ObjectiveRecent studies redefine the infant lingual frenulum as a dynamic structure formed by oral mucosa, floor-of-mouth fascia, and genioglossus muscle, rather than a mucosal band. Many existing studies rely on simple sublingual mucosa 'snip' techniques, which have led to high revision rates (8-29%). We review a protocol for infant ankyloglossia management aligned with current expert recommendations to achieve optimum frenulum release.MethodsIn this retrospective case series from a single academic pediatric otolaryngology practice (2002-2023), infants with clinically significant ankyloglossia underwent frenulotomy with complete division of the lingual frenulum to the sublingual fold. If release was functionally incomplete, central dissection continued to include floor of mouth fascia and genioglossus fibers. Demographics, procedural characteristics, mother-infant dyad satisfaction, and complications were recorded.ResultsOf 1,367 infants evaluated, 585 underwent in-office frenulotomy. Mean age was 27.66 days (SD = 31.08), and 62.22% were male. Anterior division was performed in 91.45% of cases, while 8.55% required posterior release. Successful division, defined as improved tongue mobility and/or feeding, was achieved in 98.97% of cases. Five infants (0.85%) required revision surgery. One child required silver nitrate cautery for bleeding.ConclusionsThis microscopically guided approach to infant lingual frenula release demonstrates excellent results with few complications in the office setting.Level of Evidence4 - Case Series.
BackgroundPostoperative urinary difficulty (POUD) is a common complication following surgery under general anesthesia. This study aims to evaluate the prevalence of and identify the risk factors associated with POUD in patients undergoing otolaryngology head and neck surgery.MethodsWe retrospectively reviewed the medical records of consecutive patients who underwent otolaryngology head and neck surgery under general anesthesia between July 2020 and September 2020. Patients complaining of POUD were evaluated using an automatic portable bladder ultrasound scanner to assess bladder distension and urine volume. The prevalence and clinical characteristics of POUD were analyzed.ResultsA total of 680 patients were enrolled (417 males, 61%; 263 females, 39%), with a mean age of 52 years. The overall prevalence of POUD was 14.1%, with a mean urine volume of 449 ml. Male gender was the independent risk factor of POUD, with males (18%) more common than females (8%). Age and operation time were also the independent risk factors of POUD. The prevalence of POUD increased significantly with age in males (p<0.001) but no significant association was observed in females (p=0.687). Notably, POUD occurred in 23% of males over 50 years old and 46% of those over 70. Patients with rocuronium plus neostigmine had the highest risk for POUD (43%). No patients with rocuronium plus sugammadex had POUD.ConclusionsPOUD is common following otolaryngology head and neck surgery, particularly in older male patients and with prolonged operation time. It is essential to develop targeted interventional strategies to prevent and manage POUD in these high-risk groups.
ObjectiveThis study aims to describe the clinical characteristics, multimodal management, and outcomes of SMARCB1 (INI-1)-deficient sinonasal carcinoma (SDSC) within a single-institution cohort.MethodsA retrospective descriptive study of 12 SDSC patients diagnosed between March 2019 and December 2024 was conducted. All patients received multimodal therapy, including surgery, radiotherapy, chemotherapy, and immunotherapy. Clinical outcomes evaluated included overall survival (OS), progression-free survival (PFS), and the response to neoadjuvant treatment.ResultsThe cohort consisted of 10 males (83%) and 2 females (17%), with a mean age of 37 years (range: 23-63). The ethmoid sinus was the most frequently involved site (7/12, 58%), and 10 patients (83%) presented with locally advanced T4 disease. Notably, immunotherapy (PD-1 blockade) was universally integrated into the multimodal continuum for all 12 patients at various disease stages. Among the nine patients who received neoadjuvant therapy, three (3/9) achieved an objective response, and all nine patients (9/9) achieved disease control prior to local consolidation. With a median follow-up of 30 months (range: 4-50), the median OS was 41 months. The 1-, 2-, 3-, and 4-year OS rates were 83%, 83%, 66%, and 22%, respectively. The median PFS was 34 months, with 1-, 2-, 3-, and 4-year PFS rates of 75%, 64%, 43%, and 43%, respectively.ConclusionOur findings suggest that integrating PD-1 blockade into multimodal treatment regimens is feasible and shows promising potential for disease control in SDSC. This descriptive series provides practical reference data and highlights a potential therapeutic avenue for future research.
Rhabdomyosarcoma of the temporal bone is an uncommon but important malignant mimic of pediatric otomastoiditis. We describe a 4-year-old boy who presented with persistent right-sided otorrhea after an upper respiratory tract infection, followed by an external auditory canal mass and progressive right peripheral facial nerve paralysis. Temporal bone computed tomography showed soft-tissue opacification of the right external auditory canal, tympanic cavity, mastoid antrum, and mastoid air cells. Magnetic resonance imaging demonstrated an irregular, heterogeneously enhancing lesion involving the same regions and adjacent to the expected course of the facial nerve canal. Initial imaging favored otomastoiditis with possible cholesteatoma. Biopsy revealed a malignant small round cell soft-tissue tumor infiltrating the subepithelial stroma. Immunohistochemistry showed desmin positivity and nuclear MyoD1 and myogenin positivity, supporting rhabdomyoblastic differentiation; embryonal rhabdomyosarcoma was favored. This case emphasizes that persistent pediatric otorrhea with an aural mass, blood-stained discharge, facial paralysis, or extensive temporal-bone soft tissue should prompt early imaging and biopsy to avoid diagnostic delay.
Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis that typically presents with nodal disease in young males. Extranodal involvement occurs less frequently and may involve the nasal cavity, paranasal sinuses, or orbit. Airway involvement is particularly uncommon, and simultaneous sinonasal and subglottic disease is exceptionally rare. We describe a 39-year-old female presenting with progressive nasal obstruction, throat fullness, and hoarseness. Nasal endoscopy demonstrated bilateral polypoidal tissue, while flexible laryngoscopy revealed a posterior subglottic nodule. Computed tomography showed diffuse sinonasal disease and a subglottic soft-tissue lesion without bony erosion. Histopathology confirmed RDD through characteristic emperipolesis and an S100+/CD68+/CD1a- immunophenotype. Treatment with systemic corticosteroids resulted in rapid improvement with near-complete resolution of both lesions. This case presents a highly unusual anatomical distribution of RDD with significant clinical teaching value, representing the first such report in Saudi Arabia. Awareness of this presentation may prevent misdiagnosis and unnecessary surgical intervention.
Schneiderian inverted papilloma is a benign, locally aggressive tumor that typically arises in the respiratory mucosa of the nasal cavity and paranasal sinuses. These tumors are often asymptomatic but can cause unilateral nasal obstruction, discharge, hyposmia and epistaxis. They warrant attention particularly due to the potential for malignant transformation. They are treated most often with surgical excision. This case report describes a patient with Schneiderian inverted papilloma arising outside its usual location and managed with definitive radiation therapy instead of surgical excision due to concerns for functional impairment. Remission was obtained with radiation therapy, although the patient experienced treatment-related side effects.
Spindle cell lipoma (SCL) is a rare benign lipomatous tumor that typically arises in the posterior neck, upper back, and shoulders. SCL of the retropharyngeal space is exceptionally rare, with only a few cases reported in the literature. We present a case of a 32-year-old man with a 3-year history of progressive neck swelling, dysphagia, and dysphonia. The patient initially attributed the neck swelling to his heavier body habitus. After weight loss failed to resolve the mass, worsening voice quality and cosmetic concerns prompted him to seek medical attention. Computed tomography revealed a large heterogeneous mass measuring 21 cm, extending from the oropharynx to the superior mediastinum and occupying the entire retropharyngeal space. Physical examination demonstrated a diffuse, bilateral neck mass that was soft, elastic, and non-tender, with intact cranial nerve function. Transcervical en bloc excision with finger dissection was performed in collaboration with a thoracic surgeon (total operative time: 276 minutes). Histopathological examination confirmed spindle cell lipoma, characterized by bland spindle cells, mature adipocytes, and ropey collagen fibers. Immunohistochemical staining showed positivity for CD34 and S100 and negativity for desmin and MDM2, confirming the benign diagnosis. The patient became symptom-free immediately after surgery, with the most notable improvement being resolution of breathing difficulty. At 22 months of follow-up, there was no evidence of recurrence on clinical examination and contrast-enhanced computed tomography. This is the fifth reported case of retropharyngeal SCL in the English literature and the largest by size. Despite the extensive dimensions and proximity to critical neurovascular structures, simple transcervical excision with finger dissection proved fully effective. Clinicians should be aware of this rare entity and its distinction from malignant lesions such as liposarcoma to avoid overtreatment.
BackgroundThe endotype of allergic rhinitis (AR) known as local allergic rhinitis (LAR) is distinguished by localized nasal allergic reactions despite negative skin and blood tests for systemic IgE. This work aims to evaluate the offending allergens, sensitivity of diagnostic tests, and quality of life differences in different endotypes of AR.MethodsA clinical study was conducted on 44 patients complaining of AR symptoms and 44 healthy controls. Three endotypes of persistent Allergic rhinitis: Type (I): (AR), Type (II): (LAR) subdivide to group (a) (LAR) with positive nasal allergen provocation test (NAPT) with elevated nasal specific IgE and group (b) LAR with positive nasal allergen provocation test (NAPT) and non-elevated nasal specific IgE. All patients were subjected to C-reactive protein, blood IgE (total and specific) and nasal IgE (total and specific), nasal allergen provocation test (NAPT) and the Mini Rhino Conjunctivitis Quality of Life Questionnaire (MINI RQLQ).ResultsThe serum-specific IgE levels of aeroallergens, the mean of Dermatophagoides pteronyssinus (D. pteronyssinus) and Dermatophagoides farinae (D. farinae) was significantly higher in Type (I) patients (17.75±17.71 IU/ml (11.16 ±12.55 IU/ml), (p=0.021, p=0.030) respectively. Regarding nasal-specific IgE levels of aeroallergens, a mean of D. pteronyssinus and D. farinae were significantly higher in the Type (II) (17.25 ±7.88), (12.75 ±4.92 IU/ml) respectively, (p<0.001). There were significant differences between A and B groups, nasal specific IgE regarding D. pteronyssinus and D. farinae (p<0.05). D. pteronyssinus and D. farinae was significantly higher among patients type II A compared to type II B. The sensitivity of NAPT and nasal specific IgE in AR (85.71%, 55.17%) respectivily. The specificity of NAPT and nasal specific IgE in type I (88.89%, 47.85%). The total score of miniRQLQ was significantly higher in type I (41.28), (p<0.001).ConclusionThe NAPT is the most sensitive and specific test to differentiate between systemic and local form while nasal specific IgE can differentiate between the two endotypes of LAR.
ObjectiveTo prospectively document the incidence, characteristics, and management of intraoperative and postoperative complications in elective septoplasty performed by supervised residents at a university teaching hospital.MethodsThis prospective longitudinal study enrolled 173 consecutive American Society of Anesthesiologists (ASA) class I patients (age 18-60 years) undergoing elective septoplasty at Al-Mouwasat University Hospital, Damascus. Procedures were performed by residents (PGY 3-4) under continuous attending supervision using the closed Killian technique. Postoperative care included intranasal packing removed on day 2 and Silastic splints removed on day 7, with monthly clinical follow-up for 3 months.ResultsThe cohort was predominantly male (111/173, 64.2%) with a mean age of 26.01 ± 7.65 years. Mean operative duration was 69.84 ± 23.46 minutes and mean intraoperative blood loss 151.45 ± 97.72 mL. Mucosal lacerations occurred in 139 patients (80.3%), of whom 84.9% required no intervention and 15.1% underwent suturing. Intraoperative bleeding resolved within 10 minutes in all but two cases (1.2%), which required electrocoagulation. Laceration size strongly correlated with blood loss (r = 0.634, p < 0.01). Over three months, no patient developed septal perforation, adhesions, postoperative hemorrhage requiring intervention, abscess, or cerebrospinal fluid leak. Minor events included nasal vestibulitis in two patients (1.16%) and postoperative vomiting in nine (5.2%).ConclusionDespite an 80.3% mucosal laceration rate, no major postoperative complication occurred. Prompt intraoperative recognition and selective repair of mucosal tears, rather than their avoidance, appears sufficient to prevent long-term sequelae, even in a supervised resident training setting.
PurposeMajor maxillary and facial tumor resections are often associated with substantial intraoperative blood loss due to rich vascular supply from branches of the external carotid artery (ECA). We present a case series of three selected patients undergoing extensive maxillofacial tumor resection in whom temporary proximal ECA restriction using a Rummel tourniquet was applied.ResultsEstimated blood loss ranged from 550 to 1500 mL. No postoperative neurological deficits or delayed arterial hemorrhage were observed. Temporary proximal ECA restriction was technically feasible through cervical exposure and provided reversible arterial inflow modulation.ConclusionsAlthough limited by the small sample size and lack of comparative analysis, this case series suggests that temporary proximal ECA restriction using a Rummel tourniquet may serve as a practical adjunct in selected patients undergoing extensive maxillofacial tumor resection. Further studies are warranted to better define its clinical value.
ObjectiveMedical students applying to Otolaryngology-Head and Neck Surgery (OHNS) increasingly complete a dedicated research year, yet the relationship between research-year output and match success is poorly defined. We compared research-year scholarly output between fellows who did and did not match into OHNS and examined whether output and home program status were associated with matching.MethodsWe conducted a retrospective bibliometric cohort study of 82 research fellows from 10 OHNS research fellowship programs. PubMed-verified publications were counted at application, at residency start, and cumulatively.ResultsSixty-two of 82 fellows (75.6%) matched into OHNS. OHNS-matched fellows had higher research-year-associated publication counts than non-OHNS-matched fellows, with a median of 1 vs 0 at application (p=0.006) and 5 vs 3 at residency start (p=0.005) and more had ≥1 first-author publication at application (45.2% vs 15.0%; p=0.02). Each additional research-year publication at application was associated with higher odds of matching (OR 1.68; 95% CI, 1.19-2.82; p=0.02). Home-program status was not associated with matching (adjusted OR 1.74; 95% CI, 0.55-5.45; p=0.34).ConclusionsGreater research-year publication output, both at the time of application and at the start of residency, was associated with matching into OHNS, whereas home-program status was not.
Introduction Xerostomia is a common condition that can impair quality of life. Google and ChatGPT are increasingly used for patient education, though the readability and understandability of this information remain unclear. This study evaluated commonly asked questions about xerostomia and assessed the quality of online and AI-generated patient educational material (PEM). Methods “SEO minion” was used to identify Google People Also Ask (PAA) questions from four primary search terms. Questions were categorized using Rothwell’s classification and entered into ChatGPT. Online sources and ChatGPT responses were evaluated using the Flesch Kincaid Grade Level (FKGL), where higher scores indicate higher reading grade level; Flesch Reading Ease (FRE), where lower scores indicate more difficult readability (0 (complex) to 100 (easy)); JAMA benchmark criteria, where higher scores indicate greater source quality (0-4); and Patient Education Materials Assessment Tool (PEMAT), where higher scores indicate greater understandability (0-100). Results A total of 117 unique PAA questions were identified, most of which were value-based (55.6%) or fact-based (42.7%). Online sources had a mean JAMA score of 1.09, mean FKGL of 9.87, mean FRE of 51.37, and mean PEMAT score of 79.92. ChatGPT responses performed worse, with a mean FKGL of 15.24, mean FRE of 30.14, and mean PEMAT score of 72.33. Conclusions Both online PEM and ChatGPT responses on xerostomia exceeded recommended reading levels, with ChatGPT generating substantially less readable content. Although many materials met understandability thresholds, their elevated reading level may still limit accessibility. More readable, reliable, and patient-centered educational materials are needed.
BackgroundNasal tip surgery frequently requires the combined use of multiple grafting techniques, making communication, visualization, and operative planning complex, particularly in teaching settings. Existing descriptions of tip graft combinations are often technique-oriented and lack a unified symbolic framework for conceptual mapping.ObjectivesThis study introduces the "Da Vinci Concept," a symbolic visual framework inspired by the Vitruvian Man for representing spatial relationships among nasal tip grafts. The primary aim was to evaluate whether the framework could facilitate conceptual understanding and communication of graft configurations among surgeons. Secondary exploratory analyses assessed its feasibility in operative planning.MethodsThe study consisted of two components. First, a survey-based educational evaluation was conducted among rhinoplasty surgeons to assess interpretability and conceptual clarity of the symbolic framework. Second, a pilot clinical cohort of 30 selected primary rhinoplasty patients was retrospectively reviewed. In the Da Vinci planning group, the symbolic framework was used preoperatively to organize graft relationships and operative planning. Outcomes including operative duration and standard nasal tip measurements were explored descriptively.ResultsSurgeons participating in the educational evaluation demonstrated high interpretability of the symbolic graft representations and reported facilitated conceptual visualization of graft combinations. In the pilot clinical cohort, the framework was feasible for preoperative planning and intraoperative communication. Exploratory comparisons suggested potential workflow advantages; however, the study was not designed to establish clinical superiority between techniques.ConclusionsThe Da Vinci Concept proposes a symbolic and educational framework for visualizing nasal tip graft architecture and facilitating communication in rhinoplasty planning. Rather than representing an idealized anatomical model, the system functions as a conceptual mapping tool. Further prospective and multi-center studies are needed to validate its educational utility and potential clinical applications.
Purpose Oropharyngeal lateral wall collapse (OPLW) on drug-induced sleep endoscopy (DISE) may influence outcomes after hypoglossal nerve stimulation (HNS) for obstructive sleep apnea (OSA). This systematic review and meta-analysis evaluates whether DISE-defined OPLW collapse is associated with HNS treatment success. Methods PubMed, Embase, and Scopus were searched through February 2026. Eligible studies included adults undergoing HNS for OSA, assessed OPLW collapse using DISE, and reporting extractable postoperative outcomes. PRISMA guidelines were followed. Binary treatment success was pooled using Mantel-Haenszel random-effects models and reported as odds ratios (ORs) with 95% confidence intervals. Results Seven retrospective and prospective observational studies were included. In the primary meta-analysis of three studies comprising 502 patients, complete OPLW collapse was associated with significantly lower odds of HNS treatment success compared with non-complete collapse (OR 0.43, 95% CI 0.28 to 0.64; I 2 = 0.0%). Secondary analyses showed no significant association for any versus no OPLW collapse (OR 0.72, 95% CI 0.41 to 1.24), while complete versus no OPLW collapse remained significant (OR 0.50, 95% CI 0.27 to 0.91). Conclusion Complete DISE-defined OPLW collapse is associated with lower odds of HNS treatment success. These findings support complete OPLW collapse as an unfavorable airway phenotype that may inform preoperative counseling and patient selection.
