S193 – Voice and Swallowing after Jugular Foramen Surgery

Objectives This study was designed to evaluate the role and timing of surgical procedures for voice and swallowing rehabilitation in patients after surgery for jugular foramen tumors. Methods A retrospective case series. The records of patients operated for jugular foramen tumors from January 2002 to February 2008 were reviewed for lower cranial nerves function, hoarseness, dysphagia and aspiration, recovery course and rehabilitation procedures. Results 17 patients underwent surgery for jugular foramen tumors. Tumors included 12 glomus jugulare, 4 schwannomas and 1 meningioma. 3 patients had presented with vagal and glossopharyngeal paralysis and 6 more patients developed post-operative paralysis. All patients with paralysis experienced dysphagia and hoarsheness. 6 experienced aspiration. Gastrostomy or nasogastric tube feeding were required in 3 patients. 7 patients did not recover nerve function by the end of follow-up. Treatments to improve voice and swallowing included vocal cord medialization by collagen injection (n=3), thyroplasty type 1 (n=5) with arytenoid adduction (n=4), cricopharyngeal myotomy (n=2), and palatal adhesion (n=3). Conclusions Postoperative dysphonia, dysphagia, and aspiration are common in patients after surgery for jugular foramen tumors. Most patients are unlikely to regain vagal or glossopharyngeal nerve functions at 1 year of follow-up, and will eventually elect to undergo corrective surgery to improve voice quality and swallowing function. Preoperative evaluation and close postoperative follow-up by an experienced laryngologist will help identify patients who will benefit from early surgical rehabilitation.

Download Full-text

DOZ047.34: Oral feeding attainment

Diseases of the Esophagus ◽

10.1093/dote/doz047.34 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

K Hernandez ◽

K Davidson ◽

J Dargie ◽

R Jennings ◽

M Manfredi

Keyword(s):

Esophageal Atresia ◽

Genetic Diagnosis ◽

Tube Feeding ◽

Case Series ◽

Oral Feeding ◽

Retrospective Case ◽

Genetic Syndrome ◽

Feeding Success ◽

Therapeutic Services

Abstract Aim A primary goal of esophageal atresia repair is to establish esophageal continuity to allow for swallowing of secretions, liquid, and food boluses. The transition to oral feeding and acquisition of oral sensorimotor skills following repair of long-gap esophageal atresia (LGEA) can be challenging. The timing of attaining full PO status (F-PO), without need for enteral tube feeding support, can vary greatly. A retrospective study was performed to identify predictors of oral feeding success in children with LGEA. Methods A retrospective case series was conducted with chart review of patients with a diagnosis of LGEA who underwent Foker process for staged repair from 2012 to 2017. Children with previous failed attempts at esophageal repair or other significant surgeries were excluded. Comparison was made between patients who achieved full PO status (F-PO) within the study follow-up period (minimum of one year postrepair) and those who did not. Results Twenty-three patients were included: twelve male and eleven female. Eight patients (35%) had an accompanying genetic diagnosis. Thirteen patients (57%) were born prematurely. Six patients (26%) were F-PO at 6 month post-repair; four of which were on an age appropriate diet without restrictions/modifications. Thirteen patients (57%) achieved F-PO by end of the study follow-up period while 43% required supplemental nutrition. Gestational age ≥ 37 weeks (P = 0.03), younger age at first PO trial (P = 0.013), shorter time between Foker 2 and first PO trial (P = 0.011), consistent PO intake at 6 months post-repair (P = 0.02), and fewer total number of airway/esophageal procedures within 1 year post-repair (P = 0.018) were found to be significantly associated with achieving F-PO. Total number of esophageal dilations within 2 years of esophageal repair and presence of a genetic syndrome were not significantly different between groups. Conclusion A majority of patients (57%) who undergo repair of LGEA via Foker process will progress to oral feeding; however, the timing of this progression is variable. Predictors of oral feeding success can be used to guide prognosis and identify patients at greatest need of therapeutic services.

Download Full-text

THU0319 DEVELOPMENT AND OUTCOME OF AORTIC COMPLICATIONS DURING TOCILIZUMAB TREATMENT OF GCA AND HISTOPATHOLOGIC EVIDENCE OF RESIDUAL INFLAMMATION-A CASE SERIES.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4660 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 388.2-389

Author(s):

A. Rubbert-Roth ◽

P. K. Bode ◽

T. Langenegger ◽

C. Pfofe ◽

T. Neumann ◽

...

Keyword(s):

Structural Changes ◽

Case Series ◽

Aortic Aneurysms ◽

Imaging Data ◽

Limited Data ◽

Retrospective Case ◽

Pet Ct ◽

Fdg Pet Ct ◽

Pet Ct Scan

Background:Giant cell arteritis (GCA) may affect the aorta and the large aortic branches and lead to dissections and aortic aneurysms. Tocilizumab (TCZ) treatment has the capacity to control aortic inflammation as has been demonstrated by CRP normalization and imaging data. However, limited data are available on the histopathological findings obtained from patients who underwent surgery because of aortic complications during TCZ treatment.Objectives:We report on 5 patients with aortitis who were treated with TCZ and developed aortic complications.Methods:We describe a retrospective case series of patients with GCA treated with TCZ, who presented in our clinic between 2011 and 2019. Three patients underwent surgery. Histopathologic examination was performed in specimen from all of them.Results:Five female patients were diagnosed with GCA (4/5) or Takaysu arteritis (1/5) involving the aorta, all them diagnosed by MR angiography and/or FDG PET CT scan. Three patients (one with aortic aneurysm, one with dissection) underwent surgery after having been treated with TCZ for seven weeks, nine months and four years, respectively. Imaging before surgery showed remission on MRI and/or PET-CT in all cases. At the time of surgery, all patients showed normalized CRP and ESR values. Histopathological evaluation of the aortic wall revealed infiltrates, consisting predominantly of CD3+CD4+ T cells. Enlargement of pre-existing aneuryms was observed in the other two patients 10 weeks and 4 months after discontinuation of TCZ, respectively. Both patients were not eligible for surgical intervention and died during follow-up.Conclusion:Our case series suggests that during treatment with TCZ, regular imaging is necessary in this patient population to detect development of structural changes such as aneurysms or dissections. Despite treatment, residual inflammation might persist which could contribute to eventual aortic complications.Disclosure of Interests:Andrea Rubbert-Roth Consultant of: Abbvie, BMS, Chugai, Pfizer, Roche, Janssen, Lilly, Sanofi, Amgen, Novartis, Peter Karl Bode: None declared, Thomas Langenegger: None declared, Claudia Pfofe: None declared, Thomas Neumann: None declared, Olaf Chan-Hi Kim: None declared, Johannes von Kempis Consultant of: Roche

Download Full-text

Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02888-3 ◽

2021 ◽

Author(s):

Gabriele Colo’ ◽

Mattia Alessio Mazzola ◽

Giulio Pilone ◽

Giacomo Dagnino ◽

Lamberto Felli

Keyword(s):

Range Of Motion ◽

Case Series ◽

Deformity Correction ◽

Tibialis Posterior ◽

Open Wedge ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

Download Full-text

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

Ocular Oncology and Pathology ◽

10.1159/000512030 ◽

2021 ◽

pp. 1-9

Author(s):

Biljana Kuzmanović Elabjer ◽

Mladen Bušić ◽

Andrej Pleše ◽

Mirjana Bjeloš ◽

Daliborka Miletić ◽

...

Keyword(s):

Uveal Melanoma ◽

Tumor Regression ◽

Corneal Thickness ◽

Case Series ◽

Ultrasound Biomicroscopy ◽

Close Monitoring ◽

Single Institution ◽

Retrospective Case ◽

Caucasian Patients

Introduction: Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective: Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods: This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results: The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion: The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

Download Full-text

Bilateral ocular surface squamous neoplasia: A study of 25 patients and review of literature

European Journal of Ophthalmology ◽

10.1177/11206721211007109 ◽

2021 ◽

pp. 112067212110071

Author(s):

Vijitha S Vempuluru ◽

Monalisha Pattnaik ◽

Neha Ghose ◽

Swathi Kaliki

Keyword(s):

Risk Factors ◽

Ocular Surface ◽

Histopathological Examination ◽

Topical Steroid ◽

Case Series ◽

Intraepithelial Neoplasia ◽

Excisional Biopsy ◽

Ocular Surface Squamous Neoplasia ◽

Retrospective Case

Purpose: To describe the risk factors, clinical presentation, management, and outcomes of patients with bilateral ocular surface squamous neoplasia (OSSN). Methods: Retrospective case series. Results: Of the 25 patients with bilateral OSSN, the mean age at diagnosis of OSSN was 31 years (median, 24 years; range, 2–60 years). Risk factors for bilateral OSSN included xeroderma pigmentosum ( n = 15, 60%), human immunodeficiency virus infection ( n = 3, 12%), conjunctival xerosis ( n = 1, 4%), and topical steroid use ( n = 1, 4%). There were no identifiable ocular or systemic risk factors in 7 (28%) patients. Presentation was synchronous in 14 (56%) and metachronous in 11 (44%) patients. Tumor morphology was bilaterally similar in 12 (48%) patients. Histopathological examination ( n = 36) revealed conjunctival intraepithelial neoplasia (CIN) grade 1 in 4 (8%); grade 2 in 7 (14%); carcinoma in situ in 5 (10%), and invasive carcinoma in 20 (40%). Primary management of OSSN ( n = 49) included excisional biopsy ( n = 31, 62%), topical immunotherapy (IFN α2B) ( n = 11; 22%), topical Mitomycin C (MMC) ( n = 3, 6%), enucleation ( n = 1, 2%), orbital exenteration ( n = 2, 4%), and plaque brachytherapy (PBT) ( n = 1, 2%). One patient was lost to follow-up after detection of tumor in the second eye. Recurrent tumors were noted in 16 (32%) eyes and binocular globe salvage was achieved in 16 (64%) patients at a mean follow up of 41 months (median 30 months; range, 1–164 months). Conclusion: OSSN occurrence can be synchronous or metachronous. Meticulous examination of the fellow eye is important for an early diagnosis of OSSN.

Download Full-text

Transmastoid Hydroxyapatite Resurfacing for Sigmoid Sinus Wall Anomalies Causing Pulsatile Tinnitus

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420987407 ◽

2021 ◽

pp. 000348942098740

Author(s):

Ian Newberry ◽

Julie Highland ◽

Alvin DeTorres ◽

Richard Gurgel

Keyword(s):

Case Series ◽

Sigmoid Sinus ◽

Pulsatile Tinnitus ◽

Retrospective Case ◽

Tertiary Referral Center ◽

Operative Outcomes ◽

Sinus Wall ◽

Objective Tinnitus ◽

Materials Used

Objective: Comprising 4% of tinnitus, pulsatile tinnitus (PT) can be particularly difficult for affected patients as well as surgeons looking to address their symptoms. Often the cause is not identified but can be secondary to turbulent flow in or near the sigmoid sinus, particularly if there is an identifiable sigmoid sinus dehiscence (SSDe) and/or diverticulum (SSDi). These sigmoid sinus wall anomalies (SSWA) may be treated with transmastoid sigmoid sinus resurfacing; however, this intervention remains relatively novel and its technique, materials used, resolution success, and complications need to be continuously reviewed. Methods: A retrospective case series of patients with PT due to SSWA at a tertiary referral center was reviewed. A total of 6 patients (7 ears) treated by transmastoid resurfacing using hydroxyapatite (HA) were retrospectively assessed. Pre-operative demographics and symptoms, pre- and post-operative hearing results, and post-operative outcomes were reviewed. Results: All patients were female with an average BMI of 32.9 (±5.4) and a mean age of 45.5 years (±15.3). Mean follow-up was 648 days. Objective tinnitus was noted in all ears with SSDi (100%); however, no objective tinnitus was noted with purely SSDe. In 100% of ears, PT was diminished with ipsilateral jugular compression and was amplified with contralateral head turn. Pre-operative symptoms of PT resolved in all patients, but delayed recurrence (>1 year) occurred in 1 ear (14%). No patient had pre- or post-operative hearing loss. No major complications were encountered. Conclusions: Transmastoid resurfacing for SSWA with HA bone cement is a safe, reliable intervention in properly identified PT patients.

Download Full-text

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

Foot & Ankle International ◽

10.1177/10711007211006032 ◽

2021 ◽

pp. 107110072110060

Author(s):

Michael F. Githens ◽

Malcolm R. DeBaun ◽

Kimberly A Jacobsen ◽

Hunter Ross ◽

Reza Firoozabadi ◽

...

Keyword(s):

Case Series ◽

High Energy ◽

Ankle Fractures ◽

Posttraumatic Arthritis ◽

Retrospective Case ◽

Level Of Evidence ◽

Radiographic Findings ◽

Posttraumatic Arthrosis ◽

Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand

Foot & Ankle International ◽

10.1177/1071100719883266 ◽

2019 ◽

Vol 41 (2) ◽

pp. 187-192

Author(s):

Ricardo E. Colberg ◽

Monte Ketchum ◽

Avani Javer ◽

Monika Drogosz ◽

Melissa Gomez ◽

...

Keyword(s):

Conservative Treatment ◽

Plantar Fasciitis ◽

Case Series ◽

Successful Outcome ◽

Oral Steroid ◽

Tarsal Tunnel ◽

Retrospective Case ◽

Level Of Evidence ◽

Plantar Fasciotomy

Background: Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. Methods: A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% ( N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. Results: The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders ( P < .05). Being an athlete was a positive confounder ( P = .02). Conclusion: Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. Level of Evidence: Level IV, retrospective case series.

Download Full-text

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

Foot & Ankle Specialist ◽

10.1177/1938640020980925 ◽

2021 ◽

pp. 193864002098092

Author(s):

Devon W. Consul ◽

Anson Chu ◽

Travis M. Langan ◽

Christopher F. Hyer ◽

Gregory Berlet

Keyword(s):

Case Series ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Implant Survival ◽

Ankle Arthritis ◽

Single Institution ◽

Retrospective Case ◽

Ankle Replacement ◽

End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

Download Full-text

One-year Follow-Up Results with Hydrogel Implant in Therapy of Hallux Rigidus: Case Series with 44 Patients

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1365-9655 ◽

2021 ◽

Author(s):

Christoph Zanzinger ◽

Norbert Harrasser ◽

Oliver Gottschalk ◽

Patrick Dolp ◽

Florian Hinterwimmer ◽

...

Keyword(s):

Learning Algorithm ◽

Case Series ◽

Metatarsophalangeal Joint ◽

Hallux Rigidus ◽

Therapy Failure ◽

Retrospective Case ◽

Aofas Score ◽

Medium Level ◽

One Year

Abstract Background The Cartiva implant (CI) is being increasingly used in the surgical therapy of hallux rigidus. Despite a growing number of studies, numerous questions regarding patient selection remain unanswered. Patients and Methods As part of a retrospective case series with prospective follow-up (average follow-up period: 12 months), a total of 44 patients (male/female = 16/28; mean age at the time of surgery: 55.4 years) with 44 CI were analysed (VAS, EFAS-, AOFAS-score). Using a correlation analysis and a machine learning algorithm, risk factors for therapy failure were investigated. Results The overall survival rate of the CI was 93% at 12 months. The VAS, EFAS and AOFAS scores showed a significant improvement in comparison to the preoperative condition. The mobility of the metatarsophalangeal joint showed no increase. Patients with a medium osteoarthritis grade and a medium level of clinical restraint showed the greatest improvement in relation to their preoperative condition. Conclusion The CI can be seen as an effective therapy for hallux rigidus. Nonetheless, realistic patient expectations must be communicated.

Download Full-text