Does preoperative administration of hypotensive agents affect the quality of the surgical field during endoscopic sinus surgery? A triple-blind randomized controlled trial

PURPOSE

Endoscopic sinus surgery (ESS) is a surgical procedure widely used in the treatment of various sinonasal conditions. Excessive bleeding during ESS leads to potentially major complications. The primary aim of this trial was to explore any different effects of bisoprolol and nifedipine on the intraoperative surgical field. In addition, the correlations regarding surgical field state, total blood loss (TBL), mean arterial pressure (MAP), and heart rate (HR) were also examined.

METHODS

A prospective, triple-blinded, randomized, placebo-controlled trial was conducted, including 72 patients between 18 and 65 years of age who underwent ESS. As an indicator of the worst state of the intraoperative surgical field, the Boezaart scale score was used, as evaluated by two surgeons. Appropriate statistical analysis was conducted to explore score comparisons across groups and correlations between vital signs, bleeding, and the operative field state.

RESULTS

No statistically significant difference was found among different intervention groups regarding the worst state of the surgical field (p = 0.367 > 0.05). The Boezaart scale score was positively correlated with TBL (rxy = 0.619, p = 0.000 < 0.001) and MAP (rxy = 0.259, p = 0.028 < 0.05). Furthermore, MAP was positively correlated with HR (rs = 0.254, p = 0.32 < 0.05).

CONCLUSION

Our study demonstrates that preoperative administration of bisoprolol and nifedipine does not affect the worst state of the operative field. However, vital signs seem to either directly or indirectly affect bleeding and operative field state, and agents affecting them are worth exploring further.

Endometrial scratching during hysteroscopy in women undergoing in vitro fertilization: a systematic review and meta-analysis

Objective

Endometrial scratching (ES) during hysteroscopy before embryotransfer (ET) remains doubtable on whether it benefits the reproductive outcomes. The optimal technique is not clear and repeated implantation failure as a challenging field in in vitro fertilization (IVF) seems to be the springboard for clinicians to test its effectiveness.

Methods

Medline, PMC, ScienceDirect, Scopus, CENTRAL, Google Scholar were searched from their inception up to April 2023 for studies to evaluate the effectiveness of adding endometrial scratching during hysteroscopy before ET.

Results

The initial search yielded 959 references, while 12 eligible studies were included in the analyses, involving 2,213 patients. We found that hysteroscopy and concurrent ES before ET resulted in a statistically significant improvement in clinical pregnancy rate (CPR) [RR = 1.50, (95% CI 1.30-1.74), p < 0.0001] and live birth rate (LBR) [RR = 1.67, (95% CI 1.30-2.15), p < 0.0001] with no statistically significant difference on miscarriage rate [RR = 0.80 (95% CI 0.52-1.22), p = 0.30].

Conclusion

Our meta-analysis suggests that hysteroscopy with concurrent ES may be offered in IVF before ET as a potentially improving manipulation. Future randomized trials comparing different patient groups would also provide more precise data on that issue, to clarify specific criteria in the selection of patients.

Systematic Review Registration

PROSPERO (CRD42023414117).

Eight Month-Old-Infant Impaled by Toothbrush Through the Hard Palate

Impalement of children with foreign bodies is not uncommon. A variety of foreign bodies and mechanisms of injuries have been described. Infant tissues are more vulnerable to injuries and often penetrating traumas are very dangerous. An 8-month-old infant was referred to our department with a major impalement injury of his hard palate by a toothbrush. The integrity of the orbit was in question due to the high proximity of the foreign body to the lamina papyracea. A well-structured algorithm was followed to secure the best interests of the child. Our approach minimizes the risk of complications by taking into account every single parameter. After the removal of the foreign body, a careful reconstruction with meticulous nasendoscopy was held to restore the hard palate integrity and to check the orbit inner wall. According to the literature, toothbrushes seem to be the most common medium of impalement trauma. Parents should be educated that their offspring are at great risk when holding or sucking objects while playing.

Is the origin of the superior thyroid artery consistent? A systematic review of 5488 specimens

PURPOSE

The superior thyroid artery (STA) point of origin is strongly debated with controversial results among studies. External carotid artery (ECA), carotid bulb, and common carotid artery (CCA) have been presented as points of origin with variable percentages among authors. We conducted a systematic review of all existing studies that included cadaveric, surgical, and angiographic specimens and recorded the origin of STA according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.

MATERIALS AND METHODS

Fifty-two studies, with an overall of 5488 specimens were included.

RESULTS

Our results indicated ECA as the most common site of origin (55.0 %) followed by carotid bifurcation at 27.5 % and CCA at 15.0 %. Absent STA or branching from the internal carotid artery (ICA) was an extremely rare finding. We proposed a new simple classification system based on our results.

CONCLUSIONS

The huge variability in the branching pattern of STA makes head and neck surgery and radiographic interventions challenging and poses the integrity of STA at risk. Therefore, we strongly recommend preoperative angiographic studies for STA identification to prevent an intraoperative iatrogenic injury.

The effectiveness and safety of sialendoscopy for sialolithiasis in children: a systematic review and meta-analysis

PURPOSE

Sialendoscopy is a new, minimally invasive method that is becoming increasingly more popular than traditional methods for the treatment of sialolithiasis. In this systematic review and meta-analysis, the effectiveness and safety of this method in children with sialolithiasis are investigated.

METHODS

Inclusion criteria were children with sialolithiasis. The information sources were databases MEDLINE and PubMed Central (through PubMed), ScienceDirect, Cochrane Central Register of Controlled Trials (CENTRAL), citation indexes Scopus and Google Scholar, trial registries, and "gray literature". The last search was performed on September 18, 2022. The risk of bias in included studies was assessed using ROBINS-I tool (Risk Of Bias In Non-randomized Studies of Interventions). The pooled proportion of weighted means was calculated for the quantitative synthesis of available data.

RESULTS

The effectiveness of the method was estimated at 95.5% (95% CI 89.8-99.3%), from 13 studies including 133 cases. The safety was estimated at 97.2% (95% CI 91.8-100%), from 10 studies including 113 cases.

CONCLUSION

The limitations of this study, briefly summarized, are the small number of included studies, the fact that they are mostly retrospective, the difficult application of the guidelines suggested by the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Cochrane handbook due to the nature of this specific condition and intervention, and the difficulty in assessing reporting bias. The results of the current study indicate that sialendoscopy is an effective and safe method for the treatment of sialolithiasis in children and should be implemented in daily clinical practice.

Quality of life after mastoid surgery. Is there a real benefit to preserving the posterior wall of the external auditory canal? A systematic review and meta-analysis

OBJECTIVE

Canal wall up (CWU) and canal wall down (CWD) mastoidectomies represent the most common cholesteatoma surgical techniques. In this meta-analysis, we compare the postoperative quality of life (QoL) in patients treated with either CWU or CWD mastoidectomy.

METHODS

A literature search was conducted in the following three electronic databases: Medline/PubMed, ScienceDirect, and Google Scholar. Articles were assessed for eligibility in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and data were extracted independently by two authors. Biases assessment was conducted for each study according to the Methodological Items for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed for postoperative QoL following CWU versus CWD mastoidectomy.

RESULTS

Our systematic review included four studies that met the inclusion criteria, three prospective cohort studies, and one retrospective cohort study. The meta-analysis did not favor treatment with one of the two surgical techniques. Postoperative QoL did not show a statistically significant difference between CWU and CWD mastoidectomies (p>0.05).

CONCLUSION

Our systematic review and meta-analysis results indicate that QoL is not statistically significantly better among patients who underwent CWU mastoidectomies when compared with CWD. The trend of selecting CWU over CWD mastoidectomies in selected cases - for QoL purposes - is not always based on evidence-based data. The statistically insignificant difference between the two surgical techniques suggests that an initial more radical approach might prevent patients from further surgeries, without affecting postoperative QoL.

Four Years of Disease-Free Survival After Conservative Treatment of Subglottic Adenoid Cystic Carcinoma

Adenoid cystic carcinoma (ACC) is a rare malignancy of the larynx. Surgical excision seems to be the preferred treatment modality; however, a paucity of high-evidence suggestions due to the small number of cases have been noted. Here we present the case of a 35-year-old woman with subglottic ACC who denied laryngectomy and opted for concurrent chemotherapy and radiotherapy. She remains disease-free four years later. This case illustrates that concurrent chemoradiation, instead of laryngectomy, should be considered in selected cases.

Does the orientation of the styloid process cause Eagle Syndrome? An anatomical study of the styloid process in 72 Greek skulls

<b>Introduction:</b> Patients often suffer from an elongated styloid process. This clinical entity is well known and is described as Eagle syndrome. The presence of this anatomical variation is not always associated with symptoms. However, there is a strong correlation between the elongated styloid process and Eagle syndrome </br></br> <b>Aim:</b> This study aims to calculate the incidence of elongated styloid processes in the Greek population, to analyze the morphometric characteristics of styloid processes, and to compare these among sexes. </br></br> <b>Material and methods:</b> This is a single-center retrospective study. All skulls were donated to the Department of Anatomy, the Ari-stotle University of Thessaloniki from January 2013 to May 2019 for research purposes. A styloid process longer than 30 mm was considered elongated. We used Welch’s t-test for the statistical analysis of the data. </br></br> <b>Results:</b> The prevalence of elongated styloid processes was 35%. The average diameter was 3.32 mm and the average total length was 25.02 mm. There was no statistically significant difference between male and female skulls, though the female styloid processes were slightly longer and the male ones were slightly wider. Symmetry was recorded in 31% of skulls. Average axial angle was 650 but in 4% of cases it was less than 20⁰. </br></br> <b>Conclusions:</b> The elongated styloid process is not a rare entity. Eagle syndrome should always be considered in the differential diagnosis when patients report chronic sore throat. Our anatomical findings add a new dimension to the etiopathogenesis of Eagle syndrome.