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Objectives Iatrogenic injury to the internal carotid artery (ICA) is one of the most catastrophic complications of endoscopic sinus and skull base surgery. Previous research has shown that packing with a crushed muscle graft at the injury site can be an effective management technique to control bleeding and prevent the need for ICA sacrifice. Here, we describe a novel and readily available repair donor site—an autologous lateral tongue muscle patch. Design Three representative cases of a successful repair of ICA injuries using a lateral tongue muscle patch are included in this study. The graft measured approximately 2 × 3 cm and was taken from the lateral intrinsic tongue musculature. We describe the harvest of the graft, its advantages, and the details of operative repair. Results The lateral tongue provides a large and readily accessible source of muscle within the surgical field that can be quickly harvested during an endoscopic procedure. For the first case, an expanding parasellar ICA pseudoaneurysm was managed with a tongue muscle patch and nasal packing. In the second case, a cavernous ICA injury was sustained during craniopharyngioma resection. Case three involved an ICA injury during endonasal debridement of invasive fungal rhinosinusitis. None of the patients required embolization or neurovascular stenting. Postoperative angiograms and serial computed tomography angiograms showed complete resolution of the pseudoaneurysm, and the patients continued to do well at least 1 year after repair. Conclusion Lateral tongue muscle graft is an effective and efficient method to manage ICA injuries during endoscopic endonasal surgery. Advantages include the speed of harvest, donor site being readily accessible in the surgical field, and low donor site morbidity. It should be added to the repertoire of possible donor sites for addressing catastrophic sinonasal bleeding. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether chronic rhinosinusitis (CRS) endotypes show a differential response to endoscopic sinus surgery (ESS). We explored patient mucous inflammatory cytokine expression and associations with patient‐reported and clinically measured post‐operative outcome measures. Methods: Patients with CRS were prospectively recruited between 2016 and 2021 into a national multicenter, observational study. Mucus was collected from the olfactory cleft preoperatively and evaluated for 26 biomarkers using cluster analysis. Patient‐reported outcome measures included the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) and Questionnaire of Olfactory Dysfunction (QOD). Additional clinical measures of disease severity included threshold, discrimination, and identification (TDI) scores using "Sniffin' Sticks" testing and Lund–Kennedy endoscopic score (LKES). Results: A total of 115 patients were clustered into type 2 inflammatory, non–type 2 inflammatory, noninflammatory, and two indeterminate clusters based on individual protein levels. Overall, the type 2 inflammatory cluster was found to have the highest mean improvement in both SNOT‐22 (−28.3 [standard deviation, ±16.2]) and TDI (6.5 [standard deviation, ±7.9]) scores 6 months after ESS. However, on average, all endotype clusters demonstrated improvement in all outcome measures after ESS without statistically significant between‐group differences in SNOT‐22 (p = 0.738), QOD (p = 0.306), TDI (p = 0.358), or LKES (p = 0.514) measures. Conclusions: All CRS endotype clusters responded favorably to surgery and showed improvements in patient‐reported and objective outcome measures. Thus, ESS should be considered a more generalized CRS therapy, and benefits appear to not be limited to specific endotypes. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses the use of a polydioxanone suture (PDS) plate with a dural substitute for repairing anterior skull base defects. The study reviews a retrospective cohort series of 155 patients who underwent this technique and reports long-term outcomes. The results show that the PDS plate reconstruction is safe and effective, with a low rate of postoperative cerebrospinal fluid (CSF) leaks and no cases of cranial nerve or internal carotid artery injury. The study also suggests that there may be a learning curve associated with this technique. [Extracted from the article]

Objective: The purpose of this study was to analyze barriers to medical care and follow‐up in patients with allergic fungal rhinosinusitis (AFRS). Study Design: Cross‐sectional questionnaire‐based study with retrospective chart review. Setting: Tertiary Medical Center. Methods: Subjects with AFRS and chronic rhinosinusitis with nasal polyps (CRSwNP) were prospectively recruited for completion of the Barriers to Care Questionnaire (BCQ) and formal chart review. Results: Fifty‐nine AFRS and 51 CRSwNP patients participated. AFRS patients were more likely to be lost to follow‐up within 6 months of surgery (35.6% vs 17.7%, P = 0.04) and no‐show at least 1 appointment (20.3% vs 5.9%, P = 0.03) compared to CRSwNP patients. Men with AFRS were more likely to have only a single follow‐up visit (37.0% vs 3.1%, P < 0.001) and be lost to follow‐up (66.7% vs 9.4%, P < 0.001) than women. There were no significant differences in the BCQ between groups; however, rate of questionnaire completion was lower in the AFRS group than the CRS group (62.7% vs 80.4%, P = 0.042). AFRS patients who did not complete the BCQ were more likely to be male (63.6% vs 35.1%, P = 0.034), lost to follow‐up (77.3% vs 10.8%, P < 0.0001), and have a single follow‐up visit (40.9% vs 5.4%, P < 0.0001). Younger age was associated with increased likelihood of having a single follow‐up visit (odds ratio 1.143, 95% CI 1.022‐1.276). Conclusion: Young, male AFRS patients are more frequently lost to follow‐up after surgery and less likely to complete questionnaires assessing barriers to care. Further investigation is needed to assess barriers to follow‐up in these at‐risk groups. [ABSTRACT FROM AUTHOR]

Objective: Some previous studies have shown an increased prevalence of allergic fungal rhinosinusitis (AFRS) among young, black patients with poor access to health care; however, results have been mixed. The purpose of this study was to investigate the relationship between social determinants of health and AFRS. Data Sources: PubMed, Scopus, CINAHL. Review Methods: A systematic review was performed searching for articles published from date of inception to September 29, 2022. English language articles describing the relationship between social determinants of health (i.e., race, insurance status) and AFRS as compared to chronic rhinosinusitis (CRS) were selected for inclusion. A Meta‐analysis of proportions with comparison (Δ) of weighted proportions was conducted. Results: A total of 21 articles with 1605 patients were selected for inclusion. The proportion of black patients among AFRS, chronic rhinosinusitis with nasal polyps (CRSwNP), and chronic rhinosinusitis without nasal polyps (CRSsNP) groups was 58.0% [45.3%‐70.1%], 23.8% [14.1%‐35.2%], and 13.0% [5.1%‐24.0%], respectively. This was significantly higher among the AFRS population compared to both the CRSwNP population (Δ34.2% [28.4%‐39.6%], p <.0001) and the CRSsNP population (Δ44.9% [38.4%‐50.6%], p <.0001). The proportion of patients who were either uninsured or covered by Medicaid among the AFRS, CRSwNP, and CRSsNP populations was 31.5% [25.4%‐38.1%], 8.6% [0.7%‐23.8%], and 5.0% [0.3%‐14.8%], respectively. This was significantly higher among the AFRS group than the CRSwNP group (Δ22.9% [15.3%‐31.1%], p <.0001) and the CRSsNP group (Δ26.5% [19.1%‐33.4%], p <.0001). Conclusion: This study confirms that AFRS patients are more likely to be Black and either uninsured or on subsidized insurance than their CRS counterparts. [ABSTRACT FROM AUTHOR]

Sinonasal small cell neuroendocrine carcinoma (SNEC) is an extremely rare and aggressive neoplasm that can arise in the sinonasal region. These tumors are associated with high morbidity and mortality, are difficult to diagnose, and are hard to treat. We describe 2 cases of this poorly understood malignancy and review imaging, pathology, and treatment decisions. A 41-year-old male and a 64-year-old female presented to a tertiary center in 2019 after developing nasal obstruction and were found to have sinonasal masses on imaging. Both biopsies showed strong expression of pancytokeratin with dot-like reactivity and expression of neuroendocrine markers chromogranin and synaptophysin. The findings were diagnostic of SNEC. Staging positron emission tomography/computed tomography and brain MRI were performed, and patients were discussed at a multidisciplinary tumor board. Neither had distant metastatic disease at presentation. One patient had no intracranial or orbital disease and underwent a subtotal endoscopic resection with adjuvant chemoradiation. The other patient demonstrated middle cranial fossa, dural, and orbital involvement as well as cranial nerve V palsy. This patient was treated with induction chemotherapy, followed by concurrent chemoradiation. Both patients are presently alive at 4 months follow-up, but one with persistent local disease and the other distant metastasis. Sinonasal small cell neuroendocrine carcinoma is a rare and poorly understood malignancy with an aggressive clinical course. Continued careful review of pathology and study of molecular features are needed for improved understanding of SNEC, and particularly for head and neck SNEC, to establish a staging system and better formulate treatment protocols. [ABSTRACT FROM AUTHOR]

Onset and duration of symptoms of loss of smell/taste in patients with COVID-19: a systematic review. A recent study also reported that COVID-19 patients had nearly double the average total SNOT-22 scores compared with the matched negative controls.10 Thus, the SNOT-22 instrument may be useful in measuring and following post-COVID-19 rhinologic symptoms and olfactory dysfunction. Keywords: comorbidities; COVID-19; duration; olfaction; outcomes; SARS-CoV2; severity; smell loss; SNOT22; taste loss EN comorbidities COVID-19 duration olfaction outcomes SARS-CoV2 severity smell loss SNOT22 taste loss 108 111 4 12/31/21 20220101 NES 220101 INTRODUCTION From the beginning of the SARS-CoV-2 pandemic, olfactory and taste dysfunction have been identified as key and distinctive presenting symptoms,1,2 but the evolution of these sensory deficits over time remains unclear. [Extracted from the article]

Background: Recent advances in molecular biology have enabled the identification of potential inflammatory endotypes of chronic rhinosinusitis (CRS), with prior work suggesting differential short‐term surgical outcome trajectories based on cytokine signatures. However, there is a paucity of data assessing long‐term treatment failure and need for revision surgery based on inflammatory biomarkers. Methods: Retrospective analysis of prospectively collected cross‐sectional data from 231 patients electing surgical therapy for CRS. Intraoperative mucus specimens were quantitatively sampled for inflammatory cytokines using a multiplex flow cytometric bead assay. Univariate Spearman correlations between cytokine levels and prior number of surgeries were assessed. A stepwise adjusted multivariate Poisson regression analysis was used to model patient‐reported prior sinus surgery counts as a function of cytokine levels. Results: Several cytokines (interleukin [IL]‐1β, IL‐4, IL‐5, IL‐6, IL‐8, IL‐10, IL‐13, IL‐17A, tumor necrosis factor α [TNF‐α], interferon γ [IFN‐γ], and eotaxin) demonstrated significant positive correlations with number of prior surgeries. However, only higher IL‐17A levels were independently associated with a higher number of prior sinus surgeries (β = 0.345, p = 0.0003) after adjusting for the significant covariates of age (β = 0.018, p = 0.0036), Lund‐Mackay score (β = –0.046, p = 0.02), history of aspirin‐exacerbated respiratory disease (β = 1.01, p < 0.0001) and allergic fungal rhinosinusitis (β = 1.08, p < 0.0001). Higher levels of regulated on activation, normal T‐cell expressed and secreted (RANTES) were conversely associated with a lower number of prior surgeries (β = –0.17, p = 0.048). Conclusion: An IL‐17A–predominant cytokine profile is linked to an increased number of prior sinus surgeries. Thus, type 3 inflammatory markers may indicate a particularly difficult‐to‐treat, recalcitrant CRS endotype. [ABSTRACT FROM AUTHOR]

Background: Sinonasal teratocarcinosarcoma (SNTCS) is a rare malignancy of the anterior skull base with only 127 cases described in the English literature. Given the rarity of this tumor, new cases and analysis of published reports may assist in future management of SNTCS. Objectives: 1) Describe findings from a systematic review of all available literature for malignant SNTCS including the clinical presentation, treatment modalities and outcomes. 2) Present two new cases of this rare anterior skull base tumor. 3) Compare treatment outcomes with respect to recurrence and mortality. Methods: A systematic review of all English literature available in 2 comprehensive databases was conducted by two independent reviewers using PRISMA guidelines. 85 publications were identified. Each case was reviewed for demographics, treatment and survival, and aggregate treatment outcomes were compared using Kaplan-Meier analysis. Results: A total of 64 articles meeting inclusion criteria were reported in the literature between 1977-2018. This represented a total of 127 patients, with a strong male predominance (83%) and mean age of 50 years (range 10–82). Mean follow-up was 21 months. Recurrence rate was 38%, with mean survival at 2 years of 55%. Almost all patients underwent surgery as a primary treatment modality (90%). The majority of cases were treated with multimodal therapy, with 55% receiving surgery and radiation and 20% receiving surgery with adjuvant chemoradiation. Kaplan-Meier analysis demonstrated a significant survival advantage for patients treated with combined therapy compared to surgery alone (p < 0.001) but did not show differences in recurrence (p = 0.085). Conclusion: Two-year survival rates for SNTCS are 55%. Multimodality treatment outcomes appear to be superior to surgery alone based on the published data of this rare skull base tumor, although heterogeneity of treatment methods and reporting bias limits the generalizability of these findings. [ABSTRACT FROM AUTHOR]