A Novel Surgical Landmark to Identify the Recurrent Laryngeal Nerve

Background: Although several surgical landmarks have been proposed to localize the recurrent laryngeal nerve (RLN), there is still no reliable landmark. Aims: To validate the reliability of a novel reference point at the intersection of the inferior border of the cricopharyngeal muscle and the inferior cornu of thyroid cartilage for locating the RLN. Study Design: Cadaver dissection study in the academic department of otolaryngology-head and neck surgery. Methods: Sixty-four RLNs in cadavers were assessed, and measurements of different surgical landmarks in conjunction with the proposed surgical landmark were obtained. Descriptive statistics, Pearson's chi-squared test, and Student's t-test were performed to analyze the data using GraphPad Prism (version 9.4.1; Dotmatics, Boston, Massachusetts, USA). Results: The average distance from the proposed landmark to the RLN was 2.3 ± 0.85 mm. The RLN was located just posterior to the reference point in 95.31% of the cadavers. The RLN passed under the inferior constrictor muscle in 90.63% of the cadavers. There was no statistically significant difference between right- and left-sided RLNs in terms of their relation with the reference point. Conclusion: The proposed reference point can be used as a reliable landmark to locate the RLN. This reference point may help surgeons during difficult thyroidectomy surgeries by providing an additional anatomical landmark.

Mini Med School: why you should try a virtual, medical student-led program.

Mini Med School (MMS) programs led by medical students provide a unique opportunity for community members to access free and accurate health information while engaging with the education of medical students. Virtually delivered MMS programs reduce barriers to access. 90.3% of participants in a recent MMS enjoyed medical students delivering the seminars. 63.6% of participants preferred virtual MMS seminars, with 31.8% preferring a combination of virtual and in-person delivery. Student-led, virtually delivered MMS programs are an engaging way to support both medical student and community education while strengthening community ties with local medical schools.

Les séminaires de la mini-école de médecine (MÉM) présentés par des étudiants en médecine offrent une occasion unique aux membres de la communauté de profiter d'informations gratuites et précises en matière de santé tout en contribuant à la formation des étudiants. L'offre de séminaires MÉM en mode virtuel rend ces activités plus accessibles. Une grande majorité des participants (90,3 %) à une MÉM tenue récemment ont aimé le fait que des séminaires soient animés par des étudiants, 63,6 % d'entre eux ont préféré les séminaires MÉM virtuels et 31,8 % se sont dits favorables à une combinaison de séminaires virtuels et en personne. Les séminaires présentés virtuellement par des étudiants dans le cadre de la MÉM constituent un moyen intéressant de promouvoir aussi bien l'éducation des étudiants que celle de la communauté, tout en renforçant les liens entre cette dernière et les facultés de médecine locales.

Surgical Management of Inferior Turbinate Hypertrophy in the Era of Widespread Communicable Disease.

Inferior turbinate reduction procedures have been performed for decades. After significant evolution, turbinoplasty and other mucosal-sparing techniques have become the main method to successfully reduce turbinate hypertrophy. The debate of which technique produces the most effective and durable outcomes is ongoing. During this critical era of widespread communicable diseases, including but not limited to COVID-19, HIV, and hepatitis, additional attention is necessary to balance outcomes with a degree of generation of airborne particles when selecting a technique. This review article aims to identify the optimal method for inferior turbinate reduction that weighs both outcomes and aerosol production. The MEDLINE database was searched to discover relevant publications through August 2022. Key search terms included inferior turbinate hypertrophy, turbinate reduction surgery, turbinoplasty methods, surgical management of turbinate hypertrophy, surgical aerosol generation, COVID-19 surgery, surgery smoke plume, SARS-CoV-2 transmission during surgery, and nasal procedures COVID-19 aerosols. Surgical management of the inferior turbinates includes radiofrequency ablation (RFA), microdebrider-assisted turbinoplasty (MAIT), electrocautery, laser, and ultrasound. Piezo-assisted turbinoplasty and a turbinate-specific coblation wand are new additions to the literature. All techniques appear to improve patient symptoms of nasal obstruction. MAIT and RFA are comparable, although MAIT demonstrated better long-term outcomes in some studies and appears to generate fewer airborne particles. Studies evaluating the production of aerosols due to RFA are lacking. Ultrasound outcomes are also excellent and generate no aerosols, but the technique has not been compared against the microdebrider. Electrocautery can result in increased pain and crusting for patients and causes the highest amount of aerosols. Deficiencies of current studies, including a lack of comparison of aerosol generation, duration of follow-up, omission of outfracture, and inadequate randomized controlled trials among existing and new techniques, have limited the identification of the best inferior turbinate reduction method. Given the durability of MAIT and its minimal aerosol production, it can be reinforced as the most sensible technique until further evidence is available.

Geographic Distribution of Otolaryngology Training Programs and Potential Opportunities for Strategic Program Growth.

OBJECTIVE: To characterize the geographic distribution of US otolaryngology residents based on geographical population density to determine current status and identify potential opportunities for otolaryngology residency program expansion. METHODS: The locoregional population of otolaryngology residency programs was analyzed (as defined by the US Census) and the number of resident trainees per 100,000 people in each region was calculated. Otolaryngology residency program location was determined by mailing address, and program size was determined by AAMC public data. RESULTS: The average metropolitan city in the United States contained 2.07 otolaryngology trainees per 100,000 people. Cities with low trainee numbers per population included Phoenix, AZ (0.20 trainees per 100,000 people); Las Vegas, NV (0.26 per 100,000); Dallas, TX (0.26 per 100,000), Atlanta, GA (0.33 per 100,000); and Miami, FL (0.34 per 100,000). Comparing otolaryngology to other surgical subspecialties demonstrated similar distributions. Metropolitan centers with a population over 1 million without full academic representation in otolaryngology were also identified and included Charlotte, NC; Orlando, FL; Austin, TX; Providence, RI; Jacksonville, FL; Raleigh, NC; and Grand Rapids, MI. CONCLUSION: Strategic residency training program expansion should be considered in cities that exhibit a low trainee to population ratio. Although many factors ultimately determine program expansion or development of new training programs, this study provides substantiated population data describing where expansion could be prioritized. LEVEL OF EVIDENCE: NA Laryngoscope, 133:1600-1605, 2023.

Cystic fibrosis exacerbations treated with medical therapy with and without concurrent sinus surgery.

OBJECTIVE: This analysis investigates any potential differences in pulmonary function test (PFT) outcomes among pediatric patients with cystic fibrosis (CF) receiving both medical management (MM) and functional endoscopic sinus surgery (FESS) versus MM alone for CF exacerbation. STUDY DESIGN: Prospective cohort. SETTING: Pediatric tertiary care facility. METHODS: The data was prospectively collected from July 2011 to March 2020. Diagnosis of CF and age ≤ to 18 were required. All patients were hospitalized and treated for CF exacerbations with both FESS with MM and MM alone at variable time intervals, although the order of initial treatment received differed. Two-way ANOVA with repeated measures were used to determine the effect of receiving FESS with MM versus MM alone on PFT outcomes over time (during admission, at discharge, at 3 months, at 6 months, and at 12 months). RESULTS: 13 pediatric patients, 7 of which had FESS with MM initially and 6 who had MM alone initially, and 20 events of both FESS and MM were included for analysis. For PFT outcomes, there was no statistically significant two-way interaction between treatment type and time following treatment, p = 0.492. The main effect of treatment did not show a statistically significant difference in FEV1 between treatment types, p = 0.737. There was no statistically significant association between treatment type and time between hospital readmission in months, p = 0.111. CONCLUSION: There was no significant difference between PFT outcomes in pediatric patients hospitalized for CF exacerbation treated with MM with or without FESS at any time interval.

Association between ethnicity and hypertension in Northern Colombia in 2015.

BACKGROUND: Studies in the United States have shown a genetic predisposition to hypertension in individuals of African descent. However, studies on the associations between ethnic groups and hypertension in Latin America are lacking and the limited results have been inconsistent. The objective of this study is to determine whether Afro-Colombian ethnicity increases the risk of hypertension. METHODS: This study is a secondary data analysis of a cross sectional study from five provinces in Northern Colombia. Randomly selected individuals (N = 2613; age-range 18-74 years) enrolled in a health care insurance company underwent physical examinations and completed questionnaires regarding ethnicity, lifestyle, and other risk factors. Hypertension in these patients was determined. Unadjusted and adjusted logistic regression analysis were calculated to determine the association between ethnicity and hypertension. RESULTS: No association between Afro-Colombian ethnicity and hypertension was found (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.66-1.09). As expected, people with a body mass index (BMI) of 30 or higher were at a greater risk of having hypertension (OR, 3.12; 95% CI, 2.35-4.16) compared with those with a normal BMI. CONCLUSIONS: Findings from this study suggest no independent association between Afro-Colombian ethnicity and hypertension. Further research should focus on genotyping or socioeconomic factors such as income level.

Decreased Levels of Soluble CD44 in a High-Risk Population following a Smoking Cessation Program.

Tobacco is a risk factor of head and neck cancer (HNC) and smoking cessation alone may reduce HNC risk by 70%. Soluble CD44 (solCD44), a cell surface receptor linked to cell proliferation and migration, and total protein (TP) levels can detect early HNC. This study aims to determine whether salivary solCD44 and TP levels in oral rinses change following a smoking cessation program. 150 smokers provided oral rinse samples at baseline and at a 12-month follow-up after participation in a smoking cessation program. Assays to measure levels of solCD44, TP, and cotinine, a metabolite used as a biomarker of tobacco exposure, were completed. A paired-samples t-test was used to determine whether there was a statistically significant (p < 0.05) mean difference in biomarker levels before and after the program. Baseline and at 12-month follow-up data were available for 88 subjects, 21 of whom quit smoking entirely. Mean levels of solCD44 significantly decreased by 0.412 ng/mL from baseline to the 12-month follow-up, p = 0.010. There was no significant difference in mean TP levels, p = 0.975. Mean cotinine levels decreased significantly by 74.7 ng/mL, p = 0.035. This is the first work demonstrating an association between smoking cessation and decreased solCD44 levels in oral rinses. Decreased expression of the tumorigenic CD44 may be one mechanism by which smoking cessation lowers cancer risk.

Current salivary biomarkers for detection of human papilloma virus-induced oropharyngeal squamous cell carcinoma.

Human papilloma virus (HPV) infection is a key risk factor and etiology for oropharyngeal squamous cell carcinoma (OPSCC). HPV-induced OPSCC is rapidly increasing in incidence, with men experiencing increased mortality. When identified at an early stage, HPV-induced OPSCC can be successfully treated. Diagnosis of HPV-related OPSCC relies on an expert physical examination and invasive biopsy. Since saliva bathes the oropharyngeal mucosa and can be collected noninvasively, saliva obtained via salivary risings is an attractive body fluid for early detection of HPV-induced OPSCC. A plethora of DNA, RNA, and protein salivary biomarkers have been explored. This review discusses these markers and their robustness for detecting oncogenic HPV in OPSCC saliva samples. Methods detecting HPV DNA were more reliable than those detecting RNA, albeit both require time-consuming analyses. Salivary HPV proteomics are a new, promising focus of HPV detection research, and while more practical, lag behind nucleic acid detection methods in their development.

Green Salad Intake Is Associated with Improved Oral Cancer Survival and Lower Soluble CD44 Levels.

Deficiencies in fruit and vegetable intake have been associated with oral cancer (oral cavity and oropharyngeal). Salivary rinses contain measurable biomarkers including soluble CD44 (solCD44) and total protein, which are known markers of oral cancer risk. This study investigates the effect of nutritional factors on solCD44 and protein levels to evaluate oral cancer risk and survival. We evaluated solCD44 and protein levels from 150 patients with oral and oropharyngeal squamous cell carcinoma and 150 frequency-matched controls. We subsequently characterized the effect of food group consumption and these biomarkers on progression-free survival (PFS) and overall survival (OS). Patients reported eating fewer servings of salad (p = 0.015), while controls reported eating fewer servings of potatoes (p < 0.001). Oral cancer patients who consumed at least one serving per week of green salad were found to have significantly lower CD44 levels than those who ate salad less frequently (mean of log2[solCD44]1.73 versus 2.25, p = 0.014). Patients who consumed at least one serving per week of "salad or other vegetables" had significantly longer PFS (median 43.5 versus 9.1 months, p = 0.003, adjusted hazard ratio (HR) = 0.39 p = 0.014) and OS (median 83.6 versus 10 months, p = 0.008, adjusted HR = 0.04 p = 0.029). These findings suggest that dietary factors, namely greater green salad and vegetable intake, may be associated with lower CD44 levels and better prognosis in oral cancer patients.

The inferior turbinate: An autonomic organ.

The inferior turbinate has well-recognized respiratory and immune functions to provide the airway with appropriate warmth, humidification, and filtration of the inspired air while sampling the environment for pathogens. Normal functioning of the inferior turbinate relies on an intact autonomic system to maintain homeostasis within the nasal cavity. The autonomic nervous system innervates the submucosal glands and the vasculature within the inferior turbinate, resulting in control of major turbinate functions: nasal secretions, nasal patency, warmth, and humidification. This review will summarize the autonomic innervations of the turbinates, both the normal and abnormal autonomic processes that contribute to the turbinate functions, and the clinical considerations regarding optimal functioning of the turbinate autonomic system.