Urgent endoscopic orbital decompression for vision deterioration in dysthyroid optic neuropathy.

AIMS: To report visual acuity outcomes and potential complications in patients undergoing endoscopic transnasal orbital decompression in the setting of acutely deteriorating sight secondary to dysthyroid optic neuropathy (DON) unresponsive to corticosteroid therapy. No previous reports describe vision outcomes in this specific patient population undergoing urgent endoscopic decompression. MATERIAL AND METHODS: Retrospective case review at a tertiary-care academic hospital. Four patients with DON were identified that underwent urgent endoscopic orbital decompression for acutely deteriorating vision. Three patients underwent a later decompression of the other orbit, yielding seven decompressions in total for acutely deteriorating vision. Operative technique entailed inferior and medial wall decompressions. The posterior limit of medial wall decompression was within the sphenoid, just anterior to the annulus of Zinn to fully decompress the optic nerve. Primary outcome was visual acuity. RESULTS: In all seven decompressions, visual acuity improved substantially. In 5/7 eyes, preoperative vision was severely impaired at 20/150 or worse. Two eyes had mild and moderate impairment at 20/50 and 20/100. Post-operatively, the moderately and severely impaired eyes improved to 20/60 or better. No complications were encountered. CONCLUSION: Transnasal endoscopic orbital decompression is a safe, effective treatment for acutely worsening visual loss from DON. All cases demonstrated significant objective improvement in visual acuity. Given the need for later contralateral decompression in 3 patients, consideration should be given to performing bilateral orbital decompressions at the time of surgery.

A paired comparison analysis of third-party rater thyroidectomy scar preference.

OBJECTIVE: To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. METHODS: Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. RESULTS: Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability. CONCLUSION: Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population.

BACKGROUND: Sexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada. METHODS: Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993-1999, 2000-2005, and 2006-2011. RESULTS: Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993-1999 to 2006-2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993-1999 vs. 84% in 2006-2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome. INTERPRETATION: The present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.