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  • ISSN: 2379-948X
    Volume 1, Issue 2
    Research Article
    Pier Guido Ciabatti1, Francesca Romana Fiorini2*, Giulia Burali1, Roberto Santoro2, Christina Cambi2 and Oreste Gallo2
    Background: Robot-assisted transaxillary thyroid surgery (RATS) and conventional open thyroidectomy (COT) represent two valid alternatives for treating thyroid disease. We compared postoperative outcomes and complications in patients submitted to thyroid lobectomy and total thyroidectomy via RATS or COT for benign diseases.
    Methods: We selected 274 consecutive patients submitted to thyroid lobectomy or total thyroidectomy at the Otolaryngology Department of Arezzo and Florence University from 2011 to 2014, with similar clinical characteristics: female gender and benign thyroid disease. We used the Fisher exact test to compare mean operative time, hospital length of stay (HLS), postoperative histopathology diagnosis, complications and postoperative pain in patients submitted to lobectomy via RATS (n=58, 21.16%) and COT (n=99, 36.13%), and in patients submitted to total thyroidectomy via RATS (n=39, 14.23%) and COT (n=78, 28.46%).
    Results: Mean operative time was not increased in patients submitted to lobectomy or total thyroidectomy via RATS (p=0.87), while HLS and postoperative pain were reduced in both groups (p<0.0001).
    The incidence of postoperative complications was 0.6% in the thyroid lobectomy group. The postoperative incidence of hemorrhage, hypocalcaemia and transient recurrent laryngeal nerve paralysis in the total thyroidectomy group was 5.9% and did not differ significantly in patients operated via RATS or COT (p=0.42).
    Conclusions: RATS are comparable to COT in terms of operative time and postoperative complications, while HLS and postoperative pain seem to be reduced. Prospective trials evaluating cost, quality of life and patient satisfaction are needed in order to define the real advantages and applicability of these procedures.
    Anthony G. Del Signore Pharm1; Anthony Reino2, Alan Weinberg3 and William Lawson1*
    Objectives: Introduced almost 30 years ago there has been no published follow up on this novel external approach to a select group of bilateral ethmoid and anterior skull base lesions. We review the complications and long-term results of the superior rhinotomy approach.
    Study Design: Retrospective review.
    Methods: From 1985 to 2013, fifty-nine patients presenting to a tertiary care medical center with bilateral ethmoid tumors with and without intracranial extension were resected utilizing the superior rhinotomy approach. Tumors were classified by pathology and stage at presentation. Long term outcomes and complications were reviewed.
    Results: Fifty-nine patients with bilateral ethmoid tumors were treated by the superior rhinotomy technique, with or without a bifrontal craniotomy. The mean age of this cohort was 55 years. The mean duration of the follow up was 91 months. Complication rates were noted primarily in patients undergoing craniotomy and adjuvant radiotherapy; and consisted of central nervous system, functional, cosmetic, wound and systemic complications.
    Conclusions: In this endoscopic age it is important to retain approaches that may assist in the treatment of large ethmoid lesions. As described, the superior rhinotomy is a safe, versatile and highly effective approach for the en-bloc resection of advanced malignancy of the ethmoid sinuses. Based on our experience the authors feel that this approach should be part of the otolaryngologist's armamentarium for the treatment of advanced disease of the bilateral ethmoid sinuses and the anterior skull base.
    Alexei Mlodinow1, Nima Khavanin1, Courtney Shires2, Sandeep Samant2, Jon Ver Halen3* and John Kim1
    Background: We reviewed the 2005-2012 ACS-NSQIP database to evaluate factors associated with adverse events after total laryngectomy.
    Methods: All total laryngectomies performed from 2006 to 2012 were identified for analysis. The cohort was characterized with respect to preoperative and demographic characteristics, complications, reoperation, and mortality.
    Results: 713 cases were identified. Complications of any category occurred in 273 cases (38.3%). Factors that were found to confer significant risk for medical complications were increased age [Odds Ratio (OR) 1.03], prior PCI (OR 2.84), disseminated cancer (OR 2.47), chronic steroid/immunosuppression use (OR 2.87), unintended weight loss > 10% over 6 months prior to surgery (OR 2.02), increasing work RVU total (OR 1.02), and increased anesthesia Z-score (OR 1.31). Only increased anesthesia Z-score (OR 1.27) was found to be a statistically significant risk factor for surgical complications. Chronic steroid/immunosuppression use (OR 3.16) and increased anesthesia Z-score (OR 1.29) were both found to be statistically significant risk factors of reoperation within 30 days.
    Conclusions: NSQIP is the only dataset that correctly discerns between minimally invasive and wide excision in laryngectomy. The use of the NSQIP dataset may be imperfect, as pertinent details of chemotherapy and radiation, and procedure-specific complications, including fistula formation, are not tracked. Capture rates of laryngectomy are low, but the granularity of patient data is unrivaled. In spite of this, our findings suggest avenues for improvement in the care of total laryngectomy patients, and suggest directions for a laryngectomy-specific outcomes database.
    Review Article
    Luca D'Ascanio*
    Abstract: The approach used by the founding fathers of rhinoplasty has incorrectly been called “closed” rhinoplasty, since the term “closed” suggests that the surgeon cannot see or access vital areas of the nose during surgery. The term “endonasal” more accurately describes this particular approach. However, with the advent of “open” or “external” septorhinoplasty in the late ‘70s, the former “endonasal” techniques were progressively abandoned. “Open” rhinoplasty is the most commonly taught approach to residents in Otolaryngology, Plastic Surgery and Maxillo-Facial Surgery in western countries thanks to its advantages in terms of surgical exposure and consequent teaching/learning easiness. Furthermore, most medical literature now a days focuses on “open” procedure, thus making “closed” rhinoplasty appear an out-of-date approach not worthy to be learnt and developed. We describe the principles of “endonasal” rhinoplasty with respect to “open” approach, together with the present and potential future of such technique.
    Case Report
    Luca D'Ascanio*
    Abstract: Lymphoma is usually the malignant tumor which originates from lymph node or lymph-tissues. The nasal cavity and paranasal sinuses are rare primary sites for lymphoma. In the paranasal sinuses, lymphoma of maxillary sinuses is the most common, ethmoidal sinuses is more than that of frontal sinuses, sphenoid sinuses is the least. The most common presenting symptoms are nasal obstruction, rhinorrhoea and epistaxia. The majority of the malignant non-Hodgkin's lymphoma of the sinonasal tract is T/NK cell lymphoma, while B cell lymphoma is rare. The B-cell malignant non-Hodgkin's lymphoma of the sphenoid sinus cavity has never been reported in the previous literature. In this report, we present a case of B-cell malignant non-Hodgkin's lymphoma of the sphenoid sinus, and the important immunohistological marks including CD3, CD20, CD79a and CD45RO are all positive.
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