Extratemporal facial nerve branching patterns: systematic review of 1497 cases.

OBJECTIVE: The aim of this systematic review was to analyse the complex anatomy of the extratemporal portion of the facial nerve with an accurate description of the branching patterns based on the Davis classification. METHOD: Medline, ScienceDirect and the Cochrane Library databases as well as other sources were searched by two independent reviewers. RESULTS: Analysis of 21 studies with a total of 1497 cases showed that type III is the most common branching pattern accounting for 26.8 per cent of cases. The type I pattern, previously considered as the normal anatomy in most textbooks, was the fourth most common branching pattern at 16.3 per cent. The majority of specimens (96.4 per cent) were found to have a bifurcated main trunk, and only 3.2 per cent were found with a trifurcated main trunk. CONCLUSION: Surgeons should be aware of anatomical variations in the course of the facial nerve. An early identification of the branching pattern during surgery reduces the risk for iatrogenic facial nerve injury.

Role of spreader flaps in primary rhinoplasty, functional and aesthetic outcomes: a systematic review.

BACKGROUND: The standard treatment for reconstructing the middle vault of the nose is to use spreader grafts. Recently, an alternative technique using spreader flaps has become widely accepted. METHODOLOGY: A literature search was performed in MEDLINE, Science Direct, the Cochrane Library and multiple trial registries. The systematic review included studies evaluating the effectiveness of spreader flaps, with or without comparison to the spreader graft technique, in patients who had undergone primary rhinoplasty. RESULTS: Thirteen studies with a total of 500 patients met the inclusion criteria and were reviewed systematically. All studies measured breathing function improvement. Additionally, aesthetic improvement/satisfaction was evaluated in seven studies. The use of spreader flaps seems to improve breathing function, as seen in twelve out of thirteen studies. Furthermore, the studies assessing the aesthetic aspect of a primary rhinoplasty showed that spreader flaps can provide satisfactory results. The comparison between spreader flaps and spreader grafts showed similar results in most studies dealing with this topic in both the breathing function improvement and aesthetic improvement/satisfaction domains. CONCLUSIONS: This study is the first systematic review assessing the functional and aesthetic outcomes of spreader flaps in primary rhinoplasty, and it shows encouraging results comparable to those of spreader grafts.

Twenty-year experience with salvage total laryngectomy: lessons learned.

OBJECTIVE: The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. METHOD: A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. RESULTS: Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1-T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. CONCLUSION: More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.

Endoscopic transnasal orbital decompression for Graves.

BACKGROUND: The aim of this study was to assess all available data regarding the efficacy of endoscopic transnasal orbital decompression for Graves' ophthalmopathy. METHODOLOGY: MEDLINE, ScienceDirect and the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcome was the reduction in orbital proptosis. Secondary outcomes were the improvement in visual acuity, post-operative diplopia, and complications RESULTS: Twelve prospective and retrospective case series met the inclusion criteria. All of them demonstrated an improvement in postoperative proptosis that ranged from 2.07 mm to 8.2 mm (weighted mean improvement 5.05 mm). Improvement in visual acuity was reported in all but one study. Studies presented a wide range of results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in ten studies, the most serious of which being 3 cases of Cerebrospinal fluid (CSF) leak presented in 2 studies. CONCLUSIONS: The present systematic review shows that endoscopic transnasal decompression safely addresses symptoms of Graves’ ophthalmopathy. However, high-quality, large-sample, controlled studies need to be performed in the future.

A rare case of jugular bulb diverticulum presenting as Meniere's disease, treated with embolization.

BACKGROUND:   Jugular bulb diverticulum constitutes a rare clinical entity that may present with variable symptoms. When obstructing the endolymphatic duct, it may cause sensorineural hearing loss and vertigo, mimicking Meniere's disease. Diagnosis is based on computed tomography and magnetic resonance imaging scans, with magnetic resonance and digital subtraction angiography being more specific and detailed diagnostic methods. Treatment options include surgical decompression, endovascular embolization, or stenting. Description of the case: We report a jugular bulb diverticulum case manifesting as Meniere's disease and treated with endovascular embolization. The procedure was uneventful, and the patient's vertigo gradually disappeared over two months. No medical treatment was required for the next 2.5 years as the patient remained asymptomatic with no more vertigo attacks. CONCLUSION: Endovascular embolization can be the method of choice in selected cases of jugular bulb diverticulum. HIPPOKRATIA 2019, 23(4): 172-174.

Monoclonal antibodies for the treatment of chronic rhinosinusitis with nasal polyposis: a systematic review.

BACKGROUND: Monoclonal antibodies have been proposed as a novel therapy in patients suffering from chronic rhinosinusitis with nasal polyposis (CRSwNP). The purpose of this systematic review was to evaluate their efficacy and safety. METHODOLOGY: A literature search was performed in MEDLINE, Web of Science, the Cochrane Library and multiple trial registries followed by extensive hand-searching for the identification of relevant studies. Only randomized controlled trials (RCTs) comparing the use of monoclonal antibodies with placebo or another therapy in adult patients with CRSwNP were included. RESULTS: Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in two studies, anti-interleukin (IL)-5 therapy in three studies (1 reslizumab, 2 mepolizumab) and finally anti-IL-4 and anti-IL-13 therapy in only one. With the exception of one study, biologic therapy was proved to be effective in reducing total nasal endoscopic polyp score (TPS) in treatment as compared to placebo groups. Monoclonal antibodies brought about improvement in several other outcomes, such as opacification in computed tomography (CT), quality of life measures, nasal airflow, olfaction and type 2 helper T-cell (Th2) associated biomarkers. Overall, the use of these agents was deemed safe and well-tolerated. CONCLUSIONS: This is the first systematic review showing encouraging results for the use of all three main categories of monoclonal antibodies in CRSwNP patients and highlights the need for further well-designed and with larger sample sizes RCTs.