Assessment of a limited-access parotidectomy technique's complications and scar characteristics - A cohort study.

OBJECTIVE: Parotidectomy is the treatment of choice for benign tumors of the parotid gland, with the modified Blair incision most commonly utilized. This retrospective analysis aimed to determine the incidence of complications and assess the relationship between the mass and scar characteristics, in patients who had undergone parotidectomy. MATERIALS AND METHODS: The scar characteristics of patients who had undergone parotidectomy for benign neoplasms at our medical center between 2013 and 2019 were evaluated. RESULTS: Overall, 49 patients met the inclusion criteria, of whom 33 agreed to participate in the study. The mean patient age was 52.8 years; 57.5% were males. No correlation was identified between the parotid mass size or location and scar type or length. The most common complications in this study were similar to those reported in the literature. CONCLUSION: The results of this study suggest that the smaller, tailored modified Blair incision for parotidectomy does not increase complication rates. Future studies with larger cohorts should be conducted to further assess the potential benefits of tailored incision size during modified Blair parotidectomies.

National differences in cost analysis of Afirma Genomic sequencing classifier.

CONTEXT: Thyroid nodules of indeterminate cytology can be subjected to molecular testing such as the Afirma Genomic Sequencing Classifier (GSC), thereby minimizing the number of unnecessary diagnostic surgeries. OBJECTIVE: This work aimed to evaluate and compare the cost of routine GSC testing of indeterminate thyroid nodules in different countries. DESIGN, PATIENTS AND MAIN OUTCOME MEASURES: The cost of diagnostic hemithyroidectomy of indeterminate thyroid nodules was calculated by performing a Monte Carlo simulation cost analysis on a Markov decision-analytic model and then compared to that of GSC testing in the UK, Australia, USA, and Israel. RESULTS: Assuming that patients are treated by surgical resection and routine GSC testing is performed for all nodules of indeterminate significance, we found the GSC test to be more cost effective compared with diagnostic hemithyroidectomy when malignancy rates of thyroid nodules are less than 22.6%-37.1%, depending on the country where the test is performed. Given the cost of a thyroidectomy in the UK, Australia and Israel, performing routine GSC tests on all Bethesda IV nodules is more expensive than routine diagnostic hemithyroidectomy and becomes cost effective for Bethesda III when the GSC cost is below 3,031-3,087 USD. In comparison, in the USA, higher cost of thyroidectomy makes the GSC test cost effective for Bethesda III nodules at its current cost, but not for Bethesda IV nodules where it becomes cost effective under the price of 3,031 USD. CONCLUSIONS: Different molecular testing and surgical costs in different countries should be considered when performing cost analysis. In addition, since different medical centres have different malignancy rates, personalized in-house assessment of cost-effectiveness is warranted.

Adenoid Obstruction Assessment in Children: Clinical Evaluation Versus Endoscopy and Radiography.

BACKGROUND: Hypertrophy of the adenoids is common in children. However, the anatomical site makes the adenoids difficult to assess, and studies evaluating the subject are ambiguous, especially with regard to the use of X-ray as an evaluation tool. OBJECTIVES: To compare medical history with clinical, radiological, and endoscopic evaluations of the adenoids and compare obstructed and non-obstructed children relative to the assessment methods. METHODS: A prospective comparative study was conducted with children who were suspected of having enlarged adenoids. All parents completed a medical history questionnaire and patients underwent clinical evaluation based on Nasal Obstruction Index (NOI) scores, radiological assessment based on the lateral neck X-ray adenoid-nasopharynx (A/N( ratio, and endoscopic evaluation based on anatomical relations. Spearman correlations were used for comparison between methods. RESULTS: We evaluated 36 patients, median age 5.33 years. Correlation measurements for clinical assessment and questionnaire (r = 0.582, P < 0.0001), questionnaire and endoscopy (r = 0.462, P = 0.005), and clinical assessment and nasal endoscopy (r = 0.621, P < 0.0001) were statistically significant. None of the parameters correlated with the radiological findings. A statistically significant difference was found between the obstructed and non-obstructed groups in both questionnaire (P = 0.004) and clinical assessment (P < 0.0001). However, no difference was found in X-ray measurements. CONCLUSIONS: Lateral neck X-ray measurements were not correlated to symptoms, signs, or endoscopic findings. Therefore, medical professionals should use lateral neck radiography when considering adenoidectomy only on a highly selective basis.