American journal of otolaryngology
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Multicenter Study Comparative Study
Perioperative management of antithrombotic medication in head and neck reconstruction-a retrospective analysis of 137 patients.
Various protocols exist to prevent thrombosis after free flap surgery in the head and neck. This study reviews the outcome and incidence of perioperative complications in patients undergoing head and neck reconstruction, simply using subcutaneous low-molecular-weight heparin. ⋯ The free flap survival rate using simple subcutaneous heparin seems to be equivalent to other management regimens. Therefore, we suggest that no additional antithrombotic treatment is needed for patients who undergo head and neck reconstruction with free tissue transfer.
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Case Reports
Backyard hazard: a case series of ingested grill brush bristles and a novel approach to extraction.
To report a small case series of an unusual ingested foreign body and a new method for removal of tongue base foreign bodies. ⋯ While oropharyngeal and esophageal foreign bodies are common, there are only a few case reports describing this particular foreign body. The presentation of an imbedded wire grill brush bristle can be insidious. Persistent pain and foreign body sensation should be taken seriously in patients with a history of barbecue food ingestion. Intraoperatively, wire bristles can be difficult to localize and extract. Radiofrequency plasma assisted lingual tonsillectomy may be helpful for identifying and removing foreign bodies that are imbedded in the tongue base. Grill brushes should undergo stringent safety regulation, as ingested wire bristles are difficult to localize and remove and may cause significant morbidity.
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Case Reports
Salvage endoscopic nasoseptal flap repair of persistent cerebrospinal fluid leak after open skull base surgery.
Persistent cerebrospinal fluid (CSF) rhinorrhea after open skull base surgery can be challenging to manage due to the risk of meningitis, brain abscess, surgical morbidity associated with revision craniotomy, and the lack of available healthy autologous tissue after failure of a pericranial flap. Given the recent success of the vascularized pedicled nasoseptal flap (PNSF) for reconstruction after endoscopic skull base surgery, we have adopted this technique as a salvage method to treat recalcitrant CSF rhinorrhea after previous open skull base surgery in order to avoid revision craniotomy. To our knowledge, use of the PNSF in this setting has not been previously described in the literature. ⋯ In patients who have undergone previous open skull base surgery as the primary approach, persistent CSF rhinorrhea can be safely repaired using the vascularized PNSF via an endoscopic endonasal approach. This minimally invasive strategy has the advantage of providing new healthy vascularized tissue for skull base reconstruction while avoiding revision craniotomy.
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Comparative Study
Laryngeal surgery using a CO2 laser: is a polyvinylchloride endotracheal tube safe?
We performed retrospective clinical analysis and in vitro testing to analyze the risks involved in laryngeal surgery using a CO(2) laser. ⋯ Burning of the tube during laryngeal surgery using a CO(2) laser could be effectively avoided when appropriate measures were taken, such as filling the endotracheal cuff with water, maintaining less than 40% oxygen concentration, using less than 8 W laser power, and using the intermittent stimulation mode.
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Lightning strike can produce an array of clinical symptoms and injuries. It may damage multiple organs and cause auditory injuries ranging from transient hearing loss and vertigo to complete disruption of the auditory system. ⋯ The exact pathogenetic mechanisms of auditory lesions in lightning survivors have not been fully elucidated. We report the case of a 45-year-old woman with bilateral profound sensorineural hearing loss caused by a lightning strike, who was successfully rehabilitated after a cochlear implantation.