Comparison of intubation and tracheotomy in patients with deep neck infection.

Possible airway compromise further complicates treatment of deep neck infections (DNI). Airway management is crucial, but factors affecting the method of choice are unclear. We retrospectively evaluated adult DNIs in a single tertiary center covering 10 years, with special attention on airway management. Patient data were retrieved from electronic data files from 2007 to 2016, and included adult patients with DNI operated through the neck. Of the 202 patients, 127 (63%) were male, with a median age of 47 years. Odontogenic (n = 74; 35%) infection was the most common etiology. Intubation was the most common method of airway management (n = 165; 82%), and most patients (n = 102; 50%) were extubated immediately after surgery. Tracheotomy was performed primarily for 35 (17%) patients, and secondarily for 25 (15%). Two patients were managed in local anesthesia. Altogether 80 (40%) patients required care in the intensive care unit for a median of 7 days. Median hospital stay was 6 days for intubated patients and 10 days for primarily tracheotomized (p = 0.036). DNI extended to the mediastinal space in 25 (12%) patients, most of whom with odontogenic infection (48%), and necrotizing fasciitis (32%). Odontogenic infection was the most common etiology for DNI with increased risk for mediastinal involvement. Intubation was most common type of airway management with high success in immediate extubation after surgery. The need for tracheotomy seemed to lead to a longer hospital care and was associated with a more severe clinical course.

Nitrous oxide for applying local anesthesia in nasal operations: a randomized placebo-controlled single-blinded study.

CONCLUSIONS: In our study setting nitrous oxide (N(2)O) did not show any clinical benefit in discomfort experienced when applying local anesthesia for nasal operations. Further studies with longer inhalation times are needed to elucidate the role of N(2)O in application of local anesthesia in nasal surgery. OBJECTIVES: N(2)O inhalation reduces the discomfort experienced in various medical procedures. The objective of this study was to assess the suitability of N(2)O inhalation before application of local anesthesia for nasal procedures in outpatient surgery. PATIENTS AND METHODS: This was a prospective, randomized, single-blinded, placebo-controlled study at the Helsinki University Central Hospital, Finland. Ninety patients were randomly divided into three groups. Group A inhaled 10 breaths of 50% N(2)O/50% O(2) through a nasal mask with a Porter 2000 MXR scavenging system before application of local nasal anesthesia, group B inhaled room air through the same mask and group C received only local anesthesia. A visual analog scale was used to assess pain, nausea, and discomfort related to the application of nasal anesthesia. RESULTS: The N(2)O inhalation was easy to perform and well tolerated. The N(2)O inhalation before applying local anesthesia for nasal operations did not show any significant additional benefit in reducing pain or discomfort.

Radiofrequency induced thermotherapy: an alternative palliative treatment modality in head and neck cancer.

Bipolar radiofrequency induced thermotherapy (RFITT) is a minimally invasive electrosurgical technique characterized by a precise controllable effect in the tissue. It has demonstrable efficacy, safety and reproducibility in the management of solid malignancies. Our aim was to assess the morbidity and efficacy of RFITT as a palliative treatment of head and neck cancer. Prospective, non-randomized case series and analysis. After evaluation by the multidisciplinary Head and Neck Tumour Board at Helsinki University Central Hospital, Finland, 12 consecutive patients with a head and neck cancer without curative treatment possibilities were enrolled into the study. Five patients had pharyngeal carcinomas, one had an unknown primary tumour growing through the skin on the neck, two had a recurrent malignant melanoma originating from the maxillary sinuses, one had a carcinoma of the tongue, two had laryngeal carcinomas, and one had a recurrent adenoid cystic carcinoma of the parotid gland. RFITT was performed with a CelonLabPrecision generator using appropriate electrodes. The treatment was administered under local or general anaesthesia. The subjective morbidity of the treatment was evaluated. The response to the treatment was assessed clinically and with radiological imaging when feasible. All but two of the patients received palliation to their disease. RFITT induced clinically a partial response in ten patients, and there were radiological detectable changes. There were no treatment related complications, and the patients tolerated the treatment well. RFITT in head and neck cancer patients is easy to perform, well tolerated, and induces reduction in the tumour mass. Continuous evaluation of RFITT treatment modality is warranted in selected palliative care patients.