Initial Experience With Ultra-High-Definition 3D Exoscope in Thyroid and Parathyroid Surgery.

BACKGROUND: Operation with a 3D exoscope has recently been introduced in clinical practice. The exoscope consists of two cameras placed in front of the operative field. Images are shown on a large 3D screen with high resolution. The system can be used to enhance precise dissection and provides new possibilities for improved ergonomics, fluorescence, and other optical-guided modalities. METHODS: Initial experience with the ultra-high-definition (4K) 3D exoscope in thyroid and parathyroid operations. The exoscope (OrbEyeTM) was mounted on a holding system (Olympus). RESULTS: We used the exoscope in parathyroidectomy (N = 6) and thyroidectomy (N = 6). Immediate advantages and disadvantages were discussed and recorded. The learning curve for use of the exoscope may be shorter for surgeons with training in endoscopic or robotic procedures. There may be improved ergonomics compared with normal open-neck operations. Further, the optical guided operations can be used with fluorescence and have potential for different on-lay techniques in the future. The 4 K 3D image quality is state-of-art and is highly appreciated during fine surgical dissection and eliminates the need for loupes. CONCLUSION: In several ways, using the ORBEYE™ in thyroid and parathyroid surgery provides the surgical team with a new and enhanced experience. This includes improved possibility for teaching, surgical ergonomics, and a 4K 3D camera with a powerful magnification system. However, it is not clear if utilization of these features would improve surgical outcomes. Furthermore, the ORBEYE™ lacks incorporation of parathyroid autofluorescence, and the current costs for the system do not facilitate general access to exoscope assisted operations.

Bacterial findings in patients referred to hospital for the treatment of acute tonsillitis with or without peritonsillar phlegmon.

BACKGROUND: The vast majority of patients with acute tonsillitis (AT) are managed in general practice. However, occasionally patients are referred to hospital for specialized management because of aggravated symptoms and/or findings suggestive of peritonsillar involvement. No prospective studies have been conducted aiming to investigate the prevalent and significant microorganisms in this highly selected group of patients. We aimed to describe the microbiological findings of acute tonsillitis with or without peritonsillar phlegmon (PP) in patients referred for hospital treatment and to point out potential pathogens using the following principles to suggest pathogenic significance: (1) higher prevalence in patients compared to healthy controls, (2) higher abundance in patients compared to controls, and (3) higher prevalence at time of infection compared to time of follow up. METHODS: Meticulous and comprehensive cultures were performed on tonsillar swabs from 64 patients with AT with (n = 25) or without (n = 39) PP and 55 healthy controls, who were prospectively enrolled at two Danish Ear-Nose-Throat Departments between June 2016 and December 2019. RESULTS: Streptococcus pyogenes was significantly more prevalent in patients (27%) compared to controls (4%) (p < 0.001). Higher abundance was found in patients compared to controls for Fusobacterium necrophorum (mean 2.4 vs. 1.4, p = 0.017) and S. pyogenes (mean 3.1 vs. 2.0, p = 0.045) in semi-quantitative cultures. S. pyogenes, Streptococcus dysgalactiae, and Prevotella species were significantly more prevalent at time of infection compared to follow up (p = 0.016, p = 0.016, and p = 0.039, respectively). A number of species were detected significantly less frequently in patients compared to controls and the mean number of species was significantly lower in patients compared to controls (6.5 vs. 8.3, p < 0.001). CONCLUSIONS: Disregarding Prevotella spp. because of the prevalence in healthy controls (100%), our findings suggest that S. pyogenes, F. necrophorum, and S. dysgalactiae are significant pathogens in severe AT with or without PP. In addition, infections were associated with reduced diversity (dysbacteriosis). TRIAL REGISTRATION: The study is registered in the ClinicalTrials.gov protocol database (# 52,683). The study was approved by the Ethical Committee at Aarhus County (# 1-10-72-71-16) and by the Danish Data Protection Agency (# 1-16-02-65-16).

Incidental FDG-Avid Focuses in Palatine Tonsils on PET/CT.

OBJECTIVES: The management of incidental findings of FDG-avid tonsils on PET/CT (IFT) is unclear. We aimed to explore the prevalence of malignancy in IFT, identify risk factors for malignancy, and calculate optimal cutoffs of maximum standardized uptake values (SUVmax ) to discriminate between benign and malignant lesions. METHODS: All patients who were tonsillectomized at our institution because of IFT from October 2011 to December 2020 were included. Patients undergoing PET/CT due to suspected tonsillar disease or cancer of unknown primary were excluded. RESULTS: In total, 77 patients were included, of which 11 (14%) of them had IFT malignancy. Dysphagia (p = 0.019) and alcohol abuse (p = 0.035) were associated with malignancy. Absolute SUVmax cutoff (≥9: sensitivity 100%; specificity 53%) was superior to SUVmax side-to-side ratio (≥1.5: sensitivity 64%; specificity 70%) to discriminate between benign and malignant lesions. CONCLUSION: We recommend tonsillectomy for patients with IFT displaying SUVmax ≥ 9.0, ratio ≥ 1.5, or symptoms or findings suggesting malignancy. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:2370-2378, 2022.

Superficial Parotidectomy: Impact of Postoperative Drainage.

BACKGROUND: Use of suction drain after superficial parotidectomy (SP) is based on national consensus considered best practice, but there is no evidence on the effect of the treatment. The aim of the present study is to evaluate the effectiveness of drainage after SP by evaluating the rate of complications after SP in relation to the (ie, duration) of drainage and tumor size. METHODS: Retrospective analysis was performed involving data from all consecutive patients undergoing SP at the Ear, Nose, and Throat department, Regional Hospital West Jutland, Denmark, between January 1, 2011, and December 31, 2017. Demographics including comorbidity, medication, tumor size, postoperative secretion through the drainage, as well as complications (hematoma, seroma, infection, fistulas, Frey syndrome, facial nerve palsy) were registered. Patients with secretion below 25 mL were compared to patients with secretion above 25 mL, that is, drainage less than 24 hours versus longer than 24 hours. Results: Two hundred five consecutive patients undergoing SP were enrolled. The overall risk of postoperative infection was 16.2%. Ten of 33 patients with infection were also diagnosed with an hematoma or seroma. The risk of infection increased with secretion above 25 mL (27.2%) compared to patients with less than 25 mL (13.1%; P = .0318). The same accounts for the risk of seromas/hematomas (P = .0055). We found no evidence that demographics or comorbidity correlated to the secretion in the drainage, but there is a tendency toward male gender having a higher risk off secretion above 25 mL (odds ratio 1.39). CONCLUSION: Overall, the risk of complications after SP increased with secretion beyond 25 mL (ie, drainage for more than 24 hours). This applied in particular to infections and seromas/hematomas demanding treatment. The use of routine drainage after SP is questionable, and a randomized trial is warranted to unravel the necessity of postoperative drainage.

Management of sore throat in Danish general practices.

BACKGROUND: The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline. METHODS: A cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients. RESULTS: In total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%). CONCLUSION: Danish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.