Functional rehabilitation of post-laryngectomy patients is a challenging task; this includes achieving optimal speech and swallowing outcomes. Botox injections are utilised to improve pharyngoesophageal segment tonicity to improve speech and swallowing outcomes. We propose a novel and efficacious technique using a portable video-laryngoscope, GlideScope®, to directly visualise the injection of botulinum toxin in total laryngectomy patients with severe radiation-induced changes.
Objectives: Salivary gland malignancies are an uncommon and heterogeneous group of cancers. We report our experience of clinicopathological variables that affect survival in patients treated by curative intent with surgery at a UK institution over a period of 15 years. Design: Retrospective cohort study Setting: Single centre study Participants We included 108 patients with malignant salivary gland tumours treated by curative intent with surgery from 2004 to 2019. Main outcome measures: The association between clinicopathological factors and their impact on overall survival (OS) and disease-free survival (DFS). Results: 77 (71.3%) presented with early pT classification and 81 (75%) of were node-negative. The parotid was the commonest site of malignancy (86, 79.6%). Perineural invasion (PNI) was present in 40 (37%) and lymphovascular invasion (LVI) was present in 20 (18.5%). 63 (58.3%) underwent adjuvant therapy. Median follow up was 36 months. Five-year OS and DFS were 81.7% and 71%. Age 50, pT classification 3-4, high tumour grade, PNI, and advanced TNM stage were all associated with worse OS and DFS, and LVI with worse DFS. There was no survival difference between a close (1-<5 mm) or negative (≥5 mm) resection margin. Conclusions: Age >50 years, advanced TNM stage, PNI and LVI are predictors of poor DFS. There was no difference in OS or DFS between patients with negative and close resection margins, indicating that close margins may be adequate for maintaining good oncologic outcomes in this group of patients.
BACKGROUND: Within a finite resource-limited national health service, a significant proportion of the cost of bariatric surgery is dependent on the length of stay of inpatients. This study was designed to investigate the factors that influence the length of post-operative stay in these patients. In particular, the effect of four common factors were explored in two bariatric procedures. METHODS: This is a retrospective study examining the length of stay in patients who underwent a laparoscopic sleeve gastrectomy (SG) and a laparoscopic Roux-En-Y gastric bypass (RNY) between July 2015 and February 2018 by a single surgeon. The significance of four factors were assessed: BMI, ASA grade, a diagnosis of diabetes and the day of the week the operation occurred. RESULTS: Median length of stay for SG patients was 2 [2,3] days. This was unaffected by our factors examined. Median length of stay for RNY was 2 [2,3] days. This was unaffected by ASA grade or a pre-existing diagnosis of diabetes. Day of the week and BMI significantly affected length of stay for RNY patients. Patients operated on a Friday stayed on average one day longer (p=0.002). Patients with a BMI over 60 stayed on average 2 days more (p=0.008) CONCLUSION: To optimise costs in the health service, more attention should be placed on when RNY and SG procedures are performed during the week. This is especially relevant when dealing with patients with high BMIs.
Otolaryngology (ENT) is a surgical speciality commonly known for its rapid advanceement and routine incorporation of newer technologies into routine clinical practice. Routine clinical integration of artificial intelligence (AI) is a field that is garnering significant interest. Within ENT, it holds a lot of potential. I will explore the use and challenges of AI in ENT by exploring case studies of particular pathologies, and look at some of its future applications.