Long-term successes of various sinus surgeries: a comprehensive analysis.

Outcome studies often examine the efficacy of sinus surgery with 1 year of follow-up data, while longer-term postoperative data is less easily available. This article reviews long-term outcomes of various endoscopic techniques to further delineate risk factors for surgical failure. A systematic review of the literature was performed and studies were stratified based on surgical technique and recognized risk factors of postoperative failure. A total of 126 abstracts were identified, 82 articles were retrieved for full review, and 56 were included in this report. A total of 30 studies had longer than 1 year of follow-up data and the longest follow-up period was 10 years. Based on the available evidence, endoscopic sinus surgery has a high success rate, but with well-recognized risk factors for failure. Aggressive postoperative local care and medical therapy should be tailored to each patient's particular disease process, and form an integral part of surgical management.

Discrimination of benign and neoplastic mucosa with a high-resolution microendoscope (HRME) in head and neck cancer.

BACKGROUND: The efficacy of ablative surgery for head and neck squamous cell carcinoma (HNSCC) depends critically on obtaining negative margins. Although intraoperative "frozen section" analysis of margins is a valuable adjunct, it is expensive, time-consuming, and highly dependent on pathologist expertise. Optical imaging has potential to improve the accuracy of margins by identifying cancerous tissue in real time. Our goal was to determine the accuracy and inter-rater reliability of head and neck cancer specialists using high-resolution microendoscopic (HRME) images to discriminate between cancerous and benign mucosa. METHODS: Thirty-eight patients diagnosed with head and neck squamous cell carcinoma (HNSCC) were enrolled in this single-center study. HRME was used to image each specimen after application of proflavine, with concurrent standard histopathologic analysis. Images were evaluated for quality control, and a training set containing representative images of benign and neoplastic tissue was assembled. After viewing training images, seven head and neck cancer specialists with no previous HRME experience reviewed 36 test images and were asked to classify each. RESULTS: The mean accuracy of all reviewers in correctly diagnosing neoplastic mucosa was 97% (95% confidence interval (CI), 94-99%). The mean sensitivity and specificity were 98% (97-100%) and 92% (87-98%), respectively. The Fleiss kappa statistic for inter-rater reliability was 0.84 (0.77-0.91). CONCLUSIONS: Medical professionals can be quickly trained to use HRME to discriminate between benign and neoplastic mucosa in the head and neck. With further development, the HRME shows promise as a method of real-time margin determination at the point of care.

Incentive spirometry for the tracheostomy patient.

OBJECTIVE: To determine the feasibility of developing and using a customized incentive spirometer device for patients who have undergone a tracheostomy procedure. STUDY DESIGN: The authors performed a prospective case series approved by the institutional review board. SETTING: Academic medical center. SUBJECTS AND METHODS: Patients were eligible for participation if they were older than 18 years and had a new tracheostomy. Spirometry exercises were performed using a protocol adapted from the American Academy of Respiratory Care guidelines. Patient data were recorded, including age, sex, tobacco use, surgical procedure, time under general anesthesia, length of hospital stay, and time until ambulation. The details of the spirometry exercises were also recorded along with any complications that occurred. RESULTS: An incentive spirometer was adapted for use with tracheostomy patients and received an investigational device exemption from the Food and Drug Administration. A total of 10 patients were enrolled (mean age 60 years). Sixty percent were current or former tobacco users, the mean anesthesia time was 9 hours, and 70% underwent a microvascular free flap reconstruction. Patients used the incentive spirometer for a mean of 1.6 days during the postoperative period, averaging 3.3 sessions per day and 6.8 breaths per session. The device was well tolerated by patients, and there were no complications associated with its use. CONCLUSION: This study supports the feasibility of using a customized incentive spirometer for tracheostomy patients and establishes a safety profile for the device to be used in future studies.