Summary:Aim: The purpose of this study was to develop a revised version of the Brief Bedside Dysphagia Screening Test for determining penetration/aspiration risk in patients prone to dysphagia. The priority was to achieve high sensitivity and negative predictive value. Methods: The study screeners conducted bedside assessment of the swallowing function in 157 patients with a neurological (mainly stroke) or an ear, nose, and throat diagnosis (mainly head and neck cancer). The results were compared with a gold standard, flexible endoscopic examination of swallowing. Results: For the neurological subgroup (N = 106), eight statistically significant bedside assessment items were combined into the Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). Cut-off score 1 produced the highest sensitivity (95.5%; 95% confidence interval CI [CI]: 84.9-98.7%) and negative predictive value (88.9%; 95% CI 67.2-96.9%). Conclusion: The BBDST-R is suitable for dysphagia screening in departments caring for patients with neurological conditions.
Introduction: The purpose of the study was to compare the incidence, diagnostics, and treatment of rhinogenic inflammatory complications over the past 50 years. Material and methods: Retrospective study of 292 patients of ENT department, University hospital: Group A treated from 1966 to 1995, Group B treated from 1996 to 2015. Results: Preseptal inflammation was the most common type (73% vs. 74%), followed by subperiosteal abscess (21% vs. 20%). Surgery was indicated in 35% vs. 37% of the patients (p = 0.434). The most commonly used surgical approach was the external route (80%) in Group A and endoscopic endonasal surgery (60%) or a combination of endoscopic surgery of the paranasal sinuses and external orbitotomy (30%) in Group B (p < 0.001). The percentage of reoperations was 13% vs. 14%. In cases of revision surgery, the orbit was always treated using the external surgical approach. Complete recovery was achieved in 92% and 98.5% of the patients belonging to Group A and B, respectively (p = 0.622). Conclusion: Nowadays, the endoscopic endonasal approach is the most frequently used surgical technique for paranasal sinuses. The technique used to treat the orbital complication itself depends on several factors. Nowadays, the endoscopic approach is preferred. The external approach can be considered in the case of recurrent or persistent abscesses, especially if they are located in the upper or the lateral part of the orbit.
The authors implemented medialization thyroplasty with a customized silicone implant in a total of 43 operations (36 patients) in 1999–2003. In 5 of these patients, the medialization thyroplasty was combined with cricothyroid subluxation (3 cases) or adduction of arytenoid cartilage (3 cases). One patient received medialization thyroplasty, cricothyroid subluxation and adduction of arytenoid cartilage. Postoperatively 36 patients reported substantial reduction of their complaints, 5 patients found their voice improved and only 2 patients (5.6%) stated that their voice had not changed. The subjective evaluation was consistent with the findings of laryngoscopy and the preoperative and postoperative phonation parameters (maximum phonation time, maximum sound pressure level, jitter and shimmer). Average maximum phonation time was 6.5 s before surgery and 12.5 s after surgery. Maximum vocal sound pressure level was, on average, about 4 dB higher after surgery. Jitter was reduced from 5.3 to 3.7% and shimmer from 32.3 to 18.6%. The differences between presurgical and postsurgical parameters in our study were all statistically significant, indicating voice improvement. Medialization thyroplasty with a silicone implant was proven to be a successful and safe surgical method for the treatment of vocal fold paralysis.
The most frequent orbital wall fractures involve the orbital floor. Such fractures can be divided into transmarginal and retromarginal (blowout) fractures. Two theories of retromarginal fracture aetiology have been described: the hydraulic theory and the bone conduction mechanism.The former refers to a direct force to the globe and its compression (blowout), which increases intraorbital pressure and leads to a fracture of the weakest point of the orbital bone (the orbital floor or the medial orbital wall). The latter suggests a force to the lower orbital rim, which transfers pressure to the orbital floor and results in its fracture (9).A conservative or a surgical therapeutic approach should be selected according to the extent and localization of the injury and according to the difficulties exhibited by the patients. In addition, retromarginal fractures of the orbital floor in children are unique due to the pathology involved in the orbital bone injury and due to a distinctive surgical approach.The report presents a fracture of the orbital floor in a child. Furthermore, therapeutical options in retromarginal fractures of the orbital floor are discussed. Case ReportA 4-year-old girl was running in a garden and hit her face against an agricultural machine. Subsequently, she started to bleed from her nose, and a haematoma of her left lower eyelid and her left cheek developed. She did not have any period of unconsciousness. A CT examination of the orbits and the paranasal sinuses in the coronal plane revealed a retromarginal fracture of the orbital floor with large soft tissue herniation into the maxillary antrum ( Fig. 1) with no ocular muscle restriction. A consulting ophthalmologist did not find any visual acuity impairment. Furthermore, movements of the eyeballs were not restricted, and the child did not report diplopia. Oedema subsided on the 6th day after the injury, and surgery was performed. The indication for surgery was a large soft tissue herniation in the maxillary sinus. Bone fragments of the orbital floor and a tear of the perforated orbital periosteum were found after performing a transconjuctival incision combined with a lateral canthotomy. After lifting the soft orbital tissues and the orbital periosteum from the maxillary antrum, a partly absorbable collagenous mesh (Pelvicol) was placed between the bone wall and the orbital periosteum to provide support. A forced duction test prior to and after the reduction proved an absence of extraocular muscle restriction. Next, the incision was sutured. After the surgery the child made an uneventful recovery, her visual acuity was not impaired, her eyeball movements were not restricted, and diplopia was not present. A follow-up MRI examination of the orbits and the paranasal sinuses one month after the surgery demonstrated the collagenous mesh and the orbital soft tissues in a good position without any signs of dislocation into the maxillary antrum (Fig. 2). DiscussionThe region medial to the infraorbital neurovascular bundle, approximately 10 mm posterior to...
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