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Overprescription of opioid analgesia is common following ambulatory Otolaryngology—head and neck surgery procedures: A multicenter study

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第2期8卷 145-151页

作者： Amr F.Hamour Frederick Laliberte Jordan Levy Jason Xu Edward Park Vincent Lin John de Almeida Julie Strychowsky Antoine Eskander Eric Monteiro Department of Otolaryngology-head and neck surgery University of TorontoTorontoOntarioCanada Department of Otolaryngology-head and neck surgery London Health Sciences CentreLondonOntarioCanada Department of Otolaryngology-head and neck surgery Mount Sinai HospitalTorontoOntarioCanada

Background: The rise in the use of prescription opioids for postoperative analgesia within surgery has mirrored an increased trend of opioid-related morbidity within Canada and the United States. This study prospectively studied daily pain levels and medication requirements postoperatively in patients undergoing elective Otolaryngology—head and neck surgery procedures.Methods: Patients were asked to prospectively document their pain level and medication use daily for 7 days postoperatively. A final survey was used to quantify unused medication left at home and clarify each patient's disposal plan. We included patients undergoing elective outpatient or short stay surgeries from three tertiary care centers in Toronto, Ontario from September 2016 to September 2017. Previous opioids users or patients suffering from chronic pain were excluded.Results: A final cohort of 56 eligible adult patients were included in the study. The most common procedures were thyroidectomy (n = 19), endoscopic sinus surgery (n= 10), tympanoplasty/ossiculoplasty (n= 7), and cochlear implant (n = 5). Most patients received a prescription for acetaminophen/codeine (n = 29, 51.8%) or acetaminophen/oxycodone (n = 22, 39.3%) and used on average 29% of their initial prescription. Patients most commonly opted to keep their unused narcotics at home (n = 23, 41%). A total of 710 tablets of narcotics were overprescribed in our study population, 351 of which were kept in patients'' home for future use.Conclusion: There is a clear tendency to overestimate postoperative pain resulting in significant overprescription of opioids among Otolaryngologists.

关键词： analgesia health policy opioid quality improvement quality of life

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Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第1期8卷 25-35页

作者： Ashton E.Lehmann Manuela von Sneidern Sarek A.Shen Ian M.Humphreys Waleed M.Abuzeid Aria Jafari Department of Otolaryngology-head and neck surgery Vanderbilt University Medical CenterNashvilleTennesseeUSA Department of Otolaryngology-head and neck surgery Geisinger Medical CenterDanvillePennsylvaniaUSA Department of Otolaryngology-head and neck surgery New York University School of MedicineNew YorkNew YorkUSA Department of Otolaryngology-head and neck surgery Johns Hopkins HospitalBaltimoreMarylandUSA division of Rhinology and Endoscopic Skull Base surgery Department of Otolaryngology-Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA

Objective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread,high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection.The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources:PubMed,EMBASE,Web of Science.A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted.Articles not reporting orbital reconstruction details were excluded.Patient and tumor characteristics,operative details,and outcomes were recorded.Variables were compared usingχ^(2),Fisher’s exact,and independentt tests.Results:Of 60 patients included from 24 studies,34(56.7%)underwent orbital reconstruction following resection.The most common types of reconstruction were pedicled flaps(n=15,44.1%)and free mucosal grafts(n=11,32.4%).Rigid reconstruction was uncommon(n=3,8.8%).Performance of orbital reconstruction was associated with preoperative vision compromise(P<0.01).The tendency to forego orbital reconstruction was associated with preoperative proptosis(P<0.001),larger tumor size(P=0.001),and operative exposure of orbital fat(P<0.001)and extraocular muscle(P=0.035).There were no statistically significant differences between the reconstruction and nonreconstruction groups in terms of short-or long-term outcomes when considering all patients.In patients with intraconal tumors,however,there was a higher rate of short-term postoperative diplopia when reconstruction was foregone(P=0.041).This potential benefit of reconstruction did not persist:At an average of two years postoperatively,all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status.This general equivalence may suggest that orbital reconstruction is not a necessity in these ca

关键词： cavernous hemangioma diplopia endoscopic endonasal surgery enophthalmos meningioma orbital reconstruction orbital tumor outcomes schwannoma

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Periorbital rejuvenation in the clinic:A state-of-the-art review

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第3期9卷 242-248页

作者： Sarah M.Russel J.Madison Clark Department of Otolaryngology head and neck surgery University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA division of Facial Plastic and Reconstructive surgery Department of Otolaryngology Head and Neck SurgeryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA

Objective:To provide an overview of the various treatment options available in the clinic to achieve periorbital rejuvenation.Data Sources:Literature review and expert opinion.Conclusions:Periorbital rejuvenation in the clinic can be accomplished through a variety of treatment modalities,including topical therapies,skin resurfacing,and fillers and injectables.Furthermore,some surgical approaches,such as upper blepharoplasties,ptosis,and brow lifts,can be performed in the clinic under local anesthesia with only mild oral sedation.However,the successful execution of such procedures depends on proper patient selection and maximizing patient comfort.

关键词： blepharoplasty chemexfoliation laser therapy rejuvenation skin aging

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Complications associated with energy-based devices during thyroidectomy from 2010–2020

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第1期9卷 35-44页

作者： Esther Lee Jane Y.Tong Luke J.Pasick Daniel A.Benito Arjun Joshi Punam G.Thakkar Joseph F.Goodman division of Otolaryngology-head and neck surgery George Washington University School of Medicine&amp Health SciencesWashingtonDCUSA Western University of Health Sciences PomonaCAUSA Department of Otolaryngology-head and neck surgery Drexel University College of MedicinePhiladelphiaPAUSA Department of Otolaryngology-head and neck surgery University of Miami Miller School of MedicineMiamiFLUSA

Objective:Harmonic Focus(Ethicon,Johnson and Johnson,Cincinnati,OH,USA),LigaSure Small Jaw(Medtronic,Covidien Products,Minneapolis,MN,USA),and Thunderbeat Open Fine Jaw(Olympus,Japan)are electrosurgical instruments used widely in head and neck surgery.The study aims to compare device malfunctions,adverse events to patients,operative injuries,and interventions related to Harmonic,LigaSure,and Thunderbeat use during thyroidectomy.Methods:The US Food and Drug Administration's Manufacture and User Facility Device Experience(MAUDE)database was queried for adverse events associated with Harmonic,LigaSure,and Thunderbeat from January 2005 to August 2020.Data were extracted from reports pertaining to thyroidectomy.Results:Of the 620 adverse events extracted,394(63.5%)involved Harmonic,134(21.6%)LigaSure,and 92(14.8%)Thunderbeat.The reported device malfunctions most frequently associated with Harmonic was damage to the blade(110(27.9%)),LigaSure was inappropriate function(47(43.1%)),Thunderbeat was damage to the tissue or Teflon pad(27(30.7%)),respectively.Burn injury and incomplete hemostasis were the most commonly reported adverse events.The operative injury reported most frequently when using Harmonic and LigaSure was burn injury.No operator injuries were reported with Thunderbeat use.Conclusion:The most frequently reported device malfunctions were damage to the blade,inappropriate function,and damage to the tissue or Teflon pad.The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis.Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.

关键词： Adverse events Harmonic LigaSure Manufacture and User Facility Device Experience Patient safety Quality Thunderbeat Thyroidectomy

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Equipping your facial plastic clinic for office-based procedures

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World Journal of Otorhinolaryngology-head and neck surgery 2023年第3期9卷 206-211页

作者： Arman Saeedi Danielle F.Eytan Department of Otolaryngology-head and neck surgery Division of Facial Plastic and Reconstructive SurgeryNew York University Grossman School of MedicineNew YorkNew YorkUSA

Office-based procedures can be a fulfilling part of the facial plastic practice with the right tools,personnel,and preparation.Equipping the clinic for office-based procedures has several unique considerations that ultimately impact its success.It is important to strategize preemptively regarding what treatments will be offered and the respective equipment that will allow the safe,cost-effective,and high-quality delivery of those treatments.Most procedures in the office-based setting are cosmetic in nature and there are often overlapping treatment modalities that target similar outcomes.Patient selection and counseling is a crucial step in preparing for office-based procedures in the effort to maximize patient satisfaction.Nearly all the most common facial plastic procedures can be delivered in the office-based based setting under local anesthesia and moderate sedation,depending on the expertise of the surgeon.To enable these and other categories of treatments,there are certain expensive pieces of technology that one might consider for their office-based practice and other fundamental supplies that are necessary for almost all practices.Though the initial investment in equipment can be costly,this article also discusses more affordable alternatives or third-party sales of devices and equipment.The field of facial plastic surgery is very dynamic and having both peer and mentorship networks is invaluable in navigating some of the financial decisions discussed herein.This article also briefly covers personnel,training,and accreditation considerations.

关键词： ambulatory surgical procedures equipment medical practice management

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Pediatric otolaryngology-head and neck surgery in China: Present situation and future prospects

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Pediatric Investigation 2019年第3期3卷 137-140页

作者： Xin Ni Jie Zhang Department of Otorhinolaryngology head and neck surgery Beijing Children’s HospitalCapital Medical UniversityNational Centerfor Children’s HealthBeijingChina Beijing Key Laboratory for Pediatric Diseases of Otolaryngology–head and neck surgery BeijingChina

Evolution Pediatric otolaryngology–head and neck surgery (OHNS) is a young discipline in the 21st century. During its development, the discipline and its sub-areas were increasingly enriched and refined, and its name evolved from 'ear, nose and throat' to 'otorhinolaryngology' and then to 'otolaryngology–head and neck surgery' In the United States, the American Laryngological Association was established in 1878, and the American Academy of Ophthalmology and Otolaryngology was founded in 1903. However, no doctors specialized in pediatric OHNS until the 1940s.

关键词： Pediatric otolaryngology–head and neck surgery (OHNS) discipline future prospects

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Three-hundred and sixty degrees of surgical approaches to the maxillary sinus

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World Journal of Otorhinolaryngology-head and neck surgery 2022年第1期8卷 42-53页

作者： Natalia C.Rezende Carlos D.Pinheiro-Neto Luciano C.P.C.Leonel Jamie J.Van Gompel Maria Peris-Celda Garret Choby division of Rhinology and Skull Base surgery Department of Otolaryngology-Head&Neck SurgeryMayo ClinicRochesterMinnesotaUSA Department of Neurologic surgery Mayo ClinicRochesterMinnesotaUSA

Objectives:To demonstrate three-hundred and sixty degrees of maxillary sinus(MS)surgical approaches using cadaveric dissections,highlighting the step-by-step anatomy of each procedure.Methods:Two latex-injected cadaveric specimens were utilized to perform surgical dissections to demonstrate different approaches to the MS.The procedures were documented with macroscopic images and endoscopic pictures.Results:Dissections were performed to approach the MS medially(endoscopic maxillary antrostomy and ethmoidectomy),anteriorly(Caldwell-Luc),superiorly(transconjunctival/transorbital approach),inferiorly(transpalatal approach),and posterolaterally(preauricular hemicoronal approach).Conclusion:A number of approaches have been described to address pathology in the MS.Surgeons should be familiar with indications,limitations,and surgical anatomy from different perspectives to approach the MS.This paper illustrates anatomic approaches to the MS with detailed step-by-step cadaveric dissections and case examples.

关键词： anatomy Caldwell-Luc dissection endoscopic sinus surgery infratemporal fossa maxillary sinus pterygopalatine fossa

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Papillary cystadenoma of the parotid gland: A case report

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World Journal of Clinical Cases 2019年第3期7卷 366-372页

作者： Li Wang Shi-Kun Zhang Ying Ma Patrick K Ha Zhi-Ming Wang Department of Oral and Maxillofacial surgery Shengjing Hospital of China Medical University Department of Pathology Shengjing Hospital of China Medical University division of head and neck Oncologic and Endocrine surgery Department of Otolaryngology-Head and Neck Surgery University of California-San Francisco

BACKGROUND Papillary cystadenoma is a rare benign epithelial tumor of the salivary gland,which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint(TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging(MRI) and computed tomography(CT) should be carefully studied, which allows for appropriate preoperative counseling and operative planning.CASE SUMMARY Here, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma(PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up period.CONCLUSION The integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors.

关键词： Papillary cystadenoma Parotid gland Temporomandibular joint Case report

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Etiology of newborn hearing impairment in Guangdong province: 10-year experience with screening, diagnosis, and follow-up

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World Journal of Pediatrics 2020年第3期16卷 305-313页

作者： Bi-Xing Fang Jin-Tian Cen Tao Yuan Gen-Di Yin Jing Gu Shu-Qi Zhang Zhi-Cheng Li Yin-Fei Liang Xiang-Li Zeng division of Otology Department of OtorhinolaryngologyHead and Neck SurgeryThird Affiliated Hospital of Sun Yat-Sen UniversityGuangzhouChina

Background Hearing impairment is one of the most common birth defects in children.Universal newborn hearing screenings have been performed for 19 years in Guangdong province,China.A screening/diagnosis/intervention system has gradually been put in place.Over the past 10 years,a relatively complete data management system had been established.In the present study,an etiological analysis of newborn cases that failed the initial and follow-up screenings was performed.Methods The nature and degree of hearing impairment in newborns were confirmed by a set of procedures performed at the time of initial hearing screening,rescreening and final hearing diagnosis.Then,multiple examinations were performed to explore the associated etiology.Results Over a period of 10 years,720 children were diagnosed with newborn hearing loss.Among these children,445 (61.81%) children had a clearly identified cause,which included genetic factor(s) (30.56%),secretory otitis media (13.30%),maternal rubella virus infection during pregnancy (5.83%),inner ear malformations (4.86%),maternal human cytomegalovirus infection during pregnancy (2.92%),malformation of the middle ear ossicular chain (2.50%) and auditory neuropathy (1.81%).In addition,275 cases of sensorineural hearing loss of unknown etiology accounted for 38.19% of the children surveyed.Conclusions Long-term follow-up is needed to detect delayed hearing impairment and auditory development in children.The need for long-term follow-up should be taken into account when designing an intervention strategy.Furthermore,the use of the deafness gene chip should further elucidate the etiology of neonatal hearing impairment.

关键词： Etiology Hereditary deafness Newborn hearing impairment Tertiary prevention

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Prevention of nosocomial COVID-19 infections in otorhinolaryngology-head and neck surgery

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World Journal of Otorhinolaryngology-head and neck surgery 2020年第S01期6卷 S6-S10页

作者： Jie Ren Xilin Yang Zhen Xu Weiwei Lei Kun Yang Yonggang Kong Jining Qu Hua Liao Yi He Huidong Chen Yan Wang Feng Zeng Qingquan Hua Department of Otorhinolaryngology-head and neck surgery Renmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina

Coronavirus disease 2019(COVID-19)has rapidly evolved into a pandemic,causing a global public health crisis.Many frontline healthcare workers providing ear,nose and throat services have been reported to contract COVID-19 at work.Early during the COVID-19 outbreak,several medical professionals in Otolaryngology-head and neck surgery were in-fected in Wuhan,China.A series of measures were then taken immediately,which successfully halted the spread of the disease.Here we would like to share the lessons we have learned,and our experience to protect our health care workers during the COVID-19 pandemic.

关键词： COVID-19 Nosocomial infection Prevention

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