International expert consensus statement: surgical failure in obstructive sleep apnea.

PURPOSE: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the 'Definition of Surgical Success/Failure after OSA Surgery'. Regarding the 'Predictive Factors of Surgical Failure in OSA Surgery', consensus was reached on 10 out of 13 statements. In the context of the 'Diagnostic Workup in OSA Surgery', consensus was achieved on 9 out of 13 statements. Lastly, in 'Treatment in Surgical Failure Cases', consensus was reached on 12 out of 24 statements. CONCLUSION: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

Unraveling the Complexities of Oxidative Stress and Inflammation Biomarkers in Obstructive Sleep Apnea Syndrome: A Comprehensive Review.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS), affecting approximately 1 billion adults globally, is characterized by recurrent airway obstruction during sleep, leading to oxygen desaturation, elevated carbon dioxide levels, and disrupted sleep architecture. OSAS significantly impacts quality of life and is associated with increased morbidity and mortality, particularly in the cardiovascular and cognitive domains. The cyclic pattern of intermittent hypoxia in OSAS triggers oxidative stress, contributing to cellular damage. This review explores the intricate relationship between OSAS and oxidative stress, shedding light on molecular mechanisms and potential therapeutic interventions. METHODS: A comprehensive review spanning from 2000 to 2023 was conducted using the PubMed, Cochrane, and EMBASE databases. Inclusion criteria encompassed English articles focusing on adults or animals and reporting values for oxidative stress and inflammation biomarkers. RESULTS: The review delineates the imbalance between pro-inflammatory and anti-inflammatory factors in OSAS, leading to heightened oxidative stress. Reactive oxygen species biomarkers, nitric oxide, inflammatory cytokines, endothelial dysfunction, and antioxidant defense mechanisms are explored in the context of OSAS. OSAS-related complications include cardiovascular disorders, neurological impairments, metabolic dysfunction, and a potential link to cancer. This review emphasizes the potential of antioxidant therapy as a complementary treatment strategy. CONCLUSIONS: Understanding the molecular intricacies of oxidative stress in OSAS is crucial for developing targeted therapeutic interventions. The comprehensive analysis of biomarkers provides insights into the complex interplay between OSAS and systemic complications, offering avenues for future research and therapeutic advancements in this multifaceted sleep disorder.

Clinical Application of Pediatric Sleep Endoscopy: An International Survey.

OBJECTIVES: To investigate through an international survey the actual clinical application of drug-induced sleep endoscopy (DISE) in pediatric patients with obstructive sleep apnea (OSA) and to clarify the use, application, clinical indications, and protocol of pediatric DISE. METHODS: A specific survey about pediatric DISE was initially developed by five international otolaryngologists with expertise in pediatric sleep apnea and drug-induced sleep endoscopy and was later spread to experts in the field of sleep apnea, members of different OSA-related associations. RESULTS: A total of 101 participants who answered all the survey questions were considered in the study. Sixty-four sleep apnea experts, equivalent to 63.4% of interviewed experts, declared they would perform DISE in pediatric OSA patients. A total of 81.9% of responders agreed to consider the DISE as the first diagnostic step in children with persistent OSA after adenotonsillectomy surgery, whereas 55.4% disagreed with performing DISE at the same time of scheduled adenotonsillectomy surgery to identify other possible sites of collapse. In the case of young patients with residual OSA and only pharyngeal collapse during DISE, 51.8% of experts agreed with performing a velopharyngeal surgery. In this case, 27.7% disagreed and 21.4% were neutral. CONCLUSION: Pediatric DISE is internationally considered to be a safe and effective procedure for identifying sites of obstruction and collapse after adenotonsillectomy in children with residual OSA. This is also useful in cases of patients with craniofacial malformations, small tonsils, laryngomalacia or Down syndrome to identify the actual site(s) of collapse. Despite this evidence, our survey highlighted that pediatric DISE is not used in different sleep centers.

Autosomal recessive IL12RB1 mutation: A case report of a Sudanese child and his father.

Introduction: Mendelian susceptibility to mycobacterial disease (MSMD) is a rare inherited condition characterized by selective susceptibility to weakly virulent mycobacteria, such as substrains of the bacille Calmette-Guérin (BCG) vaccine and different environmental mycobacteria. Case presentation: A 7-year-old Sudanese boy was referred to the immunology clinic with a suspected diagnosis of MSMD. This followed multiple presentations with disseminated tuberculosis and typhoid fever. Genetic testing surprisingly revealed pathogenic homozygous variants in IL12RB1 Exon 9, c.913A>T (p. Lys305*) in both the patient and his father, with a completely healthy asymptomatic carrier mother who is not blood related to the patient's father. Conclusion: It is challenging to diagnose MSMD, especially in developing countries where health systems are poor and have limited resources. Family history and genetic tests may help in early MSMD treatment and avoiding disease complications.

Prevalence of peste des petits ruminants virus antibodies in sheep and goats sera from Central-Western Sudan.

Clinical signs suggestive of peste des petits ruminants (PPR) involved herds of small ruminants, which were described elsewhere in Sudan. Peste des petits ruminants was confirmed using an Immunocapture ELISA (IC-ELISA) assay in samples of infected and dead animals in areas of outbreaks. Therefore, to update information regarding the current situation and for assessment of the serological prevalence of PPR in small ruminants mingled at Central and Western Sudan during 2018-2019, 368 sera were collected from sheep (325 sera) and goats (43 sera) with different ages and breeds. These sera included 186 sera (173 sheep and 13 goats) from White Nile State and 182 sera (152 sheep and 30 goats) from Kordofan States. Competitive ELISA demonstrated higher prevalence of PPRV antibodies of 88.9%, 90.7% and 88.6% in both sheep and goats, goats, and sheep sera, respectively. Moreover, 100%, 94.7% and 78.5% seroprevalence values were demonstrated in South Kordofan, North Kordofan and White Nile States. The higher seroprevalence values detected in sera of unvaccinated sheep and goats indicated the wide exposure of these animals to PPRV and presence of protection following PPR viral infection. The findings of the study indicated that PPR is endemic in the surveyed areas of Sudan.Contribution: The study will contribute effectively to the global eradication programme of PPR organised by the World Organization for Animal Health (WOAH, formerly OIE) and Food and Agriculture Organization (FAO). To completely eliminate PPR from Sudan by 2030, local efforts should be directed towards effectively and wholly vaccinating small ruminants using PPRV vaccine especially in routes of seasonal animal's movement and shared grazing areas.

Serum interleukin 1ß and sP-selectin as biomarkers of inflammation and thrombosis, could they be predictors of disease severity in COVID 19 Egyptian patients? (a cross-sectional study).

BACKGROUND: Thromboembolism was a chief cause of mortality in 70% of patients with COVID-19. Our objective was to see if serum interleukins 1 beta (IL-1ß) and soluble platelets selectin (sP-selectin) could serve as novel markers of thromboembolism in COVID-19 patients. METHODS: This cross sectional study involved 89 COVID-19 patients who were recruited from 1st of February to 1st of May 2021. Clinical and laboratory data were collected, and chest imaging was performed. The levels of IL-1ß and sP-selectin were assessed in all cases through ELISA kits. Comparisons between groups were done using an unpaired t-test in normally distributed quantitative variables. In contrast, a non-parametric Mann-Whitney test was used for non-normally distributed quantitative variables. RESULTS: Severe COVID-19 infection was associated with higher serum levels of CRP, Ferritin, LDH, D dimer, IL-1ß and sP-selectin (P <  0.001) with significant correlation between levels of IL-1ß and sP-selectin (r 0.37, P <  0.001), D-dimer (r 0.29, P 0.006) and Ferritin (r 0.5, p <  0.001). Likewise, a positive correlation was also found between levels of sP-selectin, D-dimer and Ferritin (r 0.52, P <  0.001) (r 0.59, P <  0.001). Imaging studies revealed that 9 (10.1%) patients developed venous and 14 (15.7%) developed arterial thrombosis despite receiving anticoagulant therapy. Patients with thrombotic events had significantly higher levels of IL-1ß, sP-selectin and LDH serum levels. Meanwhile, there was no statistical significance between CRP, D-dimer or Ferritin levels and the development of thrombotic events. CONCLUSION: IL-1ß and sP-selectin levels can be promising predictors for severe COVID-19 infection and predictable thrombosis.

The Effects of Barbed Repositioning Pharyngoplasty in Positional and Non-Positional OSA Patients: A Retrospective Analysis.

PURPOSE: The aim of our retrospective study is evaluating the effectiveness of barbed repositioning pharyngoplasty (BRP) in a consecutive cohort of patients and assessing its impact on positional indexes in order to potentially identify specific obstructive sleep apnea (OSA) phenotypes for patients who might benefit more significantly from this intervention. METHODS: A single-center retrospective study with baseline and follow-up type III sleep tests evaluating the Apnea Hypopnea Index (AHI), supine AHI, non-supine AHI, oxygen desaturation index (ODI), mean SaO2, percentage of time spent at SaO2 below 90% (CT90), and lowest oxygen saturation (LOS) were performed. The patients were then divided into groups according to Sher's criteria and Amsterdam Positional OSA Classification (APOC). Parametric and non-parametric tests and univariate and multivariate analyses were conducted. RESULTS: The study finally included 47 patients. The statistical analysis showed significant improvement in AHI, supine AHI, non-supine AHI, and ODI after surgery. The linear regression showed that high values of baseline AHI, AHI supine, and AHI non supine predict more significant postoperative reductions in AHI, AHI supine, and AHI non supine, respectively. Therapeutic success was achieved in 22 patients out of 47. The logistic regression did not find any independent risk factors for success. The most significant reduction in AHI, supine AHI, and non-supine AHI was observed in the APOC 3 group while the APOC 1 patients experience a substantially lower improvement. CONCLUSIONS: BRP appears to be an effective surgical procedure for the treatment of OSA. The non-positional patients might benefit more from BRP in comparison with positional patients. Moreover, OSA severity should not be considered an absolute contra-indication for this surgical procedure.

Surgical correction of nasal obstruction in obstructive sleep apnea improves CPAP outcomes and compliance.

BACKGROUND: Although continuous positive airway pressure (CPAP) therapy curtails most of the negative impacts of obstructive sleep apnea (OSA), its efficacy is limited by its low long-term adherence. Nasal obstruction contributes to OSA pathophysiology and necessitates high CPAP titration pressures which reduce CPAP compliance. AIM: This study aims at elucidating the outcomes of surgical correction of nasal obstruction in patients intolerant to CPAP therapy. METHODS: Forty-nine patients with severe OSA intolerant to CPAP secondary to surgically correctable nasal obstruction were operated upon. Patients were evaluated preoperatively and at least 3 months after the surgical intervention. Subjective assessment entailed the Nasal Obstruction Symptom Evaluation score (NOSE) and the Epworth Sleepiness Scale (ESS). Objectively the patients were assessed by acoustic rhinometry and standard polysomnography. RESULTS: Nasal surgical intervention resulted in an a statistically significant decrease in the mean NOSE score, ESS and optimal CPAP titration pressure. In addition, the minimal cross-sectional area (MCA1&2) increased significantly postoperatively. There was a positive correlation between the improvement in NOSE score as well as the MCA1& 2 and the postoperative decrease in CPAP titration pressure. Surgical correction of nasal obstruction improved CPAP outcomes and compliance in all patients. CONCLUSIONS: Nasal surgery in OSA objectively assessed by acoustic rhinometry improved nasal obstruction with a resultant decrease in the CPAP pressure requirements. Given that lower CPAP pressures improve adherence to CPAP therapy, surgical alleviation of nasal obstruction should be considered a crucial intervention in the management armamentarium of OSA.

Prognostic value of absolute lymphocyte/monocyte ratio, red cell distribution width and neutrophil/ lymphocyte ratio in diffuse large B-cell lymphoma patients.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive and rapid-growing form of non-Hodgkin lymphoma (NHL). The objective of this research was to assess the predictive role of lymphocyte to monocyte ratio (LMR), red cell distribution width (RDW) and neutrophil to lymphocyte ratio (NLR) values in the survival of DLBCL patients. A retrospective analysis of 136 DLBCL patients admitted to Nanakali Hospital for blood diseases and oncology from 2010-2020 was done. We assessed the correlation of LMR, RDW and NLR with patients' characteristics and the impact on survival by the Kaplan-Meier method, the log-rank test, and Cox regression models for multivariate analysis. The complete remission rate was 61.7%, with a 5- year overall survival (OS) and progression-free survival (PFS) of 59.5% and 60%, respectively. The Log-rank test showed that LMR was significantly correlated with Ann Arbor staging (p= 0.040). There is a significant association between RDW and Eastern Cooperative Oncology Group performance status (ECOG-performance status) (p= 0.022), B symptoms (p= 0.026), Revised International prognostic index (R-IPI) (p= 0.004), lactate dehydrogenase (LDH) (p= 0.021), and beta 2 microglobulin (B2MG) (p= 0.007), whereas NLR had a significant correlation with LDH only (p=0.016). There were no significant differences in the 5-year OS or PFS in patients with different levels of RDW, LMR, and NLR. LMR, RDW and NLR were correlated with many of patients' characteristics. However, none of the LMR, RDW and NLR did possess value to predict OS and PFS, and they cannot be used as biomarkers for survival evaluation of DLBCL.

Effect of Cooling Irrigating Saline in Tongue Base Ablation in Obstructive Sleep Apnea.

OBJECTIVE: Plasma is formed by creating a high-density energy field within an electrically conductive fluid such as saline. Sometimes ablated bits of tissue get stuck between the electrodes of the wand, obstructing the suction channel. The purpose of this study is to investigate the effect of cooling the irrigating saline during ablation of the hypertrophied tongue base in patients with obstructive sleep apnea. STUDY DESIGN: Prospective randomized controlled trial. SETTING: An otorhinolaryngology department in Main University hospitals. METHODS: Sixty adult patients with obstructive sleep apnea and tongue base hypertrophy underwent tongue base ablation surgery. Patients were randomly divided into 2 groups of 30 patients each: cooled saline and room temperature saline. The Coblation wand used was the EVac 70 Xtra HP (Smith & Nephew). RESULTS: In this study, a significant difference in operative time (mean ± SD) was seen between groups: 21.2 ± 5.5 minutes in the cold group and 47 ± 9.5 minutes in the control group (P = .001). The wands in the cold group did not obstruct, while all the wands in the control group were obstructed by tissue clogs with variable degrees, hence wasting more time to clean the wands' tips. CONCLUSION: Cooling the irrigating saline overcame the problem of wand clogs, and the wand tip did not occlude at all during the procedures, thus saving time lost in wand cleaning and demonstrating a faster and safer surgical procedure. Further studies are needed to identify the hemostatic effect of the cooled saline over the regular one.

Assessment of the New L Pharyngeal Flap for Velopharyngeal Insufficiency.

OBJECTIVE: To assess the results of the new L pharyngeal flap for treatment of velopharyngeal insufficiency (VPI). METHODS: This study included 60 patients who were diagnosed as persistent VPI (for > 1 year without response to speech therapy for 6 months at least). L-shaped superiorly based pharyngeal flap was tailored from oropharynx and inserted into the soft palate through a transverse full-thickness palatal incision 1 cm from the hard palate, then the distal horizontal part of the flap was spread 1 cm anteroposterior direction and 1 cm horizontally into the soft palate. Prior to and after surgery, patients were assessed by oral examination, video nasoendoscopy, and speech evaluation. RESULTS: Postoperative speech assessment showed significant improvement in nasoendoscopic closure, speech assessment, and nasometric assessments. Grade 4 velopharyngeal valve closure (complete closure) could be achieved in 59 (98.3%) patients at 6 months postoperatively. No patients showed dehiscence (partial or total) of the flap and no obstructive sleep apnea was reported. CONCLUSION: The newly designed L pharyngeal flap was proved to be highly effective, reliable, and safe in treating patients with persistent VPI with easy applicability and without significant complication.

Sleep medicine in otolaryngology units: an international survey.

PURPOSE: No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes. METHODS: An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training. RESULTS: A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions. CONCLUSION: Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees' lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

Determinants of the willingness of the general population to get vaccinated against COVID-19 in a developing country

Purpose@#Vaccination is a cost-efficient intervention to slow the spread of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the population's willingness to take the COVID-19 vaccine in Jordan and investigate potential determinants of their acceptance @*Materials and Methods@#This study used an online survey distributed in November 2020, before introducing the vaccine, with items investigating socio-demographic characteristics, seasonal flu vaccination history, COVID-19 vaccine acceptance once available, and factors affecting their decision-making. Also, “COVID-19 risk perception” and beliefs toward COVID-19 vaccine benefits and barriers were assessed. @*Results@#A total of 2,208 participants completed the survey with a participation rate of 13.1%. The mean±standard deviation age was 33.2±13.5, and 55.7% were females. Study participants were almost equally distributed between willingness, unwillingness, and indecision to take the COVID-19 vaccine (30.4%, 36.4%, and 31.5%, respectively). Younger adults, males, and those who were not married, do not have children, have a bachelor or higher education, employees or being students, healthcare workers, and those who reported receiving flu vaccine had higher rates of COVID-19 vaccine acceptance compared to their counterparts (p<0.001 for each category). COVID-19 risk perception, and perceived vaccine benefits, and barriers were significant predictors of intention. Among those undecided or unwilling to take the COVID-19 vaccine, its safety and side effects were the most common concerns. @*Conclusion@#The low rate of COVID-19 vaccine acceptance in a developing country is alarming, and a significant proportion are indecisive. Interventions to elevate vaccine acceptance by addressing its safety and efficacy and targeting vulnerable groups are recommended.

Manipulation of Lateral Pharyngeal Wall Muscles in Sleep Surgery: A Review of the Literature.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) occurs due to upper airway obstruction resulting from anatomical and functional abnormalities. Upper airway collapsibility, particularly those involving the lateral pharyngeal wall (LPW), is known to be one of the main factors contributing to the pathogenesis of OSAS, leading the authors of the present study to propose different strategies in order to stiffen the pharyngeal walls to try to restore normal airflow. METHODS: An exhaustive review of the English literature on lateral pharyngeal wall surgery for the treatment of OSAS was performed using the PubMed electronic database. RESULTS: The research was performed in April 2020 and yielded approximately 2000 articles. However, considering the inclusion criteria, only 17 studies were included in the present study. CONCLUSIONS: The analyzed surgical techniques propose different parts of LPW on which to focus and a variable degree of invasivity. Despite the very promising results, no gold standard for the treatment of pharyngeal wall collapsibility has been proposed. However, thanks to progressive technological innovations and increasingly precise data analysis, the role of LPW surgery seems to be crucial in the treatment of OSAS patients.

Changes in corneal biomechanics and intraocular pressure following Femto-LASIK using Goldman applanation tonometry and ocular response analyzer.

AIM: To compare intraocular pressure (IOP) measurements before and after laser in situ keratomileusis (LASIK) with a femtosecond laser for flap creation using ocular response analyzer (ORA) and Goldmann applanation tonometry, and to identify factors that may influence the preoperative and postoperative IOP. METHODS: A prospective study conducted on myopic patients who underwent LASIK using a femtosecond laser for flap fashioning. Enrolled patients were evaluated preoperatively, 6wk and 3mo postoperatively for manifest refraction (MR), keratometric (K) readings and central corneal thickness (CCT) using a scheimpflug-based topography. Corneal resistance factor (CRF), corneal hysteresis (CH), Goldmann correlated IOP (IOPg) and corneal compensated IOP (IOPcc) were measured using ORA besides IOP assessment by Goldman applanation tonometry (GAT). RESULTS: There was a statistically significant decrease in measures of IOPg by 3.35±0.83 mm Hg, followed by GAT which decreased by 2.2±0.44 mm Hg, and the least affected by operation was IOPcc which decreased only by 0.87±0.1 mm Hg after 6wk. After 3mo follow up there was a statistically significant decrease in IOPcc which decreased only by 0.76±0.4 mm Hg, followed by IOP GAT by 1.6±0.5 mm Hg, and the most affected by operation was IOPg which decreased by 2.3±0.3 mm Hg. Correspondingly, there was a statistically significant decrease in CH and CRF after 6wk and 3mo. At 3mo, the preoperative MR and preoperative GAT were prominent significant predictors of the postoperative GAT changes. The prediction equation was subsumed. CONCLUSION: IOP measurements and corneal biomechanical factors reduce significantly after LASIK with a femtosecond laser for flap creation. The IOPcc values are less influenced by changes in corneal properties than IOPg and GAT, indicating that IOPcc may provide the most reliable measurement of IOP after this procedure.

Acquired Nasopharyngeal Stenosis Correction Using a Modified Palatal Flaps Technique in Obstructive Sleep Apnea (OSA) Patients.

Background: Acquired nasopharyngeal stenosis is a rare and heterogeneous pathological condition that has different causes, generally resulting as a complication of a pharyngeal surgery, especially in patients affected by obstructive sleep apnea (OSA). Different approaches have been proposed for the treatment of nasopharyngeal stenosis but a unique and standardized management has not yet been presented. The aim of our paper is to evaluate the efficacy of our surgical technique, describing its steps and results with the aim to consider it as a possible solution for the treatment of this condition. Methods: This is a retrospective cohort study. Eight patients (mean age 27.25 years old (yo), range 8-67 yo; Male/Female ratio 4/4; mean body mass index (BMI) 26.1) affected by OSA (mean apnea hypopnea index (AHI) before OSA surgery was 22.1) and acquired nasopharyngeal stenosis as a consequence of different pharyngeal surgeries were treated with our modified approach in the Department of Otolaryngology, Morgagni Pierantoni Hospital, Forlì, Italy. Resolution of stenosis and complication rate were the main outcome measures. Results: Complete resolution of the stenosis was achieved in all cases and no complications were recorded at three weeks, six months, and 2 years follow-up. Conclusions: Our technique appears to be a promising method for the management of nasopharyngeal stenosis in OSA patients. However, further studies comparing different techniques and reporting on larger series and longer follow up time are needed to prove the efficacy of the proposed technique.

Hemostatic Options for Transoral Robotic Surgery of the Pharynx and Base of Tongue.

Surgery with transoral robotic surgery (TORS) offers significant advantages compared with traditional open surgical approaches and potentially minimizes the long-term side effects of organ preservation therapy with chemoradiation. Angled telescopes and wristed instruments allow visualization and access to areas of the pharynx that are difficult to reach with line-of-sight instrumentation. Although the application of TORS in head and neck surgery has expanded considerably, there are still only limited data available on the postoperative complications and their management. As further data become available, it is likely that further risk factors and treatment strategies will become available.

Diagnosing intussusception in preterm neonates: case report and overview.

Intussusception is extremely rare in preterm neonates and is often confused with necrotizing enterocolitis leading to considerable delay in its diagnosis. We present a case report of a preterm with colo-colic intussusception, which was diagnosed preoperatively using ultrasound. We examine the pitfalls in diagnosing intussusception in preterm neonates. Intussusception, though rare, should be considered in the differential diagnosis while managing a preterm with abdominal symptomatology. Abdominal ultrasound is useful in diagnosing intussusception in neonates.