CMF update

Transoral robotic surgery (TORS) is a minimally invasive option for supraglottic laryngeal carcinoma (SGLC) with potential functional benefits without compromising oncologic control. We systematically reviewed functional outcomes and operative features of TORS for SGLC./r/nA PRISMA-guided search of PubMed/MEDLINE, Embase, Scopus, and Cochrane (2007-2025) identified studies reporting functional outcomes after TORS for SGLC./r/nTwenty-one studies (n = 602) were included. Prophylactic tracheostomy was performed in approximately 21%, with 96% of whom were decannulated after a mean of 15 days. Feeding tubes (FT) were placed in 42%, with 92% subsequently removed after a mean dependence of 16 days; oral intake was typically resumed after approximately 5 days. PEG use was infrequent (~ 5%). Mean operative time was 64 min; mean estimated blood loss 53 mL; hospital stay was short. Complications were generally uncommon; hemorrhage requiring intervention was infrequent. Across the limited comparative literature, functional outcomes after TORS appeared broadly consistent with those reported for open approaches; however, no formal meta-analysis was performed and most included studies were retrospective./r/nIn selected SGLC, TORS appears to be associated with favorable airway and swallowing outcomes and low perioperative morbidity based on available retrospective evidence, without apparent compromise of oncologic control. These findings should be considered hypothesis-generating and warrant confirmation in prospective, comparative studies.

To assess the effectiveness of an intervention programme combining Oropharyngeal Myofunctional Therapy (OMT) and cervical spine exercises in the general population with mild to moderate Obstructive Sleep Apnoea (OSA), analysing its impact on respiratory variables (AHI, MSatO, ODI, TC90, Supine AHI), daytime sleepiness and quality of life./r/nA single-blind randomised clinical trial with 32 participants diagnosed with mild to moderate OSA, assigned into two groups: control (n = 16) and intervention (n = 16). Both groups received hygiene- and diet-related recommendations, and the intervention group completed an OMT programme and cervical spine exercises over 20 weeks (May 2023-November 2024). The respiratory variables were evaluated using respiratory polygraphy, and daytime sleepiness and quality of life were measured using the Epworth Sleepiness Scale and EuroQol-5D scales, respectively./r/nNo statistically significant differences were found between groups (Median [IQR]): Apnoea-hypopnoea index (2.0 [-6/6], CI 95%, p = 0.86), Mean oxygen saturation (-0.5 [-1/0], CI 95%, p = 0.43), Oxygen Desaturation index (1.0 [-1/5], CI 95%, p = 0.72), Time with oxygen saturation below 90% (1.0 [0/3], CI 95%, p = 0.10), Epworth Sleepiness Scale score (-1.5 [-4/0], CI 95%, p = 0.83), and EuroQol-5D quality of life questionnaire (5.0 [0-10], CI 95% p = 0.08)./r/nThe comprehensive 20-week OMT programme and cervical spine exercises showed no effectiveness in improving respiratory parameters, daytime sleepiness or quality of life in patients with mild to moderate OSA compared to hygiene- and diet-related measures alone. The null results observed in this study suggest relevant clinical implications, such as the limited efficacy of low-frequency OMT protocols.

Obstructive sleep apnoea (OSA) is common in Singapore, with moderate to severe OSA affecting around 30% of residents. These consensus statements aim to provide scientifically grounded recommendations for the management of OSA, standar-dise the management of OSA in Singapore and promote multidisciplinary collaboration./r/nAn expert panel, which was convened in 2024, identified several areas of OSA management that require guidance. The expert panel reviewed the current literature and developed consensus statements, which were later independently voted on using a 3-point Likert scale (agree, neutral or disagree). Consensus (total ratings of agree and neutral) was set a priori at ≥80% agreement. Any statement not reaching consensus was excluded./r/nThe final consensus included 49 statements that provide guidance on the screening, diagnosis and management of adults with OSA. Additionally, 23 statements on the screening, diagnosis and management of paediatric OSA achieved consensus. These 72 consensus statements considered not only the latest clinical evidence but also the benefits and harms, resource implications, feasibility, acceptability and equity impact of the recommendations./r/nThe statements presented in this paper aim to guide clinicians based on the most updated evidence and collective expert opinion from sleep specialists in Singapore. These recommendations should augment clinical judgement rather than replace it. Management decisions should be individualised, taking into account the patient's clinical characteristics, as well as patient and caregiver concerns and preferences.

The authors propose a novel variation of the Spare Roof Technique for Preservation Rhinoplasty-"NOVA Spare Roof Technique." This modification involves a newly developed maneuver, the Sail Maneuver, which is a simple rhinoplasty technique for treating dorsal humps without lateral keystone area disarticulation. The authors find that this rhinoplasty strategy can be a precise surgery for a smooth and natural dorsum with a natural transition on the dorsal keystone area and, simultaneously, can improve the dorsal aesthetic lines (DALs). This approach is based on the new "dorsal vectorial concept" in rhinoplasty. A patient with a dorsal hump on a profile view can have a significant impact on the vector of the DALs. This rhinoplasty approach addresses that problem with a mathematical rationale.

Graves' disease is an autoimmune disease of the thyroid gland causing hyperthyroidism due to thyroid-stimulating hormone receptor autoantibodies. A rare, but serious complication of anti-thyroid drug therapy is agranulocytosis, a critical reduction in granulocytes leading to neutropenia and impaired infection defense. We report a case of a 32-year-old woman with Graves' disease who developed propylthiouracil-induced agranulocytosis and pancytopenia with concurrent severe infection. The patient was treated with antibiotics and granulocyte colony-stimulating factor ultimately undergoing total thyroidectomy. The case highlights a rare, but potentially life-threatening complication of antithyroid drug therapy. We emphasize the importance of close monitoring of patients treated with anti-thyroid drugs. Early recognition and prompt intervention are crucial as agranulocytosis is not always symptomatic. Additionally, early thyroidectomy should be considered in women of childbearing age as recurrent disease flares and therapeutic switching not only increase the risk of agranulocytosis and infection, but may also delay pregnancy.