Guía de práctica clínica sobre el manejo del schwannoma vestibular / Clinical practice guideline on the management of vestibular schwannoma

Introducción: El schwannoma vestibular (SV) es el tumor más frecuente del ángulo pontocerebeloso. La mayor accesibilidad a las pruebas radiológicas ha incrementado su diagnóstico. Teniendo en cuenta las características del tumor, la clínica y la edad del paciente se han propuesto tres estrategias terapéuticas, observación, cirugía o radioterapia. La elección de la más adecuada para cada paciente es un motivo de controversia frecuente. Material y métodos: El presente trabajo incluye una revisión exhaustiva sobre cuestiones relativas al SV que pueden servir de guía clínica en el manejo de pacientes con estas lesiones. La presentación se ha orientado en forma de preguntas que el clínico se hace habitualmente y las respuestas están redactadas y/o revisadas por un panel de expertos nacionales e internacionales consultados por la Comisión de Otología de la SEORL-CCC. Resultados: Se ha elaborado un listado con los 13 bloques temáticos más controvertidos sobre el manejo del SV en forma de 50 preguntas y se han buscado las respuestas a todas ellas mediante una revisión sistemática de la literatura (artículos publicados en PubMed y Cochrane Library entre 1992 y 2023 sobre cada bloque temático). Treinta y tres expertos, liderados por la Comisión de Otología de la SEORL-CCC, han analizado y discutido todas las respuestas. En el Anexo 1 pueden encontrarse 14 preguntas adicionales divididas en cuatro bloques temáticos. Conclusiones: Esta guía de práctica clínica sobre el manejo del SV ofrece respuestas consensuadas a las preguntas más habituales que se plantean sobre este tumor. La ausencia de suficientes estudios prospectivos hace que los niveles de evidencia sobre el tema sean en general medios o bajos. Este hecho incrementa el interés de este tipo de guías de práctica clínica elaboradas por expertos.(AU)

IntroductionVestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. Material and methods: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. Results: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. Conclusions: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.(AU)

Clinical practice guideline on the management of vestibular schwannoma.

INTRODUCTION: Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. MATERIAL AND METHODS: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. RESULTS: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. CONCLUSIONS: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.

Translation into Spanish and validation of the Tinnitus Functional Index (TFI) / Traducción y validación al español del índice funcional para el tinnitus (IFT)

Objective The objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI. Materials and Methods The TFI questionnaire translated into Spanish (Sp-TFI) and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators. Its internal consistency was assessed with Cronbach’s α considering the Tinnitus Handicap Inventory (THI) as the gold standard. Further, its test-retest reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were also calculated for the THI and visual analogue scales (VAS) for tinnitus tested and retested in all participants. Results The mean age of the 18 participants was 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA) in the affected ear was 29.34 (SD: 8.08) dB-HL. Regarding internal consistency and reliability of the Sp-TFI respectively, Cronbach’s α was 0.83 and the ICC type (2,1) was 1 (CI: 0.99–1). Among the variables studied, we found the following independent predictors had statistically significant effects on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02) and Sp-TFI SL, R and A subscale scores (p = 0.03, p = 0.03, and p < 0.01, respectively). Conclusion Based on the internal consistency and reliability results obtained in this study, the cross-culturally adapted Spanish version of the TFI (Sp-TFI) has been validated for use in Spain. Level of evidence 2B: Individual cohort study/low-quality randomized control studies. (AU)

Objetivos Los objetivos del estudio fueron traducir al español, adaptar culturalmente y validar el IFT. Materiales y métodos El cuestionario del IFT traducido al castellano (C-IFT) y la adaptación cultural, se realizó mediante las guías publicadas para la adaptación cultural en los cuestionarios para la salud. La consistencia interna fue evaluada mediante el alfa de Cronbach’s considerando el cuestionario de incapacidad provocada por el tinnitus (THI) cómo el cuestionario de referencia. Además, la fiabilidad test-retest se evaluó mediante los coeficientes de correlación intraclase (ICC). También se calcularon los ICC para el THI y las escalas analógicas visuales (VAS) para el tinnitus probado y reevaluado en todos los participantes. Resultados La edad media de los 18 participantes fue de 45,77 (DE: 11,87) años; 12 eran mujeres (66,67 %) y 6 eran hombres (33,33 %). La mitad de los participantes experimentaron tinnitus en el oído izquierdo y la otra mitad en el derecho. El promedio de tonos puros (PTA) en el oído afectado fue de 29,34 (DE: 8,08) dB-HL. En cuanto a la consistencia interna y la fiabilidad del C-IFT, respectivamente, el α de Cronbach fue de 0,83 y el ICC (2,1) fue de 1 (IC: 0,99-1). Entre las variables estudiadas, encontramos que los siguientes predictores independientes tuvieron efectos estadísticamente significativos en la puntuación de THI: sexo (p < 0,01), PTA (p = 0,03), puntuación general de C-IFT (p = 0,02) y C-IFT SL, R y las puntuaciones de la subescala A (p = 0,03, p = 0,03 y p < 0,01, respectivamente). Conclusión En base a los resultados de la consistencia interna y fiabilidad obtenidos en este estudio, la versión española adaptada transculturalmente del IFT (C-IFT) ha sido validada para su uso en España. (AU)

A New Method for Gain Calculation in Quantified Visuo-vestibular Interaction Test.

OBJECTIVE: To develop a new method to quantify visually-enhanced vestibulo-ocular reflex (VVOR) gain, in patients with vestibular function loss, that is mathematically suitable given the nature of the test, and determine the reliability of the method by comparing results with those of the gold standard, the video head impulse test (vHIT). MATERIALS AND METHODS: We developed a new method for VVOR gain quantification and conducted a cross-sectional study in patients diagnosed with vestibular function loss and controls, all participants undergoing both a VVOR test and a vHIT. We measured VVOR gain with three different methods: area under the curve (AUC), slope regression, and a Fourier method (VVORAUC , VVORSP , and VVORFR , respectively); and compared these gain values with vHIT gain calculated using the AUC method. RESULTS: Overall, 111 patients were included: 29 healthy subjects and 82 patients with vestibular function loss. Intraclass correlation coefficients (ICC(1,1)) between gain from the gold standard and each of the VVOR gain methods were: 0.68 (CI: 0.61-0.75) for VVORAUC , 0.66 (CI: 0.58-0.73) for VVORSP and 0.71 (CI: 0.64-0.77) for VVORFR . No interference was found between VVOR gain calculation methods and potentially influential variables considered (p ≥ 0.98). CONCLUSION: The new method for quantifying VVOR gain showed good concordance with the vHIT method. LEVEL OF EVIDENCE: 2: Individual cross-sectional studies with consistently applied reference standard and blinding (Diagnosis) Laryngoscope, 133:3554-3563, 2023.

Translation into Spanish and validation of the Tinnitus Functional Index (TFI).

OBJECTIVE: The objectives of this study were to translate into Spanish, cross-culturally adapt and validate the TFI. MATERIALS AND METHODS: The TFI questionnaire translated into Spanish (Sp-TFI) and cross-culturally adapted following the published guidelines on cross-cultural adaptation of health questionnaires was evaluated using two indicators. Its internal consistency was assessed with Cronbach's α considering the Tinnitus Handicap Inventory (THI) as the gold standard. Further, its test-retest reliability was assessed with intraclass correlation coefficients (ICCs). ICCs were also calculated for the THI and visual analogue scales (VAS) for tinnitus tested and retested in all participants. RESULTS: The mean age of the 18 participants was 45.77 (SD: 11.87) years; 12 were female (66.67 %) and 6 were male (33.33%). Half of the participants experienced tinnitus in their left ear and half in their right. The mean pure-tone average (PTA) in the affected ear was 29.34 (SD: 8.08) dB-HL. Regarding internal consistency and reliability of the Sp-TFI respectively, Cronbach's α was 0.83 and the ICC type (2,1) was 1 (CI: 0.99-1). Among the variables studied, we found the following independent predictors had statistically significant effects on THI score: sex (p < 0.01), PTA (p = 0.03), overall Sp-TFI score (p = 0.02) and Sp-TFI SL, R and A subscale scores (p = 0.03, p = 0.03, and p < 0.01, respectively). CONCLUSION: Based on the internal consistency and reliability results obtained in this study, the cross-culturally adapted Spanish version of the TFI (Sp-TFI) has been validated for use in Spain. LEVEL OF EVIDENCE: 2B: Individual cohort study/low-quality randomized control studies.

"Omepralith": A novel simulation model for training in sialoendoscopy.

INTRODUCTION: There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. MATERIALS AND METHODS: A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. RESULTS: Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. CONCLUSION: We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.

«Omepralith»: un modelo de simulación novedoso para el entrenamiento en sialoendoscopia / “Omepralith”: A novel simulation model for training in sialoendoscopy

Introducción: No existen modelos de entrenamiento previamente descritos para aprender o enseñar cómo extraer litiasis de los conductos salivales. Es por ello que presentamos un novedoso modelo de simulación que nos permite representar fielmente el proceso de extracción endoscópica de litiasis mediante sialoendoscopia. Materiales y métodos: Se desarrolló un modelo de simulación utilizando la cabeza de un cerdo, se utilizaron esferas de omeprazol para simular la existencia de litiasis en los diversos conductos de cada glándula salival y se utilizó una cesta Dormia para entrenar la extracción del modelo de litiasis. Resultados: Veintisiete residentes en formación y/o jóvenes especialistas han entrenado con éxito esta técnica utilizando este modelo. Veintiséis (96,3%) consideraron útil el modelo para entrenar el uso de cestas, siendo todos ellos capaces de capturar la esfera de omeprazol en el conducto salival. Se obtuvo un porcentaje de satisfacción mediante una encuesta anónima de 92,25 sobre 100 puntos. Conclusión: Describimos un novedoso modelo de simulación mediante esferas de omeprazol, que permite al cirujano practicar cómo realizar el diagnóstico y tratamiento de la enfermedad obstructiva de glándulas salivales en un entorno libre de riesgos, garantizando la reproducibilidad de la técnica en condiciones similares a las de la práctica habitual.(AU)

Introduction: There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. Materials and methods: A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. Results: Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. Conclusion: We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.(AU)

Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study

Abstract Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

Synchronized refixation saccades in enhanced VVOR test. A new application for PR score.

OBJECTIVE: Main objectives for this study were to develop a quantification method to obtain a Perez-Rey (PR) score adapted to the VVOR test and to evaluate the correlation of the PR score obtained with quantified VVOR with the PR score of the vHIT test. METHODS: A new PR score calculation method for quantified VVOR test was developed using the MATLAB computational software based on saccadic response time latency variability between each head oscillation cycle of the VVOR test. Retrospective correlation between PR scores in VVOR and vHIT tests, performed in the same vHIT testing session for patients with vestibular neuritis and vestibular neurectomy, was performed to correlate new PR (VVOR) score with the classic PR (vHIT) score. RESULTS: Thirty patients were included: 11 post-neurectomy and 19 subacute vestibular neuritis. Pearson's correlation coefficient (R2) for the overall sample was 0.92 (p < 0.001) and 95% confidence interval was 0.85 -0.96. In the linear mixed-effects statistical model developed, only PRVHIT and PRVVOR scores showed statistical association in Wald X2 test (p = 0.008). CONCLUSION: The new developed PR score for synchronization measurement of saccadic responses in VVOR testing is a valid method that outputs synchronization values and highly correlates with PR score in vHIT test.

Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study.

Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

Enhanced Eye Velocity With Backup Saccades in vHIT Tests of a Menière Disease Patient: A Case Report.

Reduced eye velocity and overt or covert compensatory saccades during horizontal head impulse testing are the signs of reduced vestibular function. However, here we report the unusual case of a patient who had enhanced eye velocity during horizontal head impulses followed by a corrective saccade. We term this saccade a "backup saccade" because it acts to compensate for the gaze position error caused by the enhanced velocity (and enhanced VOR gain) and acts to return gaze directly to the fixation target as shown by eye position records. We distinguish backup saccades from overt or covert compensatory saccades or the anticompensatory quick eye movement (ACQEM) of Heuberger et al. (1) ACQEMs are anticompensatory in that they are in the same direction as head velocity and so, act to take gaze off the target and thus require later compensatory (overt) saccades to return gaze to the target. Neither of these responses were found in this patient. The patient here was diagnosed with unilateral definite Meniere's disease (MD) on the right and had enhanced VOR (gain of 1.17) for rightward head impulses followed by backup saccades. For leftwards head impulses eye velocity and VOR gain were in the normal range (VOR gain of 0.89). As further confirmation, testing with 1.84 Hz horizontal sinusoidal head movements in the visual-vestibular (VVOR) paradigm also showed these backup saccades for rightwards head turns but normal slow phase eye velocity responses without backup saccades for leftwards had turns. This evidence shows that backup saccades can be observed in some MD patients who show enhanced eye velocity responses during vHIT and that these backup saccades act to correct for gaze position error caused by the enhanced eye velocity during the head impulse and so have a compensatory effect on gaze stabilization.

Clinical Prevalence of Enhanced Vestibulo-Ocular Reflex Responses on Video Head Impulse Test.

OBJECTIVE: To measure and analyze the clinical and epidemiological characteristics of patients and healthy controls with enhanced eye velocity responses as well as evaluate their relationship with endolymphatic hydrops related diseases. STUDY DESIGN: Cross-sectional clinical study. SETTING: Tertiary hospital. PARTICIPANTS: Three hundred sixty three participants allocated to patients (310) and healthy control (53) groups were collected on first time visit to neurotology unit. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Video head impulse test records, clinical diagnose, and variables and demographic data were used to get cross tables, a general linear model, diagnostic epidemiological parameters, and machine learning variable importance evaluation methods. RESULTS: All the statistical tests revealed a significant association between enhanced vestibulo-ocular reflex (VOR) and diagnostic categories (p < 0.001). Chi-squared residual and machine learning analyses showed Menière's disease as the main associated diagnostic category, whereas the lowest residuals and gain values were found in the control group. Enhanced VOR as a diagnostic sign of Menière's disease had a sensitivity of 42.59% and a specificity of 86.32%, with an odds ratio of 4.68 (p < 0.001). CONCLUSION: There is a significantly higher prevalence of enhanced VOR responses in patients with Menière's disease, central origin vertigo, otosclerosis, and vestibular migraine than in those with other neurotologic diseases and controls. Our study found that enhanced VOR are not pathognomonic of hydrops-related diseases and the diagnosis should not solely be based on these and instead take into context other clinical and examination findings.

Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study.

INTRODUCTION: Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. METHODS: An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. RESULTS: 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical -correlation between the previous organ-preservation treatments and surgical complications (p = 0.207). An advanced T stage (p = 0.009) and the need of bilateral FND (p = 0.034) were significantly correlated with a higher risk of surgical complications. CONCLUSION: FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

"Omepralith": A novel simulation model for training in sialoendoscopy. / «Omepralith¼: un modelo de simulación novedoso para el entrenamiento en sialoendoscopia.

INTRODUCTION: There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. MATERIALS AND METHODS: A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. RESULTS: Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. CONCLUSION: We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.

Three-Dimensional Bioprinting Scaffolding for Nasal Cartilage Defects: A Systematic Review.

BACKGROUND: In recent years, three-dimensional (3D)-printing of tissue-engineered cartilaginous scaffolds is intended to close the surgical gap and provide bio-printed tissue designed to fit the specific geometric and functional requirements of each cartilage defect, avoiding donor site morbidity and offering a personalizing therapy. METHODS: To investigate the role of 3D-bioprinting scaffolding for nasal cartilage defects repair a systematic review of the electronic databases for 3D-Bioprinting articles pertaining to nasal cartilage bio-modelling was performed. The primary focus was to investigate cellular source, type of scaffold utilization, biochemical evaluation, histological analysis, in-vitro study, in-vivo study, animal model used, length of research, and placement of experimental construct and translational investigation. RESULTS: From 1011 publications, 16 studies were kept for analysis. About cellular sources described, most studies used primary chondrocyte cultures. The cartilage used for cell isolation was mostly nasal septum. The most common biomaterial used for scaffold creation was polycaprolactone alone or in combination. About mechanical evaluation, we found a high heterogeneity, making it difficult to extract any solid conclusion. Regarding biological and histological characteristics of each scaffold, we found that the expression of collagen type I, collagen Type II and other ECM components were the most common patterns evaluated through immunohistochemistry on in-vitro and in-vivo studies. Only two studies made an orthotopic placement of the scaffolds. However, in none of the studies analyzed, the scaffold was placed in a subperichondrial pocket to rigorously simulate the cartilage environment. In contrast, scaffolds were implanted in a subcutaneous plane in almost all of the studies included. CONCLUSION: The role of 3D-bioprinting scaffolding for nasal cartilage defects repair is growing field. Despite the amount of information collected in the last years and the first surgical applications described recently in humans. Further investigations are needed due to the heterogeneity on mechanical evaluation parameters, the high level of heterotopic scaffold implantation and the need for quantitative histological data.

Pedicled Supraclavicular Artery Island Flap Versus Free Radial Forearm Flap: Perioperative Outcomes in Head and Neck Reconstruction.

INTRODUCTION: Radial forearm free flap (RFFF) and supraclavicular artery island flap (SCAIF) are some of the most common fasciocutaneous flaps used for head and neck (H&N) reconstruction. MATERIAL AND METHODS: A retrospective analysis of clinical data and outcomes of 31 consecutive patients who underwent H&N reconstruction using either SCAIF or RFFF over a three-year period, aiming to compare the surgical outcomes of the SCAIF and the RFFF in H&N reconstruction. RESULTS: Thirty-two flaps were performed in 31 patients (17 SCAIFs and 15 RFFFs). There was no difference in patient demographics between both groups. Hospital stay was longer in the SCAIF group (30.7 ± 18.2 days (min: 9/max: 60) versus 19.2 ± 15.8 days (min: 7/max: 72). Patients who underwent reconstruction with a SCAIF had shorter reconstructive procedure time; 74.4 min (min: 60/max: 93) versus 147.8 min (min: 140/max: 187). Overall morbidity was not significantly different (SCAIF 52.7% vs RFFF 39.9%, p = NS). Global flap survival was higher without statistical significance in the RFFF group (100%) versus the SCAIF group (70.7%). CONCLUSION: Despite the advantages related to the use of SCAIF like regarding the time spent in the reconstructive procedure. In our experience, the RFFF continues to be the most successful technique with similar perioperative outcomes and fewer complication rates. In this vein, both techniques can be reasonably used to reconstruct post-ablative H&N defects. However, in our experience, the use of SCAIF may lengthen hospital length of stay probably due to the augmented risk of flap failure.

Functional Results of Transverse Extended Incision in Cervical Neck Dissection.

Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5%) cases in the transversal incision group, and in 7 (12.2%) patients of the group of traditional incisions in J or U, without statistical differences ( p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

Machine Learning Models for Predicting Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors.

BACKGROUND: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery (PGS) and the improvement in the preoperative radiological assessment, facial nerve injury (FNI) remains the most severe complication after PGS. Until now, no studies have been published regarding the application of machine learning (ML) for predicting FNI after PGS. We hypothesize that ML would improve the prediction of patients at risk. METHODS: Patients who underwent PGS for benign tumors between June 2010 and June 2019 were included. RESULTS: Regarding prediction accuracy and performance of each ML algorithm, the K-nearest neighbor and the random forest achieved the highest sensitivity, specificity, positive predictive value, negative predictive value F-score, receiver operating characteristic (ROC)-area under the ROC curve, and accuracy globally. The K-nearest neighbor algorithm achieved performance values above 0.9 for specificity, negative predictive value, F-score and ROC-area under the ROC curve, and the highest sensitivity and positive predictive value. CONCLUSIONS: This study demonstrates that ML prediction models can provide evidence-based predictions about the risk of FNI to otolaryngologists and patients. It is hoped that such algorithms, which use clinical, radiological, histological, and cytological information, can improve the information given to patients before surgery so that they can be better informed of any potential complications.

Functional Results of Transverse Extended Incision in Cervical Neck Dissection

Abstract Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5 %) cases in the transversal incision group, and in 7 (12.2 %) patients of the group of traditional incisions in J or U, without statistical differences (p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

A Pilot Study to Assess the Sialendoscopy-Assisted Transfacial Approach in Parotid Gland Sialolithiasis.

INTRODUCTION: Twenty percent of the total lithiasis that affect a major salivary gland will be found in the parotid gland. An exclusive sialoendoscopic approach has achieved success rates close to 80%. In a significant percentage of these remaining cases, combined transfacial approaches assisted by sialendoscopy are presented as an option to be taken into account. PATIENTS AND METHODS: A prospective analysis of cases treated by combined transfacial approach assisted by sialendoscopy for lithiasis of the parotid gland and the impact of the facial nerve stimulator used during surgery. RESULTS: Five patients were included; all of them operated satisfactorily. In 4 of them, the approach proposed by McGurk and modified by Capaccio was used, and in 1 of them, the approach proposed by Nahlieli was used. We suffered a complication in just case due to the appearance of postoperative sialocele. CONCLUSION: According to our results and those previously published, the transfacial approach assisted by sialendoscopy can be considered a useful technique. Proper planning ensures an optimal result in the treatment of parotid gland lithiasis. The use of facial nerve stimulator guarantees extra security when working near to a branch of the facial nerve is suspected.