Objectives/Hypothesis: Vocal fold sulcus and scars are benign vocal fold lesions that present as a challenge to the laryngologist. A number of different surgical techniques have been proposed, aiming at restoring the lamina propria (LP), closing the glottal gap, or both. This study aimed to provide a systematic review of surgical treatment for sulcus and scar and to propose a new classification for these techniques.Study Design: A literature search using MEDLINE and Google Scholar through August 2020.Methods: Data on study design were retrieved and outcomes were classified as acoustic, aerodynamic, self-reported, perceptual, and stroboscopic. Methodological quality was assessed using the MINORs criteria. Each technique was classified as direct, indirect, or combined.Results: Our search included 31 studies with a total of 617 patients. Direct techniques included dissection, graft interposition, or LP regeneration/scar degradation while indirect techniques aimed for glottal gap closure. Only one article performed a comparison between different types of techniques and only eight studied the five types of outcomes. No superiority of any technique was noted in our analysis. Self-reported outcomes were the most frequently improved.Conclusions: There seems to not exist a one-fits-all treatment for this clinical picture and no clear decision-making pattern. A recent trend toward sequential approaches, starting with less invasive procedures, can be observed.
<p class="abstract"><strong>Background: </strong>Adenoidectomy, tonsillectomy and adenotonsillectomy are among the most frequently performed procedures in otorhinolaryngology. Postoperative hemorrhage is, undoubtedly, the most feared complication of this kind of surgery. The authors aim to clarify the role of preoperative hemostatic assessment in adenotonsillar surgery, by reviewing the available literature on the subject.</p><p class="abstract"><strong>Methods: </strong>Articles adressing preoperative assessment on adenotonsillar surgery were searched in PubMed® database, since its publication till April 2020.</p><p class="abstract"><strong>Results:</strong> The role of hemostasis preoperative assessment in adenotonsillar surgery is still controversial, since some authors recommend its application in a selective range of patients, while others support its universal use. Most studies showed that a normal hemostatic study does not exclude the possibility of an hemostatic disease, and that most changed results are not correlated with the probability of postoperative hemorrhage. Hence, international recommendations discourage the screening of otherwise healthy patients, although most health care professionals continue to conduct preoperative tests in a systematic manner.</p><p class="abstract"><strong>Conclusions:</strong> The authors emphasize the need to discuss the subject and to protocol the preoperative approach for these patients, given the confusing and divergent existing data, in such frequently performed procedures in the otolaryngology field.</p>
Mycobacterial infection of the salivary glands is extremely rare, even in endemic countries. Differential diagnosis with benign or malignant neoplasms is challenging, and treatment is often delayed. We describe the case of a 62-year-old female patient who presented with a 2-month-old complaint of a right preauricular painless swelling. An ultrasound-guided fine-needle aspiration biopsy was performed, with a resulting lymphocytic infiltrate, without clear atypia. MRI demonstrated a lesion with ill-defined contours, described as probably malignant. Because of this mismatch in results, a core biopsy of the main lesion was performed, demonstrating granulomas with central necrosis, with no mycobacteria detected in PCR or culture. As the lesion continued to enlarge, a new biopsy was ordered, and this time Mycobacterium tuberculosis was detected. Treatment with extrapulmonary tuberculosis therapy was initiated. The sensitivity of PCR and culture combined is only 73% in extrapulmonary tuberculosis. A systematic approach may prevent unnecessary surgical interventions.
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