Injection laryngoplasty with hyaluronic acid for glottal insufficiency in unilateral vocal fold paralysis: a systematic review of the literature.

BACKGROUND: Glottal insufficiency, mostly caused by unilateral vocal fold paralysis (UVFP) or vocal fold atrophy can be treated by injection laryngoplasty (IL). Materials such as hyaluronic acid (HA) gels are now widely available and used to improve voice quality. Various durability and effects of HA injection laryngoplasties have been reported. The aim of this study is to provide a systematic review of the literature for the use of HA in injection laryngoplasties. METHODS: A systematic literature search was conducted in PubMed and Cochrane Libraries. Three reviewers assessed original research studies concerning vocal fold augmentation with HA for eligibility. English written full-text human studies from 2000 to 2020 with EBM level 1b-2 were included. In vitro studies, animal studies, case reports, case-control studies, correspondence and review articles, and articles with other injection materials were excluded. Demographical data, indication, type of HA, evaluation methods, follow-up, durability of implanted material and complications were assessed. RESULTS: A total number of 311 articles were found in PubMed and Cochrane Library, 13 studies were eligible for final analysis with 1063 patients, mean age of patients was 58.7 years. Main indication for HA IL was unilateral vocal fold paralysis, evaluation methods were subjective-VHI (Voice Handicap Index) questionnaire and objective-acoustic and aerodynamic measurements, mean time of follow-up was 5.9 months. Large-particle HA gels were more favorable for longer durability than small-particle HA, reported time of resorption of HA gels ranges between 6 and 12 months, and complication rate was low. CONCLUSION: Hyaluronic acid injection laryngoplasty increases voice quality, improves results of voice therapy, and can be recommended as overlap treatment before permanent medialization surgery. Compared to other injected materials, HA seems to have more favorable effect on vibratory functions of the vocal folds and thus on the voice quality parameters.

The effect of free glycerol intake on cerebral glycerol concentration.

OBJECTIVE: Cerebral microdialysis (CMD) is a method used to measure the concentration of metabolites and glycerol in the interstitium of the brain. The aim of this study was to investigate the effect of parenterally applied medication and nutrition containing external free glycerol (EFG) on cerebral values of glycerol in patients monitored and treated for non-traumatic subarachnoid hemorrhage (SAH). METHODS: In 13 patients, the values of CG concentrations were measured using CMD. The amounts of parenterally applied EFG (in hourly intervals) were calculated from patient records. All data were gathered retrospectively. To analyze the association between the parameters of interest and their relationship, Spearman´s correlation and p-values were calculated. RESULTS: There was no evident relationship between the CG and EFG concentrations when the dataset was analyzed as a whole (r = -0.146). However, when the analysis was applied to single patients, a varying degree of correlations was discovered in 7 patients (r = 0.431-0.867). CONCLUSION: The possible effect of externally administered glycerol contained in pharmaceuticals and nutrition on its brain concentrations must be considered when interpreting data of CMD (Tab. 2, Fig. 4,Ref. 16) Keywords: glycerol, microdialysis, brain, subarachnoid hemorrhage.

The routes of infection spread in central skull-base osteomyelitis and the diagnostic role of CT and MRI scans.

BACKGROUND: Central skull-base osteomyelitis (CSBO) represents a life-threatening complication of external ear canal infection. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in assessment of CSBO progression. METHODS: Twelve patients with CSBO were included in a retrospective clinical study. In total, 62 scans (30 CTs and 32 MRIs) were performed to evaluate the extent of inflammatory changes. The scans were read independently by two radiologists specialised in imaging of the head and neck. The regions under the skull base were specified using the online Anatomy Atlas of the skull base. To clarify the timeline, the time period was divided into four parts, and inflammatory changes in the skull-base regions were tracked. Data were statistically analysed. RESULTS: In early stages of the disease, CT scan detects inflammatory changes closely related to the stylomastoid foramen and medially to the posterior belly of the digastric muscle, changes which have been proved to be crucial for the diagnosis of CSBO. Later the infection spreads to the contralateral side causing demineralisation of the bones. CONCLUSION: Imaging methods play a crucial role not only in establishing the diagnosis, but also in anticipating the direction of infection spread underneath the skull base.

Evaluation of an Electro-Pneumatic Device for Artificial Capillary Pulse Generation used in a Prospective Study in Animals for Surgical Neck Wound Healing.

The paper examines the development and testing of an electro-pneumatic device for wound healing therapy after surgery in the neck area. The device generates air pressure values in a miniaturized cuff using electronic circuitry to drive an electro-valve and air compressor. The device works in two distinct modes: continuous pressure mode and pulsating pressure mode. The pressure value setting can vary from 3 to 11 mmHg, and the pulsating pressure mode's operating frequency range is approximately 0.1 to 0.3 Hz. Laboratory measurements were conducted to evaluate the device's correct functioning in both continuous and pulsating pressure modes. A four-day prospective study with animals (n = 10) was also conducted to evaluate neck wound healing therapy using the electro-pneumatic device. Out of the twelve histological parameters analysed to reveal the differences between the experimental and control wounds, only one demonstrated a significant difference. Out of the ten animals treated with the device, three showed a significant difference in terms of benefit after therapy. We can therefore conclude that the device potentially improves the wound healing process in the neck area if the pre-set air pressure value does not exceed 8 mmHg.

Analysis of DNA methylation and microRNA expression in NUT (nuclear protein in testis) midline carcinoma of the sinonasal tract: a clinicopathological, immunohistochemical and molecular genetic study.

The aim of this study was a detailed clinicopathological investigation of sinonasal NUT midline carcinoma (NMC), including analysis of DNA methylation and microRNA (miRNA) expression. Three (5%) cases of NMC were detected among 56 sinonasal carcinomas using immunohistochemical screening and confirmed by fluorescence in situ hybridization. The series comprised 2 males and 1 female, aged 46, 60, and 65 years. Two tumors arose in the nasal cavity and one in the maxillary sinus. The neoplasms were staged pT1, pT3, and pT4a (all cN0M0). All patients were treated by radical resection with adjuvant radiotherapy. Two patients died 3 and 8 months after operation, but one patient (pT1 stage; R0 resection) experienced no evidence of disease at 108 months. Microscopically, all tumors consisted of infiltrating nests of polygonal cells with vesicular nuclei, prominent nucleoli and basophilic cytoplasm. Abrupt keratinization was present in only one case. Immunohistochemically, there was a diffuse expression of cytokeratin (CK) cocktail, CK7, p40, p63, and SMARCB1/INI1. All NMCs tested negative for EBV and HPV infection. Two NMCs showed methylation of RASSF1 gene. All other genes (APC, ATM, BRCA1, BRCA2, CADM1, CASP8, CD44, CDH13, CDKN1B, CDKN2A, CDKN2B, CHFR, DAPK1, ESR1, FHIT, GSTP1, HIC1, KLLN, MLH1a, MLH1b, RARB, TIMP3, and VHL) were unmethylated. All NMCs showed upregulation of miR-9 and downregulation of miR-99a and miR-145 and two cases featured also upregulation of miR-21, miR-143, and miR-484. In summary, we described three cases of sinonasal NMCs with novel findings on DNA methylation and miRNA expression, which might be important for new therapeutic strategies in the future.

Univariate and multivariate models for the prediction of life-threatening complications in 586 cases of deep neck space infections: retrospective multi-institutional study.

OBJECTIVE: To identify deep neck infection factors related to life-threatening complications. METHODS: This retrospective multi-institutional study comprised 586 patients treated for deep neck infections between 2002 and 2012. The statistical significance of variables associated with life-threatening complications of deep neck infections was assessed. RESULTS: During treatment, life-threatening complications occurred in 60 out of 586 cases. On univariate analysis, life-threatening complications were linked to: dyspnoea, neck movement disturbance and dysphonia (all p < 0.001); and parapharyngeal, anterior visceral or pretracheal deep neck involvement (all p < 0.002). Aetiology was significantly linked to tonsils (p < 0.001). Regarding infection type, fasciitis was a significant factor (p < 0.001). Candida albicans was a significant bacterial culture (p < 0.001). A multivariate step-wise model disclosed fewer significant variables: retropharyngeal space (p = 0.005) and major blood vessels area (p = 0.006) involvement, and bacterial culture C albicans (p < 0.001). CONCLUSION: It can be predicted that patients with deep neck infections, with neck movement disturbances, dysphonia, dyspnoea and swelling of the external neck, accompanied by severe pain, and inflammatory changes in the retropharyngeal space and large vessel areas, with culture-confirmed infection of C albicans, are likely to develop life-threatening complications.

Bacteriology of deep neck infections: analysis of 634 patients.

BACKGROUND: The aim of this study was to review the bacteriology of deep neck infections (DNI) and identify the factors that influence the incidence of causative bacteria. METHODS: A retrospective analysis of 634 patients with DNI was performed. Statistical analysis was used to compare the incidence of common pathogens in various conditions such as age of the patients, aetiology and associated diabetes mellitus. RESULTS: Bacteria were isolated in 514 cultures (81%). Aerobic bacteria were isolated from 246 cultures (39%) and anaerobic bacteria from 61 cultures (10%). Both aerobic and anaerobic bacteria were isolated from 207 cultures (32%). The most common aerobic bacteria were Streptococcus pyogenes (41%) and Staphylococcus aureus (32%). The most common anaerobic bacteria were Peptostreptococcus species (28%), followed by Prevotela species (8%) and Proprionibacterium species (7%). The incidence of anaerobic bacteria was higher in adults, in patients with infections of dental origin and in non-diabetic patients. CONCLUSIONS: The bacteriology of DNI is polymicrobial, including both aerobic and anaerobic bacteria. The incidence of anaerobic bacteria is higher in adults, in patients with infections of dental origin and in non-diabetic patients.

Use of a silicon microsensor for pressure monitoring inside the wound and outcomes on healing.

OBJECTIVE: To ascertain the extent to which pressure within a defined neck compartment could be used as predictor for wound healing. METHOD: Thirty patients with various head and neck malignancies that were treated surgically, were considered prospectively. In the course of surgery a pressure microsensor was implanted into the defined neck compartment and data were collected over the first 48 hours postoperatively. Logistic regression analysis was used to determine the strength of inter fascial pressure (IP) as predictor for wound healing. RESULTS: Mean IP was 7.45 ± 6.15mm Hg (95%CI 7.13; 7.77).A logistic regression model relating good/disturbed healing outcome revealed that the mean pressure is the key variable, with a major influence on healing outcome. However, this type of model only explains approximately 46% of the total variation in the responses. This implies, that although pressure change contributes significantly in explaining variations in healing, there may be other significant predictors that were not included in the study. CONCLUSION: This study demonstrates the feasibility of IP measurement in the neck, verifies it in a human clinical experiment and highlights its potential in the prediction of wound healing complications.The study seems to suggest that for high probability of good wound healing (> 90%) the IP values should be monitored and maintained below 7mm Hg.At present, there are no comparator studies, as this kind of measurement in the neck area has not been reported yet.