Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Programa de entrenamiento de parotidectomía en modelo cadavérico perfundido

Introducción: La parotidectomía es una cirugía infrecuente y técnicamente compleja determinada por la dificultad de disección del nervio facial, cuya lesión produce alto grado de morbilidad en los pacientes. Los modelos de simulación animales no logran reproducir las características de la anatomía regional, por lo que se hace necesario explorar otras alternativas para el entrenamiento de estas habilidades. Nuestro objetivo es evaluar un programa de entrenamiento de técnicas de parotidectomía en un modelo cadavé-rico perfundido. Métodos: Se diseñó un programa educacional de Kern de entrenamiento de residentes de Cirugía de Cabeza y Cuello para la realización de parotidectomía total en un modelo cadavérico perfundido. La evaluación se realizó mediante el modelo de Kirkpatrick, en los niveles 1 (reacción), 2A (cambio de actitudes) y 2B (adquisición de conocimientos y habilidades). Resultados: Se elaboró un programa teórico-práctico basado en cátedras y simulación de alta fidelidad. En su mayoría los participantes: recomendarían el curso (Nivel 1); tuvieron mayor motivación para el aprendizaje (Nivel 2) y presentaron mejores indicadores sobre conocimientos, habilidades y percepción de mejoría de sus competencias (Nivel 2B). Conclusión: La utilización de un programa de parotidectomía simulado en un modelo de alta fidelidad basado en modelos cadavéricos humanos perfundidos es una alternativa que mejora la calidad de entrenamiento y es útil y factible para el aprendizaje de técnicas de parotidectomía en residentes de Cirugía de Cabeza y Cuello.

Introduction: The parotidectomy is an infrequent and technically complex surgery due to a difficult dissection that may affect the facial nerve, generating high degree of morbidity in patients. Animal simulation models may not reproduce the human characteristics of cervical anatomy. Therefore, it is necessary to explore other alternatives for training dissection skills. Our objective is to evaluate a parotidectomy's techniques training program in a perfused cadaveric model. Methods: A Kern educational program was designed to train Head and Neck Surgery residents to perform total parotidectomy in a perfused cadaveric model. The evaluation was performed using Kirkpatrick model, at levels 1 (reaction), 2A (change of attitudes) and 2B (acquisition of knowledge and skills). Results: A theoretical-practical program based on lectures and high-fidelity simulation was developed. Most of the participants would recommend the course (Level 1); had greater motivation for learning (Level 2) and showed better indicators of knowledge, skills and perception of improvement in their competencies (Level 2B). Conclusion: The use of a simulated parotidectomy program in a high-fidelity model based on perfused human cadaveric models is an alternative that improves the quality of training and is useful and feasible for learning parotidectomy techniques in residents of Head and Head Surgery.

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients

Abstract Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid =4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection (p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Cervical necrotizing fasciitis caused by oral cavity infection: a case report considering therapeutic approach and its morphofunctional implications / Fascitis necrosante cervical causada por infección de la cavidad oral. Reporte de un caso considerando el abordaje terapéutico y sus implicaciones morfofuncionales

SUMMARY: Cervical necrotizing fasciitis (NF) is a rare complication of oral cavity infection with high morbi-mortality. Given its low prevalence, adequately reporting cases of NF, its therapeutic management, and associated morphofunctional modifications to the clinical and scientific community is pivotal. To that end, we herein describe a case of cervical NF in a 60-year-old patient with comorbidities and patient presented large, painful cervical swelling associated with a necrotic ulcer lesion in the anterior neck region. Intraoral examination indicated a periodontal abscess in the right mandibular area, while computed tomography indicated the lesion's extension from the right mandibular to the submandibular region. Following empirical intravenous antibiotic treatment, a broad surgical debridement was performed, and the foci of oral infection were removed. Debridement revealed communication between deep and superficial anatomical regions in the submandibular area, where we subsequently placed a Penrose drain. Biopsies showing acute inflammatory infiltrate associated with necrotic and hemorrhagic regions confirmed the diagnosis of NF. When an antibiogram revealed resistance to the empirical treatment, the antibiotic scheme was replaced with an adequate alternative. After a second debridement, we closed the defect with fascio-mucocutaneous advancement flaps with a lateral base while maintaining suction drainage. Having reacted positively, the patient was discharged 10 days after the operation. Despite an extensive morphofunctional change generated in the treated area, the patient showed no difficulties with breathing, phonation, swallowing, or mobilizing the area during control sessions. Altogether, this report contributes to the highly limited literature describing morphological aspects that can facilitate or delay the spread of infection or the morphofunctional disorders associated with the size and depth of surgical interventions for cervical NF, information that is relevant for the comprehensive, long-term prognosis of the treatment of NF.

La fascitis necrosante (FN) cervical es una rara complicación de una infección proveniente de la cavidad bucal asociada a una alta morbimortalidad. Por lo anterior, es fundamental informar a la comunidad clínica y científica los casos de FN, su manejo terapéutico y las modificaciones morfofuncionales asociadas. Se describe un caso de FN cervical en una paciente de 60 años quien presentó una gran tumefacción dolorosa asociada a una lesión ulcerosa necrótica en la región anterior del cuello. El examen intraoral mostró un absceso periodontal en el área mandibular derecha y la tomografía computarizada mostró la extensión de la lesión hacia la región submandibular. Tras el tratamiento antibiótico empírico, se realizó un desbridamiento quirúrgico extenso y se extirparon los focos de infección oral. El desbridamiento reveló comunicación entre las regiones anatómicas profundas y superficiales del área submandibular, donde se colocó un drenaje Penrose. Las biopsias mostraron un infiltrado inflamatorio agudo asociado con regiones necróticas y hemorrágicas, confirmando el diagnóstico de FN. El antibiograma reveló resistencia al tratamiento empírico, por lo que el esquema antibiótico se sustituyó. Tras un segundo desbridamiento, se cerró el defecto con colgajos de avance fascio-mucocutáneos de base lateral manteniendo drenaje aspirativo. El positivo progreso del paciente permitió su alta 10 días después. Aun cuando se generó una gran modificación morfofuncional en el área tratada, la paciente no presentó dificultades para respirar, hablar, deglutir o movilizar el área cervical intervenida durante las sesiones de control. Este informe contribuye a la limitada literatura que describe los aspectos morfológicos que pueden facilitar o retrasar la propagación de la FN y las consecuencias asociadas a los trastornos morfofuncionales provocadas por el tamaño y profundidad de las intervenciones quirúrgicas requeridas por la FN, información relevante para el pronóstico integral a largo plazo del tratamiento de la FN.

Application of flipped classroom based on effective teaching theory in clinical teaching of nursing students in otolaryngology and head and neck surgery / 中华医学教育探索杂志

Objective:To investigate the effect of flipped classroom teaching based on effective teaching theory in the clinical teaching of otolaryngology and head and neck surgery.Methods:A total of 35 nursing students who received clinical teaching in Department of Otolaryngology and Head and Neck Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University Medical College, from June 2019 to June 2020 were selected as control group, and 35 nursing students who received clinical teaching from July 2020 to July 2021 were selected as study group. The students in the control group received traditional teaching, and those in the observation group received flipped classroom teaching based on effective teaching theory. The two groups were compared in terms of the scores of theoretical knowledge and practical operation after teaching, abilities of self-learning, analysis and problem-solving, innovative thinking, teamwork, and nurse-patient communication before and after treatment, and the degree of satisfaction with teaching among nursing students. SPSS 24.0 was used to perform the t-test and the chi-square test. Results:After teaching, the study group had significantly higher scores of theoretical knowledge and practical operation than the control group (94.24±3.25/94.65±3.41 vs. 89.54±3.36/88.76±3.37, P < 0.05). After teaching, both groups had significant increases in the scores of self-study ability, analysis and problem-solving ability, innovative thinking ability, teamwork ability, and nurse-patient communication ability, and the study group had significantly higher scores of these abilities than the control group ( P < 0.05). The study group had a significantly higher satisfaction rate of teaching than the control group [94.29% (33/35) vs. 71.43% (25/35)]. Conclusion:In the clinical teaching of nursing students in otolaryngology and head and neck surgery, the application of flipped classroom teaching based on effective teaching theory can improve the understanding of theoretical knowledge and practical operation ability, with significant increases in comprehensive ability and degree of satisfaction with teaching, and therefore, it has a good application value.

Indications and outcomes of Tracheostomy: A descriptive study using the outcome-based evaluation forms of Otorhinolaryngology - Head and Neck Surgery Department in a Tertiary Hospital (2016-2020)

Introduction@#Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it.@*Objective@#This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. @*Methodology@#This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period.@*Results@#Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. @*Conclusion@#Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications.

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study / Alterações na pressão intracuff do tubo endotraqueal após posições cirúrgicas nas cirurgias de orelha e cabeça e pescoço: estudo observacional prospectivo

Abstract Introduction The cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities. Objective The main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries. Methods A total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H2O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20-30 cm H2O at anytime, it was set to 25 cm H2O again. Results The intracuff pressure values were increased from 25 to 26.73 (25-28.61) cm H2O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52-28.67) cm H2O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02-36.94) and 34.55 (28.43-37.31) cm H2O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033). Conclusion Accessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.

Resumo Introdução O manguito ou cuff de um tubo endotraqueal sela as vias aéreas para facilitar a ventilação com pressão positiva e reduzir a aspiração de secreção subglótica. Entretanto, o aumento ou diminuição da pressão intracuff do tubo endotraqueal pode levar a muitas morbidades. Objetivo Investigar o efeito de diferentes posições da cabeça e pescoço da pressão intracuff do tubo endotraqueal durante cirurgias de orelha e cabeça e pescoço. Método Participaram do estudo 90 pacientes submetidos à cirurgia eletiva na orelha direita (Grupo 1: n = 30), orelha esquerda (Grupo 2: n = 30) ou cabeça e pescoço (Grupo 3: n = 30). Um anestésico geral padronizado foi administrado e o tubo endotraqueal com cuff foi colocado em todos os pacientes através de videolaringoscopia. O balão-piloto de cada tubo endotraqueal foi conectado ao transdutor de pressão e o monitoramento-padrão da pressão invasiva foi estabelecido para medir continuamente os valores da pressão intracuff. O primeiro valor de pressão intracuff foi ajustado para 18,4 mmHg (25 cm H2O) na posição supina e neutra do pescoço. Em seguida, os pacientes foram colocados nas posições cirúrgicas apropriadas de cabeça e pescoço antes do início da cirurgia. Essas posições foram rotação esquerda, rotação direita e extensão por rotação esquerda/direita com almofada sob o ombro, para os grupos 1, 2 e 3, respectivamente. As pressões intracuff s foram medidas e anotadas após cada posição, aos 15, 30, 60, 90 minutos e antes da extubação. Se a pressão intracuff saísse do valor desejado de 20 ~ 30 cm H2O a qualquer momento, ela era definida em 25 cm H2O novamente. Resultados Os valores de pressão intracuff aumentaram de 25 para 26,73 (25-28,61) cm H2O após a rotação do pescoço para a esquerda (p = 0,009) e de 25 a 27,20 (25,52-28,67) cm H2O após rotação do pescoço para a direita (p = 0,012) nos grupos 1 e 2, respectivamente. No Grupo 3, os valores da pressão intracuff na posição neutra, após extensão com almofada sob o ombro e rotação para a esquerda ou direita, foram 25, 29,41 (27,02-36,94) e 34,55 (28,43-37,31) cm H2O, respectivamente. Houve diferenças significativas entre a posição neutra e a extensão com almofada sob o ombro (p < 0,001) e também entre a posição neutra e a rotação após a extensão (p < 0,001). Entretanto, não houve aumento estatisticamente significante da pressão intracuff entre extensão com almofada sob o ombro e rotação do pescoço após as posições de extensão (p = 0,033). Conclusão As medições contínuas do valor da pressão intracuff antes e durante cirurgias de orelha e cabeça e pescoço são benéficas para evitar possíveis efeitos adversos/complicações de alterações de pressão relacionadas à posição cirúrgica.

Application of online and offline linkage teaching based on dynamic cases in the residency teaching of department of otolaryngology head and neck surgery / 中华医学教育探索杂志

Objective:To analyze the application effect of online and offline linkage teaching model based on dynamic cases on the residency teaching of department of otolaryngology head and neck surgery.Methods:The teaching data of 62 residents who received standardized residency training in this specialty between December 2018 and July 2020 were collected in the study. According to the sequence of admission to the department, the residents were divided into observation group ( n=32, online and offline linkage teaching) and control group ( n=30, traditional offline teaching). The professional knowledge assessment scores and teaching satisfaction of the two groups of standardized residents, the independent learning ability scores and 360-degree evaluation scale scores under different teaching methods after 6 months were compared between the two groups. SPSS 19.0 was used for chi-square test and t test. Results:The professional knowledge assessment scores of standardized residents in observation group were significantly higher than those in control group [(86.79±7.03) vs. (82.14±6.52)]. After 5 months of teaching, the independent learning ability in both groups was improved, and the scores of learning motivation and learning strategy in observation group were higher than those in control group ( P<0.05). The teaching satisfaction was 93.75% in observation group and 66.67% in control group, and that was better in observation group compared with control group ( P<0.05). The ability scores of seven roles of medical experts, communicators, collaborators, leaders, health advocates, scholars and professionals were significantly better in observation group compared to control group ( P<0.05). Conclusion:Online and offline linkage teaching model based on dynamic cases has a good effect and high teaching satisfaction for the residency teaching of department of otolaryngology head and neck surgery, and it stimulates the learning enthusiasm of the trainees and is conducive to the formation of clinical thinking.

Ritidoplastia clásica: una técnica vigente / Classic rhythodoplasty: a current technique

La cirugía de correctiva del envejecimiento facial tiene más de un siglo de historia documentada. Los cambios culturales han aumentado el número de operaciones. En Latinoamérica también ha aumentado, y la región ha sido activa en realizar aportes en los conceptos, técnicas y procedimientos complementarios. Además del crecimiento cuantitativo, la comprensión de los planos anatómicos faciales, cambios con la edad y los modos de corregirlos han sido de gran utilidad. Nuestra técnica del lifting cérvico-facial presentan ventajas como seguridad en el plano de disección, ausencia de tracción cicatricial y respeto capilar, proporcionando un resultado final natural de acuerdo a la solicitud de los pacientes

Corrective surgery for facial aging has more than a century of documented history. Cultural changes have increased the number of operations. In Latin America it has also increased, and the region has been active in making contributions in complementary concepts, techniques, and procedures. In addition to quantitative growth, the understanding of facial anatomical planes, changes with age and the ways to correct them have been very useful. Our cervical-facial lifting technique presents advantages such as safety in the dissection plane, absence of scar traction and capillary respect, providing a natural final result according to the request of the patients

Impacto en el patrón de atención en cirugía de cabeza y cuello y las medidas sanitarias adoptadas durante los primeros 150 días de la era COVID-19 / Impact on the pattern of care in Head and Neck Surgery and the regional and institutional policy changes adopted during the first 150 days of the COVID-19 era

Resumen Introducción: La pandemia COVID-19 generó una reestructuración en la atención quirúrgica mundialmente debido a su alta transmisibilidad y la inherente limitación de los recursos humanos y materiales disponibles. Objetivo: Describir el impacto de la pandemia COVID-19 en el Equipo de Cirugía Cabeza y Cuello del Complejo Asistencial Barros Luco Trudeau (CABL) en su ejecución clínico-quirúrgica y la secuenciación organizada de las medidas sanitarias aplicadas a lo largo del tiempo durante los primeros 150 días de iniciada la pandemia en Chile. Materiales y Método: Realizamos una revisión retrospectiva de los pacientes sometidos a cirugía y/o evaluados ambulatoriamente durante el período COVID-19 comprendido entre el 3 de marzo y el 31 de julio de 2020, comparado con el mismo intervalo de tiempo de 2019. Características clínicas y medidas sanitarias empleadas durante este período fueron sintetizadas. Resultados: Detectamos un descenso del 64% en atención ambulatoria y un descenso del 58% en la carga quirúrgica, comparado con el año 2019. Durante el período COVID-19 de 2020, un total de 61 pacientes fueron sometidos a intervención quirúrgica. La principal indicación de cirugía fue cáncer en un 75,4% (46). No se reportaron pacientes contagiados por COVID-19 en los 14 días siguientes a la hospitalización. Se discuten las consideraciones perioperatorias empleadas y restricciones nacionales/institucionales sanitarias. Conclusión: La crisis sanitaria mundial secundaria al COVID-19 generó una reducción en las atenciones ambulatorias y cirugías realizadas por Equipo de Cabeza y Cuello CABL. A pesar de las restricciones sanitarias, organizamos estratificadamente la atención para preservar la resolución de casos críticos no diferibles en cabeza y cuello.

Introduction: The COVID-19 pandemic generated a restructuring of surgical care worldwide due to the disease's high transmissibility and the inherent limitation of available human and material resources. Aim: The study's aim was to describe the impact of the COVID-19 pandemic on the head and neck surgery team at Complejo Asistencial Barros Luco Trudeau (CABL) in clinical-surgical execution and organization of sanitary sequencing measures implemented over time during the first 150 days after the pandemic started in Chile. Materials and Method: We performed a retrospective review of patients undergoing surgery or outpatient evaluation during the COVID-19 period from 03-03-2020 to 07-31-2020, compared to the same time interval in 2019. Clinical characteristics and sanitary measures used during this period were synthesized. Results: We detected a 64% decrease in outpatient care and a 58% decrease in surgical load from 2019. During the COVID-19 period of 2020, a total of 61 patients underwent surgical intervention. The main indication for surgery was cancer, in 75.4% of patients (46). COVID-19 was not reported in any patients in the 14 days following hospitalization. We discussed the perioperative considerations used and the national/institutional sanitary restrictions. Conclusions: The global health crisis to COVID-19 generated a reduction in outpatient care and surgeries performed by the CABL head and neck team. Despite health restrictions, we organized care stratified to preserve critical head and neck non-deferrable cases.

Expert Consensus on Otorhinolaryngology Head and Neck Diseases Responding Specifically to Traditional Chinese Medicine / 中国实验方剂学杂志

Traditional Chinese medicine （TCM） and western medicine have their respective advantages and limitations in the diagnosis and treatment of common otorhinolaryngology head and neck diseases. Although the integrated TCM and western medicine exhibits definite curative effects， there is no consensus on the otorhinolaryngology head and neck diseases responding specifically to TCM or integrated TCM and western medicine， as well as the diagnosis and treatment schemes. The China Association of Chinese Medicine （CACM） thus organized the otorhinolaryngology head and neck specialists of both TCM and western medicine to discuss the etiology， pathogenesis， and clinical diagnosis and treatment methods of common otorhinolaryngology head and neck diseases with the results of multiple clinical trials taken into account. The acute pharyngitis， chronic pharyngolaryngitis， paraesthesia pharyngis， hysterical aphasia， allergic rhinitis， subjective tinnitus， and otogenic vertigo were confirmed to respond specifically to TCM or integrated TCM and western medicine. Then a mutually agreed diagnosis and treatment scheme and recommendation with integrated TCM and western medicine was formulated as a reference for clinical practice， thus benefiting more patients.

Ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello: revisión de la literatura

Resumen El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello permite realizar evaluaciones y diagnósticos en tiempo real, tomar decisiones en un menor tiempo y realizar intervenciones, lo que aumenta la eficiencia de una consulta. A pesar del profundo conocimiento de la anatomía de cabeza y cuello del otorrinolaringólogo, esta técnica aún no es muy difundida en nuestro país. Se recomienda la acreditación en un curso impartido por una entidad conocida y realizar una evaluación en informe estructurado. El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello ha demostrado excelentes resultados para diferenciar masas cervicales benignas de aquellas malignas, y muy importantemente para tomar muestras de punción con agua fina o biopsias core. Se presenta una revisión de la literatura sobre el ultrasonido realizado por el cirujano, sus indicaciones, utilidad y recomendaciones al momento de realizarla.

Abstract Head and neck surgeon-performed ultrasound allows evaluations and diagnoses in real time, make faster decisions and carry out interventions, which increases the efficiency of the medical appointment. Despite otolaryngologists have a deep knowledge about head and neck anatomy, this technique is still not widespread in Chile. It is recommended to take an accreditation program given by a well-known entity and to perform structured evaluations and reports. Head and neck surgeon-performed ultrasound has shown excellent results to differentiate benign from certain malignant cervical masses, as well as to perform fine needle aspiration biopsies and core biopsies. We present a literature review on surgeon-performed ultrasound, its indications, efficacy and recommendations at the time of performing it.

Objective Quantification of Opioid Usage After Thyroid Surgery

Abstract Introduction It is well established that America is in the midst of an opioid crisis with 46 people dying every day from overdoses involving prescription opioids. In the last 2 years, multiple articles have been published indicating that the amount of opioid pain medication needed after discharge from thyroid and parathyroid surgery is low. Objective To objectively examine the amount of opioid pain medication required by patients in our practice after thyroid surgery. Methods Patients were given a standardized discharge prescription of 30 pills with a combination of 7.5 mg of hydrocodone and 325 mg of acetaminophen after thyroid surgery. They were asked to log the number of pills consumed per day and the level of pain per day using the Wong-Baker faces pain scale. We used in-office pill counts to ensure accuracy of the logs. Results While reaching a similar conclusion, the present study is the first to objectively examine the quantity of opioid pain medication consumed between postoperative discharge and office follow-up. Our study objectively demonstrates that 85% of patients consumed less than 75.0 morphine milligram equivalent (MME) after thyroid surgery using in-office pill counts. Conclusion Recent multimodality anesthesia research appears promising to dramatically reduce or even eliminate the need for opioid prescriptions upon postoperative discharge.

Shortening Postoperative Stay after Parathyroidectomy - A District General Hospital Experience

Abstract Introduction Historically, concerns about complications following parathyroid surgery, such as airway compromise, bleeding and hypocalcemia, have precluded its consideration as a short-stay surgical procedure. Recent advancements in perioperative care have resulted in several publications demonstrating that parathyroidectomy can be safely performed as a short-stay procedure. Objectives The aim of the present study was to describe the process of implementing a short-stay protocol focusing on preoperative patient education and postoperative calcium management for those undergoing surgery for primary hyperparathyroidism (PHP). Method A retrospective audit of consecutive parathyroidectomies performed for PHP over the period between 2010 and 2013 was performed. A short-stay protocol (SSP) was introduced focusing on postoperative calcium management. Results were reaudited over the period between 2013 and 2015. Results Consecutive parathyroidectomies in 76 patients were included in the study. A total of 42 patients underwent parathyroidectomy prior to the introduction of the protocol. A total of 26.2% of these patients were symptomatic from hypercalcemia. A total of 40 out of 42 (95.2%) patients had a biochemical cure. A total of 36 out of 42 (85.7%) cases were due to parathyroid adenomas. A total of 34 patients underwent surgery following the introduction of the protocol. A total of 13 out of 34 (38.2%) of the patients had symptomatic hypercalcemia. A total of 33 out of 34 (97.1%) had a biochemical cure. A total of 32 out of 34 (94.1%) cases were due to parathyroid adenomas. The length of stay decreased from a median of 3 days (range 2-9 days; mean 3.32) preprotocol to a median of 2 days (range 2-3 days; mean 2.16) postprotocol (p< 0.0001) with no difference in the 30-day unplanned readmission rate (4.8 versus 2.9%; p= 0.999). Conclusions The postoperative length of stay after parathyroidectomy for PHP can be safely reduced through patient education and by rationalizing postoperative calcium management without adversely affecting outcomes.

Recomendaciones generales en cirugía oncológica de cabeza y cuello durante la pandemia COVID-19 / General recommendations in head and neck oncologic surgery during COVID-19 pandemic

Resumen Durante la pandemia COVID-19, el enfrentamiento sanitario nacional e internacional ha enfocado sus esfuerzos en disminuir los riesgos inherentes del paciente oncológico. Existe un reforzamiento del enfoque resolutivo en los casos oncológicos críticos que requieren tratamiento precoz, evitando la exposición innecesaria al SARS-CoV-2 en los casos electivos y/o diferibles. Así como también, consideraciones de seguridad según riesgo para los cirujanos de cabeza y cuello acorde con la evidencia disponible hasta la fecha. Estas medidas tienen por objetivo evitar la exposición al virus y disminuir el uso de insumos limitados, enfocando nuestros esfuerzos en el tratamiento quirúrgico crítico.

During the COVID-19 pandemic, the national and international health confrontation has focused its efforts on reducing the inherent risk of cancer patients. There is a strengthening in the resolutions of critical oncological cases that require early treatment, avoiding unnecessary exposure to SARS-CoV-2 in elective or deferrable cases. And also, risk-based safety considerations for head and neck surgeons consistent with the evidence available to date. These actions aim to avoid exposure to the virus and decrease the use of limited supplies, focusing our efforts on critical surgical treatment.

Otorhinolaryngology Out-Patient Practice in the “Post”-COVID-19 Era: Ensuring a Balance Between Service and Safety

Objective@#To review available resources and provide evidence-based recommendations that may optimize otorhinolaryngologic out-patient health care delivery in the “post”-COVID-19 era while ensuring the safety of our patients, healthcare workers and staff.@*Data Sources@#Relevant peer-reviewed journal articles; task force, organizational and institutional, government and non-government organization recommendations; published guidelines from medical, health-related, and scientific organizations.@*Methods@#A comprehensive review of the literature on the COVID-19 pandemic as it pertained to “post”-COVID 19 out-patient otorhinolaryngologic practice was obtained from peer-reviewed articles, guidelines, recommendations, and statements that were identified through a structured search of the data sources for relevant literature utilizing MEDLINE (through PubMed and PubMed Central PMC), Google (and Google Scholar), HERDIN Plus, the World Health Organization (WHO) Global Health Library, and grey literature including social media (blogs, Twitter, LinkedIn, Facebook). In-patient management (including ORL surgical procedures such as tracheostomy) were excluded. Retrieved material was critically appraised and organized according to five discussion themes: physical office set-up, patient processing, personal protection, procedures, and prevention and health-promotion.@*Conclusion@#These recommendations are consistent with the best available evidence to date, and are globally acceptable while being locally applicable. They address the concerns of otorhinolaryngologists and related specialists about resuming office practice during the “post”-COVID-19 period when strict quarantines are gradually lifted and a transition to the “new” normal is made despite the unavailability of a specific vaccine for SARS-CoV-2. While they target practice settings in the Philippines, they should be useful to ENT (ear, nose & throat) surgeons in other countries in ensuring a balance between service and safety as we continue to serve our patients during these challenging times.

Application and funding status of otorhinolaryngology head and neck surgery research projects funded by National Natural Science Foundation of China from 2009 to 2019 / 中华耳鼻咽喉头颈外科杂志

Objective@#Based on the application and funding of Otorhinolaryngology Head and Neck Surgery (H13) funded by the Nature Science Foundation of China (NSFC), we analyzed the basic research status of the field of Otorhinolaryngology Head and Neck Surgery, and provided the references for developing the discipline development plan, optimizing the discipline strategic layout and promoting the discipline progress.@*Method@#The data of both applied and funded grants of Otorhinolaryngology Head and Neck Surgery in NSFC from 2009 to 2019 were collected for further analysis.@*Results@#From 2009 to 2019, H13 received 5 103 applications, accounting for 1.00% of the total number of applications in the department of health science, and 922 applications were funded (mainly from the General Projects and the Youth Science Fund Projects), with a funding rate of 18.07% and a funding amount of 445.509 million yuan, accounting for 1.02% of the total funding amount of the department of health science. Among the seven sub-categories of H13, H1304 (Hearing abnormal and balance disorders) received 1 845 applications, and 352 were funded. H1301 (Disease of smell, nose and anterior skull base) received 1 217 applications, and 248 were founded, H1303 (Ear and lateral skull base disease) and H1305 (Otorhinolaryngology and developmental related diseases) received 498 and 488 applications,and 83 and 112 were founded respectively. The National Science Fund for Distinguished Young Scholars received 33 applications, and 5 were founded, with a funding rate of 15.15%. Clinicians accounted for 81% of the General Projects principals, and researchers and technicians accounted for 19%. Clinicians accounted for 72% of the Youth Science Fund Projects principals, and researchers and technicians accounted for 24%.@*Conclusion@#The basic research of Otorhinolaryngology Head and Neck Surgery in China has some shortcomings, such as small volume, uneven development of various disciplines, less leading academic leaders, less training of young leading talents, less major projects, more clinicians instead of researchers engaged in the basic scientific research.

A Case of Quadriplegia after Parotidectomy in a Patient with Asymptomatic Cervical Spondylosis / 대한이비인후과학회지

Cervical spondylosis is a common degenerative disease of the cervical spine affecting the cervical vertebral bodies and intervertebral discs. During parotidectomy, the patient is placed in a supine position with the neck extended and head rotated to the contralateral side. This position could exacerbate pre-existing cervical spondylosis and cause cervical myelopathy. We present a case of postoperative quadriplegia secondary to cervical myelopathy after parotidectomy. A 68-year-old man without symptoms of cervical spondylosis underwent partial parotidectomy for a right parotid mass and subsequently developed quadriplegia 8 hours postoperatively. Magnetic resonance imaging revealed severe cervical myelopathy. Emergency laminoplasty was performed, and steroid therapy was initiated. He showed near-complete recovery six months later.

Application of 3D printing in the flipped classroom in practice teaching of otolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective@#To investigate the application of 3D printing in the flipped classroom in the practice teaching of otolaryngology-head and neck surgery.@*Methods@#A total of 68 medical undergraduates of the Grade 2013 in Air Force Medical University were divided into experimental group and control group, with 34 undergraduates in each group. The undergraduates in the experimental group received the teaching method of 3D printing in the with flipped classroom, and those in the control group received traditional teaching. The teaching effect was evaluated by questionnaire and examinations of basic knowledge and clinical skills, Independent-samples t test was used for between-group comparison with SPSS 20.0.@*Results@#Compared with the control group, the experimental group had significantly higher scores in theoretical examinations (34.79±2.20 vs. 31.73±3.12, t=4.676, P=0.000) and clinical skill examination (50.06±2.98 vs. 45.82±4.68, t=4.449, P=0.000). The questionnaire survey showed that among the 34 undergraduates in the experimental group, 31(91.2%) thought that the new teaching method could increase their learning interest, 33(97.0%) believed it could improve learning efficiency, 25(73.5%) believed the models obtained by 3D printing had good quality, 32(94.1%) felt that it could improve clinical skills, 28 (82.4%) thought it could enhance the interaction between students and teachers, and 29(85.3%) thought it did not bring extra burden.@*Conclusion@#The teaching method of 3D printing combined with flipped classroom in the practice teaching of otolaryngology-head and neck surgery can improve students' learning interest, academic scores, and clinical skills, and therefore, it holds promise for application in teaching.

Preliminary study on the application of real-time anatomical demonstration in the theoretical teaching of otorhinolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective@#To investigate the effects of real-time anatomical demonstration and traditional teaching in otorhinolaryngology-head and neck surgery.@*Methods@#Students who studied this course from Shanghai Jiao Tong University School of Medicine were divided into two groups: clinical students in 5-year program (n=22) were assigned to the experimental group and students from"5+3" stomatology major (n=35) were assigned to control group. Both groups had two class hours, with the same teacher teaching at the same day. Students in the experimental group were taught with theoretical teaching combined with real-time anatomical demonstration, while students in the control group was taught with traditional theoretical teaching with multimedia content. Students in the two groups completed the questionnaire and received quiz; SPSS 19.0 was used to perform the independent-samples T test of between-group data.@*Results@#According to the questionnaire, scores for different items of the teaching method in the experimental group were higher than those in the control group. But according to the examination scores, average scores of the theoretical examination in the control group was (85.143±8.268), which was obviously higher than that of (64.545±11.434) in the experimental group, with statistically significant differences (t=7.885, P=0.000).@*Conclusion@#Teaching effect combined with real-time anatomical demonstration is not obvious to short-term examination, which may be related to the short-term understanding and absorption of knowledge for students in different majors, but it is coherent with the difference of entrance-examination scores of students from the two groups. This teaching model can stimulate students' interest in learning, and help them choose their professions, which may have certain advantages in the future long-term teaching effect.