Incidence and potential risk factors for adenoid regrowth and revision adenoidectomy: A meta-analysis.

AIMS: To examine the potential risk factors for adenoid regrowth and the incidence of revision adenoidectomy. METHODOLOGY: The English-language literature published from January 1995 to January 2020 regarding adenoid regrowth and revision adenoidectomy was reviewed. The keywords used were 'adenoids', 'adenoid regrowth' and 'revision adenoidectomy'. The inclusion criteria were English language, sample size greater than five and presentation of extractable data on risk factors for adenoid regrowth and rates of revision adenoidectomy. Random-effects modelling was used to estimate summary outcomes. RESULTS: Twenty studies met the inclusion criteria. There was a total of 143369 cases of baseline adenoidectomies. The mean age at primary surgery was 4.62 years (SD = 1.47 years, range of 2.3-7.3 years) and the mean age at revision adenoidectomy was 5.43 years (SD = 1.80 years, range of 2.5-7.6 years). Six studies reported on adenoid regrowth and a total of 4950 baseline adenoidectomies were examined. The prevalence of adenoid regrowth was 8%. Fifteen studies examined the rate of revision adenoidectomy and a total of 119369 baseline adenoidectomies were analysed. The revision adenoidectomy rate was 2%. Of the patients with revision adenoidectomy, 14% had allergic rhinitis and 9% had asthma. With regards to indications for revision adenoidectomy, 26% had OSA, 86% were snorers, 63% had nasal obstruction, 32% had recurrent AOM and 73% had OME. CONCLUSION: The combined revision adenoidectomy rate from this study is 2%. Young age at first surgery was prevalent as well as co-morbidities of allergic rhinitis and asthma and indications for primary adenoidectomy like upper airway obstructive symptoms and middle ear disease. However, given the heterogeneity of these studies, direct cause and effect could not be concluded.

Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: A systematic review.

INTRODUCTION: Osteoradionecrosis of the mandible is a devastating complication of radiotherapy in patients with head and neck cancer. Many cases present at a late stage, from months to years following completion of radiation therapy. When medical treatment fails, surgery may be required with a variety of free flaps available for microvascular reconstructive techniques. OBJECTIVE: To conduct a systematic review of the literature investigating the outcomes of free flap reconstruction of the jaw in mandibular osteoradionecrosis and determine the failure rates of different flap tissue. METHODS: A systematic literature search was performed using Medline (Ovid) Pubmed and Embase databases and Google Scholar. Primary outcome measures were flap failures and complications, with donor site complications representing the secondary outcome measure. Analysis of pooled outcomes was undertaken for different flaps. RESULTS: 333 articles were identified and 15 articles met the final inclusion criteria, detailing 368 primary free tissue flap transfers. There was a flap failure rate of 9.8%. There were 146 post-operative complications (39.7%), the most common being fistula formation (8.4%), hardware plate exposure (7.1%) and flap wound infections (6.5%). CONCLUSION: The fibula is the workhorse free flap for reconstruction in mandibular osteoradionecrosis. Evidence to date is largely limited with the need for larger powered multi-institutional prospective studies to determine the ideal flap donor tissue and evaluate patient and treatment predictors of free flap outcomes in order to tailor the best patient-based surgical approach for mandibular osteoradionecrosis.

Routine tonsillar bed oversew after diathermy tonsillectomy: does it reduce secondary tonsillar haemorrhage?

Tonsillectomy is a common otolaryngological procedure and is associated with a small risk of postoperative pharyngeal haemorrhage. This study compares secondary post tonsillectomy haemorrhage rates between two operative techniques: diathermy tonsillectomy and diathermy tonsillectomy with tonsillar bed oversew. A total of 424 patients underwent tonsillectomies with or without other procedures such as adenoidectomy and grommet insertion by two ears, nose and throat surgeons at three hospitals from May 2012 to July 2013. A diathermy tonsillectomy was performed in 266 patients, while a diathermy tonsillectomy with tonsillar bed oversew was performed in 158 patients. All patients were followed up within 2-4 weeks of surgery. Primary haemorrhage did not occur in either surgical technique groups. Secondary haemorrhage occurred in 20 patients (7.52 %) in the diathermy tonsillectomy group and in 9 patients (5.70 %) in the diathermy with tonsillar bed oversew group. This result was not significantly different (OR = 0.74, 95 % CI 0.33-1.67, p = 0.47). Sex, age, indication for surgery and whether or not a tonsillectomy was performed alone or with other procedures were not significant factors for secondary haemorrhage. In summary, routine tonsillar bed oversew after diathermy tonsillectomy does not reduce the risk of secondary tonsillar haemorrhage.