The swallowing and speech after transoral robotic surgery-does the site impact the outcome?

Transoral robotic surgery (TORS) has been introduced to head and neck surgery as a minimally invasive techqniques to improve the functional outcomes of patients. Compare the functional outcome for swallowing and speech in each site of TORS within the head and neck. Retrospective cohort study for patients who underwent TORS within the head and neck unit. Patients were assessed at four different time points (one day, one month, six months and twelve months, respectively) with bedside/office testing. Methods of testing for swallowing assessment were by the International Dysphagia Diet Standardization Initiative (IDDSI), and speech assessments were carried out using the Understandability of Speech score (USS). Outcomes were compared to patient-specific pre-treatment baseline levels. 68 patients were included. 75% and 40% of the patients resumed normal fluid intake and normal diet immediately after surgery. 8.8% required a temporary feeding tube, with 1% required gastrostomy. There was a steep improvement in diet between 3 and 6 months. Fluid and diet consistency dropped significantly following the majority of transoral robotic surgery with more noticeable diet changes. Early deterioration in diet is temporary and manageable with a modified diet. Rapid recovery of swallowing is achieved before the first year. There is no long-term effect on speech.

Comparison of side effects and patient perceptions towards Rapid Rhino and Merocel packs in epistaxis.

OBJECTIVE: Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects. METHODS: A prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used. RESULTS: A total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used. CONCLUSION: Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.

Transoral robotic tongue base mucosectomy for head and neck cancer of unknown primary: six-year outcome experience.

BACKGROUND AND OBJECTIVE: Head and neck carcinoma of unknown primary is a diagnostic dilemma. The clinical and imaging workup remains ineffective in two-thirds of patients. Transoral robotic surgery has shown an advantage in the primary detection over the previous standard panendoscopy. METHODS: This is an observational cohort study that took place at a large healthcare centre with robotic surgery experience in head and neck over six-years. All included carcinoma of unknown primary patients followed the standard recommendation for primary identification. Final diagnostic step of robotic tongue base mucosectomy with or without tonsillectomy was introduced. The cancer detection rate in tongue base only, the functional outcome and the effect on the cancer pathway were evaluated. RESULTS: Carcinoma of unknown primary was reported in 44 per cent of patients. All identified specimens were human papillomavirus positive. There was no significant effect on functional outcome of swallowing and the national 62-day cancer pathway. Robotic surgery allowed optimum treatment of carcinoma of unknown primary in early nodal disease. CONCLUSION: Robotic surgery is a useful paradigm in the management of carcinoma of unknown primary. It is safe with minimal morbidity and good functional outcome after the surgery.

Ten-year prevalence of acute hospital ENT infections and the impact of COVID: A large population study.

BACKGROUND: Acute ear, nose and throat (ENT) infections were the commonest referrals from accident and emergency to ENT services. The referral rate changed dramatically with season, year, national outbreaks and during the COVID pandemic. METHOD: Retrospective longitudinal study of the epidemiology of seven acute ENT infections in secondary care over 10 years. A mixed city and rural population of over 650 000 in central England was studied. The risk factors for each wave of infection during the surge of infection were sought. A statistical analysis of their significance was undertaken. This included analysis and correlation of group A-beta haemolytic streptococcus (GABHS) in hospital and community. Seasonal variations, hospital admissions and the impact of the COVID were analysed. RESULTS: There were 16 883 reported cases of the seven index ENT infections during the 10-year period. Great seasonal and year-to-year variations were recorded. There was an incremental rise in 2018. Spring had the highest season of acute ENT infections. An outbreak of GABHS was noted in the community in 2014. The mean duration of hospital admission was 1.5 days. There was no statistical ethnic or gender predominance. A dramatically lower number of acute ENT infections were recorded during the COVID-19 pandemic, and this continued after lifting of lockdown restrictions. CONCLUSION: A resurgence in scarlet fever directly and indirectly contributed to an incremental rise in acute ENT infections in the following years. Both hospital and community B-haemolytic cultures have declined during the COVID-19 pandemic due to a reduction in infections as opposed to reduced case ascertainment.

COVID-19 Cross-Infection Rate After Surgical Procedures: Incidence and Outcome.

OBJECTIVES/HYPOTHESIS: Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) is transmitted by droplet as well as airborne infection. Surgical patients are vulnerable to the infection during their hospital admission. Some surgical procedures are classified as aerosol generating (AGP). STUDY DESIGN: Retrospective observational study of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. METHODS: Retrospective observational study in a tertiary healthcare center of four specialties associates with known AGP's during the 4 months of the first wave of UK COVID-19 epidermic to identify post-surgical cross-infection with SARSCoV-2 within 14 days of a procedure. RESULTS: There were 3,410 procedures reported during this period. The overall cross-infection rate from tested patients was 1.3% (4 patients), that is, 0.11% of all operations over 4 months. Ear, nose, and throat carried slightly higher rate of infection (0.4%) than gastroenterology (0.08%). The mortality rate was 0.3% (one gastroenterology patient from 304 positive cases) compared to 0% if surgery performed after recovery from SARSCoV-2 and 37.5% when surgery was conducted during the incubation period of the disease. Routine preoperative rapid screening tests and self-isolation are crucial to avoid the risk of cross-infection. Patients with underlying malignancy or receiving chemotherapy were more prone to pulmonary complications and mortality. CONCLUSION: The risk of SARS-COV-2 cross-infection after surgical procedure is very low. Preoperative screening and self-isolation together with personal protective measures should be in place to minimize the cross-infection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2749-E2754, 2021.

Pharmacological pupil dilatation after sinus surgery.

Orbital complications after endoscopic sinus surgery are serious problems. Inadvertent contamination of the eye by pharmacological solution can lead to early postoperative anxiety to patients and high concern to surgeons. This is a rare case report of retrograde epinephrine flow through lacrimal duct in sinus surgery with learning tips during postoperative assessment for reassurance in temporary pharmacological effect rather than serious complication.

Tips for improving access in endoscopic stapling of pharyngeal pouch.

Endoscopic stapling is the preferred technique for treatment of symptomatic pharyngeal pouches. The use of stapling with a standard pharyngoscope can be successful in difficult access patients. This modification of the technique can prevent the conversion of an endoscopic approach to an open approach.

Retropharyngeal abscess after chemotherapy.

Chemotherapy increases susceptibility to infection due to the effect on cell-mediated and humoral immunity. Retropharyngeal abscess is a serious head and neck infection that rapidly progresses from toxicity, whether the patient is neutropenic or not. The risk should be carefully assessed with any chemotherapeutic agent, especially docetaxel.

Division of tongue tie as an outpatient procedure. Technique, efficacy and safety.

OBJECTIVES: Assessment of the clinical presentations and the outcome of tongue tie division under local anesthesia. STUDY DESIGN: Retrospective study. SETTING: Glan Clwyd Hospital. INTERVENTION: All babies had tongue tie division in the ENT outpatient clinic under local anaesthesia between May 2010 and June 2011. Preoperative symptoms and parents' feedback were determined using questionnaires based on NICE guidelines. RESULTS: 63 infants had tongue tie division in outpatient clinic. Average age of the procedure was 4.1 weeks. Before the procedure, 66.7% of babies had difficulty in breast-feeding. 11.1% had poor growth. 22.2% had limitation in tongue movement. 27.7% of the mothers had breast problems such as cracking and soreness of the nipples. All the preoperative problems were resolved in 98.4%. 77.1% of parents' comments were positive. They described procedure as quick with minimal distress. 88.9% had no complications following division of tongue tie. CONCLUSION: Tongue tie division is a simple procedure with minimal complications. It can be undertaken under local anesthesia within first 3 months of life in the outpatient environment. Timely diagnosis, referral and treatment can make a difference in breast-feeding and weight gain.

Lipoma of the pinnal helix: a very unusual location for a very common tumour.

Lipomas are common benign tumours but can present in unusual locations. The authors present the rare case of a pedunculated lipoma of the pinnal helix. The lipoma was excised with good cosmetic result. Lipoma of the cartilaginous pinnal helix is rare and has not been described previously in the literature.