ABSTRACT
PURPOSE: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. METHODS: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap. RESULTS: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93-1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air-bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI - 0.79 to 2.48). CONCLUSION: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon.
Subject(s)
Tympanic Membrane Perforation , Tympanoplasty , Humans , Tympanoplasty/methods , Retrospective Studies , Treatment Outcome , Tympanic Membrane , Tympanic Membrane Perforation/surgery , Cartilage/transplantation , Randomized Controlled Trials as TopicABSTRACT
Abstract Introduction: Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. Objective: To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. Methods: A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. Results: 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. Conclusion: Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.
Resumo Introdução: A traqueostomia é um procedimento que está associada a diversas complicações já bem descritas na literatura, que podem ser divididas em transoperatórias, pós-operatórias precoces e pós-operatórias tardias. Nas crianças, esses riscos são mais incidentes do que nos adultos. Objetivo: Fazer uma revisão sistemática sobre complicações, inclusive óbitos, em pacientes pediátricos traqueostomizados. Método: Foram pesquisados artigos nas bases de dados da Latin American and Caribbean Health Sciences Literature e PubMed. Foram selecionados coortes e relatos de séries, além de revisões sistemáticas, publicados entre janeiro de 1978 e junho de 2020, com pacientes de até 18 anos, nas línguas inglesa, espanhola ou portuguesa. Resultados: Foram encontrados 1.560 artigos, dos quais 49 foram incluídos nesta revisão. A taxa média de complicações foi de 40%, que mostrou associação com idade, peso ao nascimento, prematuridade, comorbidades e procedimentos feitos em caráter de emergência. As complicações mais comuns foram lesões cutâneas e granulomas. Já a mortalidade relacionada ao procedimento chegou até a 6% em crianças e esteve relacionada principalmente à obstrução da cânula ou decanulação acidental. Conclusão: A traqueostomia pediátrica associa-se a diversas complicações. A mortalidade relacionada à traqueostomia se mostra baixa, mas a mortalidade geral de pacientes traque-ostomizados não é desprezível.
ABSTRACT
INTRODUCTION: Tracheostomy is a procedure that can be associated with several well-described complications in the literature, which can be divided into transoperative, early postoperative and late postoperative. When performed in children, these risks are more common than in adults. OBJECTIVE: To perform a systematic review of complications, including deaths, in tracheostomized pediatric patients. METHODS: A search was carried out for articles in the Latin American and Caribbean Health Sciences Literature and PubMed databases. Cohort studies and series reports were selected, in addition to systematic reviews, published between January 1978 and June 2020, with patients up to 18 years old, and written in English, Spanish or Portuguese. RESULTS: 1560 articles were found, of which 49 were included in this review. The average complication rate was 40%, which showed an association with age, birth weight, prematurity, comorbidities, and emergency procedures. The most common complications were cutaneous lesions and granulomas. Mortality related to the procedure reached up to 6% in children and was mainly related to cannula obstruction or accidental decannulation. CONCLUSION: Pediatric tracheostomy is associated with several complications. The tracheostomy-related mortality rate is low, but the overall mortality of tracheostomized patients is not negligible.
