Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis.

OBJECTIVE: To compare the efficacy and safety characteristics of endoscopic and microscopic stapes surgery based on current evidence. METHODS: A systematic literature search was conducted of three medical databases, focusing on randomised, controlled studies or observational studies. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarised using the pooled mean differences or pooled odds ratios, along with their 95 per cent confidence intervals. RESULTS: Thirteen studies were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement; this revealed comparable outcomes for the two techniques (mean difference = -0.20; 95 per cent confidence interval = -0.53, 0.14). No statistically significant difference was detected concerning post-operative complications, except for dysgeusia (odds ratio = -1.12; 95 per cent confidence interval = -1.97, -0.28) and pain (odds ratio = -2.00; 95 per cent confidence interval = -2.97, -1.04), which favoured the endoscopic approach. CONCLUSION: Though both techniques result in commensurate outcomes concerning success rate, post-operative pain and dysgeusia favour the endoscopic approach. Further high-quality studies are needed to adequately compare the two methods.

Diagnostic accuracy of fine needle aspiration cytology in parotid gland lesions.

BACKGROUND: This study aimed to estimate the fine needle aspiration cytology's (FNAC) diagnostic accuracy in differentiating neoplastic from inflammatory lesions (Q1) and malignant from their benign counterparts (Q2). METHODS: We present a retrospective case series covering a single University Hospital and six attending head and neck surgeons over eight years (January 2011 to July 2017). We concentrated on adults with clinically suspected parotid gland lesions. We offered all patients FNAC biopsy preoperatively, and the final diagnosis was established based on the findings of the final histology. The FNAC and histology results were cross-tabulated in a 2 x 2 contingency table, from which we calculated the diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values. RESULTS: From 212 consecutive patients reviewed, and after excluding thirteen cases (8 %) of valid but non-diagnostic FNAC, 161 cases (50 females and 111 males) fulfilled set eligibility criteria. The most common diagnosis was Warthin tumors (53 patients, 34 %), followed by pleomorphic adenomas (52 patients, 33.5 %). The sensitivity and specificity of FNAC in differentiating neoplastic from non-neoplastic lesions and in segregating malignant from benign conditions were estimated to be as high as 50 % and 97 %, and 98 % and 93 %, respectively. CONCLUSION: FNAC is moderately effective in differentiating non-neoplastic from neoplastic disease and highly accurate in selecting malignant lesions from benign ones. Although the lack of FNAC sensitivity can occasionally be problematic, it still comprises a valuable tool in salivary gland surgery. HIPPOKRATIA 2022, 26 (1):25-31.

Endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction: creating a window with a drill without use of mucosal flaps.

CONCLUSION: Success and complication rates of endoscopic dacrycystorhinostomy (DCR) creating a window with a drill and without using mucosal flaps are similar to those of external DCR. Moreover, any intranasal or paranasal disease can be treated simultaneously and a superior cosmetic result is achieved. OBJECTIVES: To present success and complication rates of a case series of patients treated with the same technique of endoscopic DCR for acquired nasolacrimal duct obstruction (NLDO). PATIENTS AND METHODS: This was a retrospective case review of 46 patients (25 female, 21 male; mean age 57 years). All patients had acquired NLDO with epiphora. Additionally, chronic dacryocystitis was evident at presentation in five patients. The cause of NLDO was primary acquired NLDO in 35 patients and lacrimal sac mucocele in 11 patients. An endonasal endoscopic approach using a drill was performed. Temporary silicone stenting of the nasolacrimal duct system was applied. In 19 patients additional surgery (11 FESS, 3 septoplasties, 5 FESS and septoplasty) was necessary. Patient follow-up ranged between 3 and 27 months. RESULTS: A successful functional result was obtained in 97.8% of patients. No major complications were observed. Minor complications (acute dacryocystitis or periorbital ecchymosis) occurred in four patients and were treated with antibiotics or resolved spontaneously.