The Laryngoscope
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Multicenter Study Comparative Study
Preoperative clinical predictors of difficult laryngeal exposure for microlaryngoscopy: the Laryngoscore.
To identify a clinical predictor score for difficult laryngeal exposure (DLE) during operative microlaryngoscopy. ⋯ 2b.
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Comparative Study
An evaluation of varying protocols for high-level disinfection of flexible fiberoptic laryngoscopes.
The use of flexible fiberoptic laryngoscopes (FFLs) is ubiquitous in otolaryngology practices. As with any medical device, there exists a small risk for transmission of pathogenic microorganisms between patients, necessitating high-level decontamination between uses. Most of the literature to date has studied channeled scopes such as those used in esophagogastroduodenoscopy and colonoscopy. A recent study of nonchanneled flexible laryngoscopes suggested that current high-level decontamination practices in use at some institutions, including ours, may be overly aggressive. We sought to evaluate and compare the efficacy of varying techniques of high-level disinfection of FFLs. ⋯ NA
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To propose a clinically applicable anatomic classification system describing three progressive endoscopic endonasal approaches (EEAs) to the infratemporal fossa (ITF) and their potential sequelae. Overall feasibility and outcomes of these approaches are presented through a consecutive case series. ⋯ EEAs to ITF tumors are technically feasible with low risk of complications for well-selected patients. The proposed classification system is useful for anticipating potential sequelae for each approach.
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Endonasal approaches to the pterygopalatine fossa for epistaxis or as part of a transpterygoid approach have been popularized somewhat by the ability to control the terminal branches of the maxillary artery (MA). Surgical landmarks are useful to identify these arteries. Therefore, identification of surface features on the posterior wall of the antrum that reflect the position of deeper structures within the pterygopalatine fossa would help predict anatomical position and orientation. ⋯ N/A.
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Observational Study
The relationship between hypotension, cerebral flow, and the surgical field during endoscopic sinus surgery.
Hypotensive anesthesia is often used in endoscopic sinus surgery (ESS) to improve surgical visibility; however, its safety and efficacy in this role are yet to be justified. This study aimed to evaluate the effect of hypotensive anesthesia on both real-time middle cerebral artery blood flow velocity (Vmca) and the severity of surgical bleeding in patients undergoing ESS. ⋯ Hypotensive anesthesia is an effective method of controlling intraoperative bleeding during endoscopic sinus surgery; however the effect is clinically small in low MAP ranges. In otherwise healthy patients undergoing ESS with general anesthesia, reducing MAP to below 60 mm Hg may increase the risk of cerebral ischemia.