OBJECTIVE:To evaluate how patient-reported outcomes vary by etiology of facial paralysis and to identify functional, esthetic, and psychosocial determinants of patient lived experience. STUDY DESIGN:Cross-sectional study. SETTING:Single-center, tertiary academic facial nerve clinic. METHODS:Adults with inflammatory, schwannoma, parotid neoplasm, or congenital facial paralysis completed FACE-Q modules, the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and a social support rating. Facial paralysis severity was graded with Sunnybrook scores. Kruskal-Wallis and Dunn's post hoc testing along with multivariable linear regression assessed associations between etiology and outcomes, adjusting for severity, duration, prior surgical procedures, emotional intelligence, and social support. RESULTS:Etiology independently shaped patient experience in multiple domains. Compared with inflammatory paralysis, parotid neoplasm was associated with worse lip appearance (β = -12.07, SE = 5.05, P = .036), speech function (β = -16.16, SE = 6.40, P = .010), and speech-related distress (β = -5.51, SE = 2.11, P = .009). Congenital paralysis was linked to lower appearance distress (β = 12.81, SE = 5.30, P = .017) and higher social functioning (β = 17.48, SE = 7.13, P = .028). Schwannoma resection had improved facial appearance (β = 7.96, SE = 3.03, P = .020) and psychological function (β = 6.83, SE = 2.89, P = .037). Across etiologies, higher baseline emotional intelligence improved appearance, psychosocial, and functional perceptions, while stronger social support mitigated speech-related distress and outcomes. CONCLUSION:Patient-reported outcomes and lived experience in facial paralysis differ meaningfully by etiology. Beyond clinical severity, a patient's emotional intelligence, social context, and underlying cause of paralysis shape personal perceptions of appearance, function, and well-being. These findings highlight the importance of etiology-specific counseling, rehabilitation, and psychosocial support to optimize recovery and quality of life.
OBJECTIVE:Tracheal resection (TR) and cricotracheal resection (CTR) are associated with anastomotic complications. Off-label use of inhaled corticosteroids has gained popularity for reducing tracheal granulation tissue, though adoption remains limited due to unclear safety and efficacy. This study used a national database to evaluate associations between postoperative inhaled steroid use and adverse effects, granulation tissue formation, and repeat surgical intervention. STUDY DESIGN:Retrospective cohort study. SETTING:Multicenter study using TriNetX, a federated electronic health records network. METHODS:Adult patients undergoing TR/CTR between March 2005 and March 2025 who received inhaled steroids (ciprofloxacin-dexamethasone, dexamethasone, budesonide, fluticasone, mometasone, and beclomethasone) within 1 day postoperatively were included. Patients were excluded if they had diagnoses commonly requiring similar medications or received study agents within 1 month before surgery. Propensity score matching balanced covariates, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcomes at 30 days and 3 months. Outcomes included adverse safety events, granulation tissue formation, and repeat airway surgery. RESULTS:The matched cohort included 284 patients in each group. Inhaled steroid use was associated with decreased odds of adverse safety side effects, granulation formation, and repeat airway surgeries at both timepoints, though only repeat procedures at 30 days reached statistical significance (OR 0.60, 95% CI 0.42-0.85). CONCLUSION:Postoperative inhaled steroid use in TR/CTR patients demonstrated excellent safety with no increased adverse events and was associated with a significant 40% reduction in the incidence of repeat surgeries within 30 days. Further studies should assess potential clinical benefits more definitively.
OBJECTIVE:Free jejunal transfers are a standard method for reconstruction after total pharyngolaryngectomy. However, the relative advantages of mechanical stapling compared to hand-sewn techniques for cervical esophagojejunal anastomosis remain unclear. This study aimed to compare postoperative outcomes between these two approaches. STUDY DESIGN:Retrospective observational study. SETTING:Tertiary academic medical center. METHODS:We performed a retrospective review on 28 patients undergoing free jejunal transfer after total pharyngolaryngectomy between 2014 and 2020. Patients were divided into a mechanical stapler group (n = 12) and a hand-sewn group (n = 16). Outcomes assessed included postoperative complications within 30 days and functional outcomes at or beyond 6 months postoperatively (mechanical stapler: n = 8; hand-sewn: n = 10). We conducted statistical analysis using Fisher's exact and Mann-Whitney U tests. RESULTS:The overall incidence of early postoperative complications was similar between groups. Median operative time was significantly shorter with mechanical stapling (437 vs 540 minutes; P = .002). Functional outcomes, including oral intake and dysphagia symptoms, showed no significant differences. Nasal regurgitation was less frequent with stapling (37.5% vs 90%; P = .043). One anastomotic stricture occurred in the stapler group and we successfully treated it with two sessions of endoscopic balloon dilatation. CONCLUSION:Mechanical stapling provides comparable functional outcomes to hand-sewn anastomosis while offering the advantage of shorter operative time. These findings support its use as a practical and efficient alternative for cervical esophagojejunal reconstruction following total pharyngolaryngectomy, particularly in settings seeking to optimize both efficiency and safety. TRIAL REGISTRATION:umin.ac.jp/ctr Identifier: UMIN000057262. LEVEL OF EVIDENCE:Ⅲ.
OBJECTIVE:To assess patient outcomes with regard to swallowing, feeding tube dependence, tracheostomy use, pain levels, and recovery metrics between transoral robotic surgery and (chemo)radiotherapy. DATA SOURCES:Medline, EMBASE, Web of Science Core Collection, and the Cochrane Library. REVIEW METHODS:A meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines through a literature search of data sources (CRD42023464144). RESULTS:Sixteen studies comprising 2185 patients were included. There were no significant differences in sex and age distribution between the transoral robotic surgery and (chemo)radiotherapy groups. Most patient demographics and disease status at baseline were comparable between the two groups. Meta-analysis of the studies found reduced gastrostomy tube usage in the transoral robotic surgery group at 6 and 12 months albeit poorer swallowing outcomes at 12 months according to the MD Anderson Dysphagia Index. Pain levels were generally lower in the transoral robotic surgery group in the long term. CONCLUSION:This review presents the most extensive examination to date of swallowing performance and recovery metrics in controlled trials of transoral robotic surgery versus (chemo)radiotherapy. Our findings show that transoral robotic surgery shows promise in managing difficult anatomical areas and low-grade tumors. However, methodological inconsistencies were noted between included studies, particularly in eligibility criteria and human papillomavirus p16 status. Consensus statements and/or guidelines on stratification and reporting of patients may aid in reducing this heterogeneity, while further randomized controlled trials may improve our understanding and guide the development of clinical guidelines on treatment choice.
The septoplasty has been an essential and longstanding operation in otolaryngological practice, however, the elevation of a mucosal flap over a mixed bony/cartilaginous spur remains a challenging prospect. The apex of a spur has very thin and friable mucosa, and tensioning during dissection places it at significant risk of injury. The septal spur pushback technique is a stepwise endoscopic approach to the dissection of large and complex septal spurs. The procedure leverages the technical advantages of the endoscope to minimise mucosal tension, thereby reducing the rate of iatrogenic laceration and subsequent complications. A series of 493 consecutive patients undergoing the septal spur pushback technique resulted in only 15 iatrogenic flap lacerations (3.0%), all less than 1 cm in length and none resulting in any mucosal defect when re‐apposed during suturing. There were no post‐operative haematomas or perforations.
