bluuebunny/crossref_metadata_2025 huggingface dataset:
Off‐Label Uses of Drugs and Technology: What's the Stigma?
Authors: Zur Karen B. , Derkay Craig S. , Handler Steven D. , O'Malley Bert W. , Rutter Michael J.
Published: August 2013

Program Description:

The practice of otolaryngology is rapidly evolving with new technologies and pharmaceuticals introduced into use at an exponential rate. While most new interventions are Food and Drug Administration approved, some rely on their success in other fields of medicine and are applied into our field as experimental or are used in good faith with anecdotal benefits. The purpose of this multi‐expert panel is to share the ethical considerations and controversies of such tools, with a special emphasis on the pathway for approval by the hospital as well as credentialing, off‐label use of injectables and topical medications, and application of robotics in otolaryngology.

Educational Objectives:

1) Describe the process of introducing off‐label medications, devices, and technologies into everyday practice. 2) List some commonly used topical and injectable medications and their off‐label use in the various fields of otolaryngology. 3) Recognize the limitations that are inherent to the introduction of such innovations.
Locally Advanced Laryngeal Cancer
Authors: Myers Eugene N. , Cernea Claudio R. , Walder Fernando , Olsen Kerry D. , Dias Fernando L. , Lima Roberto A. , Dedivitis Rogerio A.
Published: August 2013

Program Description:

This miniseminar is designed to update general otolaryngologists on cutting edge advances in advanced laryngeal cancer.

Educational Objectives:

1) Improve knowledge of the treatment principles of advanced laryngeal cancer. 2) Surgical organ preservation treatment for advanced laryngeal cancer, including robotic surgery. 3) Post‐treatment functional outcomes.
Novel Techniques for Detection and Treatment of Precancer
Authors: Nathan Cherie‐Ann O. , Wang Marilene B. , Nussenbaum Brian , Farwell D. Gregory , Boyle Jay O.
Published: August 2013

Program Description:

Detection and treatment of precancerous lesions is a challenge given the widespread nature of these lesions. Advances in optical visualization using the world's smallest microscope, availability of commercial products evaluating fluorescent targeting of abnormal tissue and molecular biology will play an important role in determining when to initiate treatment. Clinical trials with promising targeted agents and nutraceuticals, a billion dollar industry, will be discussed. With the emerging epidemic of HPV tumors early detection and prevention will be key in counseling patients and their families. Screening salivary rinses and serum for markers of early detection or persistent disease will be discussed.

Educational Objectives:

1) Apply novel approaches for HPV detection and prevention of oropharyngeal cancer. 2) Recognize intra‐operative detection and treatment of premalignant lesions using the world's smallest microscope, novel fluorescent agents, and laser treatment. 3) Describe chemoprevention of head and neck squamous cell carcinoma with special emphasis on clinical trials with targeted agents and nutraceuticals.
Robotic Surgery: The Current Standard of Practice
Authors: Genden Eric M. , Magnuson Scott , Kuppersmith Ronald B. , Holsinger F. Christopher
Published: August 2013

Program Description:

This miniseminar is presented by select members of the AAO‐HNS Task Force on Robotic Surgery for the purpose of defining the current standards for integrating robotic surgery into a clinical practice. The program is designed to inform the general AAO‐HNS membership of: 1) The pathway to gain training in robotic surgery; 2) The ethics of integrating new robotic technologies into clinical practice; 3) The robotic surgical learning curve; and 4) The nuts and bolts of starting a robotic surgical practice. At the completion of the panel presentations, time will be set aside to encourage questions from the audience.

Educational Objectives:

1) Describe the training pathway for gaining competence in robotic surgery. 2) Evaluate the ethical concerns of introducing new robotic technologies into a clinical practice. 3) Recognize the framework for initiating a robotic surgery program.
Sialendoscopy: Paradigm Shift in Salivary Gland Treatment?
Authors: Marchal Francis , Arndal Helge , Carrau Ricardo , Irvine Robert A. , Eisele David W. , Cernea Claudio R. , Morton Randall P.
Published: August 2013

Program Description:

This miniseminar intends to open a discussion with the audience on the exponential growth of sialendoscopy throughout the United States (about 150 centers by end 2011) and throughout the world. During the last years, it has proven to be efficient in treating salivary gland ductal pathologies, and more importantly sparing unnecessary and high morbidity removal of salivary glands. The international panel from all continents will discuss with the audience the 2013 state of the art attitude towards sialadenitis, from the first acute episode, investigations, treatment (with all options: balloon dilatation, laser fragmentation, stenting, endoscopic‐surgical combined approaches) and complications.

Educational Objectives:

1) Recognize the role of sialendoscopy, replacing gradually parotidectomy and submandibulectomy, in case of symptomatic sialadenitis due to stones or strictures. 2) Evaluate the importance this technique has gained over the years and its cost‐effective implementation on all continents. 3) Describe tips, tricks, and the state of the art attitude towards sialadenitis.
Surgical Innovations for Larynx and Pharynx Cancer
Authors: Burns James A. , Haughey Bruce H. , Weinstein Gregory S.
Published: August 2013

Program Description:

Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotic guidance systems, chemoradiation protocols dominate treatment strategies at many institutions. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and innovative technology through presentations from experts in the field.

Educational Objectives:

1) Evaluate outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Interpret the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Apply concepts of photoangiolysis in treatment of aerodigestive tract malignancy.
Thyroid Surgical Care 2013: The Impact of Molecular Testing
Authors: Witt Robert L. , Ferris Robert L. , Pribitkin Edmund A. , Randolph Gregory W. , Steward David L.
Published: August 2013

Program Description:

Increase the awareness and cost‐effectiveness of molecular alteration testing so that clinicians can consider integrating this into their thyroid practices through didactic presentations and case studies. BRAF and RET/PTC testing through routine FNA for the indeterminate nodule are nearly 100% specific for papillary thyroid cancer and can lead to initial therapeutic thyroidectomy, reducing the need for completion thyroidectomy. Molecular classifiers have a 95% negative predictive value for indeterminate nodules and may have a broad effect on reducing unnecessary diagnostic lobectomies. BRAF positive patients may have a higher rate of central neck recurrence and poorer prognosis leading to tailored surgical management.

Educational Objectives:

1) Evaluate commercially available molecular alteration testing approaches and their cost‐effectiveness for diagnosis, tailored management, and prognosis for indeterminate nodules through didactic and case presentations. 2) Interpret the potential of molecular alteration testing to lead to initial therapeutically optimal thyroidectomy for indeterminate nodules potentially reducing the rate of completion thyroidectomy. 3) Recognize the potential of molecular classifier testing to reduce unnecessary diagnostic thyroid lobectomy for indeterminate nodules that are benign.
Pearls on How to Transition to ICD‐10 Coding by 2014
Authors: Waguespack Richard W. , Setzen Michael , Buckholtz Rhonda , Lorenz Robert R. , Boynton Angela A.
Published: August 2013

Program Description:

The largest change to the healthcare system in our history is coming and careful planning will be necessary in order to successfully implement and use the ICD‐10 coding system. Attendees will participate in an interactive panel discussion about the importance of starting now and how your practice will be impacted by clinical documentation issues. Topics included in the discussion will provide a timeline of essential activities for implementation and what hurdles to anticipate in preparation for implementation. Presenters will also review commonly billed ear, nose, and throat (ENT) ICD‐9 diagnosis codes and what they will look like in ICD‐10‐CM.

Educational Objectives:

1) Evaluate how the transition to ICD‐10‐CM will impact physician practice and resources offered through the Academy to help prepare your practices. 2) Recognize why an implementation timeline is important for successful implementation and how the proper steps can lessen impact of implementation on October 1, 2014. 3) Interpret ENT case examples for clinical documentation hurdles and specificity required in ICD‐10‐CM to properly assign codes.
Injection Laryngoplasty: Contemporary Indications/Techniques
Authors: Verma Sunil P. , Courey Mark S. , Woodson Gayle E. , Simpson C. Blake
Published: August 2013

Program Description:

This miniseminar will provide a contemporary review of injection laryngoplasty (IL). Common and overlooked causes of glottal insufficiency will be reviewed. Methods of evaluating patients and the timing of IL relative to patient presentation will be addressed. Technical discussions of how to perform IL in the operating room and in the office will take place. A thorough review of in‐office IL will highlight indications and techniques for injection as well as discuss costs, billing, and other practical aspects required for establishing and maintaining an office‐based practice. Case‐based scenarios will be used to demonstrate pearls and pitfalls in performance of IL.

Educational Objectives:

1) Recognize laryngeal conditions that will benefit from vocal fold injection. 2) Gain familiarity with indications and approaches for in‐office vocal fold injection. 3) Apply techniques to improve outcomes of vocal fold injections.
Laryngeal Inflammation: Diagnosis and Treatment Challenges
Authors: Fried Marvin P. , Krouse John H. , Altman Kenneth W. , DelGaudio John M. , Postma Gregory N.
Published: August 2013

Program Description:

Using an interactive format, panelists will discuss epidemiology, symptomatology, and co‐morbid conditions contributing to laryngopharyngeal inflammation; diagnosis/differential diagnosis; challenges in diagnosing causative factors; addressing diagnostic challenges to define a treatment plan; current evidence; treatment challenges and impact of co‐morbid conditions; and future research and management implications. The panel will consider “real world” patient management algorithms. The audience will help answer the following questions: What are the typical ‘challenges’ in diagnosing laryngopharyngeal inflammation? What diagnostic testing options should be employed? Which after first treatment failure? What are the common treatment pathways? What differential data should be considered? What healthcare costs impact options? When is referral recommended?

Educational Objectives:

1) Describe current practice trends on the diagnosis and management of laryngopharyngeal inflammation. 2) Recognize the common challenges in diagnosing laryngeal inflammation to define appropriate treatment strategies. 3) Evaluate current evidence‐based literature supporting current diagnosis and treatment paradigms.
Microlaryngoscopy: Difficult Exposures/Operative Techniques
Authors: Bryson Paul C. , Benninger Michael S. , Hillel Alexander T. , Johns Michael M. , Simpson C. Blake
Published: August 2013

Program Description:

Adequate exposure in suspension microlaryngoscopy can be challenging. This miniseminar will review the principles of microlaryngoscopy and discuss the various techniques used to provide adequate operative exposure. Panel members will be from multiple institutions and training backgrounds and will share their combined experience. Case scenarios will be presented and operative techniques will be discussed. Audience participation will be solicited.

Educational Objectives:

1) Recite the principles and techniques of suspension microlaryngoscopy. 2) Prepare for difficult microlaryngeal exposures. 3) Employ a number of strategies to facilitate exposure and management of laryngeal pathology.
Auditory Neurology: Understanding Presbycusis
Authors: McKinnon Brian J. , Gates George A. , Backous Douglas D. , Francis Howard W.
Published: August 2013

Program Description:

What are we to make of the clinical sign of presbycusis: “I have difficulty understanding speech in noise, but do all right in quiet”? The need for accurate diagnosis and rational management has led to a new field, auditory neurotology. Speech understanding requires more than perception. Complex brain functions involve the associative cortical areas of the brain; activities such as executive functioning (short term memory, attention, inhibition, and decision‐making) call upon linguistic capabilities. This miniseminar will present established evaluations using an intake questionnaire, speech‐in‐noise testing, and tailored auditory rehabilitation interventions, reimbursable procedures to be incorporated for the benefit of our patients.

Educational Objectives:

1) Analyze the challenges of presbycusis to implement the necessary advocacy measures to improve evaluation and management. 2) Recognize the role of auditory neurotology in further understanding of presbycusis.
Contemporary Management of Chronic Ear Disease
Authors: Isaacson Brandon , Bojrab Dennis I. , Bennett Marc L. , Kaylie David , Warren Frank M. , Haynes David S. , Smouha Eric E.
Published: August 2013

Program Description:

This miniseminar will discuss various aspects of the management of chronic ear disease, including ossicular chain reconstruction, cartilage and pediatric tympanoplasty, the role of endoscopes, and the management of chronic otitis media without cholesteatoma. Time permitting, a discussion on the management of labyrinthine fistulas will also be presented. A case based approach to these topics will be presented by the moderators to the panel members.

Educational Objectives:

1) Describe ossicular chain reconstruction, including approaches, staging, and prosthesis selection (including autologous materials). 2) Recognize indications and methods of cartilage tympanoplasty and pediatric tympanoplasty. 3) Manage chronic otitis media without cholesteatoma and the role of endoscopes in chronic ear surgery.
Emerging Concepts in Migraine‐Associated Dizziness
Authors: Hoffer Michael , Goebel Joel A. , Gottshall Kim R. , Staab Jeffery P.
Published: August 2013

Program Description:

Over the last several years migraine has become an increasingly common diagnosis in otolaryngology. Despite the increasing frequency of this diagnosis, little is understood about how the pathophysiology of migraine impacts a range of otolaryngologic diagnoses. Nevertheless specialists in our field are increasingly being called on to diagnose and treat migraines. In this miniseminar we will discuss the role of migraines in hearing and balance disorders and examine the critical criteria that are helpful in distinguishing this disorder from other otologic diagnoses. We will examine the newest diagnostic and treatment modalities and how to apply these in common practice.

Educational Objectives:

1) Diagnose classical migraine associated dizziness. 2) Implement current treatment modalities for migraine, including medicines, therapy, and Botox treatment. 3) Discuss the evidence to support a continuum between migraines and Ménière'sdisease.
Endoscopic Ear Surgery: Tips and Pearls
Authors: Nogueira Joao F. , Tarabichi Muaaz , Marchioni Daniele , Presutti Livio , Pothier David D.
Published: August 2013

Program Description:

Endoscopic ear surgery (EES) is a current hot topic in our specialty, but it is not entirely correct to introduce EES as “new.” Although not new, it is clear that during the last few years, endoscopes have proven to be safe and effective instruments to manage ear diseases in a minimally invasive way, preserving important anatomical structures, allowing functional approaches to well‐known conditions. Moreover, endoscopes have provided a better view and understanding of traditional middle ear anatomy and physiology, allowing new landmarks, novel concepts of tissue preservation, ventilation routes, and management of other conditions within the middle ear and beyond.

Educational Objectives:

1) Describe the endoscopic anatomy of the middle and inner ears, discussing the concepts of related physiology. 2) Discuss the main totally endoscopic and combined surgical approaches to middle ear conditions, discussing the possible advantages and disadvantages. 3) Present the instruments needed, system setup, surgical skills, learning curve, and some important tips and pearls to surgeons to start doing endoscopic ear surgery.
Temporal Bone Radiology: Beyond the Basics
Authors: Monfared Ashkan , Taheri Mohammad R. , Jackler Robert K. , Blevins Nikolas H. , Gurgel Richard K.
Published: August 2013

Program Description:

Through this interactive presentation, the audience is exposed to challenging temporal bone radiology cases and offered strategies to improve his or her interpretation. We will cover key findings for chronic ear disease and conductive hearing loss, lateral skull base lesions, and the petrous apex. The emphasis is placed on subtle but pertinent findings on computed tomography (CT) and MRI examinations and their importance in creating and narrowing a differential diagnosis. We will present guidelines to aid in the efficient acquisition and interpretation of imaging for patients with common otologic symptoms such as vertigo, sudden hearing loss, and pulsatile tinnitus.

Educational Objectives:

1) Interpret key radiographic findings for common pathologic conditions of the temporal bone. 2) Order appropriate radiographic tests to evaluate common conditions and understand the strengths and limitations of various imaging modalities.
The Top 10 Business Mistakes I Have Made in Practice
Authors: Brown Seth M. , Vaughan Winston C. , Lanza Donald C. , Setzen Michael
Published: August 2013

Program Description:

This program focuses on what is often not discussed in practice management: the mistakes made in setting up and running a practice. It features four otolaryngologists who have all formed their own practices and are all in different stages of their careers. The presenters will discuss the errors they have made along the way, including poor job selection, improper choice of partners, errors in forming professional relationships, isolation of referring physicians, and failed business ventures. They will further discuss when it is time to cut anchor, disband relationships, and start anew. The pros and cons of doing this will be presented.

Educational Objectives:

1) Describe the most common mistakes otolaryngologists have made when starting a practice. 2) Learn how to make smart decisions about their practice and its development. 3) Analyze what to do and not to do in practice management and development.
Pain Management after Tonsillectomy without Codeine
Authors: Tunkel David E. , Messner Anna H. , Lauder Gillian , Lin Sandra Y. , April Max M. , Cofer Shelagh A.
Published: August 2013

Program Description:

Tonsillectomy is a painful procedure. Management of pain is more problematic with recent reports of deaths associated with codeine use and the potential for acetaminophen toxicity. We will discuss opiate sensitivity associated with childhood OSA, genetic variations in narcotic metabolism in children, and the use of non‐steroidal anti‐inflammatory drugs. We will present tonsillectomy techniques that may reduce the need for analgesics. Panelists will include general and pediatric otolaryngologists and a pediatric pain specialist, with short presentations and case discussions.

Educational Objectives:

1) Describe relative effectiveness and potential morbidities associated with narcotic use in children after adenotonsillectomy. 2) Use a safe and effective approach for pain control in children after adenotonsillectomy, including the use of narcotics and nonsteroidal anti‐inflammatory drugs. 3) Analyze surgical techniques and postoperative treatments that could help with management of pain after tonsillectomy.
Balloon Dilation in Rhinology: Reviewing the Evidence
Authors: Batra Pete S. , Stammberger Heinz R. , Marple Bradley F. , Sindwani Raj , Ryan Matthew W.
Published: August 2013

Program Description:

Balloon catheter technology was introduced in 2005 for management of paranasal sinus inflammatory disease. This miniseminar will objectively evaluate the currently available operative suite and office‐based balloon devices. Rhinologists with considerable experience without commercial conflicts on balloons will assess the frank advantages and limitations of the current balloon devices. Evidence‐based review will be incorporated to assess the strengths and weaknesses of the existing peer‐review literature. The recent large European clinical trial will be reviewed. The potential complications unique to balloon catheters will be discussed. An update on CPT coding, RUC values, and socioeconomic implications will also be addressed.

Educational Objectives:

1) Review the currently available operative suite and office‐based balloon catheter technologies and explore implications on the Functional Endoscopic Sinus Surgery (FESS) paradigm. 2) Critically appraise the existing peer‐review literature and address potential complications of balloon dilation. 3) Assess socioeconomic implications and CPT coding issues related to balloons.
Difficult Nasal Polyposis: Evolving Treatments and Remedies
Authors: Woodworth Bradford A. , Reh Douglas D. , Palmer James N. , Gosepath Jan
Published: August 2013

Program Description:

Chronic sinusitis with nasal polyposis has a detrimental impact on quality of life and may exacerbate co‐existing conditions such as asthma. This miniseminar will outline the latest theories on disease pathogenesis as well as promote rational medical and surgical strategies for severe nasal polyposis management. Treatments designed to decrease reliance on systemic steroids, including surgical methods and complementary medical therapeutics such as topical steroid irrigations, macrolides, and anti‐leukotrienes, will be discussed. A panel of international experts will provide the latest innovations in medical and surgical treatments through a case‐based approach of difficult patients and strategies for success illustrating these advancements.

Educational Objectives:

1) Interpret current theories on the pathogenesis of nasal polyposis. 2) Recognize the newest medical and surgical treatments for difficult nasal polyposis, including cystic fibrosis. 3) Initiate additional therapeutic measures to appropriately care for patients with severe nasal polyposis.
Food Allergy 2013: State of the Science
Authors: Reisacher William R. , Calhoun Karen H. , Damask Cecelia , Veling Maria C.
Published: August 2013

Program Description:

This miniseminar includes didactic lectures, an audience‐interactive section, and Q&A. The lectures will focus on why food allergies develop by taking a critical look at the latest scientific evidence available in the literature, the role of oral tolerance in human evolution, and the relationship of failure to achieve oral tolerance on the health of the individual, relevant immunology, non‐immunologic food reactions versus immunologic reactions, both immunoglobulin E (IgE)‐mediated and non‐IgE‐mediated, current methods of diagnosing food allergies, cutting‐edge strategies such as component‐resolved testing, skin and in vitro methods versus double‐blind, placebo‐controlled food challenge.

Educational Objectives:

1) Analyze the literature comparing different methods for diagnosing food allergy. 2) Evaluate the scientific basis of IgE and non‐IgE mediated food allergy. 3) Describe the currently available treatments for food allergy as well as future directions.
Iatrogenic CSF Leaks: Avoidance, Diagnosis, and Management
Authors: Kutz Joe W. , Isaacson Brandon , Batra Pete S. , Bennett Marc L. , Manes Peter
Published: August 2013

Program Description:

This miniseminar will comprehensively review the pertinent anatomy and surgical techniques to help avoid an iatrogenic CSF leak during rhinologic or otologic surgery. The role of imaging to diagnose and locate a CSF fistula will be discussed. Techniques will be discussed to repair leaks in the intraoperative and postoperative settings, including use of lumbar drainage, transmastoid and middle fossa approaches to the temporal bone, as well as endoscopic and open approaches to repair rhinologic leaks. Materials used to repair these leaks will be reviewed. A case‐based format will be used to illustrate key points.

Educational Objectives:

1) List the pertinent anatomy and techniques to avoid an iatrogenic CSF leak of the temporal bone and anterior skull base. 2) Use of the various imaging modalities for the diagnosis and localization of postoperative CSF fistulas. 3) Identify and manage an intraoperative CSF fistula using various surgical techniques and materials for repair.
Using Social Media in Medicine
Authors: Stern Wendy B. , Wei Julie L. , Chang Christopher Y. , Eisenberg Lee D. , Simon Lawrence M.
Published: August 2013

Program Description:

Social media has moved from an emerging technology to a mainstay of our patients’ lives. The panelists consist of speakers at the forefront of the social media field in otolaryngology in both academic and private arenas. This talk will demonstrate how social media has already been incorporated in the medical marketplace and future applications. We will discuss strategies for how physicians can incorporate this into their academic/private practices. Common pitfalls encountered in assimilating social media into your practice will be described. Additionally, we will discuss the inherent medico‐legal risk and ethical considerations associated with these endeavors.

Educational Objectives:

1) Discuss how social media affects medicine today. 2) Describe methods to use social media to help build/maintain your practice in an academic and private arena. 3) Apply the best uses of social media to interact with and educate your patients while being aware of the medico‐legal implications.
Consequences of Resident Case Unbundling on Future Billing Habits
Authors: Liebertz Daniel J. , Zuliani Giancarlo F
Published: August 2013

Objectives:

Recognize differences between CPT coding habits of otolaryngology residents compared to attending physicians, and analyze the possibility that resident case unbundling may affect future billing habits.

Methods:

A prospective survey was designed with four case scenarios reflecting four common procedures (septorhinoplasty, tympanomastoidectomy, thyroidectomy, and FESS) and presented to residents and staff physicians from Wayne State University. Respondents were asked to record up to 12 CPT codes for each procedure, per standard billing practices. Each procedure was accompanied by a list of all 17 categorized CPT codes found on the Accreditation Council for Graduate Medical Education (ACGME) Resident Case‐Log system. The survey results were then analyzed to determine the number of CPT codes entered per case per respondent.

Results:

Seventeen responses to the survey were recorded (14 residents, 3 attendings). Multivariate analysis comparing resident and attending responses was performed using GraphPad. Residents entered, on average, 12.86 codes in total for the 4 scenarios, attending physicians entered 8.67 (t‐test, p = 0.049). Further analysis, including comparison of individual scenarios and post‐graduate year, did not yield significant results; however, in all but one scenario resident response numbers were consistently elevated per procedure compared to attending physician responses.

Conclusions:

The practice of CPT code case unbundling in residency may affect future billing habits. Our small study indicates residents regularly over‐code routine surgical procedures compared to attending physician practices. An extension of the surveyed population will allow us to increase our data and hopefully establish wider conclusions.
Increased Expression Levels of Apoptosis Inhibitor BIRC5 Is Associated with Advanced Oropharyngeal Squamous Cell Carcinoma
Authors: Janus Jeffrey R. , Laborde Rebecca R. , Moore Eric J. , Olsen Kerry D. , Olsen Steven , Kasperbauer Jan L. , Smith David
Published: August 2013

Objectives:

1) Describe the role that BIRC5 and related activator genes (AURKB and CDCA8) play in various malignancies, and analyze the role that these genes play in oropharyngeal squamous cell carcinoma. 2) Implement innovative gene analysis technology (mRNA Seq) to determine gene expression and validate using established techniques (nCounter). 3) Analyze gene expression in the setting of human papillomavirus (HPV) status, smoking, and tumor stage.

Methods:

Tumor and adjacent normal oropharyngeal mucosal samples were obtained for validation studies from 24 patients undergoing surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) from 2010‐2012. Transcriptome data (mRNA‐Seq) were analyzed from patient matched tumor‐normal tissues. Transcript levels of target genes were validated using the nCounter system. Expression levels were correlated with tumor stage, HPV infection status, or smoking status.

Results:

A statistically significant overexpression was noted in all 3 target genes in tumor versus normal tissue. Statistically significant associations were present between expression levels of target genes and advanced tumor stage. No significant association was found between the 3 genes and etiologic subgroupings (HPV latent versus active infections or smoking status).

Conclusions:

BIRC5 and related activator genes (AURKB and CDCA8) have an established role in the development and progression of other cancers. Expression of these 3 gene targets is related to tumor stage in oropharyngeal SCC. The significant associations between the expression of these genes and tumor staging suggest that these genes may play a role in tumor progression independent of HPV viral expression patterns.
Learning Progression in the Use of Sialendoscopy for Sialolithiasis: Effect on Outcomes
Authors: Modest Mara C. , Galinat Lauren , Rabinowitz Mindy , Curry Joseph , Rosen David , Cognetti David M.
Published: August 2013

Objectives:

Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis.

Methods:

A retrospective chart review was conducted on 79 patients presenting with sialolithiasis between 2008 and 2012 who underwent sialendoscopy on 86 salivary glands at a tertiary medical center. Outcomes compared between the first 43 cases (40 patients) and second 43 cases (39 patients) included successful removal, surgical method, and any further need for intervention.

Results:

For the first 40 patients (group A), the mean age was 50.6 years (range, 21‐87), and 55.8% were male. For the second 39 patients (group B), the mean age was 50.8 (range, 15‐77), and 46.5% were male. Sialolithiasis was diagnosed based on physical exam or imaging. Mean stone size was similar in both groups: 8 versus 8.6mm, respectively. Where a stone was visualized, complete removal was accomplished in 88.6% of cases in group A versus 97.4% in Group B. Endoscopic removal occurred in 20.0% of the patients in group A, versus 35.9% in group B. A combined approach was used in 45.7% in group A versus 64.1% in group B. 34.3% in group A required gland removal versus 0.0% in group B (P = 0.005). Seventeen point nine percent of patients in group A needed further intervention (medical or surgical) versus 9.3% in group B.

Conclusions:

This study documents a clear learning curve for sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases, and there is a significant decrease in the number of gland excisions.
Lymphatic Mapping Patterns in Early Oral Squamous Cell Carcinoma
Authors: Farmer Roger W. , Civantos Francisco J. , Myers Jeffrey N. , Yarbrough Wendell G. , Siegel Barry A. , O'Leary Miriam A. , Zitsch Robert P.
Published: August 2013

Objectives:

Correlate location of sentinel nodes on lymphoscintigraphy versus sentinel lymph node biopsy (SLNB) and lymphatic metastases for T1 and T2 N0 oral cavity cancer.

Methods:

This was a prospective cooperative group trial of 140 patients with untreated T1 and T2 N0 oral cancers at academic medical centers. Interventions were lymphoscintigraphy, resection of the primary, SLNB, and immediate neck dissection. The outcome measures were location of sentinel nodes by lymphoscintigraphy versus SLNB, and location of metastases.

Results:

Lymph nodes located by lymphoscintigraphy and SLNB were found predominately in levels I through IV. There was heterogeneity in the number of the lymph nodes found at lymphoscintigraphy and at SLNB, which was significantly different in levels II and III (P < 0.0001). In 6 of 28 cases with bilateral drainage on imaging, SLNB detected only unilateral sentinel nodes. Sensitivity of lymphoscintigraphy in predicting the levels of sentinel nodes ranged from 42% to 63%, and specificity from 71% to 95%, for each level. Comparison of locations of nodal metastases to historical data showed fewer metastases to level I in our study (P = 0.0295). Metastases occurred predominantly in levels I, II, and III. In one case of a lateral tongue cancer, a contralateral node was the only positive node.

Conclusions:

Lymphatic drainage patterns and lymph node metastases involved predominantly levels I, II, and III. Lymphoscintigraphy is not very sensitive for predicting the levels of sentinel nodes. In levels II and III, the rate of detection of lymph nodes between the two modalities is significantly different.
A Novel Modular Polymer Platform for the Treatment of Head and Neck Squamous Cell Cancer
Authors: St. John Maie , Lin Yuan , Zhu Eric , Abemayor Elliot , Wu Ben
Published: August 2013

Objectives:

Evaluate the therapeutic efficacy of a novel modular polymer platform in the treatment of head and neck squamous cell carcinoma (HNSCC). 50% of HNSCC patients fail primary management, and salvage of the recurrent disease patient is of paramount importance.

Methods:

Study Design: In vivo study. Setting: Academic research laboratory. C3H/HeJ mice were randomized to receive implantation of 1) no polymer; 2) plain polymer; 3) plain polymer containing gene‐modified dendritic cells over‐expressing CCL21 (DC‐AdCCL21); and 4) plain polymer with concurrent daily CCL21 injections. Tumor size was measured until the mice were euthanized. At necropsy, the tumors were excised and weighed.

Results:

Our results using this novel polymer platform demonstrate a remarkable reduction in tumor growth. The dendritic cell CCL21 secreting polymer effectively reduced SCCVII/SF tumors in the C3H/HeJ mice by over 16‐fold (P < 0.01) as compared to control, plain polymer, and plain polymer + intratumoral CCL21 injection groups. We also demonstrate that we can effectively grow dendritic cells in the polymer that can actively secrete CCL21. Treatment with the dendritic cell CCL21 secreting polymer led to a marked reduction in tumor burden with extensive mononuclear cell infiltration of the tumors.

Conclusions:

Our promising results indicate that this polymer may represent a new therapeutic modality for patients with HNSCC. Our data provide a strong rationale for further evaluation of this DC‐AdCCL21 polymer in regulation of tumor immunity and genetic immunotherapy for HNSCC. Once this polymer platform is further optimized, we will plan for the ultimate validation in the context of a prospective trial in patients with unresectable advanced or recurrent HNSCC.
Outcome of Patients with Different MEN2A Germline Mutations
Authors: Tavares Marcos R.
Published: August 2013

Objectives:

Medullary thyroid carcinoma (MTC) behavior in MEN2 present variations, ranging from indolent MTC, in patients harboring intra‐cellular “weak mutations, to highly aggressive disease, with RET mutation in codons 634 or 918. We compared the outcomes among patients with different germline mutations.

Methods:

Retrospective chart review. Between January 2002 and December 2011, 67 MTC patients were operated at our institution: 26 (38.8%) sporadic and 41 (61.2%) carriers of MEN2A germline RET mutations. All patients were tested for RET hot spot mutations (exons 5, 8, 10, 11, 13, 16), pre‐ and postoperative calcitonin (Ct), carcinoembryonic antigen (CEA), parathyroid hormone, and calcium. They were also submitted to imaging studies (ultrasound, MRI, CT and scintigraphy). Follow‐up varied from 1 to 65 months (average 10.9 months). Patients were classified as cured when serum Ct concentration <2pg/mL in the last evaluation (Group A). Patients not cured were divided in two groups: Group B) Ct >2pg/mL and >40pg/mL and Group C) Ct>40pg/mL.

Results:

Nineteen patients (46.3%) were cured, most of them treated by prophylactic surgery. There was no difference according to the RET mutation. Preoperative calcitonin level ranged from 4.5 to 1367pg/mL (average 124.5) in group A from 9 to 180149 (average 124.5) in group B and from 98 to 8358 (average 2587) in group C. Fifteen patients (36.6%) presented postoperative hypoparathyroidism, not related to cure, although related to extended surgery. Younger patients who underwent prophylactic surgery had better prognosis (P = 0.02).

Conclusions:

Genetic test is the most important exam to perform in MTC patients. Outcome was better in younger patients treated by prophylactic surgery.
Pretreatment Interleukin‐6 Serum Levels Are Associated with Patient Survival for Oral Cavity Squamous Cell Carcinoma
Authors: Chang Kai‐Ping
Published: August 2013

Objectives:

Determine the role of serum interleukin‐6 concentration for oral cavity squamous cell carcinomas.

Methods:

Cohort study in a tertiary referral center. Two hundred thirty‐seven untreated patients, 125 healthy individuals, and 104 individuals with oral premalignant lesions were enrolled. Interleukin‐6 serum concentrations were measured by the enzyme‐linked immunosorbent assay.

Results:

Serum concentrations of interleukin‐6 were significantly higher in patients compared to the levels in healthy individuals and the subjects with oral premalignant lesions. Serum interleukin‐6 levels were significantly higher in patients with higher pT status (from pT1 to pT4, median values in pg/ml = 0, 0, 1.3, 5.0 respectively, with P < 0.001), higher pathological stages (from stage I to IV, median values = 0, 0, 1.3, 3.6 respectively, with P < 0.001), positive bone invasion (5.0 vs. 0, 1.4 vs. 0; P <0.001), and higher tumor depths (1.4 vs. 0; P 0.005). Patients with higher pre‐treatment levels of interleukin‐6 (>1.35 pg/mL, median level) had worse prognoses for 5‐year overall survival and disease‐specific survival despite treatment (75.7% vs. 54.9% and 79.1% vs. 59.8%; P = 0.001 and 0.003, respectively). Multivariate logistic regression analyses also indicated that higher interleukin‐6 serum levels were an independent prognostic factor for overall survival and disease‐free survival (adjusted hazard ratio = 2.417 and 2.364; P = 0.009 and 0.017, respectively).

Conclusions:

Our study revealed that serum interleukin‐6 levels were associated with increased tumor burden and aggressiveness of oral cavity squamous cell carcinomas and may be useful as a prognostic indicator after treatment.
Prophylactic versus Elective PEG Tube Placement in Head and Neck Cancer
Authors: Kramer Scott , Newcomb Matthew , Hessler Joshua , Siddiqui Farzan
Published: August 2013

Objectives:

1) Evaluate nutritional outcomes of head and neck cancer patients treated with prophylactic versus elective percutaneous endogastric (PEG) tubes. 2) Analyze the length of PEG tube usage when placed prophylactically versus electively.

Methods:

This is a retrospective review of 83 subjects treated with cisplatinum‐based chemoradiotherapy (CRT) for head and neck cancer between 2007 and 2011, who received PEG tubes for nutritive support. Patients were eligible if their PEG tube was placed within six months of initiating CRT. Subjects were stratified according to when PEG tube placement occurred, whether before initiating CRT (prophylactic) or after (elective). Independent variables included age, gender, TNM stage, HPV tumor association, and CRT doses; outcome measures included weight change during radiation therapy, PEG tube duration, and survival.

Results:

Fifty‐four patients received prophylactic PEG tubes, whereas 29 patients received elective PEG tubes. There was no significant difference in age, gender TNM stage, HPV tumor association, or CRT doses between the groups. Weight loss was not significantly different between the groups (‐9.9% v. ‐10.0%, P = 0.96). Prophylactic patients had a longer duration of PEG tube usage than elective patients (mean 227 days v. 139 days, P <. 01). Additionally, a higher percentage of elective patients were alive at last follow‐up (100% v. 79.6%, P =. 03).

Conclusions:

Patients requiring on‐demand PEG tube placement may use their PEG tubes for a shorter duration than those receiving up‐front placement, without suffering worse nutritional outcomes.
Quantitative Assessment of Outcomes for Sialendoscopy in Patients with Radioiodine‐Induced Sialadenitis
Authors: Lai Stephen Y. , Acharya Varun , Kongkiatkamon Suchada , Farrah Sally , Roberts Dianna B. , Sterba Jennifer , Chambers Mark S.
Published: August 2013

Objectives:

Radioiodine (I131) is an effective adjuvant therapy following surgery in patients with high‐risk thyroid cancer. Unfortunately, radioiodine treatment may result in significant xerostomia and sialadenitis. We examined outcomes in patients treated for radioiodine‐induced sialadenitis with sialendoscopy.

Methods:

Data have been prospectively collected for all patients undergoing sialendoscopy at this institution. Findings of the procedure and the intervention details were recorded. Qualitative data were obtained through patient examination and use of standard quality of life questionnaires (eg, MDASI‐HN and Xerostomia Questionnaire). Quantitative data were obtained from patients who underwent sialometry.

Results:

Twenty‐six patients (23F/3M) with an average age of 46 yrs (range: 19‐57 yrs) underwent interventional sialendoscopy for radioiodine‐induced sialadenitis. Sialendoscopy was attempted on 62 glands (45 parotid and 17 submandibular glands). In 2 patients, sialendoscopy could not be completed successfully on submandibular glands. Papillary stenosis was seen in 10 (16%) of the glands treated. Six submandibular glands ducts (9.7%) required sialdochoplasty. Patients subjectively noted the following resolution of symptoms: partial resolution (18; 69.2%), complete resolution (6; 23.1%), no change (1; 3.8%), and worsening of symptoms (1; 3.8%). Preliminary statistical analysis of the sialometry data by Wilcoxon matched pairs test (nonparametric) showed that there was a statistically significant difference in saliva production at 6 months following sialendoscopy for unstimulated saliva production (P = 0.028) but not for stimulated saliva production (P = 0.50) as compared to baseline measurements in patients with subjective improvement.

Conclusions:

Sialendoscopy is an effective treatment option for the management of radioiodine‐induced sialadenitis.
Rapid Discharge after Transoral Robotic Surgery
Authors: Richmon Jeremy D. , Chan Jason Y. , Feng Allen
Published: August 2013

Objectives:

1) Analyze the Johns Hopkins’ experience of rapid discharge after transoral robotic surgery (TORS). 2) Describe those factors that allow for rapid discharge and those which require longer postoperative hospitalization following TORS.

Methods:

All transoral robotic surgery (TORS) cases performed by the senior author were retrospectively reviewed. Length of hospitalization (LOH) was the primary outcome measurement. LOH was analyzed in regards to disease process, stage, performance of other concurrent procedures (ie neck dissection, percutaneous endoscopic gastrostomy [PEG] placement), age, gender, co‐morbidities, and intra‐operative complications. Secondary outcome measures included postoperative complications, tracheotomy and PEG dependency rates, and need for re‐admission to hospital.

Results:

Seventy‐eight cases from October 2009 through February 2013 were included for analysis. The average LOH was 1.2 days. LOH was found to be significantly longer in patients with obstructive sleep apnea undergoing lingual tonsillectomy than in oncologic patients. All patients were discharged home on a per oral diet. No patients had a tracheotomy or PEG tube at 6 months postoperatively. The postoperative complication rate was 5% and was independent of the LOH.

Conclusions:

TORS has seen tremendous growth in the last few years for the treatment of oropharyngeal carcinoma and obstructive sleep apnea (OSA). To date, there have been no formal recommendations regarding postoperative management of these patients. We demonstrate that rapid discharge after undergoing TORS is safe, well‐tolerated, has a low complication rate, and does not result in hospital re‐admission. However, patients with OSA required longer hospitalizations. This further supports the cost‐effectiveness of TORS over other treatment paradigms for oropharyngeal cancer.
Sialendoscopy Outcomes: A Study of over 100 North American Patients for Benign Salivary Gland Disorders
Authors: Modest Mara C. , Galinat Lauren , Rabinowitz Mindy , Curry Joseph , Rosen David , Cognetti David M.
Published: August 2013

Objectives:

Evaluate our institution's experience with diagnostic and therapeutic sialendoscopy in the management of nonneoplastic salivary gland disorders.

Methods:

At a tertiary medical center, a retrospective chart review was conducted of 105 patients with recurrent sialadenitis between 2008‐2012 with sialendoscopy performed on 130 glands. Outcomes measured included cause, stone size and location, surgical method, and any further need for intervention.

Results:

The mean age of presentation was 49 (range, 15‐77), and 45% were male. Reasons for recurrent sialadenitis included sialolithiasis (75), history of radioactive iodine/radiation (10), Sjogrens Syndrome (2), stricture (6), and anatomical obstruction (7). Ten patients had a history of prior transoral intervention, and two had a history of gland removal on the affected side. In patients with sialolithiasis (n = 75), the mean stone size was 8.6 mm if originating from the submandibular gland (n = 44, range, 1‐25mm), and 4.4 mm if originating from the parotid (n = 9, range, 2‐7mm). Complete stone removal was accomplished in 92% of cases on first attempt with the stone visualized. In 33.8% of the patients, the stone was removed endoscopically, while a combined approach was required in 50.7%. 15.5% required submandibular or parotid gland removal. 17.8% of patients required further intervention (medical or surgical) following their procedure.

Conclusions:

Sialendoscopy demonstrates great potential in the management of recurrent sialadenitis and minimizes the need for gland excision in that setting. Further investigation and adoption of sialendoscopy is warranted.