scholarly journals Treatment of Head and Neck Venous Malformations with Sodium Tetradecyl Sulfate

OTO Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. 2473974X1879706 ◽  
Author(s):  
Ebrahim Karimi ◽  
Mehrdad Jafari ◽  
Keyvan Aghazadeh ◽  
Saeed Sohrabpour ◽  
Fatemeh Tavakolnejad
Keyword(s):  
Head And Neck ◽  
Venous Malformation ◽  
Case Series ◽  
Neck Surgery ◽  
Lesion Size ◽  
Sodium Tetradecyl Sulfate ◽  
Venous Malformations ◽  
Medical Sciences ◽  
Before And After

Objective The purpose of this study was to discuss the clinical outcomes and complications of treating venous malformations with sclerotherapy, with sodium tetradecyl sulfate as the sclerosing agent. Study Design Case series with planned data collection. Setting Amiralam Hospital—a referral otolaryngology–head and neck surgery hospital affiliated with Tehran University of Medical Sciences. Subjects and Methods A total of 345 patients with venous malformations were treated with sclerotherapy with sodium tetradecyl sulfate 3% (1 mL for every 1 cm3 of the lesion). The venous malformation location, treatments before the current sclerotherapy with sodium tetradecyl sulfate, the number of sclerotherapy sessions, and complications resulting from sclerotherapy were recorded. Follow-up assessments were done for a minimum of 1 year following the procedure. A favorable outcome was defined as a 50% decrease in the lesion size based on clinical and radiologic assessments. Results A total of 759 injection sessions were documented, ranging from 1 to 6 injections per patient (mean = 3.1). The follow-up duration ranged from 12 to 84 months (mean = 55 months). Based on clinical assessment, a 50% reduction of size was reported for 95.6% of the patients. According to the imaging before and after the procedures, a 50% reduction of size was seen among 67.3% of the patients. Conclusion The results of the study showed that the use of sodium tetradecyl sulfate as a sclerosing substance can effectively reduce the size of venous malformation lesions.

Percutaneous sclerotherapy of para-orbital and orbital venous malformation: A single center, case series

2018 ◽  
Vol 34 (5) ◽  
pp. 355-361 ◽  
Author(s):  
Saima Ahmad ◽  
Fahd Kamal Akhtar
Keyword(s):  
Venous Malformation ◽  
Symptomatic Relief ◽  
Case Series ◽  
Uneventful Recovery ◽  
Venous Malformations ◽  
Sclerosing Agents ◽  
Percutaneous Sclerotherapy ◽  
Angiography Suite ◽  
Orbital Region

Purpose To present a case series of percutaneous sclerotherapy of para-orbital and orbital venous malformations. Method Seven patients with venous malformations in the orbital and para-orbital region were reviewed. Puncture venogram was performed on all patients and image guided bleomycin injections using biplane digital subtraction in angiography suite. Results Average age of patients at the time of the procedure was 22 years old with the youngest being five years of age and the oldest being 50 years. Follow-ups ranged from 3 months to 18 months and the average follow-up duration was 13 months. The patients had no intraprocedural complications and reported symptomatic relief of pain as per the last follow-up. Patients have shown no symptoms or signs of recurrence of lesions with uneventful recovery so far. Conclusions Percutaneous sclerotherapy of orbital Venous Malformations with bleomycin is a safe and well-controlled procedure done in real time; it has no major systemic adverse side effects and higher efficacy than other sclerosing agents.

Presbycusis and Fitness to Fly

2020 ◽  
Vol 91 (5) ◽  
pp. 403-408
Author(s):  
Stanislas Ballivet de Régloix ◽  
Louise Genestier ◽  
Olga Maurin ◽  
Salome Marty ◽  
Anna Crambert ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Speech Recognition ◽  
Head And Neck ◽  
Case Series ◽  
Neck Surgery ◽  
Maximum Percentage ◽  
Military Aviation ◽  
Surgery Department ◽  
Speech Audiometry In Noise

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient’s fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403–408.

scholarly journals Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1398
Author(s):  
Felix Boehm ◽  
Rene Graesslin ◽  
Marie-Nicole Theodoraki ◽  
Leon Schild ◽  
Jens Greve ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Large Scale ◽  
Case Series ◽  
Clinical Effectiveness ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Daily Routine ◽  
Surgical Robots ◽  
Standard Procedures

Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics “Costs,” “current clinical trials,” and “robotic research” we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.

scholarly journals Instantaneous Wave-Free Ratio Measurement During Intracranial Submaximal Angioplasty: Case Series and 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. 422-428
Author(s):  
Kunal Vakharia ◽  
Muhammad Waqas ◽  
Najya Fayyaz ◽  
Amanda Young ◽  
Elad I Levy ◽  
...  
Keyword(s):  
Case Series ◽  
Length Of Hospital Stay ◽  
Interventional Cardiology ◽  
Arterial Stenosis ◽  
Intracranial Arterial Stenosis ◽  
Ratio Measurement ◽  
Pressure Wire ◽  
Before And After ◽  
Stenosis Severity

Abstract BACKGROUND Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively. OBJECTIVE To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty. METHODS We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty. RESULTS A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients. CONCLUSION iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.

Multimodal Analgesia Protocol after Head and Neck Surgery: Effect on Opioid Use and Pain Control

2019 ◽  
Vol 161 (3) ◽  
pp. 424-430 ◽  
Author(s):  
Eugenie Du ◽  
Zainab Farzal ◽  
Elizabeth Stephenson ◽  
April Tanner ◽  
Katherine Adams ◽  
...  
Keyword(s):  
Head And Neck ◽  
Pain Control ◽  
Neck Surgery ◽  
Multimodal Analgesia ◽  
Quality Improvement Initiative ◽  
Opioid Use ◽  
Protocol Implementation ◽  
Pain Scores ◽  
Before And After ◽  
Average Pain

Objective To assess the effect that implementation of a multimodal analgesic plan has on opioid requirements and pain control in head and neck (H&N) surgery patients. Study Design Prospective cohort. Setting Tertiary academic hospital. Subjects and Methods An institutional review board (IRB)–approved quality improvement initiative was undertaken to implement a multimodal analgesic protocol for all admitted H&N surgery patients starting November 2017. Postprotocol data from January to May 2018 were compared to preprotocol data from May to October 2017. Data were obtained from the electronic health records as well as through preoperative and postoperative surveys. Average pain scores and opioid use in morphine milligram equivalents (MMEs) before and after protocol implementation were compared. Results In total, 139 postprotocol patients were compared to 89 preprotocol patients. The adjusted MMEs in the first 24 hours after surgery decreased significantly from 93.7 mg to 58.6 mg ( P = .026) with protocol implementation. When averaged over the length of stay (MME/hospital day), the change was no longer statistically significant (57.9 vs 46.8 mg, P = .211). The average pain score immediately after surgery and on day of discharge did not change with protocol implementation. Conclusion Implementation of a multimodal analgesia plan reduced opioid use immediately after surgery but not over the course of hospitalization without any change in reported pain scores. This study shows that multimodal opioid-sparing analgesia after H&N surgery is feasible. Future studies are needed further refine the optimal analgesic strategy for H&N patients and assess the long-term efficacy, safety, and cost of such regimens.

Intramuscular venous malformations of the calf: Surgical treatment outcomes of 57 patients

2020 ◽  
Vol 35 (8) ◽  
pp. 597-604
Author(s):  
Claude Laurian ◽  
Pierre Cerceau ◽  
Nikos Paraskevas ◽  
Claudine Massoni ◽  
Veronique Marteau ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Venous Malformation ◽  
Functional Limitation ◽  
Venous Malformations ◽  
Complete Excision ◽  
Muscle Involvement ◽  
Residual Functional

Objectives To report the outcomes of surgical treatment of calf intramuscular venous malformations (IMVMs) on pain, functional limitation, and quality of life. Methods We retrospectively reviewed 57 consecutive patients who had surgery for IMVM of the posterior compartment of the leg between 2010 and 2015. Treatments were all done at a single institution. Results Patients presented with pain (52), muscle contracture (14), or pulmonary embolism (4). Muscle involvement included the soleus muscle (n = 28, 49%), the gastrocnemius muscle (n = 25, 43%), and deep muscles (n = 4, 7%). Complete excision was possible in 52 patients (91%) and partial excision in 5 (9%). Thirty-five of 46 patients who had an MRI follow-up at six months had no residual venous malformation. At the final follow-up (mean 39 months), 32 of 40 patients seen had no residual pain and 37 had no residual functional impairment. Conclusion In cases where IMVM is located in one muscle in the leg, we demonstrated that surgery yielded improvement in pain, function, and quality of life.

Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

2019 ◽  
Vol 161 (4) ◽  
pp. 629-634 ◽  
Author(s):  
Andrew J. Redmann ◽  
Sonia N. Yuen ◽  
Douglas VonAllmen ◽  
Adam Rothstein ◽  
Alice Tang ◽  
...  
Keyword(s):  
Head And Neck ◽  
Case Series ◽  
Neck Surgery ◽  
Mortality Rates ◽  
Head And Neck Surgery ◽  
Additional Case ◽  
Complication Rates ◽  
Total Cost ◽  
Case Complexity ◽  
Point Increase

Objectives (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Study Design Retrospective case series. Setting Tertiary academic hospital. Subjects and Methods The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. Results In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. Conclusion For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

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