Adverse event reporting in head and neck transoral robotic surgery: a MAUDE database study.

Transoral robotic surgery (TORS) using the da Vinci Surgical system was approved by the US Food and Drug Administration in 2009. Currently, most available safety information on TORS procedures describes adverse events occurring in the context of clinical trials or series at high-volume academic centers. The goal of this study was to catalog reported adverse events associated with the da Vinci device in head and neck procedures by querying an FDA database. A search was performed on the MAUDE database inspecting for TORS safety incident reports generated from January 2009 through May 2020 using key words "da Vinci" and "Intuitive Surgical". A total of 3312 medical device records were produced. Of these 36 head and neck adverse events, reports were identified through manual screening of the data by the authors. Death was found to be the most common adverse event reported overall, manifesting in 44% of all reported incidents. The most frequent source of mortality was found to be hemorrhaging in the perioperative period rather than incidents of device malfunction or structural damage from surgery. This was found to be similar to the results of other published series for transoral ablative surgery. This study suggests that the small number of reported adverse events related to TORS with the da Vinci system seems to mirror what would be expected from the same procedures using other methods for transoral surgery.

Extraocular muscle biopsy during surgery for strabismus of unknown etiology.

Most cases of strabismus have a chronic and stable or known etiologic diagnosis prior to surgery. In some cases, however, surgery is undertaken to correct a stable ocular misalignment without a definitive etiology. We present 2 cases, one with euthyroid Graves' orbitopathy and the other with amyloid light-chain amyloidosis, in which extraocular muscle biopsy performed intraoperatively allowed histopathologic confirmation of a clinical diagnosis.

An Evaluation of SPOT Vision Screening Efficacy for Children in South Dakota.

BACKGROUND: Amblyopia is a preventable, sight stealing disorder with a prevalence of approximately 2-4 percent in the U.S. pediatric population. Identifying efficacious, early stage screening modalities is of critical importance to sustain quality of vision and quality of life. This project assessed the quality of screening methods used in the Children's Vision Screening Initiative (CVSI), administered by Northern Plains Eye Foundation in collaboration with Western South Dakota Lions Clubs, by comparing to data collected in follow-up appointments at professional eye care clinics. METHODS: Data from 120 cases for children ages 6 months-12 years collected between February 2014 to July 2016 were compared. Only cases that had undergone initial screening by CVSI using a SPOT photoscreener device and that attended a subsequently scheduled eye care professional referral follow-up appointment were evaluated. SPOT screening performance measures on detecting amblyopia risk factors and the accuracy of refractive error data were evaluated. RESULTS: Review of professional evaluations showed that 23 percent of cases referred by SPOT screening had detectable amblyopia and 82 percent of all cases referred were found to be in need of further therapy as a result of examination findings. The SPOT device showed fair sensitivity and good specificity in the detection of astigmatism (76 percent/86 percent), strabismus (50 percent/96 percent), and anisometropia (75 percent/90 percent). CONCLUSION: Vision screening performed using the SPOT device represents a valuable modality that is easily employable and can provide tremendous benefit to children in the state of South Dakota.

Oral Cavity Reconstruction Outcomes Using a Porcine Urinary Bladder Matrix: A Retrospective Case Series.

OBJECTIVE: The purpose of this study is to assess healing outcomes in full-thickness mucosal wounds following the use of a porcine urinary bladder matrix to augment mixed oral cavity repairs. MATERIALS AND METHODS: A retrospective chart analysis was conducted over a 58-month timespan. Participants included individuals with osteoradionecrosis. Descriptive measures obtained in the postoperative setting were used to examine wound healing outcomes. RESULTS: Thirty-nine encounters with 35 patients met inclusion criteria for assessment. The mean defect size repaired was 14 cm2. Successful healing occurred in 64% of cases. Scarring was observed in 10 cases, and 3 cases demonstrated transient functional deficits. Reapplication of the xenograft was required in 4 cases. Only 1 acute event of hemorrhage and 1 infection were observed in the postoperative period. CONCLUSIONS: Use of porcine urinary bladder matrix grafts for oral cavity reconstruction was well tolerated in a diverse number of wound scenarios with a relatively low risk of postoperative complication. The use of porcine urinary bladder matrix was not observed to provide any noteworthy advantages for the healing of recalcitrant osteoradionecrosis wounds.

Intraoperative and postoperative pain in cataract surgery.

Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the mechanisms, risk factors, and management of intraoperative and postoperative pain. Summaries of less common sources of physiologic pain have been included to reinforce recognition of when pain represents an expected physiologic reaction to surgery as opposed to signaling a more serious complication. We also discuss various current and emerging anesthetic and analgesic modalities.

Ascending Colon Schwannoma an Unusual Cause of Acute Lower Gastrointestinal Bleeding.

This is a case report of a 61-year-old female who presented with acute lower gastrointestinal bleeding resulting from a schwannoma involving the ascending colon. The patient was successfully treated with laparoscopic hemicolectomy. Schwannoma involving the large bowel is a rare entity; only around 90 cases of colonic schwannomas are reported in world literature. Although the vast majority of these tumors demonstrate a slow growing and benign profile, recurrence and malignant transformation can occur. Given the exceptional rarity of this pathological process, much of what is currently understood about this disease comes from case studies. Continued reporting of this pathology will be essential for further development and understanding its clinical and pathologic presentation.

Laparoscopic Treatment of a Pyogenic Hepatic Abscess Caused by Transmural Duodenal Perforation of a Toothpick.

The development of pyogenic hepatic abscess resulting from perforation of the gastrointestinal tract is a rare pathologic finding. It is a condition that can be fatal making early detection and subsequent removal of the inciting foreign body critical to avoid more deleterious sequela. Yet, its initial presentation tends to be nonspecific and typically is only discovered once surgical investigation into the cause of persisting abscess formation is performed. In this study, laparoscopic treatment of a 52-year-old male with a non-resolving hepatic abscess due to transmural gastrointestinal perforation of a toothpick is presented. Although a rare finding, reports of foreign body induced hepatic abscess have recently increased in the world literature, allowing some preliminary efforts in proposing diagnostic characterization. Yet, more case studies will be required to permit validation of these findings making continued reporting of this pathologic process critical.

Treatment of Peritonsillar Abscess in Immunosuppressed Patients.

Peritonsillar abscess (PTA) is a common pathology in otolaryngology emergency. The treatment of PTA is usually bedside drainage or surgical removal of the tonsils (Quincy tonsillectomy) in combination with antibiotic treatment. However, patients with immune suppression might have a more difficult treatment course. Such difficulties may be further magnified within older patients. This case report will describe successful multi-modality treatment of two separate incidents of PTA developing in the context of immunosuppression. Two separate incidents of PTA occurring in immunosuppressed, thrombocytopenic, cancer patients after recent chemotherapy are presented. Early utilization of incision and drainage, antibiotics, and granulocyte colony stimulating factor (G-CSF, filgrastim) for PTA presenting in the setting of chemotherapy related neutropenia appears to be a viable option in patients with immunosuppression. Review of the current literature also demonstrates that reporting of PTA in older patients is important for future research efforts.

The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study.

INTRODUCTION: Variations in the operative situation for complex head and neck defect reconstructions resulting from mechanisms such as trauma, oncologic resection, and prior radiation exposure can result in situations of a vessel-depleted neck. This requires an awareness of alternate, innovative options for use in reconstructive repairs. The purpose of this study was to provide characterization of the third segment of the maxillary artery necessary to consider its use as a recipient vessel in free flap repair of complex midface defects. MATERIALS AND METHODS: Seventeen cadaver hemifaces were used for anatomic demonstration of the maxillary artery third segment by a transmaxillary approach to obtain descriptive measures for statistical analysis. RESULTS: The average artery intraluminal cross-section diameter was obtained for the sphenopalatine (1.39 ± 0.12 mm) descending palatine (0.94 ± 0.10 mm), and terminal maxillary (1.68 ± 0.17 mm) arterial vessels. The mean transmaxillary depth with was (43 ± 1.2 mm). Mean mobilizable lengths for sphenopalatine, descending palatine, and terminal maxillary arteries were (30 ± 2 mm), (29 ± 2 mm), and (20 ± 2 mm), accordingly. Vessel patterns were characterized using Morton and Kahn classification for sphenopalatine-descending palatine bifurcation as well as the Kwak classification for maxillary artery third segment morphology. CONCLUSIONS: In situations where primary recipient vessel sites are unavailable, the maxillary artery represents an innovative option to be considered with suitable recipient artery characteristics.

Unresectable cutaneous squamous cell carcinoma of the forehead with MLH1 mutation showing dramatic response to Programmed Cell Death Protein 1 Inhibitor Therapy.

Treatment of refractory, unresectable cutaneous squamous cell carcinoma presents a great challenge in head and neck oncology with poor prognosis. Prior case reports have shown off-label pembrolizumab, a programed cell death receptor antagonist, can be effective in unresectable cutaneous squamous cell carcinoma. Furthermore, prior reports have suggested enhanced efficacy when high mutational burden is present. In this study we present a severe case of unresectable cutaneous squamous cell carcinoma invading the orbit and cavernous sinus with documented tumor MLH1 mutation. The patient had a complete response to palliative, off-label pembrolizumab therapy.