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Intramuscular lipomas, typically found in subcutaneous tissue, rarely affect deeper muscular planes, especially those of the head and neck region. The following are 3 cases of intramuscular lipomas involving the sternocleidomastoid muscle. The first 2 patients presented with painless, palpable masses confirmed by diagnostic imaging as well-circumscribed intramuscular lipomas. One was treated surgically, while the other was managed conservatively with monitoring and close follow-up. The third patient reported dysphagia associated with occasional dyspnea and mild pain. The mass was identified as infiltrative lipoma and was resected surgically. Complete tumor removal with no recurrence at 6 months was observed for the first and last cases. The second case was serially followed at 3 and 6 months with no interval changes. We report the largest case series on intramuscular lipomas of the sternocleidomastoid muscle to enhance our understanding of this rare entity. [ABSTRACT FROM AUTHOR]

Purpose: To report the efficacy of blue laser in the treatment of vocal fold polyps and Reinke's edema in an office setting. Methods: The medical records and video-recordings of patients who underwent office-based blue laser therapy in a tertiary referral center for vocal fold polyps and/or Reinke's edema were reviewed. The primary outcome measures were the Voice Handicap Index-10 (VHI-10) score and disease regression. Acoustic and aerodynamic parameters were also analyzed. Results: Thirty-five patients (21 with vocal fold polyps and 14 with Reinke's edema) were included and a total of 47 lesions were treated. Out of the 35 patients, 7 patients were lost for follow-up. The mean VHI-10 score dropped significantly after surgery by 17.41 ± 8.67 points (p < 0.001). The endoscopic examinations of 38 lesions were reviewed (17 vocal fold polyps and 21 Reinke's edema) before and up to 6 months after laser therapy. In the subgroup with vocal fold polyps (N = 17), there was complete disease regression in 13 and partial in 4. In the subgroup with Reinke's edema (N = 21), there was complete disease regression in 7 and partial disease regression in 14. For patients with vocal fold polyp, there was a significant decrease in shimmer and a significant increase in maximum phonation time postoperatively. For patients with Reinke's edema, there was a significant decrease in shimmer and noise-to-harmonic ratio following treatment. Conclusion: Office-based blue laser therapy is an effective treatment for vocal fold polyps and Reinke's edema leading to complete or partial disease regression. All patients had improvement in voice quality. [ABSTRACT FROM AUTHOR]

The authors have conducted a retrospective analysis based on two cases of patients with intra-tracheal pathologies who received treatment from the same surgeon at a tertiary referral center. The effective management of airways in patients with intra-tracheal lesions necessitates close collaboration between surgeons and anesthesiologists. Factors such as the size, location, rigidity of the tumor, and the remaining tracheal lumen space should be carefully considered. In situations where there is near complete obstruction of the trachea and a substantial risk of worsened respiratory function, resorting to cardiopulmonary bypass or extracorporeal membrane oxygenation is advisable. This pilot study aims at devising an algorithm for the airway management of intra-tracheal lesions, although a larger case cohort is needed to assess its applicability and effectiveness. [ABSTRACT FROM AUTHOR]

Objective: To investigate the sensitivity of laryngeal findings in predicting high‐grade dysplasia/carcinoma in situ (CIS) and squamous cell carcinoma (SCC) in patients with vocal fold leukoplakia. Methods: A retrospective review of the medical records and video recordings of the laryngeal examination of patients with vocal fold leukoplakia who underwent un‐sedated office‐based laryngeal biopsy in a tertiary referral center between January 2022 and August 2023 was conducted. Laryngeal findings included the size, surface, projection, and edges of the lesion. Vocal fold leukoplakia was classified according to the WHO as benign, low‐grade dysplasia, high‐grade dysplasia/CIS, and squamous cell carcinoma. Results: Seventy patients with 100 vocal fold leukoplakia were included. Size was found to have the highest sensitivity with an AUC of 0.730 (95% CI [0.618–0.842], p = 0.002) followed by surface and projection with AUCs of 0.672 (95% CI [0.548–0.795], p = 0.019) and 0.675 (95% CI [0.546–0.804], p = 0.017), respectively. Furthermore, the odds of diagnosing high‐risk lesions (high‐grade dysplasia/CIS and SCC) were the greatest when the lesion was large and rough (OR = 10.28; 95% CI [3.08–34.36]). Conclusion: The morphological features of vocal fold leukoplakia may assist the physician in predicting the risk of malignancy. Large and rough lesions were more likely to harbor high‐grade dysplasia/CIS and SCC compared to small and smooth lesions. [ABSTRACT FROM AUTHOR]

Objective: To report patient tolerance in office‐based blue laser therapy for vocal fold lesions. Methods: A retrospective review of the medical records of patients who underwent office‐based blue laser therapy for lesions of the vocal folds between November 2021 and February 2023 was conducted. A total of 48 patients were included. Patient tolerance was assessed using the Iowa Satisfaction with Anesthesia Scale (IOWA). Patient tolerance was analyzed in relation to patients' demographic characteristics, disease type and severity, and procedure‐related factors. Results: The mean tolerance score of the study group was 1.51 ± 1.1. There was a significant difference in the mean tolerance score between smokers and non‐smokers (p =.038). Patients with vocal fold cyst (n = 3) had the highest mean tolerance score followed by patients with vocal fold polyps (n = 15). There was a nonsignificant difference in the mean tolerance score between benign lesions of the vocal folds and leukoplakia. Patients with lesions extending to more than half the vocal fold had less tolerance than those with lesions limited to less than half the vocal fold (1.91 vs. 1.27, p value.041). There was a moderate and significant negative correlation between vocal fold movement VAS, swallowing VAS, and tolerance score. The mean total duration of the procedures was 10.38 ± 4.8 min. There was a mild negative correlation between the duration of the procedure and tolerance. Conclusion: Office‐based blue laser therapy for vocal fold lesions is a well‐tolerated procedure. Patient should be instructed how to breathe quietly and avoid swallows to improve tolerance to surgery. Level of Evidence: 4. This article aimed to report patient tolerance in office‐based blue laser therapy for vocal fold lesions and found that such procedure is well tolerated. Yet patients should be instructed how to breathe quietly and avoid swallows to improve tolerance to surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction.Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient’s level of comfort during the procedure was also rated using a 10-point VAS scale.A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34.Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient’s perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.Methods: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction.Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient’s level of comfort during the procedure was also rated using a 10-point VAS scale.A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34.Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient’s perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.Results: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction.Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient’s level of comfort during the procedure was also rated using a 10-point VAS scale.A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34.Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient’s perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted.Conclusion: To investigate the subjective effect of office-based blue laser therapy for inferior turbinate hypertrophy in patients with nasal obstruction.Patients with nasal obstruction who underwent office-based blue laser for the inferior turbinate hypertrophy between October 2022 and December 2023 were included in the study. The two outcome measures used to gauge the improvement in nasal obstruction and success of surgery were the Nasal Obstruction Symptom Evaluation (NOSE) scale and the Visual Analogue Scale (VAS). Patient’s level of comfort during the procedure was also rated using a 10-point VAS scale.A total of 14 patients were included in this study. The mean age of the study group was 41.47 ± 18.52 and the F/M ratio was 4.67. All patients reported significant improvement in nasal breathing. The mean NOSE score decreased significantly from 13.07 ± 3.89 pre-operatively to 2.64 ± 2.43 post-operatively (p = 0.002). Similarly, the mean VAS score decreased from 7.43 ± 0.85 to 2.0 ± 1.57 (p = 0.002) following surgery. The procedure was well-tolerated by all participants and the mean total score ranged from 6 to 9 with an average of 7.59 ± 1.34.Office-based blue laser therapy for inferior turbinate hypertrophy may be an effective treatment modality for nasal obstruction from the patient’s perspective. Although the procedures were tolerated well with no complications noted, these results should be cautiously interpreted until studies using objective measures are conducted. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes mellitus type 2 is a growing health concern that affects several systems in the body, among which is the phonatory apparatus. Voice may be affected in view of the high prevalence of myopathy and neuropathy in diseased subjects. The authors aimed to answer the following question: does type 2 diabetes have an effect on voice? Methods: The systematic review included search terms such as "speech, voice, larynx, glucose, diabetes, and hyperglycemia." The search strategy yielded 221 articles, only five of which satisfied the inclusion criteria. Articles were considered for inclusion using the PRISMA method. Analysis included 321 patients with type 2 diabetes mellitus and 171 controls. All studies included were case-control studies except for one study which was an observational cohort. Six parameters were chosen as endpoints for the systematic review and meta-analysis: the presence/absence of voice complaints, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximum phonation time. Results: There was no significant difference in the prevalence of voice complaints (i.e., hoarseness) between diabetic patients and control groups. There was also no significant difference in any of the acoustic and aerodynamic measures between patients with type 2 diabetes and controls. These findings can be ascribed to the high resilience of the laryngeal muscles to the adverse effect of systemic diseases. Conclusion: There is no consensus in the literature that the prevalence of voice symptoms in diabetic patients is significantly higher than that reported in healthy subjects. [ABSTRACT FROM AUTHOR]

The authors aimed to develop an extensive preoperative checklist of CT scan findings during endoscopic access to the ventral skull base and implement it in clinical practice. A comprehensive literature review was conducted to identify the radiological landmarks crucial to endoscopic skull base surgery. Four electronic databases were searched: PubMed, MEDLINE, EMBASE, and Google Scholar using search terms/keywords such as "radiological landmarks," "endoscopic skull base surgery," "CT scan," "pituitary surgery," "anatomical variations," "internal carotid," "optic nerve," "sphenoid sinus," "pneumatization," "dehiscence," and "protrusion". Inclusion criteria were limited to original articles and systematic reviews published in English, between the years 2000 and 2021, which pertained to the radiological landmarks to be identified during endoscopic skull base surgery. Full-text articles were retrieved and collated into a narrative review focused on a 12-item checklist the authors agreed upon. The mnemonic "O ROAD TO SELLA" was used to represent the checklist and include the following landmarks: Sphenoid Ostium, Sphenoid Rostrum, Onodi cells, Anatomic variations of the sphenoid sinus, Distance between the carotids, Tumor characteristics, Optic nerve dehiscence/protrusion, Septation/insertion of the sphenoid sinus, Entrance to the sellar floor, Lateral recess of the sphenoid sinus, cLinoid process pneumatization, and internal carotid Artery dehiscence/protrusion. The checklist is designed to be used by attending physicians, fellows, and residents and the authors intend to implement it into electronic medical records at the institution's medical center to monitor the outcomes of EEPS after implementation. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effectiveness of in-office blue laser therapy on dyspnea in patients with type 3 Reinke's edema. Methods: The medical records and video-recordings of patients with Reinke's edema type 3 who had undergone office-based blue laser therapy between March 2022 and January 2023 were reviewed. The primary outcome measures assessed before and after surgery were dyspnea severity, risk of obstructive sleep apnea (OSA), and disease regression. The severity of dyspnea was measured using the Dyspnea Severity Index (DSI), the risk of OSA was assessed using the STOP-BANG questionnaire, and disease regression was assessed by reviewing the laryngeal examination before and after surgery. The Voice Handicap Index-10 (VHI-10) was used as a secondary outcome measure. Result: A total of 10 patients were included. The mean age of the study population was 58.9 ± 4.2 years. The male-to-female ratio was 2:3. In total, 20 vocal fold lesions were treated among which 18 were reviewed. Eight lesions regressed completely and 10 partially. There was a statistically significant drop in the mean score of DSI after surgery (16.1 ± 10.2 pre-operatively vs 2.3 ± 2.3 post-operatively, p-value < 0.001). The mean STOP-BANG score decreased from 4.8 ± 1.47 to 3.1 ± 1.28 (p-value = 0.001). There was also a significant improvement in VHI-10 score (22.7 ± 7.0 vs 4.4 ± 5.6, p-value < 0.001). Conclusion: Office-based blue laser therapy offers a safe and effective treatment for shortness of breath in patients with type 3 Reinke's edema. [ABSTRACT FROM AUTHOR]

To explore the risk of obstructive sleep apnea (OSA) in patients with primary muscle tension dysphonia (MTD). The medical records of patients diagnosed with primary MTD between November 2021 and March 2023, were reviewed. The risk of having OSA was assessed by looking at the scores of two validated questionnaires, namely the STOP-BANG questionnaire and the Berlin questionnaire. A total of 40 patients with primary MTD were enrolled in this study, including 16 females (40%) and 24 males (60%). The mean total STOP-BANG score was 3.57 ± 1.67. Seventeen of the study group had intermediate risk of OSA, and 14 had high risk, accounting for 77.5% of patients with primary MTD. When using the Berlin questionnaire, the mean total score was 1.65 ± 0.95, and 67.5% of the study group had a score > 2 and were at high risk of having OSA. The results of this study indicate that patients with primary MTD are at moderate to severe risk of having OSA. [ABSTRACT FROM AUTHOR]

This article discusses the use of various techniques to reduce the occurrence of cerebrospinal fluid (CSF) leaks after pituitary surgery. The study examines the experience of a single institution over a five-year period, focusing on the use of intraoperative lumbar drains and repair techniques. The results show that the lumbar drain was used in all cases, with post-operative use in 24.2% of patients. CSF leaks were encountered intraoperatively in 28.8% of cases and postoperatively in only 4.5% of cases. Different repair techniques, such as naso-septal flaps and surgical sealants, were used depending on the size of the defect. The study also found that certain patient characteristics, such as a pre-op diagnosis of CAD and/or dyslipidemia, were associated with a higher rate of intraoperative CSF leak. The use of navigation during surgery did not significantly affect the risk of CSF leak. The article concludes that simple closure with a single sealant layer or a graft or flap is appropriate in cases with limited resources, and that patient comorbidities and intraoperative flow rate should be considered when deciding on a reconstruction technique. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the risk factors for developing diabetes insipidus (DI) after endonasal endoscopic pituitary macroadenoma resection. The study analyzes a cohort of 19 patients who developed postoperative DI out of 66 patients who underwent the procedure. The results indicate that high flow cerebrospinal fluid (CSF) leaks during surgery, the use of nasal packs, and the need for multiple layers of reconstruction are correlated with the development of DI. The study suggests that careful postoperative monitoring of patients with these risk factors can help reduce complications and readmission rates. [Extracted from the article]

Obstructive sleep apnea (OSA) is associated with many chronic diseases among which is laryngopharyngeal reflux disease (LPRD). To investigate the prevalence of laryngopharyngeal reflux (LPR)-related symptoms in patients with OSA using the Reflux Symptoms Score (RSS) and Reflux Symptom Index (RSI). The medical records and video-recordings of patients with OSA who presented to a tertiary referral center were reviewed. The diagnosis of OSA was made using the STOP-BANG questionnaire and/or polysomnography. The prevalence of LPR-related symptoms was assessed using both the RSS and RSI questionnaires. Thirty-nine patients were included in this study. Twenty-seven patients (69.2%) had a positive RSS in comparison to only 7 (17.9%) using the RSI (p =.052). Subgroup analysis of those who had polysomnography (n = 24) showed that 18 patients (75%) had a positive RSS in comparison to only 5 patients (20.8%) using the RSI. Patients in the high-risk category for OSA were also found to have a higher prevalence of LPR-related symptoms using both the RSS and RSI questionnaires in comparison to those in the lower risk categories. The results of this investigation indicate that the prevalence of LPR-related symptoms is higher using the RSS in comparison to the RSI. [ABSTRACT FROM AUTHOR]