[Transoral videoendoscopic resection of head-and-neck Tumors in 4-hand technique]. / Transorale videoendoskopische Resektion von Kopf-Hals-Tumoren in 4-Hand-Technik.

INTRODUCTION: Videoendoscopic surgery in 4-hand technique is a standard procedure in laparoscopic and also in transsphenoidal pituitary operations. In recent years transoral videoendoscopic resection of head and neck tumours in 4-hand technique (TOVR) gained more and more importance. MATERIALS AND METHODS: From March 2013 28 transoral videoendoscopic resections of oropharyngeal (n = 5)-, hypopharyngeal (n = 12) and laryngeal (n = 11) carcinomas in 4-hand technique werde successfully performed. RESULTS: In all 28 cases a R0-resection without extension to a transcervical surgical approach was achieved transorally. Even in patients with minor mobility of the cervical vertebral column (n = 9) and reduced adjustment facilities of the Kleinsasser laryngoscope or Weerda distending laryngoscope transoral tumor resection could be successfully performed with the use of rigid angular optics. CONCLUSION: TOVR is an effective, cheap and minimally invasive surgical procedure featuring numerous advantages compared to CO2 laser resection and can be considered as real alternative for traditional resection methods of head and neck tumours.

Clinical Outcome and Quality of Life After a Multimodal Therapy Approach to Ear Keloids.

IMPORTANCE: Keloids are fibroproliferative scars that can cause a huge psychological burden and severe problems for patients, such as depression. Many treatment options exist; however, recurrence rates, especially with monotherapy, remain high. OBJECTIVE: To investigate the recurrence rate and changes in quality of life after multimodal therapy. DESIGN, SETTING, AND PARTICIPANTS: A total of 33 patients with 42 auricle keloids (24 female and 9 male patients; mean [SD] age, 27 [17] years) were enrolled in a prospective cohort study and underwent intramarginal keloid excision and multimodal therapy. Patients were observed postoperatively in the outpatient Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Mannheim, from August 1, 2007, through September 30, 2014, with a mean (SD) follow-up of 30 (19) months (through August 31, 2014). A retrospective analysis of clinical outcomes was performed from September 1 through November 15, 2014. INTERVENTIONS: Excision followed by 6 intralesional corticosteroid injections at 4- to 6-week intervals and individually customized pressure splints applied at least 5 nights a week for 6 months. MAIN OUTCOMES AND MEASURES: Keloid recurrence rate and subjective handling of the pressure splint were evaluated during clinical visits. Quality of life was measured after the end of therapy with a 3-part questionnaire, including the Glasgow Benefit Inventory (GBI). RESULTS: After excluding 4 patients (with 5 keloids) for nonadherence to treatment, 3 of 37 keloids recurred, for a recurrence rate of 8% among 29 patients. Insecure handling of the pressure splint significantly correlated with a higher relapse rate (mean subjective handling score in patients with a relapse, 3.60; P = .02). Four of 8 patients with recurrent keloids had poor adherence to adjuvant pressure therapy, which suggests an association between keloid recurrence and adherence to adjuvant pressure therapy. Patients received the 3-part questionnaire by mail to collect data on quality of life. Of 43 patients approached, 33 treated with multimodal therapy completed the questionnaire for a return rate of 77%. Improvement in quality of life after keloid treatment was significant in recurrence-free patients, with a mean GBI score of 22.53 (P < .001). CONCLUSIONS AND RELEVANCE: The present study showed an improvement in quality-of-life scores after multimodal therapy for keloids. Because poor adherence to the use of ear splints correlated with a higher recurrence rate of keloids, efforts are needed to improve adherence and minimize recurrence. LEVEL OF EVIDENCE: 3.

Disposable laryngeal tube suction: standard insertion technique versus two modified insertion techniques for patients with a simulated difficult airway.

OBJECTIVE: The disposable laryngeal tube suction (LTS-D) is a supraglottic airway device that can be used as an alternative to tracheal tube to provide ventilation. We tested the hypothesis that, with a frontal jaw thrust insertion technique (FIT/JT), the rate of correct placement attempts in patients with a simulated difficult airway by means of a rigid cervical immobilization collar could be significantly increased compared to the standard insertion technique (SIT) recommended by the manufacturer. METHODS: 70 adult patients undergoing trauma surgery under general anaesthesia had an LTS-D inserted, randomly assigned to the SIT or FIT/JT. In the FIT/JT, the operator was standing in front of the patient's head, and forced chin lift to create sufficient retropharyngeal space was performed. The rate of successful tube placements within 180s and with a maximum of two attempts was the main outcome variable. To distinguish between the effects of the frontal approach and the jaw thrust manoeuvre, a third group was studied after completion of the SIT and FIT/JT groups. The standard insertion technique, but with a jaw thrust manoeuvre (SIT/JT), was employed in another 35 consecutive patients. RESULTS: Overall placement success was 49% (SIT, 17/35 patients, P<0.001), 91% (SIT/JT, 32/35 patients) and 100% (FIT/JT). The time required for successful insertion was shortest in the FIT/JT group (23±6s), and significantly longer in the SIT/JT (42±29s, P<0.001) and SIT groups (51±29s, P<0.0001). CONCLUSION: In anaesthetised patients with a simulated difficult airway created with a rigid cervical collar, the overall LTS-D placement success was significantly higher when a jaw thrust manoeuvre was performed, regardless of the particular technique used to introduce the LTS-D. Therefore, an intense jaw thrust manoeuvre should be performed whenever an LTS-D is being inserted.