Epidemiology and Histopathology of Cancers of the Upper Aerodigestive Tract in the ENT and Head and Neck Surgery Department of the Ignace Deen National Hospital

Introduction: Head and neck cancers represent a significant burden of cancer, collectively ranking fourth for cancer incidence and second for cancer mortality worldwide. Objective: To study the epidemiological and histopathological aspects of head and neck cancers in the ENT-CCF department of Ignace Deen National Hospital. Materials and Methods: This was a descriptive retrospective study covering a period of 5 years from September 1, 2016, to September 30, 2021. Results: We collected 43 cases of head and neck cancers, representing a hospital frequency of 1.85%. The mean age was 45.21 ± 13.23 years. Males predominated, accounting for 65.12%, compared to 34.88% for females, with a male-to-female ratio of 1.87. Housewives accounted for 27.90%, followed by farmers at 23.26% and traders/merchants at 18.60%, with 41.86% being uneducated. The main risk factors were tobacco (37.21%) and alcohol (34.88%). Pain (53.49%), dysphonia (51.16%), and dyspnea (39.53%) were the main presenting symptoms. Squamous cell carcinoma (74.42%) and large cell lymphoma (18.60%) were the most commonly cited histological types. Conclusion: Head and neck cancers remain relatively common in our country. Improving prognosis depends on early diagnosis of the condition, resuscitation resources, and prompt management.

Re-expression of DIRAS3 and P53 induces apoptosis and impaired autophagy in head and neck squamous cell carcinoma

Background:p53 and DIRAS3 are tumor suppressors that are frequently silenced in tumors.In this study,we sought to determine whether the concurrent re-expression of p53 and DIRAS3 could effectively induce head and neck squamous cell carcinoma(HNSCC)cell death.Methods:CAL-27 and SCC-25 cells were treated with Ad-DIRAS3 and rAd-p53 to induce re-expression of DIRAS3 and p53 respectively.The effects of DIRAS3 and p53 re-expression on the growth and apoptosis of HNSCC cells were examined by TUNEL assay,flow cytometric analysis and MTT.The effects of DIRAS3 and p53 re-expression on Akt phosphorylation,oncogene expression,and the interaction of 4 E-BP1 with eIF4 E were determined by real-time PCR,Western blotting and immunoprecipitation analysis.The ability of DIRAS3 and p53 re-expression to induce autophagy was evaluated by transmission electron microscopy,LC3 fluorescence microscopy and Western blotting.The effects of DIRAS3 and p53 re-expression on HNSCC growth were evaluated by using an orthotopic xenograft mouse model.Results:TUNEL assay and flow cytometric analysis showed that the concurrent re-expression of DIRAS3 and p53 significantly induced apoptosis(P<0.001).MTT and flow cytometric analysis revealed that DIRAS3 and p53 reexpression significantly inhibited proliferation and induced cell cycle arrest(P<0.001).Mechanistically,the concurrent re-expression of DIRAS3 and p53 down-regulated signal transducer and activation of transcription 3(STAT3)and upregulated p21WAF1/CIP1 and Bax(P<0.001).DIRAS3 and p53 re-expression also inhibited Akt phosphorylation,increased the interaction of eIF4 E with 4 E-BP1,and reduced the expression of c-Myc,cyclin D1,vascular endothelial growth factor(VEGF),fibroblast growth factor(FGF),epidermal growth factor receptor(EGFR)and Bcl-2(P<0.001).Moreover,the concurrent re-expression of DIRAS3 and p53 increased the percentage of cells with GFP-LC3 puncta compared with that in cells treated with control adenovirus(50.00%±4.55%vs.4.67%±1.25%,P<0.001).LC3 fluorescence microscopy and Western blotting further showed that DIRAS3 and p53 re-expression significantly promoted autophagic activity but also inhibited autophagic flux,resulting in overall impaired autophagy.Finally,the concurrent re-expression of DIRAS3 and p53 significantly decreased the tumor volume compared with the control group in a HNSCC xenograft mouse model[(3.12±0.75)mm^(3) vs.(189.02±17.54)mm^(3),P<0.001].Conclusions:The concurrent re-expression of DIRAS3 and p53 is a more effective approach to HNSCC treatment than current treatment strategies.

Inhibitory effect of saffron on head and neck squamous cell carcinoma via targeting of ESR1 and CCND1 by its active compound crocetin

Background:Traditional Chinese medicine is promising for managing challenging and complex disorders,including cancer,and in particular,saffron is applied in treating various cancer types.However,its potential therapeutic efficacy and active components in managing squamous cell carcinoma of the head and neck(HNSCC)remain unclear yet.Methods:Using network pharmacology approaches,active ingredients of saffron,their target genes,and HNSCC-related genes were identified.Enrichment analyses were conducted for determining molecular functions and pathways enriched by genes that overlapped between the saffron target gene set and the HNSCC gene set.Among the four known active ingredients of saffron,crocetin was found to have the strongest inhibitory impact on HNSCC,based on the findings of cell viability and migration assays.Therefore,the potential target genes of crocetin in HNSCC cells were examined using molecular docking experiments and were confirmed by qPCR.Result s:Four active ingredients of saffron and 184 of their target genes were identified.Further,a total of 34 overlapping saffron-/HNSCC-associated targets related to the four active ingredients were screened,and crocetin was chosen for further investigation because it had the strongest inhibitory effect on HNSCC cells.Molecular docking experiments indicated that ESR1 and CCND1 were the target genes of crocetin.These results were confirmed through qPCR analysis,in which crocetin was found to lower the expression of the ESR1 and CCND1 genes in AMC-HN-8 and FaDu cells.Conclusion:According to our results,crocetin is a primary active anti-cancer component of saffron that may have potential in the development of novel HNSCC-treating medications.However,more thorough molecular research is necessary for confirming these results and elucidating the anti-cancer mechanism underlying saffron.

Overview of ectopic pancreas

This editorial discusses the article written by Zheng et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery.Our primary focus is on the causes,location,diagnosis,histological classification,and therapy of ectopic pancreas.Ectopic pancreas refers to the presence of pancreatic tissue that is situated in a location outside its usual anatomical placement,and is not connected to the normal pancreas in terms of blood supply or anatomical struc-ture.Currently,the embryological origin of ectopic pancreas remains uncertain.The most prevalent form of ectopic pancreatic is gastric ectopic pancreas.Endoscopic ultrasonography examination can visualize the morphological charac-teristics of the ectopic pancreatic lesion and pinpoint its anatomical location.The histological categorization of ectopic pancreas evolves.Endoscopic treatment has been widely advocated in ectopic pancreas.

CES1 is associated with cisplatin resistance and poor prognosis of head and neck squamous cell carcinoma

Background:Head and neck squamous cell carcinoma(HNSCC)is a prevalent form of cancer globally,with chemoresistance posing a major challenge in treatment outcomes.The efficacy of the commonly used chemotherapeutic agent,cisplatin,is diminished in patients with poor prognoses.Methods:Various bioinformatics databases were utilized to examine Carboxylesterase 1(CES1)gene expression,clinicopathologic features,patient survival analysis,and gene function.An organoid model of HNSCC was established,along with the induction of drug-resistant HNSCC in the organoid model.CES1 expression was assessed using qRT-PCR and Western Blot,and differential markers were identified through transcriptome sequencing.Knockdown and overexpression models of CES1 were created in SCC-9 and patient-derived organoid(PDO)cells using shRNA and lentivirus to investigate the tumor biology and cisplatin resistance associated with CES1.Results:Research in bioinformatics has uncovered a strong correlation between the expression level of CES1 and the prognosis of HNSCC.The data suggests a significant link between CES1 expression and tobacco smoking.RNA-sequencing revealed a notable increase in CES1 expression in HNSCC-PDOcis-R cells compared to the parental PDO cells.Subsequently,we performed in vitro studies by HNSCC-PDO and SCC-9 and found that CES1-overexpressing cells exhibited reduced sensitivity to cisplatin and stronger tumor malignant biological behavior compared with CES1-knockdown cells.Conclusion:The observed association between CES1 expression and tobacco smoking implies a potential influence of smoking on the efficacy of cisplatin-based chemotherapy in HNSCC through the regulation of CES1 expression.

Comparing saccades in Visually Enhanced Vestibular-Ocular Reflex and video head impulse test in vestibular assessment

Objective:This study aimed to develop and evaluate a novel software tool for robust analysis of the Visually Enhanced Vestibular-Ocular Reflex(VVOR)and video head impulse test(vHIT)saccades.Methods:A retrospective study was conducted on 94 patients with Meniere’s Disease(MD),unilateral vestibular hypofunction(UVH),and vestibular migraine(VM).The MATLAB-based VVOR Analysis System and Saccades All in One software were utilized for data processing.New techniques,VVOR_diff and VVOR_cycle,were deployed for saccade parameter extraction.Results:Saccade incidence rates,examined through vHIT,VVOR_diff,and VVOR_cycle,exhibited distinct patterns in MD,UVH,and VM patients.Frequent instances of multiple saccades within a single cycle were noted on the affected side in MD and UVH patients.Statistically significant differences in saccade gain and incidence rates between the affected and unaffected sides were evident in MD and UVH patients.Notably,high inter-method and intra-method correlations suggested consistency across different methods and potential interactions within one.Conclusion:The software proved effective in extracting saccades and reducing noise in VVOR data,thereby enhancing the evaluation of vestibular function and potentially improving diagnostic accuracy for vestibular disorders.

Histopathological Patterns and Early Postoperative Complications among Patients with Surgically Treated Thyroid Diseases at Bugando Medical Centre, Mwanza, Tanzania

Background: Thyroid diseases are among the leading endocrine disorders affecting a large proportion of people worldwide and show geographical variation in incidence and histopathological pattern related to age, sex, dietary and environmental factors. Histopathological patterns of surgically treated thyroid diseases play an important role in early diagnosis and management of these diseases. There is, however, limited published data regarding histopathological reports on thyroid disease in our local setting. This study aimed to determine the histopathological patterns and highlight early postoperative complications among patients with surgically treated thyroid diseases at Bugando Medical Centre (BMC). Methods: This was a longitudinal study involving all patients with surgically treated thyroid diseases seen at BMC over a period of 6 months from October 2019 to March 2020. Results: A total of 84 patients were studied. Females outnumbered males by a female to male ratio of 11:1. The median age of patients was 44 [IQR, 35 - 54] years old, the youngest was 14 years old and the oldest was 76 years old. Colloid goiter was the most common non-neoplastic lesion accounting for 34 (44.7%) patients. Among the neoplastic lesions, follicular adenoma was the most commonly encountered benign pathologies (n = 16;21.1%), while papillary carcinoma was the most commonly encountered malignancy (n = 4;50%). Following thyroidectomy, 12 (14.3%) patients developed early complications, of which hemorrhage sometimes requiring blood transfusion was the leading intra/postoperative complications accounting for 4 (33.3%) patients. Other complications include temporary recurrent laryngeal nerve palsy 2 (16.7%), surgical site infection 2 (16.7%) and tracheomalacia, bronchospasm, thyroid abscess and respiratory obstruction in 1 (8.3%) patient each, respectively. In this study, malignant thyroid lesion (p Conclusion: This study demonstrated that colloid goiter was the most common non-neoplastic lesion, and on the neoplastic category, follicular adenoma was the most common benign lesion, while papillary carcinoma was the most frequent malignant lesion.

Role of TSH Inhibition Therapy in the Postoperative Management of Patients with Differentiated Thyroid Cancer

Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were selected for the study.TSH inhibition therapy was administered to the research group,while thyroxine replacement therapy was provided to the control group during the postoperative management phase.This allowed for a comparative analysis between the two groups.Results:In comparison with the control group,the research group exhibited significant decreases in serum TSH,T3,and T4 levels after treatment,while FT4 and FT3 levels significantly increased(P<0.05).Additionally,significant decreases in Tg,VEGF,TSGF,CD44V6,and sIL-2R levels were observed in the research group after treatment(P<0.05).No significant differences were found in pre-treatment thyroid function between the two groups(P>0.05).Conclusion:The application of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer demonstrates promising outcomes.

Inhibition of the NLRP3 inflammasome attenuates spiral ganglion neuron degeneration in aminoglycoside-induced hearing loss

Aminoglycosides are a widely used class of antibacterials renowned for their effectiveness and broad antimicrobial spectrum.However,their use leads to irreversible hearing damage by causing apoptosis of hair cells as their direct target.In addition,the hearing damage caused by aminoglycosides involves damage of spiral ganglion neurons upon exposure.To investigate the mechanisms underlying spiral ganglion neuron degeneration induced by aminoglycosides,we used a C57BL/6J mouse model treated with kanamycin.We found that the mice exhibited auditory deficits following the acute loss of outer hair cells.Spiral ganglion neurons displayed hallmarks of pyroptosis and exhibited progressive degeneration over time.Transcriptomic profiling of these neurons showed significant upregulation of genes associated with inflammation and immune response,particularly those related to the NLRP3 inflammasome.Activation of the canonical pyroptotic pathway in spiral ganglion neurons was observed,accompanied by infiltration of macrophages and the release of proinflammatory cytokines.Pharmacological intervention targeting NLRP3 using Mcc950 and genetic intervention using NLRP3 knockout ameliorated spiral ganglion neuron degeneration in the injury model.These findings suggest that NLRP3 inflammasome-mediated pyroptosis plays a role in aminoglycoside-induced spiral ganglion neuron degeneration.Inhibition of this pathway may offer a potential therapeutic strategy for treating sensorineural hearing loss by reducing spiral ganglion neuron degeneration.

Tranylcypromine upregulates Sestrin 2 expression to ameliorate NLRP3-related noise-induced hearing loss

Noise-induced hearing loss is the primary non-genetic factor contributing to auditory dysfunction.However,there are currently no effective pharmacological interventions for patients with noise-induced hearing loss.Here,we present evidence suggesting that the lysine-specific demethylase 1 inhibitor–tranylcypromine is an otoprotective agent that could be used to treat noise-induced hearing loss,and elucidate its underlying regulatory mechanisms.We established a mouse model of permanent threshold shift hearing loss by exposing the mice to white broadband noise at a sound pressure level of 120 d B for 4 hours.We found that tranylcypromine treatment led to the upregulation of Sestrin2(SESN2)and activation of the autophagy markers light chain 3B and lysosome-associated membrane glycoprotein 1 in the cochleae of mice treated with tranylcypromine.The noise exposure group treated with tranylcypromine showed significantly lower average auditory brainstem response hearing thresholds at click,4,8,and 16 k Hz frequencies compared with the noise exposure group treated with saline.These findings indicate that tranylcypromine treatment resulted in increased SESN2,light chain 3B,and lysosome-associated membrane glycoprotein 1 expression after noise exposure,leading to a reduction in levels of 4-hydroxynonenal and cleaved caspase-3,thereby reducing noise-induced hair cell loss.Additionally,immunoblot analysis demonstrated that treatment with tranylcypromine upregulated SESN2 expression via the autophagy pathway.Tranylcypromine treatment also reduced the production of NOD-like receptor family pyrin domaincontaining 3(NLRP3)production.In conclusion,our results showed that tranylcypromine treatment ameliorated cochlear inflammation by promoting the expression of SESN2,which induced autophagy,thereby restricting NLRP3-related inflammasome signaling,alleviating cochlear hair cell loss,and protecting hearing function.These findings suggest that inhibiting lysine-specific demethylase 1 is a potential therapeutic strategy for preventing hair cell loss and noise-induced hearing loss.

Fatal complications in a patient with severe multi-space infections in the oral and maxillofacial head and neck regions: A case report

BACKGROUND Odontogenic infection is one of the common infectious diseases in oral and maxillofacial head and neck regions.Clinically,if early odontogenic infections such as acute periapical periodontitis,alveolar abscess,and pericoronitis of wisdom teeth are not treated timely,effectively and correctly,the infected tissue may spread up to the skull and brain,down to the thoracic cavity,abdominal cavity and other areas through the natural potential fascial space in the oral and maxillofacial head and neck.Severe multi-space infections are formed and can eventually lead to life-threatening complications(LTCs),such as intracranial infection,pleural effusion,empyema,sepsis and even death.CASE SUMMARY We report a rare case of death in a 41-year-old man with severe odontogenic multi-space infections in the oral and maxillofacial head and neck regions.One week before admission,due to pain in the right lower posterior teeth,the patient placed a cigarette butt dipped in the pesticide"Miehailin"into the"dental cavity"to relieve the pain.Within a week,the infection gradually spread bilaterally to the floor of the mouth,submandibular space,neck,chest,waist,back,temporal and other areas.The patient had difficulty breathing,swallowing and eating,and was transferred to our hospital as an emergency admission.Following admission,oral and maxillofacial surgeons immediately organized consultations with doctors in otolaryngology,thoracic surgery,general surgery,hematology,anesthesia and the intensive care unit to assist with treatment.The patient was treated with the highest level of antibiotics(vancomycin)and extensive abscess incision and drainage in the oral,maxillofacial,head and neck,chest and back regions.Unfortunately,the patient died of septic shock and multiple organ failure on the third day after admission.CONCLUSION Odontogenic infection can cause serious multi-space infections in the oral and maxillofacial head and neck regions,which can result in multiple LTCs.The management and treatment of LTCs such as multi-space infections should be multidisciplinary led by oral and maxillofacial surgeons.

Clinical applications of free medial tibial flap with posterior tibial artery for head and neck reconstruction after tumor resection

Tumor resection causes damage in the head and neck which creates problems in swallowing, chewing, articulation, and vision, all of which seriously affect patients' quality of life. In this work, we evaluated the application of a free medial tibial flap in reconstruction of head and neck defects after tumor resection. We discussed the anatomy, surgical technique, and the advantages and disadvantages of the flap. We found several benefits for the flap, such as, it is especially effective for the defects that require thin-layer epithelium to cover or the separated soft tissue defect; a two-team approach can be used because the donor site is far away from the head and neck; and the flap is easy to integrate because of the subcutaneous fat layer of the free medial tibial flap is thin and the flap is soft. Thus, the medial tibial flap could replace the forearm flap for certain applications.

Basic C Experimental Study on Cheng Zai Wan for Treatment of Necrosis of the Femoral Head

Cheng Zai Wan (承载丸), a Chinese herbal preparation was administrated in the two-leg rat model of asepticnecrosis of the femoral head established by taking prednisone acetate for a long period and the osteoporosismodel rat by castration in order to explore the effects of the prescription on necrosis of the femoral head. Theresults showed that after treatment, the pitting on the surface of the femoral head disappeared, the reticularstructure with filling cells was restored; the fat droplets in bone cells or cartilage cells of the femoral headwere significantly reduced; sparse capillaries were improved, density and width of the bone trabecula wereincreased somewhat; bone mineral density, bone weight, bone strength and rigidity were significantlyincreased; and the low level of estrin was improved. It is suggested that Cheng Zai Wan has definitetherapeutic effects on aseptic necrosis of the femoral head.

Clinical impact of surveillance for head and neck cancer in patients with esophageal squamous cell carcinoma

To evaluate the clinical impact of surveillance for head and neck (HN) region with narrow band imaging (NBI) in patients with esophageal squamous cell carcinoma (ESCC).METHODSSince 2006, we introduced the surveillance for HN region using NBI for all patients with ESCC before treatment, and each follow-up. The patients with newly diagnosed stage I to III ESCC were enrolled and classified into two groups as follows: Group A (no surveillance for HN region); between 1992 and 2000), and Group B (surveillance for HN region with NBI; between 2006 and 2008). We comparatively evaluated the detection rate of superficial head and neck squamous cell carcinoma (HNSCC), and the serious events due to metachronous advanced HNSCC during the follow-up.RESULTSA total 561 patients (group A: 254, group B: 307) were enrolled. Synchronous superficial HNSCC was detected in 1 patient (0.3%) in group A, and in 12 (3.9%) in group B (P = 0.008). During the follow up period, metachronous HNSCC were detected in 10 patients (3.9%) in group A and in 30 patients (9.8%) in group B (P = 0.008). All metachronous lesions in group B were early stage, and 26 patients underwent local resection, however, 6 of 10 patients (60%) in group A lost their laryngeal function and died with metachronous HNSCC.CONCLUSIONSurveillance for the HN region by using NBI endoscopy increase the detection rate of early HNSCC in patients with ESCC, and led to decrease serious events related to advanced metachronous HNSCC.

Postoperation of preauricular fistula cellulitis caused by methicillin-resistant staphylococcus aureus infection

A one-year-old baby girl with one-month history of recurrent pus fluid exuding from her left preauricular sinus orifice, who failed multiple courses of surgical drainage of the abscess and persistent debridement for the wound, presented with MRSA infection. The patient was treated with linezolid for three days. Her pain and paresthesia resolved, and C-reactive protein decreased to normal.

A possible objective test to detect benign paroxysmal positional vertigo. The role of the caloric and video-head impulse tests in the diagnosis

Background:Benign paroxysmal positional vertigo(BPPV)is characterized by vertigo lasting from seconds to minutes,induced by head movements.Objectives:Our study aimed to investigate the clinical significance of the caloric vestibular and video head-impulse tests(vHIT)diagnosing the disorder.Methods:68 patients suffering from posterior canal BPPV(25 male,43 females,mean age±SD,54.5±13.2 years)and 56 patients with a normal functioning vestibular system as control were investigated.Bithermal caloric test and vHIT was performed during the same medical check-up.Canal paresis(CP%),gain(GA)and asymmetry(GA%)parameters were calculated.Results:The Dix-Hallpike manoeuvre was only positive in 4%of this population.The CP%parameter was only pathologic in two patients,and there was no significant difference between control and BPPV patients(p=0.76).The GA value was never under 0.8 in this population,but GA%was abnormal in 63.2%.A significant difference comparing the GA%values to the control group was seen(p=0.034).There was no correlation detected between the CP%and GA%values in BPPV.Regarding the GA%value,61%sensitivity and 76%specificity was seen.Conclusion:The Dix-Hallpike manoeuvre was not often positive in the non-acute phase of BPPV;therefore,objective testing is essential.The caloric test does not have clinical significance in BPPV,but vHIT can be helpful based on the GA%parameter。

Postoperative secondary aggravation of obstructive sleep apneahypopnea syndrome and hypoxemia with bilateral carotid body tumor:A case report

BACKGROUND Carotid body tumor(CBT)is a chemoreceptor tumor located in the carotid body,accounting for approximately 0.22%of head and neck tumors.Surgery is the main treatment method for the disease.CASE SUMMARY We reviewed the diagnosis and treatment of one patient who had postoperative secondary aggravation of obstructive sleep apnea–hypopnea syndrome(OSAHS)and hypoxia after surgical resection of bilateral CBTs.This patient was admitted,and relevant laboratory and imaging examinations,and polysomnography(PSG)were performed.After the definitive diagnosis,continuous positive airway pressure(CPAP)treatment was given,which achieved good efficacy.CONCLUSION This case suggested that aggravation of OSAHS and hypoxemia is possibly caused by the postoperative complications after bilateral CBTs,and diagnosis by PSG and CPAP treatment are helpful for this patient.

Role of ^(18)F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma

Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced disease(typically stage Ⅲ and Ⅳ) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Somepatients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography(CT) or magnetic resonance imaging(MRI). 18F-2-fluoro-2-deoxyD-glucose positron emission tomography/CT(18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning.

Postoperative surgical site infection in cholesteatoma surgery with and without mastoid obliteration, what can we learn?

Introduction:This study aims to describe the occurrence of postoperative complications related to cholesteatoma surgery and to determine factors influencing the most common complication,i.e.postoperative surgical site infection(SSI)in cases with and without mastoid obliteration.Materials and methods:Retrospective analyses were performed on surgically treated cholesteatomas in our hospital between 2013 and 2019.Patient characteristics,peri-and postoperative management and complications were reviewed.The cases were divided into two groups based on whether mastoid obliteration was performed or not.Results:A total of 336 cholesteatoma operations were performed,of which 248 cases received mastoid obliteration.In total 21 complications were observed,of which SSI was the most common(15/21).No difference in occurrence of any postoperative complication was seen between the obliteration and noobliteration group(p=0.798),especially not in the number of SSI(p=0.520).Perioperative and/or postoperative prophylactic antibiotics were not associated to the development of an SSI in both groups.In the no-obliteration group a younger age(p=0.015),as well as primary surgery(p=0.022)increased the risk for SSI.In the obliteration group the use of bioactive glass(BAG)S53P4 was identified as independent predictor of SSI(p=0.008,OR 5.940).Discussion:SSI is the most common postoperative complication in cholesteatoma surgery.The causes of SSI are multifactorial,therefore further prospective research is needed to answer which factors can prevent the development of an SSI in cholesteatoma surgery.