European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
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Eur Arch Otorhinolaryngol · Oct 2009
ReviewFrom the expert's office: localized neural lesions following tonsillectomy.
Due to various reasons, localized neural lesions following tonsillectomy are presumably an under-reported complication in the literature. This study was undertaken to compile our experiences including a literature review to disseminate useful insights in the etiology and prognosis of this rare entity. A retrospective chart review of expert reports written by at least one of the authors for malpractice claims in relation to tonsillectomy was undertaken. ⋯ A long-term follow-up is recommended for patients with dysgeusia related to glossopharyngeal nerve injury and patients with recurrent nerve dysfunction. Other lesions are much less likely to resolve in the long-term. Localized neural lesions should adequately be included in the informed consent for tonsillectomy as well as for surgical treatment of post-tonsillectomy hemorrhage.
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Eur Arch Otorhinolaryngol · Oct 2009
Randomized Controlled Trial Comparative StudyApplication methods of local anaesthetic infiltrations for postoperative pain relief in tonsillectomy: a prospective, randomised, double-blind, clinical trial.
Perioperative local anaesthetics are often used to reduce the postoperative pain in tonsillectomy. There exist three different ways of applying local anaesthetics: (1) pre-incisional peritonsillar; (2) post-tonsillectomy wound infiltration; (3) post-tonsillectomy packing with soaked gauze. The objective of the study is the evaluation of differences of pain reduction comparing the three different techniques of application. ⋯ Postoperative bleeding was observed in 11 (7.3%) cases without any correlation to an application procedure. No other adverse effects were observed. In conclusion, post-tonsillectomy infiltration of the wounds with bupivacaine is superior to pre-incisional infiltration technique as well as post-tonsillectomy packing of the wounds with 0.5% bupivacaine-soaked gauze swab.
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Eur Arch Otorhinolaryngol · Oct 2009
Randomized Controlled TrialThe effectiveness of gabapentin on post-tonsillectomy pain control.
Postoperative pain is one of the most troublesome aspects of tonsillectomy for patients. Although various analgesics have been administered for pain control following tonsillectomy, it has still not been effectively controlled. Therefore, this study was conducted to evaluate the effectiveness of premedication using gabapentin on postoperative pain control in patients undergoing tonsillectomy. ⋯ There were no significant differences in the rVAS observed between the two groups throughout the postoperative period. Thus, premedication with gabapentin decreased post-tonsillectomy pain. So the addition of gabapentin prior to tonsillectomy may have an adjunctive role in pain control.
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Eur Arch Otorhinolaryngol · Oct 2009
Comparative StudyCurved rigid laryngoscope: missing link between direct suspension laryngoscopy and indirect techniques?
Microlaryngoscopy is the standard procedure for endolaryngeal surgery. The advantages are a steady operating field, bimanual handling and stereoscopic view in high-resolution magnification. The major drawback is that the oropharyngeal structures have to be brought into an unnatural position by the straight rigid laryngoscope with considerable forces occurring. ⋯ In conclusion, we could show that even with a moderate-curved rigid laryngoscope a significant reduction of the forces to the oro-pharyngeal tissues can be obtained and that endolaryngeal exposure is possible in virtually all patients. Bimanual precise operations should be possible in the common way like in standard microlaryngoscopy with the only difference of not using a microscope, but operating via a monitor. We do not think that traditional microlaryngoscopy with straight instruments can or should be replaced by curved laryngoscopes, but these techniques could bridge the gap to indirect techniques in particular in specialised institutions dealing frequently with difficult patients and situations.
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Eur Arch Otorhinolaryngol · Oct 2009
3D computer-assisted assessment of complicated penetrating foreign bodies cases in ENT practice.
A retrospective research was performed in order to evaluate three-dimensional (3D) computer-assisted detection of penetrating foreign bodies (FB) in the ENT practice in order to assess its usefulness and to specify its application. FBs in the head and neck were detected using 3D CT imaging in order to assess the usefulness of 3D images in the ENT operative practice. Three blinded surgeons were involved in comparison between plain and 3D CT images in order to assess 3D usefulness for precise formulation of a surgical plan. ⋯ It helps to understand the relationships between a FB and surrounding anatomical structures better then the plain X-rays or CT-scan. There was no significant difference in cost between plain CT and 3D images. 3D computer-assisted detection of FBs increase our diagnostic abilities and appears to be a valuable addition to our diagnostic technique. Its main importance, however, lies in its capacity to help a surgeon plan an operation much more carefully avoiding improvisation during the operation itself.