YO-IFOS Guidelines for Pediatric ENT Surgery during COVID-19: An Overview of Recommendations.

OBJECTIVE/HYPOTHESIS: To review the literature on pediatric ENT COVID-19 guidelines worldwide, in particular, surgical practice during the pandemic, and to establish a comprehensive set of recommendations. STUDY DESIGN: Review. METHODS: A comprehensive literature review through an independent electronic search of the COVID-19 pandemic in PubMed, Medline, Google, and Google Scholar was performed on April 26-30, 2020. Resources identified comprised of published papers, national and international pediatric ENT society guidelines. RESULTS: Fourteen guidelines fit the inclusion criteria. Key statements were formulated and graded: 1) Strong recommendation (reported by 9 or more/14); 2) Fair recommendation (7-8/14); 3) Weak recommendation (5-6/14); and 4) Expert opinion (2-4/14). Any single source suggestion was included as a comment. Highly scored recommendations included definition of urgent/emergent cases that required surgery; surgery for acute airway obstruction; prompt diagnosis of suspected cancer; and surgical intervention for sepsis following initial first-line medical management. Other well scored recommendations included senior faculty to perform the surgery; the use of open approaches rather than endoscopic ones; and avoidance of powered instruments that would aerosolize virus-loaded tissue. A tracheostomy should be performed on a case by case basis where key technical modifications become necessary. CONCLUSIONS: The COVID-19 pandemic will have a profound short and long-term impact on pediatric ENT practice. During this rapidly evolving climate, guidelines have been based on local practice and expert opinion. Until evidence-based practice in the COVID era is established, a comprehensive set of recommendations for pediatric ENT surgical practice based on a review of currently available literature and guidelines, is therefore, appropriate. Laryngoscope, 131:1876-1883, 2021.

Porcine experimental model for perforator flap raising in reconstructive microsurgery.

BACKGROUND: Perforator free flap-based reconstruction of the head and neck is a challenging surgical procedure and needs a steep learning curve. A reproducible mammal large animal model with similarities to human anatomy is relevant for perforator flap raising and microanastomosis. The aim of this study was to assess the feasibility of a swine model for perforator-based free flaps in reconstructive microsurgery. METHODS: Eleven procedures were performed under general anesthesia in a porcine model, elevating a skin flap vascularized by perforating musculocutaneous branches of the superior epigastric artery to evaluate the relevance of this model for head and neck reconstructive microsurgery. RESULTS: The anterior abdominal skin perforator-based free flap in a swine model irrigated by the superior epigastric artery was elevated in eleven procedures. In six of these procedures, we could perform an arterial and venous microanastomosis to the great vessels located in the base of the neck. CONCLUSIONS: The porcine experimental model of superior epigastric artery perforator-based free flap reconstruction offers relevant similarities to the human deep inferior epigastric artery perforator flap. We could demonstrate this model as acceptable for perforator free flap training due to the necessity of perforator and pedicle dissection and transfer to a distant area.

Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio / Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear

Introducción. Las fístulas espontáneas de líquido cefalorraquídeo (LCR) al oído medio por dehiscencias espontáneas óseas del tegmen pueden ser origen de hipoacusia de transmisión y complicarse con meningitis u otras complicaciones intracraneales. El tratamiento quirúrgico para el cierre de estas comunicaciones anómalas puede realizarse por vía transmastoidea o por abordaje por fosa craneal media (FCM). Material y métodos. Se realiza un estudio retrospectivo de los pacientes intervenidos en nuestro servicio de fístulas de LCR espontáneas a oído medio por medio de abordaje por FCM en un período de 6años (2009-2014). Resultados. Se intervienen 13 pacientes con fístulas espontáneas por este abordaje, siendo el síntoma de presentación de todos ellos la hipoacusia de transmisión. En todos los casos se realiza un cierre multicapa (músculo, fascia temporal y cortical ósea) para cerrar el defecto o defectos existentes. El seguimiento mínimo en todos ellos es de 14meses, con cierre de la fístula en todos los casos salvo en uno, que precisó reintervención. No hubo complicaciones intraoperatorias ni postoperatorias debido a la técnica empleada, y la audiometría se normaliza en todos los casos, salvo en el caso de fracaso mencionado. Conclusiones. El abordaje por FCM y cierre en multicapa es una técnica adecuada y eficaz para el cierre de fístulas de LCR espontáneas a oído medio y consigue, además del cierre de la comunicación, el re-establecimiento de la audición (AU)

Introduction. Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. Material and methods. We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). Results. Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. Conclusions. The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients (AU)

Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear. / Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio.

INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. MATERIAL AND METHODS: We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). RESULTS: Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. CONCLUSIONS: The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.