Objectives/Hypothesis
To evaluate the application of the Flex Robotic System in transoral robotic surgery (TORS).
Study Design
Multicenter, prospective, open‐label, single‐armed clinical study.
...Methods
A prospective clinical follow‐up multicenter study was performed from July 2014 to October 2015 assessing the safety and efficacy of the Medrobotics Flex Robotic System for access and visualization of the oropharynx, hypopharynx, and larynx as well as for resection of benign and malignant lesions. A total of 80 patients were enrolled. Access and visualization of five anatomic subsites (base of tongue, palatine tonsil area, epiglottis, posterior pharyngeal wall, and false vocal cords) were individually graded by the surgeon. Setup times, access and visualization times, surgical results, and adverse events were documented.
Results
The relevant anatomic structures could be exposed and visualized properly in 75 patients, who went on to have a surgical procedure performed with the Flex Robotic System. Access and visualization of the palatine tonsil area, posterior pharyngeal wall, epiglottis, and posterior pharyngeal wall were excellent. However, false vocal cords and vocal cords were more difficult to expose. Seventy‐two patients were treated successfully with the Flex Robotic System. There were no serious or unanticipated device‐related adverse events caused by the Flex Robotic System.
Conclusions
Lesions in the oropharynx, hypopharynx, and larynx could be successfully resected with the Flex Robotic System, specifically developed for TORS. Our study provides evidence that the Flex Robotic System is a safe and effective tool in TORS. Laryngoscope, 2016 127:391–395, 2017
Background
There are still only a few therapeutic strategies to improve taste sensation, which is part of oral health and quality of life.
Objective
Therefore, here we aimed to investigate gustatory ...functions of healthy subjects performing mechanical tongue cleaning (MTC), an easy‐to‐perform oral hygiene procedure, to demonstrate taste changes and to describe possible negative side effects.
Methods
Prior to and 14 days following MTC with an Orabrush®, the following tests were conducted in 65 healthy participants including both non‐smokers (n = 50, 76.9%) and smokers (n = 15, 23.1%): ‘taste strips’ test, the Winkel Tongue Coating Index (WTCI), and subjective self‐assessment.
Results
Among non‐smokers, subjective self‐assessments of gustatory function (P < .01), halitosis (P = .03) and tongue coating (P < .01) improved after 14 days of MTC; furthermore, they exhibited higher total taste (P < .01) and lower WTCI (P < .01) values. Their age and sex did not correlate with the differences between the pre‐ and post‐MTC WTCI scores; however, differences between pre‐ and post‐MTC total taste values were correlated with age. The total taste value improvements were greater in non‐smokers aged 45‐91 years than in those aged 20‐44 years (P = .01). In smokers, total taste values (P < .01), as well as sweet (P = .03) and sour (P = .04) taste values, were significantly improved after 14 days of MTC.
Conclusion
Fourteen days of MTC using an Orabrush® can improve gustatory functions in non‐smokers and smokers. Therefore, MTC might be a useful, costless and easy option to improve taste and should be considered as a part of the daily oral care.
Objectives/Hypothesis
Olfactory dysfunction is common among the general population, with chronic rhinosinusitis (CRS) as one of the leading causes. Patients affected by CRS often report changes in ...taste sensations; however, quantitative measurements have not been performed to date. Therefore, the present study aimed to investigate gustatory and olfactory function in CRS patients prior to and after multimodal treatment.
Study Design
Prospective cohort study.
Methods
Twenty‐one patients suffering from CRS with nasal polyps (14 male, seven female) with a mean age of 48 ± 15 years were included in the study. Chemosensory function was assessed prior to and approximately 190 days after multimodal treatment, which included endoscopic sinus surgery, oral antibiotics for 5 days, oral steroids for 12 days, and at least 6 weeks of topical nasal steroids. Olfactory function was tested with the Sniffin’ Sticks test battery, whereas gustatory function was measured with taste strips. A clinically relevant change in olfactory function was defined as a change of ≥5 points in the threshold, discrimination, and identification scores.
Results
Compared to normative data, patients baseline gustatory and olfactory function was impaired. After multimodal treatment, improvements were seen in olfactory function for eight patients (42%), remained stable in 10 patients (53%), and deteriorated in one patient (5%). Taste function remained unchanged following sinus surgery.
Conclusions
Patients suffering from CRS with polyps exhibit olfactory and taste dysfunctions. Multimodal treatment leads to an improvement in olfactory, but not gustatory functionality.
Level of Evidence
4. Laryngoscope, 128:E86–E90, 2018
Postoperative haemorrhage following tonsillectomy occurs in 5.98% of all cases with up to 10 deaths reported annually in Germany. When comparing tonsillectomy (TE) and tonsillotomy (TT), the same ...long-term frequency of ENT infections is displayed in children and young adults. However, taking postoperative haemorrhaging into account, TT is more favourable. Chronic tonsillitis is one of the most common indications for TE in the adult population; however, a histopathological characterization may reveal objective criteria and provide a foundation for routinely performing TT in adults too. Three essential parameters hyperplasia (HP), grade of inflammation (GOI) and activity of inflammation (AOI), which are responsible for, and associated with a clinically relevant disease were histopathologically examined in the tonsils of 100 adult patients with chronic recurrent tonsillitis. The parameters were analysed and compared separately in the pharyngeal and basal parts of the tonsils as well as in three sections (upper and lower pole of the tonsil, middle part) as this may influence the indication for TT. The comparison of the basal and pharyngeal portions displayed a significant difference in the GOI and the HP in all three sections: grade 2 HP as well as GOI were more commonly found in the basal than pharyngeal portions (
p
> 0.001). AOI (grade 2) displayed the same properties in the middle section (
p
< 0.002), but did not reach statistical significance in the cranial and caudal sections (
p
= 0.107 and
p
= 0.186). An overabundance of grade 1 GOI, AOI, and HP was seen in the pharyngeal sections. The results show that two out of three relevant parameters that demonstrate histopathological changes in recurrent inflamed tonsils have a significantly stronger presence in the basal section of the tonsil as opposed to the pharyngeal section. The processes initiated by inflammation next to the surface responsible for a clinically relevant recurrent tonsillitis seem to cause stronger reactions in the deep follicular portion of the tonsils.
Highlights • Transoralvisualisation of pharyngeal tumors is feasible using the novel Medrobotics® Flex® System. • Transoralresection of pharyngeal tumors with a monopolar cautery is feasible using ...the novel Medrobotics® Flex® System. • The flexibility of the endoscope and instruments allow for good access and visualisation of target structures within the pharynx.
With the Bonebridge, a new bone-anchored hearing aid has been available since March 2012. The objective of the study was to analyse the visualisation of the implant itself as well as its impact on ...the representation of the bony structures of the petrosal bone in CT, MRI and cone beam CT (CBCT).
The Bonebridge was implanted unilaterally in two completely prepared human heads. The radiological imaging by means of CBCT, 64-slice CT, 1.5-T and 3.0-T MRI was conducted both preoperatively and postoperatively. The images were subsequently evaluated from both the ENT medical and nd radiological perspectives.
As anticipated, no visualisation of the implant or of the petrosal bones could be realised on MRI because of the interactive technology and the magnet artefact. In contrast, an excellent evaluability of the implant itself as well as of the surrounding neurovascular structures (sinus sigmoideus, skull base, middle ear, inner ear, inner auditory canal) was exhibited in both the CT and in the CBCT.
The Bonebridge can be excellently imaged with the radiological imaging technologies of CT and CBCT. In the process, CBCT shows discrete advantages in comparison with CT. No relevant restrictions in image quality in the evaluation of the bony structures of the petrosal bones could be seen.
Background. Preoperative imaging of the nose and paranasal sinus is standard in otorhinolaryngology. Previous studies on phantoms demonstrated the potential for dose reduction of cone beam computed ...tomography (CBCT) by varying the application parameters. Methodology. Based on previous studies, the standard protocol of paranasal sinus imaging by CBCT was altered. One hundred and fifty examinations using the old protocol (01/2010–01/2011, high dosage) and 150 examinations using the new protocol (09/2012–09/2013, low dosage) were evaluated and compared for the visibility of 17 anatomical structures, the Lund-Mackay Score, and technical parameters. Results. Alteration of the protocol resulted in a significant reduction in dosage (6.64 mGy versus 2.88 mGy). Both groups showed the same amount of pathology (Lund-Mackay Score: 4.95±3.79 versus 5.26±5.77; p=0.558). There was a significant better visibility of the anatomical structures (all visible = 1, nothing visible = 4) (results: 1.25 versus 1.17; p=0.001) in the low-dosage group. Conclusion. Despite a significant reduction in the applied dosage, reliable visualization of the bony anatomy of the anterior skull base is possible by CBCT. This demonstrates the need for the discussion of the required clinical imaging quality.
Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to ...traditional tonsillectomy (TEtrad). Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery 0 or thereafter 1). The findings at resection site and pain were measured. Results. 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p>0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p=0.007). Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons.
Objective
Endonasal endoscopic dacryocystorhinostomy (DCR) is a common treatment for saccal and post-saccal stenosis of the lacrimal pathway or chronic dacryocystitis (DC). The main symptom is ...chronic epiphora (tearing) and dacryocystitis (infection). The objective of this study is to assess the short-term surgical result of this treatment based on possible prognostic factors; such as gender, age, the pathogen spectrum and the histopathological result as well as the influence of these parameters on hospital stay.
Methods
It is a retrospective analysis, which includes 197 cases in 177 patients, who received an endonasal endoscopic DCR with a silicone tube between January 2009 and December 2016, as primary procedure. The follow-up was carried out 3 months after the surgery, with the silicone tube being removed as part of the last examination including a flushing of the tear ducts with saline. This procedure is part of determining to measure the short-term success of the intervention. The definition of success of the surgery is an absence of epiphora or an acute infection of the nasolacrimal duct system, as well as an absent reflux in case of flushing the tear duct.
Results
The success rate was 86.3% (
N
= 170). Higher incidence was seen in females (
N
= 146; 74.1%) and patients with a mean age of 65.4 (± 17.2). The presence of pathogens as well as the histopathological result do not have an impact on the short-term surgical success. Patients diagnosed with rheumatic diseases appear to have a worse prognosis with relation to procedure success. Also, the length of hospital stay was related to possible prognostic factors. Type II diabetes and glaucoma had a significant influence on a longer hospital stay.
Conclusion
The endonasal endoscopic DCR is a surgical procedure with high success rate. Patients with rheumatic diseases should be aware of increased failure rates. Patients with glaucoma and Type II diabetes might need a more intense aftercare.
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