Kornkiat Snidvongs

Background: The optimal surgical management of high‐grade parotid carcinoma confined to the superficial lobe remains controversial, with limited evidence comparing total and superficial parotidectomy in this setting. Objective: To compare oncologic outcomes and complications between total parotidectomy with postoperative radiotherapy (TP + PORT) and superficial parotidectomy with postoperative radiotherapy (SP + PORT). Study Design: Multicentre retrospective cohort study. Methods: Adult patients (> 18 years) with high‐grade parotid carcinoma confined to the superficial lobe treated between 2011 and 2023 were identified at tertiary centres. Exclusion criteria included preoperative facial nerve palsy, metastatic disease to the parotid gland, prior head and neck radiotherapy, receipt of concurrent chemoradiation and follow‐up < 12 months. Results: A total of 108 patients were included (TP + PORT, n = 63; SP + PORT, n = 45) with a median follow‐up of 53 months. Baseline characteristics were comparable except for older age and a higher proportion of Milan category VI cytology in the TP + PORT group ( p < 0.05). Local, regional and distant recurrence rates and mortality did not differ significantly between groups ( p = 0.55, 0.26, 1.00 and 0.36, respectively). All local recurrences occurred within 24 months (mean: 7.2 months). Age and positive resection margins were independent predictors of mortality ( p < 0.01). Five‐year overall survival was 73.0% in the TP + PORT group and 81.5% in the SP + PORT group. IPTW‐adjusted analyses confirmed no significant differences in recurrence or mortality between groups (hazard ratio for mortality, 0.78; 95% CI: 0.32–1.90; p = 0.59). Permanent facial nerve palsy was significantly more common after TP + PORT (14.3% vs. 2.2%, p < 0.001), while other complications were similar. Conclusion: Superficial parotidectomy with adequate margins followed by PORT achieves comparable oncologic outcomes with significantly fewer complications and may be preferred for high‐grade parotid carcinoma confined to the superficial lobe. Level of Evidence: 2d (JBI).

Objective: Preoperative systemic corticosteroids are frequently used in chronic rhinosinusitis with nasal polyps (CRSwNP). This meta‐analysis aimed to evaluate the effect of preoperative systemic steroids on tissue eosinophil count (TEC) in CRSwNP. Data Sources: PubMed, EMBASE, and Cochrane Library. Review Methods: Systematic searches were conducted through March 2026 for studies assessing TEC following preoperative systemic steroids in adult CRSwNP patients. Eligible designs included randomized controlled trials, cohort studies, and pre‐post studies. TEC was reported as cells per high‐power field (TEC/HPF) or as a percentage of eosinophils among inflammatory cells (%TEC). Pooled mean differences (MD) were calculated using random‐effects models. Results: Seventeen studies (930 participants) were included, of which 13 were eligible for quantitative synthesis. Systemic steroids significantly reduced TEC/HPF (MD −36.57; 95% CI: −43.94 to −29.20) and %TEC (MD −18.14; 95% CI: −24.88 to −11.39). Reductions were consistent across steroid dose, duration, and concomitant intranasal steroid use. However, low dose (4.2–18.6 mg/day) given in ≤ 7‐day regimens showed a non‐significant reduction (MD −17.78; 95% CI: −62.62 to 27.05). Adverse events were not statistically different between the steroid and control groups (5.60% vs. 1.12%, odds ratio = 5.22, p = 0.12). No adverse events were reported in studies using low‐dose or tapering regimens. Conclusion: Preoperative systemic corticosteroids significantly reduce TEC in CRSwNP, regardless of the quantifying method. This effect may interfere with histologic assessment when biopsy is taken intraoperatively. To avoid misinterpretation, clinicians may consider either withholding preoperative systemic corticosteroids, using a less suppressive regimen, or obtaining a biopsy prior to steroid initiation. Level of Evidence: N/A.

Objective: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disorder of the upper airway that drives substantial healthcare burden and impairs health‐related quality of life (HRQoL). This study aimed to translate and validate the Vietnamese version of the 22‐item Sinonasal Outcome Test (SNOT‐22), a widely used patient‐reported outcome measure for CRS. Study Design: Prospective cohort study. Setting: Tertiary academic center. Methods: The SNOT‐22 was translated following a standardized forward‐backward procedure. Reliability, validity, and responsiveness were assessed in 110 participants (69 CRS patients, 31 controls). Among 52 surgical patients, questionnaires were administered preoperatively and at 1, 3, and 6 months postoperatively. Correlations were examined with endoscopic, radiologic, symptom severity, and disease‐specific measures. Results: The Vietnamese SNOT‐22 demonstrated excellent internal consistency (Cronbach's α = 0.95), test‐retest reliability (intraclass correlation coefficient = 0.94). Postoperative stability between 1 and 3 months was high ( r = 0.78). Validity was demonstrated by clear discrimination between CRS patients and controls ( P < .01) and across HRQoL levels ( P = .01). No significant score difference was found between CRS phenotypes with or without nasal polyps. The SNOT‐22 significantly correlated weakly with the modified Lund‐Kennedy score, strongly with the VAS symptom score, and showed no correlation with the Lund‐Mackay score. Responsiveness was robust, with significant postoperative improvement ( P < .01) and a large effect size of 1.81 at 6 months. Conclusion: The Vietnamese SNOT‐22 is a reliable, concise, and responsive instrument for assessing HRQoL in CRS patients and can be recommended for both clinical practice and research in Vietnamese‐speaking populations.

Objectives: Access to the frontal sinus after receiving angled Draf 2a frontal sinusotomy remains challenging, while adequate postoperative irrigation is essential in managing chronic inflammatory sinus disease. This study compared frontal sinus irrigation distribution between the angled Draf 2a and Carolyn's window approaches, a modification of Draf 2a which removes the nasofrontal beak by drilling to permit direct 0° endoscopic access. Methods: Fresh human cadaver heads underwent sequential dissection with angled Draf 2a followed by Carolyn's window approach. Each cavity was irrigated using a 250 mL high‐pressure squeeze bottle filled with 1/1000 10% fluorescein‐labeled water in the Frankfort horizontal position. Fluid irrigation was recorded using an endoscope placed within the frontal sinus. Blinded grading of fluid distribution was performed using a 0–4 scale: 0 (nasal cavity only), 1 (frontal recess), 2 (medial half), 3 (lateral half), and 4 (complete lavage). Scores were compared between two surgical approaches. Results: Eight cadaveric specimens (16 frontal sinuses) were evaluated. Compared with angled Draf 2a frontal sinusotomy, Carolyn's window approach achieved a greater distribution: grade 1 (50.0% vs. 0%), grade 2 (31.3% vs. 0%), grade 3 (6.3% vs. 43.8%), and grade 4 (12.5% vs. 56.3%). The median (IQR) distribution grade following angled Draf 2a frontal sinusotomy was 1.5 (1, 2), and 4 (3, 4) for the Carolyn's window approach ( p < 0.01). Conclusion: Carolyn's window significantly enhances frontal sinus irrigation compared to angled Draf 2a by improving access and distribution. This technique is robust for enhancing postoperative topical therapy in chronic frontal sinus disease. Level of Evidence: N/A.

Objectives: The Chronic Rhinosinusitis Patient‐Reported Outcome (CRS‐PRO) questionnaire was recently developed for use in chronic rhinosinusitis (CRS) patients. This instrument was developed using current diagnostic criteria. This study aimed to translate and validate CRS‐PRO for Thai CRS patients. Methods: The three‐phase translation process and validation were conducted at Rajavithi Hospital, a tertiary hospital in Bangkok, Thailand. Adults (> 18 years) with primary CRS, diagnosed using EPOS2020 criteria, were recruited alongside non‐CRS controls. Discriminant validity was assessed by comparing scores between CRS patients and non‐CRS controls. Concurrent validity was evaluated by correlating CRS‐PRO with the Thai version of the Sinonasal Outcome Test‐22 (SNOT‐22). Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest reliability using intraclass correlation coefficient (ICC). Results: A total of 85 CRS patients and 40 non‐CRS controls were enrolled. The Thai CRS‐PRO was completed in (101.80 ± 26.36) seconds. CRS patients had significantly higher scores than controls (16 [10–24] vs. 2 [0–5], p < 0.001) (median [IQR]). CRS‐PRO demonstrated strong concurrent validity with SNOT‐22 ( ρ = 0.82, p < 0.001), high internal consistency (Cronbach's alpha = 0.89), and high test–retest reliability (ICC = 0.81, 95% confidence interval 0.72–0.88). Conclusions: The Thai‐translated CRS‐PRO has been developed and validated. It demonstrated significant discriminant validity between patients and non‐patients, a very strong correlation with the Thai version of SNOT‐22, and good reliability. Its brevity and time efficiency support its applicability in both clinical practice and research, enhancing its potential for widespread adoption.

Key Points: Defining eosinophilic chronic rhinosinusitis is crucial for treatment strategies. There is a lack of data of the cut‐point of tissue eosinophil count from real‐world study. The cut‐point of three eosinophils/high‐powered field indicates high clinical severity.