Constantinos Bourolias

Ligasure versus Cold Knife Tonsillectomy

Objective: To assess parameters related to ligasure tonsillectomy (LT) versus cold knife tonsillectomy (CKT) procedure.

Thermal welding technology vs ligasure tonsillectomy: a comparative study

OBJECTIVE The objective of the study was to compare and assess parameters related to thermal welding tonsillectomy (TWT) vs ligasure tonsillectomy (LT). STUDY DESIGN This was a prospective randomized study. METHOD A prospective study was conducted on 143 consecutive adult patients undergoing tonsillectomy. Indications included chronic tonsillitis and obstructive sleep apnea syndrome. Patients undergoing adenoidectomy or any procedure together with tonsillectomy and patients with peritonsillar abscess history or bleeding disorders were excluded. Patients were randomly assigned to either the TWT or LT group. Intraoperative bleeding, operative time, postoperative pain using a visual analogue scale, and complication rates were evaluated. RESULTS There was no measurable intraoperative bleeding in any group. No significant difference regarding mean operative time was noted. Mean postoperative pain score was significantly lower in the TWT group. Late postoperative hemorrhage was noted in 1 subject of the TWT and 2 subjects of the LT group. Mild uvula edema was significantly lower in the TWT group. CONCLUSION Both TWT and LT procedures provide sufficient hemostasis and reduced operative time, although lower postoperative pain and mild uvula edema were noted in TWT procedures. Furthermore, since both methods use single-use instruments, they provide safety against diseases such as Creutzfeld-Jakob disease.

Lidocaine spray vs tetracaine solution for transnasal fiber-optic laryngoscopy.

STATEMENT OF PROBLEM The aim of this study was to evaluate the efficacy of lidocaine spray 10%, compared with tetracaine 2% solution, as a local anesthetic for patients undergoing transnasal fiber-optic laryngoscopy. METHOD OF STUDY A prospective study was conducted on patients undergoing transnasal fiber-optic laryngoscopy. Microsurgical sponges were applied in each side of the nose for 10 minutes before laryngoscopy. Patients were randomly classified into group A and group B, in which tetracaine 2% solution and lidocaine spray 10% were used, respectively. Patients were asked to evaluate the severity of pain during the procedure by a visual analog scale. Patients data, pain score, and potential complications were placed in a database and statistically assessed. MAIN RESULTS Our series consisted of 48 patients. Statistical analysis showed significant lower mean nasal discomfort score in favor of the tetracaine group (2.29 vs 3.04 [P < .001]). No tetracaine complications or side effects occurred. PRINCIPAL CONCLUSION Neurosurgical sponge application of tetracaine 2% solution is an easy, safe, inexpensive, and effective analgesia for transnasal fiber-optic laryngoscopy.

Diagnosis and Management of Substernal Goiter at the University of Crete

The objective of this work was to evaluate the diagnosis and management of patients with substernal goiter (SSG) on the basis of our experience. We conducted a retrospective study of all SSGs within a series of 591 thyroidectomies performed in a tertiary referral center over a period of 14 years, analyzing epidemiological data, diagnostic criteria, and surgical results. There were 37 (6%) patients with descending goiter: 28 women (mean age 57.1 years) and 9 men (mean age 61 years). All 37 patients underwent successful surgical treatment without any major postoperative complications. A postoperative histological examination revealed a 16.6% incidence of malignancy. Despite the size and close proximity to vital organs in the mediastinum, all of the SSGs were managed successfully. A neck approach was used in all except for one patient who was operated on via sternotomy. A thorough preoperative evaluation including computed tomography scan of the neck and mediastinum, and an appropriate surgical technique ensure a positive outcome for most patients with an SSG.

Epiglottis reshaping using CO2 laser: A minimally invasive technique and its potent applications

Laryngomalacia (LRM), is the most common laryngeal abnormality of the newborn, caused by a long curled epiglottis, which prolapses posteriorly. Epiglottis prolapse during inspiration (acquired laryngomalacia) is an unusual cause of airway obstruction and a rare cause of obstructive sleep apnea syndrome (OSAS).We present a minimally invasive technique where epiglottis on cadaveric larynx specimens was treated with CO2 laser. The cartilage reshaping effect induced by laser irradiation was capable of exposing the glottis opening widely. This technique could be used in selected cases of LRM and OSAS due to epiglottis prolapse as an alternative, less morbid approach.

Ectopic internal carotid artery presenting as an oropharyngeal mass

Ectopic internal carotid artery (ICA) is a very rare variation. The major congenital abnormalities of the ICA can be classified as agenesis, aplasia and hypoplasia, and they can be unilateral or bilateral. Anomalies of the neck artery may be vascular neoplasms or ectopic position. Carotid angiograms provide absolute confirmation of an aberrant carotid artery, while EcoColorDoppler (ECD) gives also important information about the evaluation of carotid vassels. Nevertheless Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) of the neck provide spatial information about the adjacent pharyngeal anatomy and are less invasive than angiogram. Injuries to the ICA during simple pharyngeal surgical procedures can be catastrophic due to the risk of massive bleeding. We report a case of a 56 year-old male patient suffering from dysphagia associated with aberrant ICA manifesting itself as a pulsative protruding of the left lateral wall of the oropharynx.

Sphenoid sinus barotrauma after free diving

We report 2 cases of a 29- and a 37-year-old male patient both having sphenoid sinus barotrauma associated with free diving at about 12-m depth. A unilateral occupation of the sphenoid sinus was revealed in both cases by computed tomography and magnetic resonance imaging examination of the paranasal sinuses.

Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite

BackgroundTraumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected.MethodsWe present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases.Results and discussionThe prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed.ConclusionThe Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation.

Anaphylactic Reactions on the Beach: A Cause for Concern?

BACKGROUND The commonest causes of anaphylaxis include hymenoptera bites, high-risk food, exercise, and jellyfish bites and may often be encountered on the beach. Therefore, millions of visitors at popular touristic locations are exposed to increased risk of anaphylactic reactions every year. At least 35 cases of acute allergic reactions requiring medical attention took place on the beaches of Crete, Greece during the previous summer. OBJECTIVE To evaluate the level of training of lifeguards working on the beaches of the island of Crete, Greece, with regard to emergency management of anaphylaxis as well as to assess the sufficiency of medical equipment that lifeguards possess to treat an anaphylactic reaction. METHODS A questionnaire was prepared by the authors and administered to 50 lifeguards working on various beaches of Crete. Queries included the definition of anaphylaxis, proper medical treatment, and the existence or not and composition of an emergency kit with regard to the management of acute allergic reactions. RESULTS Our series consisted of 50 lifeguards, 39 (78%) male and 11 female (22%). Although 41 (80%) lifeguards were aware of an acceptable definition of anaphylaxis, no one knew that epinephrine is the first-choice treatment, and 32 (60%) lifeguards replied that steroids should be used for emergency treatment. Additionally, no one possessed an emergency kit that would qualify for management of acute allergic reactions. CONCLUSIONS The beach should be considered as a high-risk place for the appearance of anaphylactic reactions. Lifeguards who would be the first trained personnel to encounter this condition should be sufficiently trained and equipped for emergency treatment. Our department is currently introducing a training program to local authorities for the proper training and equipping of lifeguards in the island of Crete.

Non-Candida albicans Candida mediastinitis of odontogenic origin in a diabetic patient

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.