This article is devoted to a review of advances in Pharyngeal Surgery over the past 10 years. Pharyngeal Surgery is defined herein as a cluster of operative interventions designed to open or stabilize the upper airway from nasopharynx to laryngopharynx, in adult and pediatric patients with obstructive sleep apnea/sleep-disordered breathing. Interventions from 2013 to current are included, provided they are published in the peer reviewed literature and generally accepted by the International Surgical Sleep Society community. Such surgeries have been tabulated in various publications in the last decade (eg, Table 1 in 2013 MJA Perspectives 1 ).

This article is a review of advances in pharyngeal surgery over the past 10 years regarding literature, surgical technique, assessment, collaboration, and future direction in the management of adult and pediatric obstructive sleep apnea.

"Rapidly evolving frontal sinusitis-associated orbital roof subperiosteal abscess." Orbit, ahead-of-print(ahead-of-print), p. 1 Disclosure statementThe authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.

Study Objectives Polysomnography parameters measure treatment efficacy for obstructive sleep apnea (OSA), such as reduction in apnea-hypopnea index (AHI). However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery. Methods This retrospective cohort study consisted of a consecutive sample of 331 patients with OSA managed with multilevel airway surgery as second-line treatment (N = 97) or CPAP (N = 234). Therapeutic effectiveness (MDA as % change or as corrected change in AHI) was calculated as the product of therapeutic efficacy (% or absolute change in AHI) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilized to manage confounding variables. Results Surgery patients achieved greater MDA % than CPAP users (67 & PLUSMN; 30% vs. 60 & PLUSMN; 28%, p = 0.04, difference 7 & PLUSMN; 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p = 0.14, difference 8 & PLUSMN; 5%, 95% confidence interval -18% to 3%). MDA measured as corrected change in AHI showed similar results. Conclusions In adult patients with OSA, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.

Background To investigate the association between keratoconus (KC) and allergic eye diseases, eye rubbing, and atopy. Methods PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies investigating eye allergy, atopy, and eye rubbing as risk factors for KC up to April 2021. Two authors independently screened all titles and abstracts against the predefined inclusion and exclusion criteria. The study analysed the prevalence of KC and its risk factors, including eye rubbing, family history of KC, atopy, and allergic eye diseases. The National Institutes of Health Study Quality Assessment Tool was used. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). The analysis was conducted using RevMan version 5.4 software. Results The initial search yielded 573 articles. After screening, 21 studies were identified for qualitative analysis and 15 for quantitative synthesis. A significant association was found between KC and eye rubbing (OR = 5.22, 95% CI [2.80, 9.75], p < 0.00001), family history of KC (OR = 6.67, 95% CI [4.77, 9.33], p < 0.00001), and allergies (OR = 2.21, 95% CI [1.57, 3.13], p < 0.00001). However, no significant association was found between KC and allergic eye disease (OR = 1.82, 95% CI [0.37, 8.97], p = 0.46), atopy (OR = 1.54, 95% CI [0.58, 4.09], p = 0.39), allergic rhinitis (OR = 0.85, 95% CI [0.54, 1.33], p = 0.47), smoking (OR = 0.96, 95% CI [0.76, 1.21], p = 0.73), and asthma (OR = 1.58, 95% CI [0.99, 2.53], p = 0.05). Conclusion Significant associations were observed between KC and eye rubbing, family history, and allergy, but not with allergic eye disease, atopy, asthma, and allergic rhinitis.

Objective: To evaluate whether prolonged operative time is negatively associated with post-operative complications and length of stay in patients undergoing microvascular free flap reconstruction for complex head and neck defects. Methods: 342 consecutive patients undergoing microvascular reconstruction for head and neck defects between 2017-2019 at a single institution were evaluated. Operative outcomes and operative time were compared whilst controlling for patient and treatment related factors. Results: Mean operative time was 551 minutes and length of stay was 16.2 days. An 11% increase in the risk of a post-operative complication was observed for every additional hour of operative time (OR 1.11, 95%CI 1.03 – 1.21, p=0.011) after adjusting for patient and treatment factors. A cut-off of 9 hours yielded a 92% increase in complications on either side of this (OR 1.92, 95%CI 1.18 – 3.13, p=0.009). Increased operative time was also associated with increased length of stay and return to theatres, but not medical complications. Conclusion: Prolonged operative time is significantly associated with increase surgical complications, length of stay and return to theatres when performing microvascular reconstructive surgery for head and neck defects. Keywords : free flap, microsurgery, operative time, length of hospital stay, complication rate, head and neck surgery Key points : 1. This study analyzed a contemporary cohort over a relatively short period where outcomes can reliably be recorded and verified 2. This is the first Australian study that demonstrated operative time as it relates to surgical technique, comparing pedicled and free flaps and also stratified by flap type, oncological resection, or comorbidity 3. Operations more than 9 hours duration were associated with an 89% increase in the odds of developing a surgical complication 4. Prolonged operative time was also significantly associated with length of stay and return to theatres 5. Future studies are needed to investigate associations with each component of operative time element separately in a multi institutional design

Microvascular free‐flap reconstruction of the head and neck is a common technique utilized across many ages. The purpose of this study was to identify if advanced age or comorbidity was associated with worse post‐operative outcomes in patients undergoing free‐flap reconstruction.

AbstractObjectiveTo describe transient and permanent hypocalcaemia following partial and total pharyngolaryngectomy with parathyroid gland preservation or autotransplantation.MethodsThirty patients underwent partial or total pharyngolaryngectomy by a single surgeon during the period 2009‐2020. Intraoperative parathyroid gland preservation or autotransplantation (where the gland appeared devascularized) was routinely performed. Calcium levels performed on day 1, 3 months, and at 12 months postoperatively were collected. Rates of transient and permanent hypocalcaemia were calculated.ResultsA total of 13% of patients had transient hypocalcaemia, and 10% permanent hypocalcaemia. Rates of transient and permanent hypocalcaemia in total pharyngolaryngectomy were 14% and 14%, respectively. Partial pharyngectomy hypocalcaemia rates were 13% for transient and 0% for permanent. The majority of patients underwent salvage surgery for oncological resection, often following radiotherapy (63%). Ipsilateral hemithyroidectomy was preferred to total (57% vs 7%), with high rates of concurrent neck dissection (67%) and reconstruction (87%).ConclusionThis data supports preservation or autotransplantation of parathyroid glands as a means of reducing permanent postoperative hypocalcaemia.Level of EvidenceLevel IV, case series, retrospective.

BACKGROUND:Head and neck surgeons are moving away from routine tracheostomy in free-flap reconstruction. We reviewed prophylactic tracheostomy use in patients undergoing oral cavity or oropharynx free-flap reconstruction to identify patient groups who avoided tracheostomy. Secondary aims were to describe complications associated with and without tracheostomy.METHODS:A retrospective cohort study was undertaken, using a prospectively maintained database. Inclusion criteria was free-flap reconstruction for an oral cavity or oropharyngeal defect, excluding partial or total laryngectomy. Variables collected included demographics, comorbidity, American Society of Anesthesiologists grade, Charlson Comorbidity Index, tumour site and subsite, extent of resection, surgery duration, tracheostomy, complications, return to theatre and re-intubation.RESULTS:A total of 344 head and neck free-flap reconstructions were performed between January 2017 and July 2019. A total of 164 (87.7%) oral cavity and 23 (12.3%) oropharyngeal reconstructions were included totalling 187 free flaps. A total of 107 (57.2%) were males and 80 (42.8%) females, mean age 62.4 years (range 21-89). Of 187 patients, 100 (53.5%) underwent prophylactic tracheostomy at time of reconstruction. Longer operative time (P < 0.001), resection site (P < 0.001), number of subsites resected (P = 0.007), segmental mandibulectomy (P = 0.04), lip-split (P = 0.05), floor of mouth resection (P < 0.001), lingual release (P = 0.007), glossectomy (P < 0.001), extent of tongue resection (P < 0.001), extent of hard palate resection (P = 0.04), soft palate resection (P < 0.001) and double free-flap reconstruction (P = 0.04) were associated with tracheostomy use.CONCLUSION:A personalized approach to postoperative airway management allowed almost half of our cohort to avoid tracheostomy. In high-volume institutions with the necessary expertise and support, appropriately selected patients may be safely managed without routine tracheostomy.

Purpose: Oral and maxillofacial surgery (OMS) has an expansive scope, with myriad diagnoses treated by practicing surgeons. Patients and referring providers are increasingly turning to Web-based sources to find information about clinical conditions before consultations or in conjunction with ongoing care. The purpose of this study was to examine the current trends of public interest of OMS procedures as assessed by online search trends. Materials and Methods: A cross-sectional study of Internet search data obtained via Google Trends (GT; Alphabet, Mountain View, CA) was conducted. Data were collected using GT for OMS-related search terms between January 2004 and May 2019. The search terms used in the analysis were "wisdom teeth,'' "TMJ,'' "dental implants,'' "jaw surgery,'' "jaw fracture,'' "facial trauma,'' and "facial cosmetic surgery,'' defined to be the core surgical aspects of OMS based on public awareness campaigns sponsored by the American Association of Oral and Maxillofacial Surgeons. Relative search volumes, trends over time, geographic trends, and seasonal trends were analyzed. For all analyses, P <= .05 was considered significant. Results: Overall search volume trends for OMS procedures showed an increase over time, with seasonal and geographic trends. "Wisdom teeth'' was the most searched termand had the greatest increase in search volume over time. "Facial trauma'' was the least searched term, with no appreciable trend over time. Geographic search volume was greatest in the United States. Seasonal changes were most apparent with searches for "wisdom teeth'' and "jaw surgery.'' Conclusions: Analysis of GT data shows substantial interest in core OMS procedures, with seasonal variations noted for certain areas of practice (third molars and jaw surgery) and consistent interest in other areas (facial cosmetic surgery, dental implant reconstruction, and temporomandibular disorders). The use of GT data may be a powerful tool for predicting demand for OMS services and for public education campaigns. (C) 2020 American Association of Oral and Maxillofacial Surgeons

James Every ,*† Narayana Subramaniam ,* Rebecca Dawson,* Sydney Ch’ng,* Tsu-Hui (Hubert) Low,*† Carsten E. Palme,* Jonathan Clark*†‡ and James Wykes* *Department of Head and Neck Surgery, Chris O’Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia †Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia and ‡Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia