Operative Techniques in Otolaryngology - Head and Neck Surgery最新文献

{"title":"Anterior glottic webs","authors":"William E. Karle MD,&nbsp;David G. Lott MD","doi":"10.1016/j.otot.2023.05.007","DOIUrl":"10.1016/j.otot.2023.05.007","url":null,"abstract":"<div><p>Anterior glottic webs can have a significant negative impact on patient quality-of-life. Anterior glottic webs can be classified as either congenital or acquired. Any process that leads to the disruption of mucosal integrity on the anterior aspect of both vocal folds may ultimately lead to an anterior glottic web. Improving a patient...s breathing or voice are the primary indications to fix a glottic web. Due to the risk of worsening the anterior glottic web with surgery, only symptomatic patients should be treated. There is a long list of procedures aimed at correcting anterior glottic webs. The variety of surgeries speaks to their unfortunately high failure rate. Broadly speaking, anterior glottic webs may be treated through an open or endoscopic surgical approach. This chapter discusses the more common endoscopic approaches. Coupled with appropriate post-operative care, anterior glottic webs can be successfully treated and patient quality-of-life improved.</p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 108-114"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41507910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic laryngotracheoplasty (Maddern procedure) for idiopathic subglottic stenosis","authors":"Hannah Kavookjian MD ,&nbsp;Alexander Hillel MD","doi":"10.1016/j.otot.2023.05.008","DOIUrl":"10.1016/j.otot.2023.05.008","url":null,"abstract":"<div><p>Endoscopic laryngotracheoplasty, also known as the “Maddern procedure,” is a definitive endoscopic treatment for subglottic stenosis via a scarless approach. This technique focuses on endoscopic resection of the subglottic mucosa and scar without disturbing the cartilaginous framework of the larynx and trachea. A split-thickness skin graft is then used to reline the tracheal lumen, in order to facilitate healing and avoid scar recurrence. The skin graft is held in place by a silastic stent. This article describes the surgical technique of endoscopic laryngotracheoplasty, as well as peri-operative considerations and possible complications.</p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 115-119"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45544940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cricoarytenoid joint mobilization with mucosal flap reconstruction for posterior glottic stenosis","authors":"Mark S. Weidenbecher MD","doi":"10.1016/j.otot.2023.05.006","DOIUrl":"10.1016/j.otot.2023.05.006","url":null,"abstract":"<div><p><span>Posterior glottic stenosis (PGS) is usually caused by long-term intubation<span><span> and can be very challenging to manage in particular if both cricoarytenoid joints (CAJ) are involved. Most surgical approaches are limited to enlarging the airway by resecting portions of the posterior commissure and </span>glottis<span><span> compromising on both, voice and respiratory function. In the following, we describe an endoscopic technique that can restore arytenoid mobility in a selected group of patients suffering from high-grade PGS. Patients must have intact </span>CAJ facets<span> and a normal joint space that is not replaced by fibrosis or bone to benefit from this procedure. When performing this procedure, the fibrotic tissue between the arytenoids and around both CAJ is ablated and both arytenoids are mobilized by performing CAJ capsulotomies to restore arytenoid mobility. A mucosal rotational advancement flap, raised from the postcricoid and medial </span></span></span></span>pyriform sinus, is used to reconstruct the interarytenoid space and the posterior commissure.</p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 103-107"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43929846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subglottic stenosis","authors":"Brandon LaBarge MD,&nbsp;John P. Gniady MD, FACS","doi":"10.1016/j.otot.2023.05.005","DOIUrl":"10.1016/j.otot.2023.05.005","url":null,"abstract":"<div><p><span>Subglottic stenosis is a narrowing of the airway that has significant impact on patient breathing and </span>quality of life<span><span>. The majority of cases result from intubation<span><span>, prior tracheostomy, or trauma but some instances still have no known etiology. Knowledge of the disease has increased substantially over recent decades with advances in basic science research and collaborative clinical studies. </span>Treatment approaches typically range from endoscopic to open surgery, including innovative strategies to prevent </span></span>restenosis<span>. This article presents a review of subglottic stenosis, focused on understanding pathophysiology and treatment paradigms.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 97-102"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47245944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic management of subglottic stenosis","authors":"Julian S. De La Chapa MD,&nbsp;James J. Daniero MD, MS","doi":"10.1016/j.otot.2023.05.003","DOIUrl":"10.1016/j.otot.2023.05.003","url":null,"abstract":"<div><p><span><span><span>Subglottic stenosis (SGS) is a narrowing of the airway below the </span>vocal cords that can lead to respiratory distress and in severe cases, airway obstruction. Endoscopic surgical management of SGS has been established as a safe and effective </span>treatment option. The aim of this manuscript is to provide an overview of the current state of the art in endoscopic surgical management of SGS. Endoscopic management of SGS typically utilizes laser (CO</span>₂<span><span> or Nd:YAG) or cold knife incision or </span>wedge excision<span><span><span> in combination with rigid or balloon dilation<span>. Topical antifibrotic therapies and steroid injections are frequently employed intraoperatively. The choice of technique depends on the location and severity of the stenosis, and a multimodal approach is common. For patients with extensive stenosis or who have failed previous endoscopic treatments, open surgery may be necessary. Preoperative assessment of the airway is critical for identifying the extent of the stenosis and ensuring appropriate treatment planning. Postoperative care includes close monitoring for complications such as bleeding, infection, and airway edema and adjuvant medical therapies such as </span></span>proton pump inhibitors, inhaled corticosteroids, and antibiotics are used frequently. In conclusion, endoscopic surgical management of SGS has become an important treatment option for patients with subglottic stenosis, and new techniques such as </span>endoscopic resection with adjuvant medical therapy (ERMT) have been employed effectively in some patients. With proper patient selection, technique selection, and postoperative care, this approach can provide effective relief of symptoms and improve patient outcomes.</span></span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 85-90"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45094409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Office based steroid injections for subglottic stenosis","authors":"Ramon A. Franco Jr MD","doi":"10.1016/j.otot.2023.05.009","DOIUrl":"10.1016/j.otot.2023.05.009","url":null,"abstract":"<div><p><span><span><span>Serial Intralesional Steroid Injection (SILSI) has been gaining popularity among patients and physicians as a first-line treatment<span> for idiopathic subglottic stenosis. Patients are followed by in-office and at-home </span></span>spirometry to assess the </span>peak inspiratory flow<span><span> (PIF), peak expiratory flow (PEF) and the PEF% values, along with quality-of-life instruments such as the RAND36, EQ5D and the new subglottic stenosis-specific, iSGS6. The initial procedure can be performed in the operating room using balloons and cold instruments to remove the subglottic scarring with injection of </span>triamcinolone acetate 40 mg/cc into the subglottis. Subsequent injections are performed in the awake-office setting at 3-week intervals until reaching a total of 6 injections (1 at surgery + 5 in-office). This single-surgeon experience with SILSI at Mass Eye and Ear now spans 13+ years, 95 patients and over 1,000 injections. A total of 58% (55/95) of patients have only required one SILSI Round (4 to 6 injections) while we have an overall success rate of 96% (91/95). A total of 95% of subjects (90/95) tolerated awake SILSI. The 52 patients with greater than 2 years of follow-up have an average follow-up of 68 months. As a group they started at a PEF% of 55% and ended their SILSI at a PEF% of 93%. Their most recent PEF% is 92% reflecting the lasting efficacy SILSI offers. As a group they underwent an average of 7 steroid injections and 1.6 surgeries resulting in an average of 36 months between interventions. A total of 29% of patients (15/52) in the Long-Term group have not had recurrences in the 53 months they have been followed. They have a group PEF% of 94% highlighting the durable SILSI effects allowing them to breath without restriction. SILSI is a safe and reliable method to treat airway stenosis that is rooted in many years of clinical success. These patients have excellent </span></span>quality of life<span> and can maintain a high level of breathing for much longer than those treated with balloon dilation (36 months vs. 12 months).</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 120-128"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42469460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stents, T tubes, and springs: The use of devices in airway reconstruction","authors":"Ari D. Schuman MD, MSCR,&nbsp;Adam R. Szymanowski MD","doi":"10.1016/j.otot.2023.05.004","DOIUrl":"10.1016/j.otot.2023.05.004","url":null,"abstract":"<div><p>Stenosis of the glottis<span>, subglottis, and cervical trachea are challenging entities plagued by frequent recurrences of stenosis regardless of the site involved. Since the earliest airway surgeries, there have been attempts to create various devices to keep the reconstructed airway open. In the modern era, these are most commonly silicone stents, T tubes, and keels. Additional modifications of these procedures, including the new interarytenoid spring, and novel methods, like the use of a sutured silastic sheet to stage posterior glottic stenosis repair, have also been published. The success rates of these devices vary widely and study populations are small, but these devices play an important role in maintaining patency in both transcervical and endoscopic approaches to airway reconstruction.</span></p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 2","pages":"Pages 91-96"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45242052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional Pulmonology: Approaches to treatment of benign subglottic and tracheal stenosis","authors":"Pankitkumar Patel, J. Toth","doi":"10.1016/j.otot.2023.05.011","DOIUrl":"https://doi.org/10.1016/j.otot.2023.05.011","url":null,"abstract":"","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45249385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-affirming facial surgery: Anatomy and fundamentals of care","authors":"Tania Benjamin MD,&nbsp;P. Daniel Knott MD,&nbsp;Rahul Seth MD","doi":"10.1016/j.otot.2023.01.002","DOIUrl":"10.1016/j.otot.2023.01.002","url":null,"abstract":"<div><p>Caring for patients who identify as transgender and gender diverse (TGD) requires a ground level understanding of proper patient communication, a framework for decision-making surrounding medical and surgical interventions, and an awareness of obstacles surrounding healthcare. The objective of this chapter is to highlight appropriate terminology and definitions, discuss the current standards of care for transgender health, raise awareness of the barriers to healthcare access facing the TGD population, and discuss basic facial anatomy and sexual dimorphisms. Gender incongruence occurs when birth-assigned sex and gender identity differ for an individual, and gender dysphoria is the distress felt in this state. Persons who experience gender dysphoria may seek gender-affirming hormone therapy or surgery. Access to care is not straightforward, and the current standards of care aim to provide a guideline for administration of hormones and surgery. In order to offer the highest level of care, surgeons should have a fundamental understanding of issues surrounding the TGD community combined with a robust comprehension of facial features characterizing gender.</p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 1","pages":"Pages 3-13"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46741495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-affirming hair procedures","authors":"Jeffrey Epstein MD ,&nbsp;Anthony Bared MD","doi":"10.1016/j.otot.2023.01.004","DOIUrl":"10.1016/j.otot.2023.01.004","url":null,"abstract":"<div><p>Hair transplantation can play a complementary role in the spectrum of gender affirming procedures. Amongst the hair restoration procedures sought by transgender patients, female hairline feminization, beard and eyebrow transplantation, surgical hairline lowering, and body hair transplantation are the most popular. Hairline lowering, hairline feminization, and eyebrow and pubic hair transplantation can play roles for the male to female (MTF) transition patient while beard and body hair transplantation can play integral roles for the female to male (FTM) transitioning patient to create a more feminine or masculine appearance and to help conceal prior surgical scarring. This chapter will delineate the role hair restoration plays for the transitioning patient. The various surgical approaches and treatment paradigms will be detailed for the hair restoration surgeon.</p></div>","PeriodicalId":39814,"journal":{"name":"Operative Techniques in Otolaryngology - Head and Neck Surgery","volume":"34 1","pages":"Pages 19-29"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41806789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}