Hyperspectral imaging for monitoring of free flaps of the oral cavity: A feasibility study.

OBJECTIVES: Hyperspectral imaging (HSI) provides spectral information about hemoglobin, water and oxygen supply and has thus great potential in perfusion monitoring. The aim of the present study was to investigate the feasibility of HSI in the postoperative monitoring of intraoral free flaps. METHODS: The 14 patients receiving reconstructive head and neck surgery with a radial forearm free flap were included. HSI was performed intraoperatively (t0), on Day 1 (t1), 2 (t2), 3-6 (t3), 7-9 (t4), 10-11 (t5) and 12-15 (t6) postoperatively. Flap tissue perfusion was assessed on defined regions of interest by calculating the perfusion indices Tissue Hemoglobin Index (THI), hemoglobin oxygenation (StO2 ), Near Infrared Perfusion Index (NIR Perfusion Index) and Tissue Water Index (TWI). RESULTS: Image quality varied depending on location of the flap and time of measurement. StO2 was >50 intraoperatively and >40 on t1 for all patients. A significant difference was found solely for TWI between t0 and t2 and t0 and t4. No flap loss occurred. CONCLUSIONS: The use of HSI in the monitoring of intraoral flaps is feasible and might become a valuable addition to the current clinical examination of free flaps.

Primary injection laryngoplasty after chordectomy for small glottic carcinomas.

OBJECTIVES: The purpose of this study was to analyze the short- and middle-term effects of primary injection laryngoplasty in patients having tumor resection within the same surgery concerning the vocal outcome. Injection laryngoplasty was performed after harvesting autologous adipose tissue via lipoaspiration. METHODS: A prospective study was performed with 16 patients (2 female; 14 male) who received tumor resection and an injection laryngoplasty using autologous adipose tissue during a single stage procedure. Multidimensional voice evaluation including videostroboscopy, patient self-assessment, voice perception, aerodynamics, and acoustic parameters was performed preoperatively, as well as 1.5, 3 and 6 months postoperatively. RESULTS: Results show an improvement in the roughness-breathiness-hoarseness (RBH) scale, voice dynamics and subjective voice perception 6 months postoperatively. Maintenance of Voice Handycap Index, jitter and shimmer could be observed 6 months postoperatively. There was no deterioration in RBH and subjective voice perception 2 and 6 weeks postoperatively. No complications occurred in the fat harvesting site. CONCLUSIONS: Using the lipoaspiration and centrifugation approach, primary fat injection laryngoplasty shows short-term maintenance und middle-term improvement in voice quality in patients with vocal fold defect immediately after chordectomy 6 months postoperatively. Cancer recurrence rate is comparable to the reported cancer recurrence rate for laryngeal carcinoma and thus not elevated through primary augmentation.

Misjudgment of Skills in Clinical Examination Increases in Medical Students Due to a Shift to Exclusively Online Studies during the COVID-19 Pandemic.

In medical school, practical capacity building is a central goal. During the COVID-19 pandemic, a shift to online teaching methods in university was mandated in many countries to reduce risk of SARS-CoV-2 transmission. This severely affected the teaching of psychomotor ability skills such as head and neck examination skills, resulting in a share of students that have only been taught such ENT-specific examination skills with online courses; our study aimed to measure performance and capacity of self-evaluation in these students. After completing a new extensive online Ear Nose Throat (ENT) examination course, we conducted a standardized clinical skills exam for nine different ENT examination items with 31 students. Using Likert scales, self-evaluation was based on questionnaires right before the clinical skills exam and objective evaluation during the exam was assessed following a standardized regime. Self-evaluation and objective evaluation were correlated. To compare the exclusive online teaching to traditional hands-on training, a historic cohort with 91 students was used. Objective examination performance after in-classroom or online teaching varied for single examination items while overall assessment remained comparable. Overall, self-evaluation did not differ significantly after online-only and in-classroom ENT skill teaching. Nevertheless, misjudgment of one's skill level increased after online-only training compared to in-classroom teaching. Highest levels of overestimation were observed after online training in simple tasks. While gender and interest in ENT did not influence self-evaluation and misjudgment, higher age of participants was associated with an overestimation of skills. Medical students with online-only training during the COVID-19 pandemic achieved similar ENT examination skills to those with traditional on-campus training before the pandemic. Nevertheless, students with online-only training were more prone to misjudge their skills when they assessed their skills. Due to the COVID-19 pandemic, current medical students and graduates might therefore lack individual specific psychomotor skills such as the ENT examination, underlining the importance of presence-based teaching.

[ToSkORL: self- and objective assessment of examination skills in the head and neck region]. / ToSkORL: Selbst- und Fremdeinschätzung bei der Untersuchung des Kopf-Hals-Bereichs.

BACKGROUND: A central goal of medical school is acquisition of theoretical and practical competences. However, evidence on how capacity acquisition can be measured for special examination techniques is scarce. ToSkORL (Teaching of Skills in Otorhinolaryngology) is a project aimed at scientifically and didactically investigating students' self-evaluation skills in otorhinolaryngologic and head and neck examination techniques. METHODS: During the examination techniques course, a standardized oral and practical exam for nine different techniques was conducted. Using Likert scales, self-evaluation was based on questionnaires before the clinical skills exam and objective evaluation was performed by the examiners during the examination using a checklist. Self- and objective evaluation were correlated. Nine different examination skills were assessed 42 times each by a total of 91 students. RESULTS: Self-evaluation of competence in the different examination skills varied widely. Nevertheless, self- and objective evaluation correlated well overall, independent of age and gender. Students highly interested in otorhinolaryngology rated their own skills higher but tended toward overestimation. For examination items with intermediate difficulty, the highest divergences between self- and objective evaluation were found. CONCLUSION: Student self-evaluations are an appropriate instrument for measuring competences in otorhinolaryngologic examinations. Instructors should focus on items with allegedly intermediate difficulty, which are most often over- and underestimated.

Evaluation of hyperspectral imaging to quantify perfusion changes during the modified Allen test.

OBJECTIVES: To evaluate the capability of hyperspectral imaging (HSI), a contact-less and noninvasive technology, to monitor perfusion changes of the hand during a modified Allen test (MAT) and cuff occlusion test. Furthermore, the study aimed at obtaining objective perfusion parameters of the hand. METHODS: HSI of the hand was performed on 20 healthy volunteers with a commercially available HSI system during a MAT and a cuff occlusion test. Besides gathering red-green-blue (RGB) images, the perfusion parameters tissue hemoglobin index (THI), (superficial tissue) hemoglobin oxygenation (StO2), near-infrared perfusion (NIR), and tissue water index (TWI) were calculated for four different regions of interest on the hand. For the MAT, occlusion (OI; the ratio between the condition during occlusion and before occlusion) and reperfusion (RI; the ratio between the non-occlusion state and the prior occlusion state) indices were calculated for each perfusion parameter. All data were correlated to the clinical findings. RESULTS: False-color images showed visible differences between the various perfusion conditions during the MAT and cuff occlusion test. THI, StO2, and NIR behaved as expected from physiology, while TWI did not in the context of this study. During rest, mean THI, StO2, and NIR of the hand were 34 ± 2, 72 ± 9, and 61 ± 6, respectively. The RI for THI showed a roundabout threefold increase after reperfusion of both radial and ulnar artery and was thus, distinctly pronounced when compared with StO2 and NIR (~1.25). The OI was lowest for THI when compared with StO2 and NIR. CONCLUSIONS: HSI with its parameters THI, StO2, and NIR proved to be suitable to evaluate perfusion of the hand. By this, it could complement visual inspection during the MAT for evaluating the functionality of the superficial palmary arch before radial or ulnar artery harvest. The presented RI might deliver useful comparative values to detect pathological perfusion disorders at an early stage. As microcirculation monitoring is crucial for many medical issues, HSI shows potential to be used, besides further applications, in the monitoring of (free) flaps and transplants and microcirculation monitoring of critically ill patients.