European Archives of Oto Rhino Laryngology

European Archives of Oto Rhino Laryngology

The author’s reply regarding “Clinical Behaviours and Prognoses of High and Low Risk Parotid Malignancies Based on Histology”

01-09-2019 – L Tao

Letter

Letter to the Editor regarding “Clinical behaviors and prognoses of high- and low-risk parotid malignancies based on histology” by Tao L. et al.

01-09-2019 – D Stodulski,B Mikaszewski,J Kuczkowski

Letter

Comparison of superelastic nitinol stapes prostheses and platin teflon stapes prostheses

01-09-2019 – M Teschner,G Lilli,T Lenarz

Journal Article

Abstract Introduction Stapes plasty is an established procedure to improve hearing in case of otosclerosis. By reinforcing the prostheses, an optimization of the prosthesis could be achieved. The aim of the study was to evaluate the audiological results of the Nitinol Superelastic stapes prosthesis compared with a Platin–Teflon prosthesis. Material and methods In a retrospecitve setting, the audiological results of nine patients who have been implanted with a Nitinol Alloy Superelastic stapes prothesis were compared with the results of ten patients, which have been implanted with a Platinum–Teflon piston prostesis. All operations were performed by the same experienced ear surgeon. Results The Nitinol-group presented an average of postoperative air–bone-gap over all frequencies (0.5–6 k
Hz) of all patients of 15.1 d
B. In the Platin–Teflon group, the average of postoperative air–bone-gap was 14.9 d
B. Moreover, the post surgery delta–bone-conduction pre- to post surgery showed no differences (0.5–6 k
Hz). There were no surgical complications in both groups. Conclusion Based on the patient collective, stapes plasty using a Nitinol Superelastic stapes prosthesis is a sufficient method for improving the hearing conduction. Design Retrospective case series. Setting University Department.

Comment on “Sarcopenia is a prognostic factor for overall survival in elderly patients with head-and-neck cancer”

01-09-2019 – V Binay Safer,S Eyigör

Letter

Reply to comment on “Sarcopenia is a prognostic factor for overall survival in elderly patients with head and neck cancer”

01-09-2019 – N Chargi,SI Bril,PA de Jong,MH Emmelot-Vonk,R de Bree

Letter

Evaluation of the information given to patients undergoing total pharyngolaryngectomy and quality of life: a prospective multicentric study

01-09-2019 – A Bozec,P Schultz,J Gal,E Chamorey,Y Chateau,O Dassonville,G Poissonnet,F Peyrade,E Saada,J Guigay,K Benezery,A Leysalle,L Santini,A Giovanni,L Messaoudi,N Fakhry

Journal Article

Abstract Background Providing cancer patients with adequate information is essential to their confidence and satisfaction regarding medical care. The aims of this study were to evaluate the information given to patients undergoing total pharyngolaryngectomy (TPL) as well as the evolution and predictors of patient quality of life (QoL). Methods We conducted a prospective multicentric study on patients undergoing TPL for a locally advanced laryngeal/hypopharyngeal cancer. All patients completed the EORTC QLQ-INFO25, QLQ-C30, and QLQ-H&N35 questionnaires, before and after surgery. Results This study enrolled 46 patients. Between the pre- and post-therapeutic periods, we observed no significant changes in the global QLQ-INFO25 and QLQ-C30 scores. However, we found a significant deterioration in 4 QLQ-INFO25 scales/items and in social functioning, as well as an increase of sense, speech, and social contact problems. N-stage and professional activity were significant predictors of preoperative QLQ-INFO25 scores. Younger age was significantly associated with financial difficulties, whereas professional activity and lower education level were significant predictors of xerostomia and swallowing problems, respectively. Conclusion In patients undergoing TPL, we observed significant changes in QLQ-INFO25 scores between the pre- and post-treatment periods and, particularly, a deterioration of patient satisfaction with the information received. Several clinical factors were identified as significant predictors of QLQ-INFO25 and QoL scores.

Do changing trends in tonsil surgery affect hemorrhage rates? A longitudinal study covering 1,452,637 procedures

01-09-2019 – JP Windfuhr,YS Chen

Journal Article

Abstract Purpose To evaluate whether changing trends in tonsil surgery between 2005 and 2017 in Germany were associated with different age- and gender-specific hemorrhage rates. Methods A longitudinal population-based inpatient cohort study was performed including all patients who had undergone tonsillectomy (with or without adenoidectomy), tonsillotomy, abscess-tonsillectomy, removal of tonsillar remnants and surgical treatment to achieve hemostasis following tonsil surgery. The population was stratified by age (groups of 5 years) and gender. Operation rates were calculated in relation to the end-year population number according to the German Federal Office of Statistics. Results The surgical rates per 100,000 had significantly decreased from 170.39 to 90.95 (46.62%) in female patients and from 147.33 to 88.19 (40.14%) in male patients within the study period (p < 0.001). A total of 42.352 female patients had required surgical treatment to achieve hemostasis following 783,005 procedures (5.41%). In contrast, only 669,632 operations were performed in male patients but were complicated by hemorrhage in 51.185 cases (7.64%) which was significantly different (p < 0.001). The male-to-female ratio of the surgical rates had increased from 0.86:1 to 0.93:1. Hemorrhage rates differed significantly between age groups (p < 0.001). Male gender is a significant risk factor for bleeding at all ages < 85 years with greatest differences in 20- to 25-year-old patients (12.19% male vs. 6.26% female). Conclusions Changing trends in tonsil surgery are not associated with increased rates of bleeding complications. Hemorrhage following tonsil surgery is significantly related to age and gender and this should be noted when reported hemorrhage rates in the literature are appraised by the reader.

Hospital admissions for acute throat and deep neck infections versus tonsillectomy rates in Germany

01-09-2019 – JP Windfuhr,YS Chen

Journal Article

Abstract Purpose To evaluate trends in hospital admissions in Germany for acute infections of the upper airway and deep neck in the context of the number of tonsil-related surgical procedures between 2005 and 2017. Methods A retrospective longitudinal population-based cohort study was performed including all unplanned admissions for acute pharyngitis/tonsillitis, abscess formation of the peritonsillar or retropharyngeal/parapharyngeal space. Elective procedures included tonsillectomy (with or without adenoidectomy), secondary tonsillectomy, and tonsillotomy. Emergency operations encompassed abscess-tonsillectomy and transoral drainage procedures of the peritonsillar/parapharyngeal/retropharyngeal space. Results 553.600 admissions were registered in total with a significant, stepwise increase between 2005 and 2017, including retropharyngeal/parapharyngeal abscess (47.0%), acute tonsillitis (30.8%), acute pharyngitis (26.5%) and peritonsillar abscess (7.9%). There were 1.323.984 elective operations with a significant decrease during the study period. A total of 188.316 emergency operations were done, a significant decrease in the number of abscess-tonsillectomies was compensated by the increased number of transoral peritonsillar abscess drainages. The number of transoral parapharyngeal and retropharygeal abscess drainage procedures did not change significantly (p = 0.846; p = 0.846). Negative correlation was significant between admissions for chronic tonsillitis and emergency admissions (Pearson correlation coefficient = − 0.879, p < 0.001) and also between elective and emergency operations (r = − 0.667; p = 0.013). Conclusions Concerning infections of the upper airway and deep neck spaces, German Hospitals have to prepare strategies for the increasing challenge by unplanned admissions and emergency operations. Further research is required to clarify whether this phenomenon is caused by the significant decrease in the number of elective operations.

Assessment of the cancerization risk for oral potentially malignant disorders by clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry

01-09-2019 – Z Sun,L Liu,C Wang,L Qian,J Yang,Z Zhao,Y Fan,Z Peng

Journal Article

Abstract Purpose To explore the feasibility of assessing the cancerization risk of oral potentially malignant disorders (OPMD) through a clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry. Methods We collected the baseline clinical data of 269 patients; then, performed autofluorescence, brush biopsy with DNA-image cytometry and histopathological examination. Then, we obtained the significant factors by univariate logistic analysis, constructed the clinical risk model by multiple logistic regression and selected the optimal cutoff value according to the maximum Youden index. Finally, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical risk score ≥ cutoff value, autofluorescence and brush biopsy with DNA-image cytometry, and plotted the receiver-operating characteristic (ROC) curves and decision curve analysis (DCA). Results The clinical risk model is represented by the formula: 1 × gender + 1.6 × age group + 1 × lesion site + 1.4 × local stimulus + 1.5 × drink. The area under the curve (AUC) was 0.83, and the optimal cutoff score was 3. The AUC indicated that the clinical risk score ≥ 3 (0.74) and autofluorescence (0.77) had a certain diagnostic values, while brush biopsy with DNA-image cytometry (0.92) displayed a good value. Besides, the DCA showed that all three tests had clinical significance. Conclusions The cancerization risk of patients can be assessed by the clinical risk model combined with sequence application of autofluorescence and brush biopsy with DNA-image cytometry, to decide whether histopathological examination or other intervention measures should be selected.

A prospective, feasibility study to evaluate the efficacy and usability of a novel drivable endoscope in patients with chronic rhinosinusitis

01-09-2019 – T Van Zele,E Soudry,R Landsberg,P Gevaert

Journal Article

Abstract Purpose To carry out a pilot study to evaluate the efficacy of a novel, drivable endoscope (the Peregrine™ Drivable ENT Scope), compared to standard rigid endoscopes in the access, visualization, and irrigation of the paranasal sinus anatomy. Methods A prospective, multi-center, feasibility study was conducted on seventeen subjects who underwent primary functional endoscopic sinus surgery and were evaluated with the drivable endoscope and standard, rigid endoscopes (0°, 30° and 70°, as applicable). A CT scan was available for image guidance, as needed. The primary efficacy endpoint was the ability to access and visualize sinonasal anatomic landmarks. Secondary endpoints included device usability, as measured by a usability questionnaire given to surgeons postoperatively; the device’s ability to irrigate the sinuses and patient reports of tolerability and pain during postoperative procedures. Results The drivable endoscope success rate in visualizing all paranasal sinus anatomic landmarks was 55.6% better than the standard rigid endoscopes: 98.3% (178/181) versus 42.7% (76/178); p < 0.001. Surgeons rated scores of over 4 (on a 1–5 scale) for the usability of the drivable endoscope to enter the maxillary, frontal and sphenoid sinuses. The ability to irrigate the sinuses using the drivable endoscope was given a mean score of 4.3, and image quality was given a mean score of 3.4. The three patients evaluated postoperatively reported low pain and high tolerability scores with the drivable endoscope. Conclusions These preliminary results indicate that the drivable endoscope is effective, easy to use and highly tolerable in sinonasal endoscopy.

Optimal levothyroxine dose in post-total thyroidectomy patients: axa0prediction model for initial dose titration

01-09-2019 – SF Al-Dhahri,SS Al-Angari,J Alharbi,M AlEssa

Journal Article

Abstract Purpose As the lack of consensus in the initial levothyroxine (LT4) dose titration following total thyroidectomy exists, the aim of this study was to identify and quantify predictive factors for LT4 dose replacement. Methods A retrospective analysis of a prospectively gathered data of 234 patients who underwent total-thyroidectomy at two institutions between November 9, 2009 and January 1, 2016 was conducted. Outcome variable was the clinically observed optimal LT4 dose. Linear and polynomial regression methods were used for prediction. Continuous variables were tested for mean differences using Student’s t-test and association using Pearson’s correlation. Results We identified Body Surface Area (BSA) as the most significant predictor. We propose a model that titrates LT4 dose based on BSA (1.4 µg /kg/day for BSA > 1.79 m2 vs. 1.7 µg /kg/day for BSA ≤ 1.79 m2; P = 0.00). Men required higher doses than women and no differences were noted based on DM status or pathological diagnosis. Conclusions Our analysis shows BSA as an independent predictor of LT4 dose post total thyroidectomy. Despite the possibility of generating different equations for predicting LT4 post total-thyroidectomy, finding a practical and clinically relevant prediction model is yet of limited efficiency.

Comparison of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of peritonsillar abscess

01-09-2019 – C Mansour,G De Bonnecaze,E Mouchon,A Gallini,S Vergez,E Serrano

Journal Article

Abstract Purpose The treatment of peritonsillar abscess (PTA) is still controversial regarding the best method of drainage to perform. This study aims to compare effectiveness and safety of needle aspiration versus incision and drainage under local anaesthesia for the initial treatment of PTA. Methods A retrospective review of patients (age > 15 years) admitted in two tertiary medical centres for a PTA between November 2010 and October 2016 was performed. Patients were divided into two groups according to the type of drainage: needle aspiration or incision and drainage, under local anaesthesia. The primary outcome was the length of hospital stay; the need to repeat the procedure or to go to the operating room was also assessed. Complications or adverse events were listed in each group to assess safety. Results Over a 6-year period, 182 patients were admitted for a PTA and included in the analysis, with 82 patients in the aspiration group and 100 patients in the incision group. Mean age was 36.3 years, with a sex ratio of 1.33. The length of hospital stay ranged from 1 to 7 days (mean 2.7 days, median 2 days) with a median length of stay of 3.0 days (interquartile range 2–4) in the aspiration group versus 2.0 days (IQR 2–3) in patients who underwent incision and drainage (p = 0.009). A repetition of the needle aspiration was made for 46.3% of patients versus 10% of repetition of the procedure in the incision group (p = 0.0001). 12 patients (14%) of the aspiration group and 4 patients (4%) of the incision group required an additional drainage under general anaesthesia (p < 0.001). We found no differences regarding safety in both groups. Conclusion Our study showed a significant decrease in the length of hospital stay in patients admitted for a PTA who underwent an initial incision and drainage under local anaesthesia, compared to needle aspiration, as well as a lower risk of repeating the procedure. A well-designed prospective and randomized study on a larger sample of patients is required to support these findings.

Profiling of heat shock proteins 27 and 70 in adenoids of children

01-09-2019 – HJ Min,JS Park,CE Kim,KS Kim

Journal Article

Abstract Purpose Heat shock protein (HSP)27 and 70 are molecular chaperones that may have immunomodulatory functions. We determined if and at what levels each are expressed in the adenoids of pediatric subjects. We also examined tissue distributions, associated clinical characteristics, and antibacterial effects. Methods Western blot, enzyme-linked immunosorbent assay (ELISA), and immunohistochemistry were applied to adenoidal tissues and lavage fluids obtained from children (N = 40) undergoing adenotonsillectomy. Results Via western blot and ELISA, both HSP27 and 70 were regularly detected in adenoidal tissue and in lavage fluid samples. HSP27 was highly expressed in epithelium, whereas HSP70 showed strong subepithelial positivity and bore a significant relation to adenoidal size. Assayed levels of HSP27 and 70 correlated inversely, and their addition to culture media independently increased bacterial numbers (Staphylococcus aureus). Upon the precipitation of each from adenoidal lavage fluids, bacterial counts declined. Conclusions HSP27 and 70 are readily expressed in the adenoids of children and may be implicated in immunologic responses.

Endoscopic tympanoplasty with limited tympanomeatal flap elevation in pediatric cases: comparison of anatomic and audiological results of grafts

01-09-2019 – A Şen,K Özdamar

Journal Article

Abstract Objectives The anatomical and functional success rates of tragal cartilage perichondrium and temporal muscle fascia, in pediatric patients who underwent endoscopic type 1 tympanoplasty with limited tympanomeatal flap elevation, were compared. Methods In total, 35 pediatric patients (21 females, 14 males; mean age 11.0 ± 1.5 years; range 8–14 years) who underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of the tympanomeatal flap were included in this study. Patients in group A received a tragal cartilage perichondrium graft and those in group B received a temporal muscle fascia graft. The groups were compared with respect to the pre- and postoperative air–bone gap (ABG) and tympanic membrane status. Results The mean preoperative and postoperative ABG were 27.0 ± 9.2 and 9.0 ± 8.5 d
B in group A, and 26.8 ± 8.8 and 11.6 ± 9.2 d
B in group B, respectively. The group differences in pre- and postoperative ABG values were not significant (p = 0.882 and p = 0.417, respectively). However, in both groups, the postoperative ABG was significantly lower than the preoperative ABG (both p = 0.0001). The graft retention rate was 100% in group A and 88.2% in group B; the difference was not statistically significant (p = 0.134). There was also no statistically significant difference between the pre- and postoperative bone conduction values of the patients at 0.5, 1, 2, 3 or 4 k
Hz (all p > 0.05). Conclusions Our study demonstrated that in pediatric patients undergoing endoscopic tympanoplasty, both the tragal cartilage perichondrium and the temporal muscle fascia can be used successfully and safely as grafts in endoscopic type 1 tympanoplasty performed by limited tympanomeatal flap elevation.

A pilot study to determine the effects of nasal co-phenylcaine on drug-induced sleep endoscopy

01-09-2019 – AL Pendolino,I Kwame,AL Poirrier,MJ Rouhani,S Unadkat,G Preti,G Ottaviano,PJ Andrews,B Kotecha

Journal Article

Abstract Purpose The use of nasal decongestant and nasal anaesthesia is currently not recommended during drug-induced sleep endoscopy (DISE) according to the European position paper. The evaluation of the effects of nasal decongestant/anaesthesia on DISE has not been performed before and our aim is to perform a pilot study to determine whether nasal decongestants/anaesthesia affects DISE outcomes. Methods 27 patients undergoing DISE for OSA or for simple snoring were included. On each patient, DISE was performed twice, before and approximately 10 min after the administration of two puffs of co-phenylcaine nasal spray (lidocaine hydrochloride 5%, phenylephrine 0.5%, and benzalkonium chloride 0.01%) into each nostril. A nasal peak inspiratory flow was used for the objective assessment of nasal airway obstruction. During the first and the second DISE the loudness of the snoring was also recorded. Results Change in DISE total grading after nasal spray administration was not statistically significant. For the same grading, changes in percentage of contribution to collapse were not statistically significant. Sex, AHI, BMI, tonsils grade, presence of rhinitis, turbinate hypertrophy, nasal septal deviation, or nasal peak inspiratory flow limitation had no influence on the effect of nasal spray. Co-phenylcaine did not significantly influence the loudness of snoring. Conclusions Our pilot study supports the use of co-phenylcaine nasal spray during DISE and the positive effects of the nasal spray do not influence the grading outcome. Importantly, the decongestant enhances the nasal assessment during DISE and potentially aids in the diagnosis of nasal obstruction while the nasal anaesthetic component may be beneficial by reducing nasal discomfort during DISE and thereby helping to reduce the total dose of intravenous anaesthetic administered. However, further studies on a larger population are needed to confirm our results.

Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study

01-09-2019 – J Zarins,K Aro,L Bäck,T Atula,J Vuola,P Lassus,H Keski-Säntti

Journal Article

Abstract Purpose Surgical complications after total laryngopharyngectomy (TLP) are common, reconstruction is challenging, and patients often lose their ability to swallow and speak. To evaluate these aspects, we analysed outcome after TLP. Methods We reviewed all patients who underwent TLP and subsequent circumferential pharyngeal reconstruction through 2004–2017 at the Helsinki University Hospital. Results For the 26 eligible patients, TLP was the primary treatment for 11 and salvage surgery for 15, followed by reconstruction with free flaps in 22 patients and pedicled flaps in 4. An early (≤ 30 days) pharyngocutaneous fistula developed in seven patients (27%; median time 13 days; range 6–26), and a late (> 30 days) fistula in five patients (19%; median time 370 days; range 46–785). In addition, ten patients (39%) developed an oesophageal stricture. Four patients (15%) resumed full oral feeding. A speech prosthesis was inserted for 15 patients (58%) and most of them could produce intelligible speech. We found acceptable survival figures for patients undergoing TLP both as a primary treatment and as salvage procedure: the overall survival at 1 year was 82% and 67%, and at 5 years 33% and 27%, respectively. Disease-specific survival at 1 year was 90% and 70%, and that at 5 years was 45% and 43%, respectively. Conclusions Despite fair survival, TLP carries a high risk for postoperative complications with limited functional outcome, thus necessitating cautious patient selection and surgical experience.

Clinical benefit of wideband-tympanometry: a pediatric audiology clinical study

01-09-2019 – L Stuppert,S Nospes,A Bohnert,AK Läßig,A Limberger,T Rader

Journal Article

Abstract Purpose Wideband-tympanometry (WBT) could give more informative data about the tympanic condition than the conventional tympanometry. In the actual literature, the clinical profit of wideband-tympanometry in pediatric audiological settings is not well evaluated. The aim of this study was to analyze the additional clinical benefit. Methods 150 children (281 ears) with normal hearing, at the age from 11 days up to 14;10 years, checked with pure tone audiometry or auditory brainstem responses (ABR) participated in this retrospective study. We divided in four age ranges (≤ 6 month; > 6 month ≤ 3 years; > 3 years ≤ 11 years; > 11 years). All children were evaluated with ENT examination including ear microscopy, conventional 226-Hz or 1000-Hz tympanometry and WBT. Ear canal volumes were determined. Results Compared with literature data, our patients aged ≤ 3 years showed smaller mean ear canal volumes (≤  4 ml). We found a good statistical correlation between the WBT-results and 1000-Hz tympanometry but a rare correlation between WBT-results and ear microscopic findings. In the patients with pathologic ear microscopic results in all groups of age, a significant reduction of WBT-absorbance in 1000 Hz and 2000 Hz was found. Conclusions This study confirms that WBT collects additive data to detect the correct middle ear status. In pediatric audiology, WBT is an additional useful method to value middle ear problems and to analyze the character of infantile hearing loss. Standard guidelines for the interpretation of the pediatric population are needed. Hence, it will be necessary to determine these findings in a larger number of infantile ears.

Gusher in stapes surgery: a systematic review

01-09-2019 – M Alicandri-Ciufelli,G Molinari,MS Rosa,D Monzani,L Presutti

Journal Article, Review

Abstract Objective The aim of this study is to perform a systematic literature review on the occurrence of gusher during stapes surgery, to understand its surgical management and outcomes. Methods The PRISMA standard was applied to identify English, Italian or French-language studies, related to stapes surgery and mentioning gusher or perilymphatic leak. Full-texts lacking information on the management of gusher and/or the post-operative hearing outcome were excluded. Results Twenty-four articles were eventually included. Seventy-six patients were involved in the qualitative synthesis. The management of gusher mostly consisted in covering the oval window and/or filling the tympanic cavity, with absorbable and autologous graft materials. Packing of the external auditory canal was reported in 51 patients (67%). Gusher was related to complete/profound loss of hearing in 25% of the cases and to a worsening of hearing function in 31% of patients. In 19% of patients an improvement in hearing tests was reported; in 28% the hearing function was unchanged. Post-operative vestibular symptoms were reported in 7 patients, and were mainly mild and transient. The absence of vestibular symptoms was underlined in 9 cases, while in 79% of the patients the authors did not provide information. Conclusion The unexpected occurrence of gusher during stapes surgery represents a relevant issue for the otologic surgeon. Its management most commonly consists in plugging the oval window and the tympanic cavity. In most of the cases, a stapes prosthesis could be positioned. The results on hearing and vestibular functions are widely variable.

Comparing the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy

01-09-2019 – M Hatami,M Mashayekhi,H Abbasi,V Ayatollahi,S Vaziribozorg

Journal Article

Abstract Introduction This study was conducted to compare the effect of dexmedetomidine and labetalol on hemodynamic variables in patients undergoing microlaryngoscopy. Material and methods In this randomized clinical trial study 70 patients undergoing microlaryngoscopy were involved. The patients were randomly assigned into two groups. Patients in dexmedetomidine group received 0.5 μg/kg of dexmedetomidine diluted in 100 ml of saline solution and the patients in the second group received 0.25 mg/kg of labetalol before anesthesia induction. At the beginning of the surgery, dexmedetomidine was infused at the dose of 0.4 μg/kg/h in the dexmedetomidine group, and labetalol at the dose of 1.8 mg/kg/h in the labetalol group. Patients’ systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate at different times and anesthesia and surgery duration, recovery time and dose of prescribed propofol were recorded and compared between two groups. Results There was a significant difference in mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate between two groups at different times (p value < 0.05). Conclusion The results of this study indicated that dexmedetomidine had higher efficacy, compared to labetalol, in reducing diastolic blood pressure, systolic blood pressure, heart rate, and mean arterial blood pressure following microlaryngoscopy.

Fibrin sealant and parotidectomy wound complications in 100 patients

01-09-2019 – SR Chorney,JT Ryan

Journal Article

Abstract Purpose To determine whether the use of fibrin sealant impacted the rate of postoperative wound complications following parotidectomy. Methods We retrospectively reviewed 100 consecutive parotidectomies with and without fibrin sealant. Primary outcomes were development of seroma, sialocele, abscess, or hematoma within the first 30 days as well as length of hospital stay for drain output if one was placed. Secondary outcomes analyzed wound complications based on several patient and surgical factors. Results In our cohort, there were 82 superficial parotidectomies (82%), and the most common pathology was pleomorphic adenoma (39%) followed by Warthin’s tumor (27%). Fibrin sealant was used in 46 patients (46%). Postoperative wound complications occurred in 20 patients, and were not statistically different with or without fibrin sealant placement (23.9% vs. 16.7%, p = 0.454). Fibrin sealant did not significantly reduce wound complications regardless of tissue volume removed, use of acellular dermis, history of smoking, diagnosis of diabetes, or active anticoagulant/antiplatelet use. Only four patients without fibrin sealant (7.4%) required hospitalization beyond 24 h for high drain output. Conclusions In our retrospective cohort, the development of postoperative wound complications following parotidectomy did not appear to be significantly impacted by the use of a fibrin sealant.