, FOIS, PAS, or NIH-SSS scores (p > 0.05).

CONCLUSION: According to the results of our study, KT is a new option in the treatment of stroke-related dysphagia, is an effective treatment approach and its efficacy is main tained throughout long-term follow-up.

PMID:34781221 | DOI:10.1016/j.clineuro.2021.107020

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Comparison of the value of ultrasound and enhanced magnetic resonance imaging in judging cervical lymph node metastasis in patients with oral cancer

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Bull Cancer. 2021 Nov 12:S0007-4551(21)00423-9. doi: 10.1016/j.bulcan.2021.09.010. Online ahead of print.

ABSTRACT

BACKGROUND: Oral cancer is the twelfth largest malignant tumor in the world. Oral cancer is prone to lymph node metastasis in the early stages of the disease, and lymph node metastasis will directly affect the treatment and survival rate. Therefore, whether the lymph node metastasis can be accurately evaluated is of great significance to the treatment and prognosis of patients.

OBJECTIVE: The diagnostic efficacy of three methods of preoperative ultrasound, enhanced magnetic resonance (enhanced MR), and ultrasound combined with enhanced MR on cervical lymph node metastasis of oral cancer were compared.

MATERIALS AND METHODS: A retrospective analysis of 399 cases of oral cancer completed by head and neck surgery at Cancer Center of Sun Yat-sen University, China. In all cases, the maxillofacial and neck enhanced M R and cervical lymph node ultrasound examinations were performed before surgery, and imaging diagnosis was made for cervical lymph node metastasis and compared with pathology. All judgment results were statistically processed using the chi-square test.

RESULTS: Compared with the above three methods, the diagnostic efficiency of ultrasound alone is better, and the diagnostic efficiency of enhanced MR combined ultrasound is not significantly better than that of ultrasound alone. There are differences in the diagnostic efficacy of the three inspection methods in different clinical sub-periods, all of which are better for the diagnosis of stage I. For patients with stage I, II, and III, there were no differences between the three examination methods. However, for stage IV patients,the diagnostic efficiency of ultrasound alone is better. For patients with stage N0, there was no difference in diagnostic efficacy between the three methods. For the assessment of lymph nodes in the I-I II region, there are differences between the three methods of examination: the diagnostic efficiency of ultrasound alone is better, and enhanced MR combined ultrasound is not significantly better than ultrasound alone. For the evaluation of lymph nodes in the IV-VII region, there was no difference in diagnostic efficacy between the three methods.

CONCLUSION: According to the clinical characteristics and prognosis of patients with oral cancer, although enhanced MR can better evaluate the tumor, ultrasound may be considered as the preferred imaging method for cervical lymph node metastasis.

SIGNIFICANCE: Accurate assessment and proper and timely treatment of lymph node metastasis can help improve the survival rate of patients.

PMID:34782121 | DOI:10.1016/j.bulcan.2021.09.010

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Patient partnership and patient education in oncology

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Bull Cancer. 2021 Nov 12:S0007-4551(21)00440-9. doi: 10.1016/j.bulcan.2021.09.016. Online ahead of print.

ABSTRACT

INTRODUCTION: Over the last 40years, the French health system has opened up to patient engagement. Society has recognised the legitimacy of the patient as a decision-maker in his or her own health and as an expert in his or her illness. This is true at the individual level in the context of doctor-patient relationship, and at the organisational level within institutions, in decision-making or academic groups. The aim of this study is to present the concepts of patient-partnership, patient education and to illustrate the different functions that patient-partners can take within the organisation of patient education programmes, and in the field of oncology.

METHOD: A narrative review of the literature was carried out to extract relevant and recent seminal articles to address these points.

RESULTS: The Montreal mo del establishes the patient partner as a full care actor. He can thus contribute his expertise in many fields of application: care, research or teaching. The aim of patient education is to empower the patient in the management of his or her disease, treatment and the consequences of these on daily life. The patient partner has a full place in this system where he can accompany his peers, but also collaborate with the educational team to develop new programmes, evaluate them and even conduct research. The implementation of these systems consists of getting individuals with different cultures and operating methods to work together. It is a process that requires time, effort and attention to each other.

PMID:34782118 | DOI:10.1016/j.bulcan.2021.09.016

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Artificial intelligence and medical imaging

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Bull Cancer. 2021 Nov 12:S0007-4551(21)00422-7. doi: 10.1016/j.bulcan.2021.09.009. Online ahead of print.

ABSTRACT

The use of artificial intelligence methods for image recognition is one of the most developed branches of the AI field and these technologies are now commonly used in our daily lives. In the field of medical imaging, approaches based on artificial intelligence are particularly promising, with numerous applications and a strong interest in the search for new biomarkers. Here, we will present the general methods used in these approaches as well as the potential areas of application.

PMID:34782120 | DOI:10.1016/j.bulcan.2021.09.009

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