Ohad Ronen

Purpose: Percutaneous dilational tracheostomy (PDT) is a widely performed procedure. However, it is sometimes contraindicated based on manufacturer guidelines and existing literature. This study evaluates the safety and feasibility of performing PDT in patients with documented contraindications. Methods: A systematic review was conducted using PubMed and TDNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines. Studies describing PDT performed in the presence of absolute or relative contraindications were included . The literature search included studies published between 1991 and 2024. Data on patient demographics, contraindications, complications, and clinical outcomes were extracted. Statistical analysis incorporated findings from both the included studies and our case series. Results: A total of 76 studies, along with our case series, included 2232 patients with a mean age of 48.5 years. The most common contraindications were bleeding diathesis (n = 947, 42.4%), and morbid obesity (n = 360, 16.1%). Many patients presented with multiple contraindications. The primary indications for tracheostomy were anticipated prolonged intubation, airway obstruction, and trauma. Bronchoscopic guidance was used in 45.6% of cases, and ultrasound guidance in 24.6%. The most frequently reported complication was bleeding (5.96%), followed by stoma narrowing (0.67%) and infection (0.63%). The overall procedural failure rate was 0.36%, and procedural mortality was rare (0.13%). Conclusion: This review suggests that PDT may be safely performed in carefully selected patients with traditional contraindications when conducted by experienced teams with appropriate backup. These findings do not support the routine use of PDT in all patients with traditional contraindications, but rather highlight its feasibility in carefully selected cases managed by appropriately skilled teams. Future controlled studies are warranted to re-evaluate current contraindications guidelines.

Objectives: Juvenile nasopharyngeal angiofibroma is a highly vascular benign tumour affecting adolescent males. Our aim was to compare operative outcomes in embolised and non-embolised patients, with emphasis on tumour stage. Methods: A systematic review was conducted using three databases (PubMed, Scopus and Google Scholar) in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Results: Overall, 17 studies with a total of 524 patients met the inclusion criteria. The meta-analysis showed a significant difference in estimated blood loss between embolised and non-embolised groups (overall effect size -685 ml; p < 0.001). Additionally, embolised patients with advanced stage tumours tended to lose less blood during surgery than non-embolised patients (mean of 1551.9 ml vs. 4051.5 ml; p = 0.065). Conclusion: This systematic review and meta-analysis demonstrate that pre-operative endovascular embolisation provides an operative advantage in patients undergoing juvenile nasopharyngeal angiofibroma surgical resection. A near-significant trend towards greater benefit in higher-stage tumours was observed ( p = 0.065), warranting further prospective investigation.

Purpose: Fine needle aspiration (FNA) is the primary diagnostic tool for evaluating thyroid nodules. However, 10%–21% of FNAs yield non‐diagnostic (ND) results (Bethesda category I). Repeated ND findings occur in 25%–67.5% of cases, creating diagnostic uncertainty and increased healthcare costs. Our aim was to evaluate whether cumulative analysis of repeated ND cytology samples enables reclassification into a diagnostic Bethesda category. Methods: This retrospective observational study (2013–2024) included patients with ≥ 2 ND FNA results from the same thyroid nodule. Two blinded cytopathologists performed cumulative assessment of cellular material from consecutive ND samples to determine if reclassification into diagnostic Bethesda categories was feasible. Results: Among 1861 FNA procedures, 29 patients (1.56%) had ≥ 2 ND results. Cumulative assessment enabled reclassification in 3/29 patients (10.3%), into Bethesda category II (benign). Findings: In selected cases, cumulative cytological assessment of multiple ND FNAs may provide sufficient diagnostic material to allow reclassification. This novel cost‐effective approach may help reduce diagnostic uncertainty and unnecessary procedures, and improve patient care.

Objective: To evaluate whether the proportion of resected thyroid tissue or the residual lobe volume predicts postoperative hypothyroidism following hemithyroidectomy. Study Design: Multicenter retrospective cohort study. Setting: Ziv Medical Center and Galilee Medical Center, Israel. Methods: The study included 134 adult patients who underwent hemithyroidectomy between 2017 and 2024. Patients with preexisting hypothyroidism or malignant histopathology were excluded. Preoperative thyroid gland volumes were measured by computed tomography (CT) and correlated with serum thyroid hormone profiles (T3, T4, and TSH) obtained preoperatively, and at 1 and 6 months postoperatively. Associations between thyroid volume parameters and postoperative hypothyroidism were analyzed statistically. Results: Postoperative hypothyroidism developed in 29.1% of patients, within the first postoperative month. Affected patients exhibited significantly higher baseline TSH levels than euthyroid counterparts (3.0 vs 1.4 μIU/mL, P < .001). No significant correlation was found between postoperative thyroid function and total gland volume, resected lobe volume, or residual‐to‐total volume ratio. At 6 months, only 12% of patients remained hypothyroid, suggesting partial recovery of thyroid function in the remaining lobe. Conclusion: Neither the extent of resection nor the residual thyroid volume predicted postoperative hypothyroidism. These findings imply that factors beyond gland size—such as preoperative functional reserve or intrinsic thyroid health—may play a more decisive role in maintaining postoperative endocrine stability. Identifying these predictors could enhance patient selection, risk stratification, and postoperative follow‐up.

Background: The nose plays a central role in facial aesthetics and perceptions of beauty. While personality influences the quality of life and self-perception, its effect on post-rhinoplasty satisfaction remains underexplored. This study investigates the relationship between personality traits and satisfaction with rhinoplasty outcomes. Methods: A comparative analysis was conducted between rhinoplasty patients and the general population, assessing personality traits and nasal perceptions using the Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) scale pre and post-surgery, along with the NEO Five-Factor Inventory (NEO-FFI) for personality structure profiling based on the Big Five model. Results: A total of 117 rhinoplasty patients and 95 controls participated. Rhinoplasty patients, especially females, showed lower neuroticism and agreeableness but higher conscientiousness than controls. Female rhinoplasty patients had reduced negative affect and self-reproach, while males exhibited lower positive affect relative to controls. RHINO scale scores indicated post-surgery improvement in all aesthetic and functional domains. As for the relationship between personality traits and rhinoplasty satisfaction scores, significant correlations emerged between neuroticism and aesthetic satisfaction, while conscientiousness showed an inverse association with satisfaction among females. Conclusion: These findings suggest distinct personality patterns among rhinoplasty candidates compared to the general population, with specific traits linked to postoperative satisfaction. We recommend using the NEO-FFI as a preoperative screening tool to identify patients at risk of dissatisfaction and encourage further research across diverse populations to validate these findings. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Purpose: Obesity is a prevalent condition with potential implications for surgical outcomes, including thyroidectomy. This study investigated the relationship between body mass index (BMI) and the duration of thyroidectomy surgery and length of hospital stay. Method: A retrospective analysis of patient records. Data included patient age, sex, procedure type, surgery duration, length of hospital stay, histological results, and BMI. Statistical analysis methods (t-tests, ANOVA, Spearman/Pearson correlation, linear regression) were used. Patients were categorized into groups based on BMI. The primary outcome was the relationship between BMI and surgical outcomes. The research was conducted in a tertiary care academic medical center over 7 years (2016–2022). Included were patients who underwent a thyroidectomy performed by otolaryngology residents (N = 232). Results: Surgery duration was significantly prolonged in obese patients, with an average increase of 1.3 min per BMI category (p-value < 0.01), resulting in a mean difference of approximately 10 min between normal weight and obese patients. Length of hospital stay was significantly extended for overweight and obese patients compared to the non-obese group (p-value < 0.01), with an average extension of 0.9 days between normal weight and obese groups. Conclusions: Obesity is associated with prolonged thyroidectomy surgery duration and length of hospital stay. Our findings highlight the importance of considering BMI in surgical planning and resource allocation. These results can inform preoperative counseling and perioperative management of obese patients undergoing thyroidectomy. Further research is needed to investigate specific factors contributing to prolonged surgery in obese patients.