Manejo cirúrgico de ferimento auto-infligido por arma de fogo em região maxilofacial / Surgical management of self-inflicted injury by gun in the maxillofacial region

INTRODUÇÃO: O manejo dos pacientes vítimas de PAF possui vertentes divergentes a respeito do tratamento cirúrgico, que pode ser realizado de forma imedata ou tardia. Em lesões auto-infligidas, a distância entre a arma e a região acometida é menor, causando consequências estéticas e funcionais mais devastadoras. Aliado ao fato desse tipo de trauma criar uma ferida suja devido à comunicação com a cavidade oral e seios paranasais, o manejo das lesões representam um desafio mesmo à cirurgiões experientes. OBJETIVO: Estre trabalho relata o manejo cirúrgico de uma ferida auto-infligida por arma de fogo que resultou em avulsão dos tecidos moles na região maxilofacial. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 35 anos, vítima de projétil de arma de fogo auto-infligido em região maxilofacial, cursando com extenso ferimento em região de língua e mento. Clinicamente, o paciente não apresentava sinais de fratura em ossos da face. Ambos os ferimentos apresentavam secreção purulenta e o paciente manifestava disfonia devido a grande destruição tecidual. CONSIDERAÇÕES FINAIS: O tratamento de ferimentos por arma de fogo não só é um grande desafio para o cirurgião, como para toda a equipe multidisciplinar requerida para tais casos, visto que não há protocolos bem definidos para o tratamento dessas lesões(AU)

INTRODUCTION: The management of patients who are victims of FAP has divergent aspects regarding surgical treatment, which can be performed immediately or late. In self-inflicted injuries, the distance between the weapon and the affected region is smaller, causing more devastating aesthetic and functional consequences. Allied to the fact that this type of trauma creates a dirty wound due to the communication with the oral cavity and paranasal sinuses, the management of injuries represents a challenge even for experienced surgeons. OBJECTIVE: This paper reports the surgical management of a self-inflicted gunshot wound that resulted in soft tissue avulsion in the maxillofacial region. CASE DESCRIPTION: Male patient, 35 years old, victim of a self-inflicted firearm projectile in the maxillofacial region, coursing with extensive injury in the region of the tongue and chin. Clinically, the patient did not show signs of facial bone fractures. Both wounds had purulent secretion and the patient had dysphonia due to extensive tissue destruction. FINAL CONSIDERATIONS: The treatment of gunshot wounds is not only a great challenge for the surgeon, but also for the entire multidisciplinary team required for such cases, since there are no well-defined protocols for the treatment of these injuries(AU)

Facilitating the removal of a foreign body in the tongue by intraoperative ultrasound guidance: A case report.

The presence of soft tissue foreign bodies (FBs) presents a substantial concern due to their potential to induce both acute and chronic pain as well as tissue irritation. This case report documents the admission of a 25-year-old female with a history of bur fractures during endodontic treatment, accompanied by signs of infection. The clinical examination and radiographic assessment revealed an embedded foreign body within her tongue. The surgical procedure was informed by repeated ultrasound scans through the incision, facilitating precise targeting. Intraoperative ultrasound enables the accurate detection of submucosal foreign bodies in dynamic tissues like the tongue and facilitates focused and image-guided dissection, thereby decreasing surgical trauma to the delicate soft tissues.

Oral complications associated with metal ion release from oral piercings: a systematic review.

PURPOSE: This systematic review explored dental complications associated with metal ion release from oral piercings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. METHODS: Item retrieval from October 2022 to December 2022 from databases, such as Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Scopus and Web of Science, using predefined search terms was undertaken by two independent reviewers. Data were extracted and risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. From 1509 identified studies, 25 were included for analysis. RESULTS: Of the 25 studies, 20 included both clinical examination and questionnaire-based data. The remaining five studies were deemed low quality based on the Joanna Briggs Institute criteria. The average time piercings were worn ranged between 5 and 48 months. Most studies did not investigate complications from metal ion release. Only two studies examined the direct effects of metal ion release and showed that metal ions may cause hypersensitivity reactions and mucosal changes. Other soft tissue complications were reported, with gingival recession noted in 16 out of 25 studies, especially due to lip piercings. Studies reporting other complications were as follows: swelling (9), pain (8), infection (6), bleeding (6), inflammation (5), alterations to speech, eating and/or swallowing (5), changes to taste or metallic taste (5), and mucosal changes (4). Ten studies reported tooth chipping from tongue piercings. CONCLUSION: Oral piercings leach metal ions into surrounding tissues which may cause local mucosal changes. Furthermore, oral piercings cause damage to both soft and hard oral tissues, particularly gingival recession for lip piercings and tooth chipping for tongue piercings. Thus, to prevent such adverse injuries, dental professionals should discourage patients against oral piercings.

A surprising finding: The curious case of a tongue lesion misdiagnosed as paracoccidioidomycosis / Un hallazgo inesperado: el curioso caso de una lesión en la lengua diagnosticada erróneamente como paracoccidioidomicosis

Background: Paracoccidioidomycosis is an endemic mycosis caused by members of the Paracoccidioides genus. Brazil remains the focus area and, to a lesser extent, the disease has been reported from Argentina, Colombia and Venezuela. Aims: A Venezuelan Paracoccidioides brasiliensis strain, isolated from a patient diagnosed with chronic multifocal paracoccidioidomycosis, was subjected to whole genome sequencing to provide more insight about Paracoccidioides outside the endemic focus area. Methods: P. brasiliensis strain CBS 118890 was whole genome sequenced using nanopore; library preparation with the ‘native barcoding genomic DNA kit’ was followed by sequencing on Flongle and MinION flowcells. Batches of strain CBS 118890 were re-identified by sequencing the internal transcribed spacer (ITS) region, and final identification was made based on phylogenetic analysis. Results: Surprisingly, the Venezuelan P. brasiliensis strain CBS 118890 turned out to be a Nannizziopsis species. The batches of this strain were ITS sequenced followed by phylogenetic analysis and resulted in the final identification of Nannizziopsis arthrosporioides. Conclusions: Nannizziopsis infections are commonly seen in a wide variety of reptiles, but are particularly rare in human infections. This case underlines the need for molecular characterization of cases that clinically mimic paracoccidioidomycosis but that are serologically negative for Paracoccidioides.(AU)

Antecedentes: La paracoccidioidomicosis es una micosis endémica causada por especies del género Paracoccidioides. Brasil sigue siendo el área con la mayor incidencia y, en menor medida, se ha informado de casos en Argentina, Colombia y Venezuela. Objetivos: Una cepa venezolana de Paracoccidioidesbrasiliensis, obtenida de un paciente diagnosticado con paracoccidioidomicosis multifocal crónica, se sometió a secuenciación completa del genoma para obtener más información sobre Paracoccidioides fuera del área de foco endémico. Métodos: Se secuenció el genoma completo de la cepa CBS 118890 de P. brasiliensis mediante la técnica de secuenciación de nanoporos; tras la preparación de la librería con el «native barcoding genomic DNA kit» se procedió a la secuenciación con el Flongle y MinION flowcells. Los lotes de la cepa CBS 118890 se volvieron a identificar mediante la secuenciación de la región del espaciador transcrito interno (ITS), y la identificación final se realizó en función del análisis filogenético. Resultados: Sorprendentemente, la cepa venezolana P. brasiliensis CBS 118890 resultó ser una especie de Nannizziopsis. Los lotes de esta cepa se secuenciaron mediante ITS seguido de un análisis filogenético y dieron como resultado la identificación de la especie Nannizziopsis arthrosporioides. Conclusiones: Las infecciones por Nannizziopsis se observan comúnmente en una amplia variedad de reptiles, pero son particularmente raras en infecciones humanas. Este caso subraya la necesidad de la caracterización molecular de los casos que clínicamente reflejan paracoccidioidomicosis, pero que son serológicamente negativos para Paracoccidioides.(AU)

[Tongue Lacerations in Children. The Zurich Tongue Scheme]. / Zungenverletzungen bei Kindern: Das Zürcher Zungenschema.

Tongue Lacerations in Children. The Zurich Tongue Scheme Abstract. Treating injured children is part of everyday life at a pediatrician's office or in an emergency department. Among the most common injuries are lacerations, mainly of the head, but the tongue can also be affected. Lacerations of the tongue mostly occur in early childhood due to fall when the child bites its tongue. No evidence-based treatment recommendations exist, even though such injuries are common. It makes a huge difference to the parents and children affected whether the treatment consists of a primary wound closure in general anesthesia or spontaneous healing can be awaited. In this article, the development and implementation of the Zurich Tongue Scheme will be discussed, the first evidence-based treatment recommendations for uncomplicated tongue lacerations in children.

Epidermoid cyst of the tonge: two new cases of an extremely uncommon entity / Quiste epidermoide de la lengua: dos nuevos casos de una entidad extremadamente infrecuente

El quiste epidermoide (QE) es una lesión benigna que emerge como un aumento indoloro y fluctuante del volumen. Es una lesión rara en la cavidad oral y su diagnóstico a través de exámenes clínicos y radiografía convencional proporciona resultados limitados. Por lo tanto, el propósito del presente trabajo es reportar dos casos de lesiones raras de la lengua diagnosticadas como QE en dos pacientes adultos tratados quirúrgicamente. Un hombre de 65 años y una mujer de 40 años se quejaban de una “bolita” en la lengua. Los pacientes presentaron lesiones en la lengua en sitios anatómicos con distintas presentaciones clínicas. El tratamiento adoptado fue una resección de la lesión y, tras un análisis histopatológico, el diagnóstico final apuntó a un quiste epidermoide. En los casos actuales, la lesión ocurrió en el vientre y el dorso de la lengua, y ambos fueron tratados quirúrgicamente. Así, se convirtieron en los casos 14 y 15 de QE en lenguas encontradas en la literatura, confirmando así la relevancia del trabajo actual. (AU)

Epidermoid cyst (EC) is a benign lesion that emerges as a painless and fluctuating increase of volume. EC is a rare injury in the oral cavity and its diagnostic through clinical exams and conventional radiography provides limited results. Thus, the purpose of the current work is to report two cases of rare tongue lesions diagnosed as EC in two adult patients treated surgically. A 65-year old man and a 40-year old woman were complaining of a “little ball” in their tongue. The patients presented tongue lesions in anatomical sites with distinct clinical presentations. The adopted treatment was a resection of the lesion and, after a histopathological analysis, the final diagnostic pointed to an epidermoid cyst. In the current cases, the lesion occurred in the belly and dorsum of the tongue, and both were treated surgically. And so they became the 14th and 15th cases of EC in tongues found in the literature, thus confirming the relevance of the current work. (AU)

Influência da via hippo em carcinomas de células escamosas de língua oral / Influence of the hippo pathway on oral tongue squamous cell carcinomas

O carcinoma de células escamosas de língua oral (CCELO) apresenta altas taxas de morbidade e mortalidade. Apesar dos progressos alcançados nesta área, os pesquisadores continuam em busca de biomarcadores moleculares que tenham valor preditivo no prognóstico dos pacientes e que possibilitem o desenvolvimento de novas estratégias terapêuticas. Neste contexto, várias pesquisas têm destacado o papel da via Hippo com esta finalidade. Portanto, esta pesquisa teve como objetivo avaliar se as proteínas relacionadas à Via Hippo, LATS2 e YAP1, exercem alguma influência sobre o comportamento biológico dos CCELOs. A amostra foi constituída por 26 casos de CCELO e 8 casos de mucosa oral normal como controle. Para avaliar a morfologia dos CCELOs foram utilizadas as gradações propostas pela OMS (2005) e por Almangush et al. (2014). O perfil imunoistoquímico de LATS2 e YAP1 foi avaliado por escores (0-3), com base na sua imunoexpressão em localização intracelular (núcleo e/ou citoplasma) e distribuição epitelial. Para a análise entre os parâmetros estudados foram realizados os testes estatísticos Qui-quadrado de Pearson e Exato de Fisher. A análise de sobrevida foi realizada através do método de Kaplan Meier e do teste log-rank. Para todas as avaliações foram considerados valores significativos com p<0,05. Foi observada alta expressão da LATS2 tanto em mucosa oral normal (100%) quanto na maioria dos CCELOs (73,1%), sem diferença estatística significativa (p=0,160). Foi possível evidenciar o aumento da imunoexpressão da YAP nos casos de CCELO em comparação à mucosa oral normal (p<0,001). Verificou-se ainda que a baixa expressão da LATS2 foi associada com menores taxas de sobrevida livre da doença (p=0,039). Além disso, constatou-se que a elevada expressão da YAP foi associada à classificação de alto risco do modelo BD (p=0,034), sugerindo que a imunoexpressão desta proteína pode estar associada a TEM e invasão celular em CCELO. A elevada expressão de ambas as proteínas, na maioria dos CCELOs, sugere que outras vias de sinalização, além da regulação através da LATS2, podem estar induzindo a expressão nuclear de YAP nestes tumores. Portanto, conclui-se que a via Hippo pode influenciar o comportamento biológico dos CCELOs (AU).

Oral tongue squamous cell carcinoma (OTSCC) has high morbidity and mortality rates. Despite the progress made in this area, researchers continue to search for molecular biomarkers that have predictive value in the prognosis of patients and allow the development of new therapeutic strategies. In this context, several studies have highlighted the role of the Hippo pathway for this purpose. Therefore, this research aimed to evaluate whether the proteins related to the Hippo pathway, LATS2 and YAP1, have some influence on the OTSCC biological behavior. The sample consisted of 26 OTSCC cases and 8 normal oral mucosa cases as control. For the morphological assessment of OTSCC, the gradations proposed by the WHO (2005) and by Almangush et al. (2014) were performed. The immunohistochemical profile of LATS2 and YAP1 was evaluated by scores (0-3), based on their immunoexpression in intracellular location (nucleus and/or cytoplasm) and epithelial distribution. Pearson's Chi-square and Fisher's Exact statistical tests were performed for the analysis of the studied parameters. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. For all evaluations, values with p<0.05 were considered significant. High expression of LATS2 was observed both in normal oral mucosa (100%) and in most OTSCC (73,1%), with no statistically significant difference (p=0,160). It was possible to observe the increase in YAP immunoexpression in cases of OTSCC compared to the normal oral mucosa (p<0.001). It was also found that the LATS2 low expression was associated with lower rates of disease-free survival (p=0.039). Furthermore, YAP high expression was found associated with the BD model's high-risk classification (p=0.034), suggesting this protein immunoexpression may be associated with EMT and cell invasion in OTSCC. The high expression of both proteins in most OTSCC suggests that other signaling pathways, in addition to regulating through LATS2, may be inducing the nuclear YAP expression in these tumors. Therefore, it is concluded that the Hippo pathway can influence the OTSCC biological behavior (AU).

Hemangioma capilar lobular: granuloma piógeno en lengua / Lobular capillary hemangioma: pyogenic granuloma of tongue

El granuloma piógeno es una lesión benigna, reactiva y multifactorial que resulta de le- siones repetitivas, microtraumatismos e irritación local en piel o mucosas y cambio hormonal. Cuando aparece en la cavidad oral tiene predilección por la encía vestibular, pero es importante que el odontólogo esté consciente y familiarizado con el hecho de que puede estar localizado en otras áreas anatómicas. Clínicamente se presenta como lesión hiperplásica altamente vascularizada, de tamaño generalmente no mayor a 2 cm, pediculada en la base o sésil y de lento crecimiento. Sin mostrar preferencia por edad o sexo, tiende a aparecer principalmente en encías, labios y mucosa oral, siendo muy pocos los casos reportados en el área lingual. Es por ello que, en este artículo, nos referimos a un caso de ubicación inusual, en conjunto con una revisión de la literatura (AU)

Pyogenic granuloma is a benign, reactive, and multifactorial lesion caused by repetitive injuries, microtrauma and local irritation on the skin or mucous membranes, and hormonal change. When it appears in the oral cavity, it has a predilection for the vestibular gingiva, but the dentist must be aware and familiar with the fact that it can be present in other anatomi- cal areas. Clinically, it is presented as a hyperplasic injury highly vascular-related, with a size generally no bigger than 2 cm, pedunculated in base or sessile, and slow in growth. Without showing any preference in age or gender, it tends to appear mainly on the gums, lips, and oral mucosae, with very few, reported cases in the lingual area. Therefore, in this study, we refer to a case of unusual localization with a literature review (AU)

Tumor miofibroblástico de lengua / Myofibroblastic tongue tumour

El tumor miofibroblástico inflamatorio (TMI) es un tumor del estroma submucoso raro cuya presentación más frecuente es en el pulmón. Se trata de un tumor heterogéneo, formado por células fusiformes, inflamatorias y miofibroblastos, que por lo general es benigno, pero puede producir invasión local, recidiva y transformación maligna. Presentamos un paciente joven con una neoplasia en la lengua de aspecto invasivo e infiltrante que resultó ser un tumor miofibroblástico, pero que causó gran preocupación por su rápido crecimiento.(AU)

An inflammatory myofibroblastic tumour is a rare submucosal stromal tumour whose most common presentation is in the lung. This is a heterogeneous tumour, comprised of spindle cells, inflammatory cells and myofibroblasts, which is generally benign. However, it can cause local invasion, recurrence and malignant transformation. We report a young patient with an invasive and infiltrating tumour on the tongue that turned out to be a myofibroblastic tumour but caused major concern due to its rapid growth.(AU)

An unusual case of a foreign body: A child's tongue entrapped in a soft drink bottle.

Young children often present at the emergency department (ED) with foreign bodies in their mouths, including the occasional bottles and cans. Previous reports of tongue entrapment have presented cases where bottles were mostly made of glass or metal. A 4-year-old girl presented to the ED with her tongue entrapped in a uniquely designed plastic bottle. Attempts at conservative methods of removal such as gentle traction, breaking of the vacuum seal and use of lubricants were unsuccessful. The child was brought to the operating theatre for further management. Anaesthesia induction with a facemask was not possible as the plastic bottle was protruding from the tongue and would not allow an adequate seal around the nose and mouth. To overcome such challenges of a shared airway and workspace, the child was placed under intravenous propofol sedation initially until the prompt removal of foreign body allowed subsequent mask placement and oral intubation. The foreign body was eventually removed by sectioning the inflexible plastic into two pieces with a water-cooled high speed dental diamond bur. The child remained stable intra-operatively and subsequent post-operative recovery was uneventful. This report highlights the importance of multidisciplinary coordination to reduce delays when liberating the entrapped tongue so as to minimize potential complications from the injury.

An approach to a repeated self-biting tongue injury in a toddler.

BACKGROUND: Children with tongue injuries often visit the pediatric emergency department. The vast majority of cases can be conservatively treated, while some injuries require operative repair. The aim of this article was to demonstrate a "back-to-basics" approach to a refractory bifid tongue injury in a toddler. CASE DESCRIPTION: A 1-year-old toddler with a tongue injury was unsuccessfully treated three times within a week by a surgeon in another specialty; all reconstructions were mucosal only. The case was then referred to our maxillofacial unit for proper management. On examination, the recurrent injury seemed to occur because of the patient's self-biting habit. We performed the fourth reconstruction of the tongue muscles and mucosa, and because of no dental prosthetic laboratory available in our hospital, we used transparent adhesive drapes fixed by resorbable sutures to cover the patient's anterior teeth instead of bite guards. The toddler was fed via a nasogastric tube for 1 week under 2-day antibiotic prophylaxis and routine oral care. The patient was discharged without any complications 1 week later. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The causes of repeated orofacial injuries should be identified and require particular attention to establish a proper treatment. For intraoral injuries in pediatric patients, self-biting habits should not be overlooked. The application of materials in an operating theater can help the treating clinicians improve the treatment outcomes.

The chimeric medial sural artery perforator flap as the ideal for partial tongue reconstruction: A case series and technical refinements.

BACKGROUND: The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction. METHODS: A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap. RESULTS: A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8 mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented. CONCLUSION: The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction.

Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center.

OBJECTIVE: To evaluate the risk factors that pertain to stricture recurrence and oral complications. METHODS: Patients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. RESULTS: For patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06-24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35-14.06; P = .014). CONCLUSION: Our study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.

Use of an improvised clamp to manage bleeding tongue injuries.

We report a case of a 67-year-old Chinese man admitted to the emergency department for a persistent bleed on the tongue. Initial digital pressure and application of topical tranexamic acid did not stop the bleeding. An improvised clamp applied to the tongue was successful in achieving haemostasis. Using this method, there was no need for a clinical staff to be present for manual application of pressure. This frees up the staff for other clinical duties and matters.

Riga-Fede Disease: A Case of Sublingual Trauma Not Associated With Abuse.

OBJECTIVES: The following case presents a pediatric patient with Riga-Fede disease (RFD), a rare disorder in children under 2 years of age characterized by sublingual ulceration of the tongue due to trauma from repeated rubbing against the primary teeth. Riga-Fede disease is well reported in dental literature but is relatively unknown to the general pediatric community. It can be confused with nonaccidental trauma (NAT) from forced feeding or other abusive trauma because it presents with injury of oral structures including the sublingual frenulum and often results in problems with growth. This case highlights the importance for physicians to recognize RFD as a source of isolated oral injury that is distinct from NAT. Although approximately 35 cases of RFD have been reported in the literature, this is the first case to describe the process of distinguishing this disease from child abuse. METHODS: We present a case of an 8-month-old female infant who presented with extensive injury of her ventral tongue from RFD who underwent a full workup for NAT. We review the literature for guidance on diagnosing RFD and discuss how to distinguish it from abuse. RESULTS: Infants with characteristic ulceration of the ventral tongue opposing new teeth and with no other medical, social, or developmental concerns do not need to undergo further workup. Clinical examination and thorough history are sufficient to make the diagnosis. CONCLUSIONS: Traumatic intraoral injury in nonmobile children is highly concerning for child abuse. However, RFD is a well described cause of sublingual ulceration in infants that is not associated with abuse.

Real-Time, Intraoperative, Ultrasound-Assisted Transoral Robotic Surgery for Obstructive Sleep Apnea.

OBJECTIVES/HYPOTHESIS: To investigate the lingual artery (LA) position in the tongue base through intraoperative ultrasound (IOU) imaging during transoral robotic surgery (TORS) and evaluate bleeding complications with or without the assistance of IOU. STUDY DESIGN: Cohort study with historical control. METHODS: Patients with obstructive sleep apnea (OSA) who underwent TORS for tongue base resection were recruited since 2016. During surgery, ultrasound imaging was employed to identify anatomic parameters of the LA in the tongue base, including distance to the midline and arterial depth and diameter. RESULTS: Ninety-three OSA patients (82 men, 88.2%) were analyzed. Mean age was 42.2 ± 10.0 years and body mass index was 29.2 ± 4.5 kg/m2 . Average apnea-hypopnea index (AHI) was 58.1 ± 21.4 events/hour. Overall, 70 patients who underwent TORS with IOU had a shorter operation time (191.7 ± 3.8 vs. 220.1 ± 6.6 minutes), lower total blood loss (11.3 ± 10.8 vs. 19.6 ± 26.7 mL), and higher tongue base reduction volume (7.1 ± 2.5 vs. 3.9 ± 1.6 mL) than 23 patients who underwent TORS without IOU. Significant predictors of arterial depth included higher AHI level during the rapid eye movement sleep (P = .038), larger tonsil size (P = .034), and more elevated Friedman tongue position (P = .012). Postoperative complications associated with LA injury were not found in patients subjected to IOU. CONCLUSIONS: With the assistance of IOU, surgeons can confidently determine LA position. The use of IOU can maximize efficiency and minimize catastrophic bleeding complications when OSA patients undergo TORS for tongue base resection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E1383-E1390, 2021.

Comparison of three fixation methods for orotracheal intubation in 95 adults.

BACKGROUND: The present study aimed to compare three fixation methods for orotracheal intubation. METHODS: Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape-fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared. RESULTS: The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant. CONCLUSION: The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.