Diagnostic Algorithm for Evaluating Nasal Airway Obstruction.

Nasal obstruction is a common symptom and can have a large impact on patient quality of life. There are numerous causes, including anatomic, congenital, inflammatory, infectious, neoplastic, toxic, and systemic. An algorithmic approach can aid in ensuring all pertinent patient information is incorporated into the final diagnosis and treatment plan. Key components include a thorough history, physical examination including modified Cottle and Cottle maneuver, patient-reported outcome measures and/or quality of life questionnaires, examination with and without decongestion, and nasal endoscopy. The resultant information can then be effectively used to narrow the differential and guide the next steps in management.

Robotics and telesurgery in otolaryngology.

This article reviews the use of robotic technology for otolaryngologic surgery. The authors discuss the development of the technology and its current uses in the operating room. They address procedures such as oropharyngeal transoral robotic surgery (TORS), laryngeal TORS, and thyroidectomy, and also note the role of robotics in teaching.

Robotic thyroid surgery: an initial experience with North American patients.

OBJECTIVE: To review the initial experience of gasless transaxillary robot-assisted endoscopic thyroid surgery in a series of patients and describe modifications of the technique for the North American patients, selection criteria, and other issues related to this technology. METHODS: Retrospective review of the first 31 consecutive cases at a single institution. RESULTS: Thirty-one patients underwent robotic thyroid surgery. Twenty thyroid lobectomies and 11 total thyroidectomies were performed. Improvements in the length of time to perform components of the procedure were noted from the early group of cases to later group of cases. No major or permanent complications occurred. CONCLUSIONS: Robotic thyroid surgery is feasible in North American patients and can be safely performed. The procedure has potential complications and a definite learning curve exists for both surgeons and operating room staff. Training methods need to be validated to ensure safe adoption. More studies need to be performed to further evaluate the relative benefits of this technique.

Clinical evaluation of a bioresorbable implant for medialization of the middle turbinate in sinus surgery.

BACKGROUND: During endoscopic sinus surgery (ESS), postoperative lateralization of the middle turbinate can lead to scarring and obstruction of key drainage pathways, including the osteomeatal complex. The technique of suturing the middle turbinate to the nasal septum to enhance exposure can be difficult and time consuming. This study presents the first clinical results using the Middle Turbinate Implant (MTI), a device composed of absorbable copolymer polylactide-co-glycolide and intended to medialize the middle turbinate during surgical procedures such as ESS. METHODS: The trial included 22 implantations (21 successful implantations) on 14 subjects (6 unilateral and 8 bilateral implantations). The primary outcome measure was the position of the middle turbinate at 1, 2, and 4 weeks postoperatively. The extent of tissue reaction at the site of implantation was also evaluated. RESULTS: At 1, 2, and 4 weeks postoperatively, 100% of the middle turbinates were held medially or in the neutral position with no significant synechiae present. At 1, 2, and 4 weeks postoperatively, there was either no (95%, 90%, and 95%) or mild (5%, 10%, and 5%) tissue reaction at the site of implantation. No complications were noted during implantation. CONCLUSION: The use of the bioresorbable MTI appears to be a safe and effective method of medializing the middle turbinate during ESS.

Robotic thyroidectomy: a framework for new technology assessment and safe implementation.

Robotic thyroidectomy is a new approach to thyroid surgery that offers the benefit of eliminating the anterior neck incision utilized in traditional approaches. Although no level I evidence exists to strongly support a robotic approach to thyroid surgery, initial non-randomized reports of robotic surgical approaches, in a variety of surgical specialty areas such as cardiothoracic, urologic, gynecologic and head and neck surgery suggest possible advantages of robot assisted techniques. These include platform and instrument stability, tremor reduction, articulating end effectors, three-dimensional, magnified imaging, and improved surgeon ergonomics. Potential negatives associated with robotic surgery include its expense, the lack of haptic feedback, instrument limitations, and the implicit learning curve. Robotic thyroidectomy introduces new potential risks, not typically associated with thyroid surgery. These risks are related to a new approach to the surrounding anatomy and are also associated with the learning curve. The introduction of new technology to any surgery mandates a rational framework for initial assessment and safe implementation. A New Technology Task Force was convened to draft guiding principles which may serve as a framework for the safe implementation of emerging technologies in thyroid surgery. This document suggests initial minimum steps that surgeons should consider during initial implementation of robotic thyroidectomy.

Robotic thyroidectomy: operative technique using a transaxillary endoscopic approach without CO2 insufflation.

In the last 20 years, there has been a significant increase in the diagnosis of benign and malignant thyroid tumors. With improved ultrasound technology and better access to sonographic imaging, many tumors are identified at earlier stages. Consequently, there has been an evolution in surgical technique, moving toward minimally invasive approaches. This article describes the technique of robotic thyroidectomy via transaxillary endoscopic approach without CO(2) insufflation.

A clinical evaluation of bioresorbable staples for mucoperichondrial flap coaptation in septoplasty.

BACKGROUND: During septoplasty surgery, the formation of dead space between the mucosal flaps must be minimized to prevent septal hematoma and promote healing. Historically, this has been achieved by using techniques such as nasal packing or the continuous septal quilting or whip suturing. This study presents the first clinical results using a septal stapling device that uses bioresorbable staples to achieve mucoperichondrial flap coaptation during septoplasty. METHODS: The septal stapler was used in 24 subjects. The primary outcome measure was whether septal coaptation was accomplished 1 week postoperatively. The extent of tissue reaction at the site of staple placement was also evaluated. RESULTS: In all subjects, coaptation with septal staples was successfully accomplished with no septal hematoma formation. At 1 week follow-up, there was either no (79%) or minimal (21%) tissue reaction at the site of staple placement. CONCLUSION: The use of bioresorbable staples appears to be a safe, efficient, and effective alternative to other methods used for mucoperichondrial flap coaptation in septoplasty surgery.

American Thyroid Association's central neck dissection terminology and classification for thyroid cancer consensus statement.

The American Thyroid Association recently published a consensus statement on central neck dissection terminology and classification for thyroid cancer. The American Academy of Otolaryngology-Head and Neck Surgery had representation in this multidisciplinary effort, which also included endocrinologists and general endocrine surgeons. This important statement will help surgeons standardize terminology and clarify the intent (elective vs therapeutic) and extent (unilateral vs bilateral) of central neck dissection in operative reports and publications.

Advanced approaches for thyroid surgery.

Over the past several years, new surgical approaches to the thyroid have been described, and efforts to further refine thyroid surgery continue. These new approaches can be classified by the anatomic location that access is obtained and whether CO(2) insufflation is necessary for the procedure to be performed. While these new approaches provide the potential for exciting innovation, more work should be done to refine some of these techniques and study the implications of adopting them from the perspective of patient outcomes and cost.

Extracts from The Cochrane Library: Antibiotics for acute maxillary sinusitis.

The "Cochrane Corner" is a quarterly section in the Journal that highlights systematic reviews relevant to otolaryngology-head and neck surgery, with invited commentary to highlight implications for clinical decision making. This installment features a Cochrane Review entitled "Antibiotics for acute maxillary sinusitis," which concludes a small treatment effect in patients with uncomplicated acute sinusitis in a primary care setting with symptoms for more than seven days.

The physician-patient relationship and the Internet.

In a relatively short time, the Internet has altered the traditional physician-patient relationship. Physicians must recognize and understand these changes and must use the tools of the Internet to avoid pitfalls and to provide better service to their patients.

Searching the medical literature on the Internet.

The volume of new information being added to the medical literature is expanding quickly. Hence, computer-assisted literature searches frequently are used to assist in patient care and clinical problem solving, including choosing the most appropriate diagnostic tests, properly diagnosing medical conditions, and developing and implementing suitable treatment plans. This article describes techniques for performing more efficient medical literature searches using the PubMed interface of MEDLINE.