Sialoendoscopy, sialography, and ultrasound: a comparison of diagnostic methods.

OBJECTIVE: To compare the accuracy of ultrasound, sialography, and sialendoscopy for examining benign salivary gland obstructions. METHODS: In this prospective study, patients with symptoms of obstruction of the major salivary gland duct system presenting at the ENT Clinic University Hospital, Ostrava, from June 2010 to December 2013 were included. All patients (n=76) underwent ultrasound, sialography, and sialoendoscopy. The signs of sialolithiasis, ductal stenosis, or normal findings were recorded after the examinations. Statistical analysis of the sensitivity and specificity of all the methods was performed, as well as a comparison of the accuracy of each method for different kinds of pathology (sialolithiasis or stenosis). RESULTS: The sensitivity of ultrasound, sialography, and sialoendoscopy for sialolithiasis findings were 71.9%, 86.7 %, and 100%, respectively. The sensitivity of sialography and sialoendoscopy for stenosis of the duct was 69.0%, and 100%, respectively. The study showed impossibility of ultrasonic diagnostics of ductal stenosis. The sensitivity of sialoendoscopy for both pathologies was significantly higher than that from ultrasound or sialography (p<0.05). The specificity of sialoendoscopy was significantly higher than that from by ultrasound or sialography (p<0.05). CONCLUSION: Sialoendoscopy was the most accurate method for examination ductal pathology, with significantly higher sensitivity and specificity than by ultrasound or sialography.

Bipolar thermofusion BiClamp 150 in thyroidectomy: a review of 1156 operations.

OBJECTIVES: To compare the bipolar thermofusion BiClamp 150 with conventional ligature techniques for thyroid gland surgery, and report the advantages/disadvantages of both techniques. METHODS: In this retrospective comparative study, all thyroid gland operations performed in the ENT Clinic Faculty Hospital Ostrava from 2006 to 2013 were included (1156 operations, 2122 lobes). Patients were categorized into two groups according to the type of vessel sealing method used, group I (BiClamp, n = 819 operations) and group II (conventional ligature, n = 337 operations). The number of revision surgeries due to wound hematoma was recorded as a bleeding event. Statistical analysis of the complication rate (bleeding rate, recurrent nerve palsy) and time of duration was performed. RESULTS: The rate of revision surgery performed due to postoperative wound hematoma was significantly lower in group I (15/819, 1.83%) compared with group II (14/337, 4.15%) (P = 0.022). There was no statistically significant difference in the frequency of recurrent laryngeal nerve palsy between groups I and II (P = 0.36). The average surgery time was significantly shorter in group I (P < 0.001). CONCLUSION: Bipolar thermofusion BiClamp is an effective vessel sealing method that leads to a significant reduction in postoperative wound bleeding rates and reduces surgical time compared with conventional vessel ligature.

Lacrimal sac dacryolith (76 cases): a predictive factor for successful endonasal dacryocystorhinostomy?

To evaluate whether the presence of dacryolith is a predictive factor for successful dacryocystorhinostomy. The success rate of endonasal dacryocystorhinostomy (EDCR) performed to relieve obstruction of the nasolacrimal duct was evaluated according to the presence of dacryolithiasis. The surgical results of patients with (group I) and without dacryoliths (group II) were analysed and compared 1-year post surgery. A total of 771 EDCRs performed from 1994 to 2010 were evaluated. Dacryolith was found in 76/771 procedures (9.9%). Complete improvement was achieved significantly more frequently in group I (76/76; 100.0%) than in group II (633/695; 91.1%; p < 0.001). EDCRs were performed significantly more frequently in people aged 31-50-years, the average age of the group I was 41.1 years (range 18-72 years), of the group II 53.3 years (range 3 months-86 years; p < 0.001). There was no significant difference in the female-to-male ratio in the two groups. The presence of dacryoliths is a predictive factor for successful endonasal dacryocystorhinostomy.

Monocanalicular versus bicanalicular intubation in the treatment of congenital nasolacrimal duct obstruction.

BACKGROUND: To compare the success rate of monocanalicular intubation (MCI) compared with bicanalicular silicone intubation (BCI) in congenital nasolacrimal duct obstruction (CNLDO) in infants and toddlers. METHODS: In a prospective, nonrandomized, comparative study, MCI (n = 35 eyes) through the inferior canaliculus or BCI (n = 35 eyes) were performed under general anaesthesia in children aged 10 to 36 months with CNLDO. The tubes were removed 3-4 months after tube placement, and the children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the fluorescein dye disappearance test grade 0-1, corresponding with a complete resolution of previous symptoms. Partial success was defined as improvement with some residual symptoms. RESULTS: Complete and partial improvement was achieved in 31/35 (88.57%) in the BCI group and 34/35 (97.14%) in the MCI group. The difference between the two groups was not significant (p = 0.584). Complications occurred in both groups. Dislodgement of the tube and premature removal was observed in four BCI cases, and loss of the tube was observed twice in the MCI group. Canalicular slitting was observed in five eyes in the BCI group. Granuloma pyogenicum observed in 2 cases with MCI revealed a few weeks after the tube removal. Corneal erosion in the inferior medial quadrant was observed in one MCI eye and revealed in a few days after the local treatment without tube removal. CONCLUSIONS: Both MCI and the BCI are effective methods for treating CNLDO. MCI has the advantage of a lower incidence of canalicular slit and easy placement.

Conjunctivocystorhinostomy with Jones tube--is it the surgery for children?

BACKGROUND: To present experience with conjunctivocystorhinostomies (CDCR) at pediatric age. METHODS: Operative and postoperative data were collected for 15 pediatric CDCRs (aged 9 to 14.5 years) performed endonasally. Four procedures were performed bilaterally, seven unilaterally. The follow-up examinations were made every 3 months in the first year, every 6 months in the second year, and every 12 months afterwards. The patient s satisfaction with the surgery, lacrimal drainage function, and complications were evaluated. The drainage function of the lacrimal system was assessed on the basis of the history, clinical examinations, and the fluorescein dye disappearance test. The data were taken from the medical records and written questionnaires. RESULTS: After the surgery, 12 children were very satisfied, two children partially satisfied, and one child was not satisfied (due to the loss of the tube). Full or partial functional success was found in 14 cases (93.3%); no functional success was observed in one case. The number of complications was higher than in other studies concerning adult patients. A total of 37 complications were observed in our study; most of the complications occurred in more than one of the children, and were observed in some children several times. The most frequent complications were lateral or medial malposition (25 times) and the extrusion of the tube (eight times). It was necessary to re-insert the tube in seven cases under general anaesthesia. The complications mostly occurred within the first 3 months after the surgery (seven complications during the first week, 12 complications between the 2nd and the 4th week, eight complications between the 5th and the 12th week, and three complications between the 9th and the 12th postoperative week). CONCLUSIONS: CDCR appears to be a reasonable procedure in children over 10 years old. Experience in lacrimal surgery (pediatric dacryocystorhinostomy, CDCR in adults), and good cooperation and compliance of children are a fundamental assumption for successful pediatric CDCR.

Primary pediatric endonasal dacryocystorhinostomy--a review of 58 procedures.

OBJECTIVES: The objectives of this study are to report the outcomes of pediatric patients with lacrimal system obstruction who underwent primary endoscopic dacryocystorhinostomy (EDCR). STUDY DESIGN: The authors conducted a retrospective noncomparative case series. METHODS: The operative and postoperative data have been collected in 58 children aged between 3 months and 13 years (mean 4.1 years). The total of 58 primary EDCRs has been performed by two surgeons using a standardized surgical technique. The EDCRs were performed 52 times on one eye, 6 times on both eyes (3 times simultaneously, 3 times at the separate sitting with an interval of 4-6 months). The follow-up evaluations include taking history, clinical examinations including a fluorescein disappearance test. RESULTS: The follow-up interval ranged from 12 to 36 months (mean 17 months, median 15 months). The success rate was 51/58 (87.9%) in all 58 EDCRs. The success rate was 47/51 (92.2%) in the group of postsaccal obstructions, 3/5 (60.0%) in the group of postsaccal and suprasaccal obstrutcions and 1/2 (50.0%) in presaccal obstructions. The procedures were successful in all eight children aged under 1 year old (100%) and in 14 of 15 children between 1 and 2 years old (93.3%). The silicone intubation was used in 54 EDCRs. CONCLUSIONS: The endoscopic DCR is a safe and effective procedure for most children with the success rate comparable to that achieved in the external DCR and in adults. The success rate of the postsaccal obstructions is significantly higher than in presaccal or combined pre- and postsaccal obstructions.