Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

Index of Body Inflammation for Maxillofacial Surgery Purpose-to Make the Soluble Urokinase-Type Plasminogen Activator Receptor Serum Level Independent on Patient Age

Background: The serum suPAR level is affected in humans by it increases with age. Therefore it makes difficult interpretation and any comparison of age varied groups. The aim of this study is to find simple way to age independent presentation of suPAR serum level for maxillofacial surgery purpose. Methods: In generally healthy patients from 15 to 59 y.o. suPAR level was tested in serum before orthognathic or minor traumatologic procedures. Five ways to make the suPAR serum level assessment independent of age are proposed. Results: One way of making suPAR levels independent of age led to the result with the same statistical distribution as in the raw suPAR serum material and this distribution is the normal. Conclusion: The simple way for suPAR serum level analysis without its dependence on patient age is calculation of the index of body inflammation understood as square root of squared suPAR serum level divided by logarithm of patient age to base 10.

Post-tonsillectomy taste dysfunction: Myth or reality?

Lingual branches of the glossopharyngeal nerve (CN Ⅸ) are at risk of injury during tonsillectomy due to their proximity to the muscle layer of the palatine tonsillar bed. However, it is unclear how often this common surgery leads to taste disturbances. We conducted a literature search using PubMed, Embase, Cochrane Library, Google Scholar, PsychInfo, and Ovid Medline to evaluate the available literature on post-tonsillectomy taste disorders. Studies denoting self-reported dysfunction, as well as those employing quantitative testing, i.e., chemogustometry and electrogustometry, were identified. Case reports were excluded. Of the 8 original articles that met our inclusion criteria, only 5 employed quantitative taste tests. The highest prevalence of self-reported taste disturbances occurred two weeks after surgery (32%). Two studies reported post-operative chemical gustometry scores consistent with hypogeusia. However, in the two studies that compared pre- and post-tonsillectomy test scores, one found no difference and the other found a significant difference only for the left rear of the tongue 14 days post-op. In the two studies that employed electrogustometry, elevated post-operative thresholds were noted, although only one compared pre- and post-operative thresholds. This study found no significant differences. No study employed a normal control group to assess the influences of repeated testing on the sensory measures. Overall, this review indicates that studies on post-tonsillectomy taste disorders are limited and ambiguous. Future research employing appropriate control groups and taste testing procedures are needed to define the prevalence, duration, and nature of post-tonsillectomy taste disorders.

Diffuse optical localization of blood vessels and 3D printing for guiding oral surgery

Diffuse optical imaging through centimeters of tissue has emerged as a powerful tool in biomedical research. However, applications in the operating theater have been limited in part due to data set requirements and computational burden. We present an approach that uses a small number of optical source-detector pairs that allows for the fast localization of arteries in the roof of the mouth and has the potential to reduce complications during oral surgery. The arteries are modeled as multiple-point absorbers, allowing localization of their complex shapes. The method is demonstrated using a printed tissue-simulating mouth phantom. Furthermore, we use the extracted position information to fabricate a custom surgical guide using 3D printing that could protect the arteries during surgery.

Specified data for tonsil surgery in Germany

Background: Tonsillectomy rates vary considerably among different states, regions, and times. This study was conducted to identify the prevalence of “chronic” tonsillitis, peritonsillar abscess, hypertrophy of the tonsils with and without adenoids in absolute and relative numbers in an 80 million people nation. Moreover, the number and rates of different surgical procedures to resolve either “chronic” tonsillitis, peritonsillar abscess, or upper airway obstruction due to (adeno)tonsillar hypertrophy over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy, abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was calculated and analyzed in relation to age and gender.

Material and methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013.

Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142,574 (in 2000) to 87,624 in 2013 (38.5%). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833,896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120,993 in 2006 to 84,332 procedures in 2013 (30.3%). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10,000 in 2010 to 58.68 per 10,000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10,000 to 10.90 per 10,000. In contrast, an increasing number of tonsillotomies was observed between 2007 (4,659 procedures) and 2013 (11,493). The cumulated number of procedures was 59,049. A constant number of 15,000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100,000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to the transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced in 5.98% of all patients after 245,721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06% vs. 7.02%). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only.

Conclusion: Chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continually, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance in insurance companies and authorities in the national health system of an 80 million people nation. (Tab. 1)

Dental arch dimensional changes after adenoidectomy or tonsillectomy in children with airway obstruction: A meta-analysis and systematic review under PRISMA guidelines

BACKGROUND

Children with severe airway obstruction tend to have a vertical direction of growth, class II malocclusion, and narrow arches. Adenoidectomy and tonsillectomy were recommended for the promotion of balanced dentition growth in these children.The aim of this study was to determine the effect of adenoidectomy and tonsillectomy on the growth of dental morphology in children with airway obstruction.

METHODS

A comprehensive search of the Medline, Embase, Web of science, and OVID databases for studies published through to January 17, 2016 was conducted. Prospective, comparative, clinical studies assessing the efficacy of adenoidectomy, or tonsillectomy in children with airway obstruction were included. The weighted mean difference (WMD) and 95% confidence interval (CI) were used for continuous variables. Forest plots were drawn to demonstrate effects in the meta-analyses.

RESULTS

Eight papers were included in our study. We found that adenoidectomy and tonsillectomy led to a significant change in nasal-breathing in children with airway obstruction. Children with airway obstruction had a significantly narrower posterior maxillary dental arch than children without airway obstruction (WMD = -0.94, 95% CI [-1.13, -0.76]; P < 0.001). After surgery, these children still had a significantly narrower dental arch than the nasal-breathing children (WMD = -0.60, 95% CI [-0.79, -0.42]; P < 0.001). In terms of dental arch width, malocclusion, palatal height, overjet, overbite, dental arch perimeter, and arch length, a tendency toward normalization was evident following adenoidectomy or tonsillectomy, with no significant differences evident between the surgical group and the normal group. The small number of studies and lack of randomized controlled trials were the main limitations of this meta-analysis.

CONCLUSIONS

Following adenoidectomy and tonsillectomy, the malocclusion and narrow arch width of children with airway obstruction could not be completely reversed. Therefore, other treatments such as functional training or orthodontic maxillary widening should be considered after removing the obstruction in the airway.

[Septoplasty and tonsillectomy: acute stress response as a measure of effectiveness of local anesthetics]

AIM

To compare the effectiveness of lidocaine and articaineused as local anesthetics in septoplasty and tonsillectomy based on the physiological stress response.

PATIENTS AND METHODS

The study included 125 patients with nasal septum deviation (NSD) and chronic tonsillitis (CT). The patients presenting with NSD were divided into two groups. Those comprising group 1A (n=32) were treated with a 2% lidocaine solution for local infiltration analgesia (LIA), the patients of group 1B (n=30) were given 2%articaine as LIA. Group 2A contained 32 patients with CT treated with lidocaine, group 2B consisted of 31 patients given articaine. In all the patients, the overall heart rate variability (HRV) including its high, low, and very low components was measured.

RESULTS

Evaluation of HRV revealed a certain degree of disadaptation in the patients of groups 1B and 2A. High dispersion of SDANN, SDNN index, andrMSSD in group 1Bas well as SDANN values in group 2A indicates the sympathetic/parasympathetic imbalance. The high-frequency component was augmented in group 2B which suggested the prevalence of parasympathetic tone, but its high dispersion was just aswell indicative of disadaptation.

CONCLUSION

Local analgesia with articaine during septoplasty leads tosympathetic/parasympathetic imbalance during the early postoperative period. Lidocaine analgesia for tonsillectomy does not prevent disadaptation induced by surgical stress.