This study demonstrates that TORS offers an alternative surgical approach to recurrent tumors of the oropharynx with acceptable oncologic outcomes and better functional outcomes than traditional open surgical approaches. This adds to the growing amount of clinical evidence to support the use of TORS in selected patients with recurrent oropharyngeal SCC as a feasible and oncologically sound method of treatment.

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Introduction Numerous surgical techniques exist to treat nasal septal perforation (NSP). The surgical closure of large NSPs (>2cm) is still challenging. Posterior septectomy has been reported as a simple alternative to treat large NSP, yet its mechanisms for symptom relief are not clear, and if failed, its consequence cannot be easily reversed. Methods Ten NSP patients were recruited: five underwent posterior septectomy and five conventional flap or button repair. Computational Fluid dynamics (CFD) simulated the nasal aerodynamics based on CT scans. All patients had preoperative CT, however, only four had postoperative CT – two underwent posterior septectomy and the other two flap repair. We examined surgical outcomes and the nasal airflow features among the two treatment options. Results Both groups of patients had good outcomes based on chart review. Patients undergoing septectomy had significantly larger perforation size (2.32±0.87 vs 1.21±0.60 cm), higher flow rate across the perforation (47.8±28.6 vs. 18.3±12.2 ml/s) and higher wall shear stress (WSS) along the posterior perforation margin (1.39±0.52 vs. 1.15±0.58 Pa). The posterior WSS significantly correlate with cross-over flow velocity (r=0.77, p=0.009) and was reduced by almost 67% post-septectomy, and by 29% post-repair. Conclusions This is the first CFD analysis on NSP patient cohort. NSP resulted in flow disturbance and increased WSS that potentially lead to symptomatology. The removal of high stress points along the posterior margin may explain why posterior septectomy can be an effective treatment option. Aerodynamic abnormalities, in addition to perforation size and location, could serve as basis for future treatment decisions.

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The vast majority of lateral frontal sinus pathology was managed using endoscopic techniques with excellent outcomes and a low revision rate in the current study.

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