bluuebunny/crossref_metadata_2025 huggingface dataset:
Hylan B Gel Restores Structure and Function to Laser-Ablated Canine Vocal Folds
Authors: Jahan-Parwar Babak , Chhetri Dinesh K. , Ye Ming , Hart Steven , Berke Gerald S.
Published: October 2014

Objectives:

We evaluated cross-linked hyaluronic acid (hylan B gel) as a scaffold for tissue regeneration and mucosal wave restoration in carbon dioxide laser–ablated canine vocal folds.

Methods:

Five beagles underwent stroboscopy before ablation of the left vocal fold with a carbon dioxide laser. Four weeks later, stroboscopy was repeated before and after submucosal injection of hylan B gel into the left vocal fold of 4 animals and of saline solution in 1 animal. Stroboscopy was repeated 12 weeks later, and histologic analysis was performed.

Results:

Four weeks after laser ablation, all animals had soft tissue defects and absence of mucosal waves. Hylan B injection restored mucosal waves, and saline injection did not. Twelve weeks after injection, hylan B–injected larynges had tissue regeneration and mucosal waves, and the saline-injected larynx had neither. Histology showed regenerated lamina propria with residual foci of hylan B in the hylan B–injected larynges and dense submucosal scar in the saline-injected animal.

Conclusions:

Submucosal hylan B gel injection in laser-ablated canine vocal folds restored tissue volume and mucosal waves and facilitated functional tissue regeneration over 12 weeks. Hylan B gel may have utility as a soft tissue scaffold for rehabilitation of phonatory function in vocal folds with lamina propria defects.
Plasma 25-Hydroxyvitamin D Levels in Young Children Undergoing Placement of Tympanostomy Tubes
Authors: Linday Linda A. , Shindledecker Richard D. , Dolitsky Jay N. , Chen Tai C. , Holick Michael F.
Published: October 2014

Objectives:

We report the plasma 25-hydroxyvitamin D [25(OH)D] levels of 16 young children who were undergoing ambulatory surgery for placement of tympanostomy tubes.

Methods:

We previously obtained blood samples from young children who were undergoing ambulatory surgery and reported that they had lower blood levels than adults of eicosapentaenoic acid (an omega-3 fatty acid), vitamin A, and selenium. Plasma frozen continuously at −80°C was available from 16 subjects who were undergoing placement of tympanostomy tubes.

Results:

The mean (±SD) age of the patients was 3.7 ± 1.6 years (median, 2.9 years; range, 1.9 to 7.4 years). Sixty-two percent were male; half were white, and half were Hispanic. Sixty-two percent were private patients; the parents reported that half were taking vitamin supplements. None had a history of rickets. None had 25(OH)D levels less than 10 ng/mL; 50% had 25(OH)D levels less than 20 ng/mL (deficient in adults); another 31% had levels from 21 to 29 ng/mL (insufficient in adults).

Conclusions:

Vitamin D is essential for the production of endogenous antimicrobial peptides, and has been linked to seasonal, epidemic influenza A. However, the level of 25(OH)D needed to prevent infection with various human pathogens has not been defined. In view of increasing bacterial resistance and emerging new pathogens, further research on the relationship of infection to 25(OH)D and other nutritional factors is warranted.
Improvement of Olfaction after Endoscopic Sinus Surgery in Smokers and Nonsmokers
Authors: Danielides Vassilios , Katotomichelakis Michael , Balatsouras Dimitrios , Riga Maria , Tripsianis Gregory , Simopoulou Maria , Nikolettos Nikolaos
Published: October 2014

Objectives:

The aim of this prospective study was to examine the short-term benefit of endoscopic sinus surgery (ESS) on the olfactory function of patients operated on for nasal polyposis. We also studied the predictive value of smoking for the recovery of the olfactory function in these patients.

Methods:

We studied 116 patients with nasal polyposis who underwent ESS. Olfactory testing was performed with the Sniffin' Sticks test before operation and 1, 3, and 6 months after operation.

Results:

All patients achieved a statistically significant stepwise increment of all of the indices of olfactory function over time. The composite threshold-discrimination-identification score was lower in smokers than in nonsmokers in all testing sessions, but none of these differences reached statistical significance. After adjustment for preoperative olfactory measures and all other potential confounders, the effect of smoking on the 6-month postoperative measurement was not significant. However, we did find a statistically significant adverse effect of the quantity of smoking on the olfactory threshold scores.

Conclusions:

Both smokers and nonsmokers achieve a highly significant improvement on their olfactory function from ESS. Although smoking is not a major predictive factor for the short-term outcome of the olfactory function after ESS, a greater quantity of smoking may have an effect on the 6-month postoperative odor thresholds.
Efficacy and Safety of Adenotonsillectomy for Pediatric Obstructive Sleep Apnea in Prader-Willi Syndrome
Authors: Tanna Neil , Choi Sukgi S.
Published: October 2014

Objectives:

We performed a retrospective analysis in a tertiary care children's hospital to evaluate the efficacy and safety of adenotonsillectomy for the treatment of pediatric obstructive sleep apnea (OSA) in Prader-Willi syndrome (PWS).

Methods:

We studied all PWS patients who underwent adenotonsillectomy to treat OSA from January 1, 2004, to December 31, 2005. The main outcome measures were 1) preoperative and postoperative full overnight polysomnography and 2) postoperative complications.

Results:

Three PWS patients were identified, including female twins and 1 boy. All patients had preoperative evidence of OSA without central apnea. Resolution of OSA after adenotonsillectomy was variable. The patient with the highest body mass index and tonsil size had the least residual OSA after adenotonsillectomy. No perioperative complications or adverse events were observed.

Conclusions:

Adenotonsillectomy did not consistently improve OSA in this population of patients with PWS. No perioperative complications were noted. Postoperative polysomnography should be considered for evaluation of possible residual OSA, as additional interventions may be warranted.
Initial Anatomic Geographic Presentation of Glottal Dysplasia
Authors: Lahav Yonatan , Burns James A. , Feinberg Steven , Heaton James T. , Zeitels Steven M.
Published: October 2014

Glottal dysplasia is likely the most common laryngeal disease with a discernible lesion; however, investigations describing its initial anatomic geographic presentation are rare. To examine this, we identified 52 patients who did not have significant prior treatment or glottal cancer. Thirty-one patients had bilateral disease, so there were 83 vocal folds with precancerous dysplasia. The phonatory mucosa was the dominant disease site in all; the epicenter was on the superior surface in 65 of the 83 folds and on the medial surface in 18 of the 83 folds. The arytenoid mucosa was involved in 8 of the 83 folds. Nineteen of the 52 patients had direct anterior-commissure involvement, and none had interarytenoid mucosal disease. The investigation established the commonly held principle that glottal dysplasia occurs primarily on phonatory mucosa. Given the frequent occurrence and recurrence of glottal dysplasia, treatment goals should focus on disease control to prevent malignant degeneration while preserving the subepithelial superficial lamina propria, necessary for phonatory mucosal pliability, vocal fold vibration, and optimal vocal function.
Prevalence of Vitamin D Deficiency among Patients Attending a General Otolaryngology Clinic in South Auckland
Authors: Bartley Jim , Reid David , Morton Randall P.
Published: October 2014

Objectives:

We performed a prospective observational study to estimate the prevalence of vitamin D deficiency in patients attending a general otolaryngology clinic in South Auckland, New Zealand.

Methods:

From July 21, 2008, to August 7, 2008, all new patients presenting to otolaryngology clinics at which one of the authors (D.R.) was present had their vitamin D status assessed by measurement of their plasma 25-hydroxyvitamin D [25(OH)D] level.

Results:

Of 48 patients, 2% had 25(OH)D levels of 17.5 nmol/L or less (a level associated with osteomalacia), 58% had 25(OH)D levels of 50 nmol/L or less (a level associated with vitamin D deficiency), and 100% had 25(OH)D levels of 80 nmol/L or less.

Conclusions:

Most of the patients attending a general otolaryngology clinic in South Auckland are vitamin D–deficient. It is unclear whether low vitamin D levels are associated more directly with otolaryngological disorders or skin type, because the small size of this study and the broad range of conditions seen precluded a meaningful statistical analysis. Further research into the relationship of vitamin D to specific otolaryngological presentations is required.
Piezoelectric Surgical Device in Endoscopic Sinus Surgery: An Initial Clinical Experience
Authors: Bolger William E.
Published: October 2014

Revision endoscopic sinus surgery presents special challenges, such as the need to remove thick osteoneogenic bone close to the orbit or skull base. Currently available drills and microdebriders have shortcomings for this task, including risk to the underlying periorbita or dura. Recently, piezoelectric ultrasound technology has been used to remove bone while preserving adjacent soft tissue structures. This technology has been effective in several areas of the body, and it logically follows that it may have beneficial rhinologic applications. The purpose of this medical communication is to report an initial clinical experience with piezoelectric technology in revision sinus surgery. The piezoelectric surgical device was used during revision endoscopic sinus surgery in 14 patients in the author's practice from June 2006 to January 2009. All patients had an underlying bone component to their sinus condition, such as osteoneogenesis adjacent to the orbit or skull base. The piezoelectric surgical device performed successfully in removing osteoneogenic bone, and no complications were noted from its use. Piezoelectric surgical technology generates low-frequency ultrasound that dissects bone and appears to offer an option to mechanical drill instrumentation when used during endoscopic sinus surgery to address thick osteoneogenic bone. The clinical experience reported herein shows initial feasibility of the technology in selected cases of sinus surgery. On the basis of the favorable observations from this clinical experience, further exploration and discussion would appear to be valuable.
Hypertrophic Anterior Cervical Osteophytes Causing Dysphagia and Airway Obstruction
Authors: Lin Harrison W. , Quesnel Alicia M. , Holman Allison S. , Curry William T. , Rho Michael B.
Published: October 2014

Hyperostosis of anterior cervical vertebral osteophytes can produce otolaryngological symptoms ranging from mild dysphagia, dysphonia, and foreign body sensation to severe food impaction and stridulous dyspnea. Airway compromise necessitating a tracheostomy is very rare. We discuss the case of an elderly man who presented with progressive dysphagia and a large hypopharyngeal mass as his initial manifestations of hypertrophic anterior cervical osteophytes. After a biopsy of the mass, the patient went into airway distress due to bilateral vocal fold fixation by the enlarging mass and consequently required a surgical airway. A combined team approach to the removal of the osteophytes successfully resolved his symptoms. The clinical, diagnostic, radiologic, and therapeutic principles involved in this case are presented and discussed. The recognition of hypertrophic osteophytes as a potential cause of common otolaryngological symptoms in the elderly population is paramount, as these symptoms can rapidly progress and lead to life-threatening airway obstruction. Medical and surgical interventions can be employed for the treatment of hypertrophic anterior cervical osteophytes, and they often result in favorable outcomes.
ProEx C Stain Analysis in Recurrent Respiratory Papillomatosis
Authors: Bhandarkar Naveen D. , Sims H. Steven , David Odile
Published: October 2014

Objectives:

We evaluated the presence and pattern of ProEx C stain, a marker for the proliferative capacity of cells, in laryngeal tissues, including benign, malignant, and recurrent respiratory papilloma (RRP) specimens, and compared it to hematoxylin and eosin staining for the presence of dysplasia.

Methods:

We performed a retrospective study with chart review.

Results:

A total of 26 specimens (9 benign, 7 malignant, 10 RRP) representing 21 patients were stained. ProEx C stained positive in the nuclei of laryngeal tissue, consistent with its localization in cervical cytology specimens. Seven of 9 benign and 7 of 10 RRP specimens stained positive. The benign specimens were mostly polyps. The malignant specimens were either well or moderately differentiated squamous cell carcinoma, and they stained strongly and diffusely. In benign and RRP specimens, the basal layer typically stained positive. Other areas of epithelium stained weakly in benign specimens and variably in RRP specimens. Current analysis of hematoxylin and eosin—stained RRP specimens revealed that 30% of specimens had at least moderate dysplasia and 80% exhibited viral changes (koilocytosis).

Conclusions:

ProEx C is a clean and reliable stain in laryngeal tissue, and stains positive in RRP. This study could not definitively correlate positive ProEx C staining in areas of greater dysplasia, although a trend was observed. Further studies are necessary to determine whether ProEx C can be used in triage of cases of clinically aggressive RRP for closer follow-up or frequent operative intervention.
Age-Specific Size of the Upper Airway Structures in Children during Development
Authors: Songu Murat , Adibelli Zehra H. , Tuncyurek Ozum , Adibelli Hamit
Published: October 2014

Objectives:

The purpose of this study was to establish the largest magnetic resonance imaging study so far, by including 292 cases in a prospective fashion, to investigate the normative values of the upper airway and surrounding tissues during development.

Methods:

We enrolled in the study 448 children who underwent cranial magnetic resonance imaging. We included 292 patients who had no sleep disorders or any associated symptom that could be related to breathing disorders. Using midsagittal and axial images, we evaluated the variations in size of the upper airway tissues.

Results:

On images from the midsagittal plane, the normative values of the length and the thickness of the soft palate, the length and height of the tongue, the distance between the mental spine and the clivus, the thickness of the adenoid pad and the nasopharyngeal area, the adenoid pad oblique width, the soft palate oblique width, and the tongue oblique width were obtained for several age groups. Using images from the axial plane at the level of maximal tonsillar cross-sectional area, we measured the normative values of the mean tonsillar width and intertonsillar space.

Conclusions:

Magnetic resonance imaging is an excellent method of assessing upper airway structures. Knowledge of variations in size of the upper airway and surrounding tissues is essential in determining the significance of incidental findings in this area.
Predictors of Aspiration Pneumonia following Radiotherapy for Head and Neck Cancer
Authors: Purkey Michael T. , Levine Marc S. , Prendes Brandon , Norman M. Frank , Mirza Natasha
Published: October 2014

Objectives:

Aspiration following radiotherapy for head and neck cancer (HNC) is a common event, but not all patients with aspiration will develop pneumonia. Our aim was to identify predictors of pneumonia in patients with aspiration following radiotherapy for HNC.

Methods:

We performed a retrospective study of 52 patients referred for modified videofluoroscopic barium swallow (MVBS) testing at our institution from 2003 to 2007 in order to identify clinical variables associated with the diagnosis of aspiration pneumonia.

Results:

Independent risk factors for the development of pneumonia were tracheobronchial aspiration on MVBS testing (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.2 to 20.5; p = 0.025), malnutrition (OR, 4.4; 95% CI, 1.3 to 14.7; p = 0.018), and smoking history (OR, 1.04 per pack-year; 95% CI, 1.01 to 1.07; p = 0.011). Through logistic regression analysis, we developed a bivariate predictive model with a sensitivity of 58%, a specificity of 90%, a positive predictive value of 79%, and a negative predictive value of 77% for the development of aspiration pneumonia in our patient population.

Conclusions:

Depth of aspiration on MVBS testing, malnutrition, and smoking history were strongly associated with the development of aspiration pneumonia in our patient population. The use of clinical variables to determine the risk of aspiration pneumonia is feasible and may help identify high-risk patients.
Endonasal Repositioning of the Upper Lateral Cartilage and the Internal Nasal Valve
Authors: Stupak Howard D.
Published: October 2014

Objectives:

Collapse of the upper lateral cartilage (ULC) is associated with narrowing of the internal nasal valve (INV). The goal of this article is to describe a novel procedure that repositions the ULC, opening the INV, without implants, grafts, or permanent sutures.

Methods:

Before-and-after digital photographs of patients with ULC and INV collapse who underwent endonasal ULC repositioning were analyzed. The surgical procedure consists of an intercartilaginous incision and the creation of a surface that permits scarification upon cartilage reapproximation. Precise placement of a support apparatus permits the ULC to heal into a position in direct contact with the lower lateral cartilage, thus dilating the INV. The percentage of collapse of the ULC (PCULC), determined by ULC shape measurements made with computer-aided design software, was compared on before- and-after photographs by use of Student's t-test (paired).

Results:

The study included 52 patients (79 procedures) followed for 1 to 18 months after surgery in the period 2007 to 2009. There were no complications or revision surgeries. The preoperative mean PCULC was 58.6%. The postoperative mean PCULC was 5.7% (p < 0.0001).

Conclusions:

Repair of the INV via ULC repositioning is a simple, relatively safe procedure that produces a statistically significant improvement in the PCULC. The functional change at the INV may be inferred from the ULC shape, but further prospective clinical studies are required.
School Performance and Behavior of Korean Elementary School Students with Sleep-Disordered Breathing
Authors: Kim Jin Kook , Lee Ji Hye , Lee Seung-Hoon , Hong Seok-Chan , Cho Jae Hoon
Published: October 2014

Objectives:

It is known that children with sleep-disordered breathing (SDB) often have accompanying growth retardation and learning and behavior disabilities. However, these results are based mainly on studies of children from European and North American countries. The objective of this study was to investigate the school performance and behavior of Korean children with SDB.

Methods:

We enrolled 302 third-grade elementary students from an elementary school in Seoul. A survey was conducted, using information from the children's parents for the diagnosis of SDB. The children's height, weight, midterm examination scores, and behavioral disturbances were analyzed.

Results:

Overall, 299 parents returned the survey. Of the 299 students, 29 (9.7%) were considered to have SDB. They showed no difference from the control in terms of body mass index. The mean examination score was higher in the control group than in the SDB group. However, there was a statistical difference only in social science. The prevalences of students who were inattentive (58.6% versus 23.7%) and lacking in self-control (44.8% versus 14.1%) were significantly higher among students with SDB.

Conclusions:

SDB is not closely associated with poor school performance among Korean elementary students. However, behavioral disturbance is more frequent among the students with SDB than in those without.
Acute Supraglottitis in Adults
Authors: Riffat Faruque , Jefferson Niall , Bari Noor , McGuinness John
Published: October 2014

Objectives:

Adult supraglottitis is a potentially life-threatening airway infection. We reviewed the management and outcome of supraglottitis in 169 adults admitted to Liverpool Hospital between 1999 and 2009.

Methods:

A retrospective review was conducted of all admissions with supraglottitis in patients at least 18 years of age. The diagnosis was confirmed by fiberoptic nasolaryngoscopy or direct laryngoscopy under general anesthesia. The main outcome measure was the need for intubation or tracheotomy. Univariate analysis was performed to determine factors that led to a worse outcome.

Results:

There were 80 men and 89 women in the cohort, with a median age of 51 years. Of these, 140 patients were admitted to the intensive care unit for a mean duration of 2 days. The common symptoms and signs at presentation were odynophagia and dysphagia (94%), dysphonia (65%), and stridor (33%). Endotracheal intubation was performed in 16 patients, and an awake tracheotomy was required in 4 patients. Dexamethasone acetate was used in 103 patients. Thirty-five patients had diabetes mellitus as a comorbidity. The presence of diabetes was predictive of the need for intubation or tracheotomy (p < 0.05), and the use of steroids was predictive of an intensive care unit stay of 24 hours or less (p < 0.05).

Conclusions:

Fiberoptic laryngoscopy is the gold standard for diagnosis of supraglottitis, and close airway monitoring is crucial. Conservative management of the airway is a viable option, but the presence of diabetes makes airway intervention more likely. The use of steroids aids in symptom alleviation and hastens resolution of airway swelling, with no negative sequelae.
Clinical Outcomes of Sinogenic Intracranial Suppuration: The Alder Hey Experience
Authors: Leong Samuel Chee , Waugh Lucy-Katherine , Sinha Ajay , De Sujata
Published: October 2014

Objectives:

The aim of this study was to present a series of cases of sinogenic intracranial suppuration in a pediatric tertiary referral center and to review the long-term outcomes of the patients.

Methods:

We performed a retrospective review of the hospital database and the patient case notes.

Results:

Over 10 years, 14 patients were identified. The clinical presentations at the time of admission tended to include headache, vomiting, pyrexia, limb weakness, and decreased level of consciousness, in decreasing order of frequency. Sinonasal symptoms such as discharge and obstruction were only present in 36% and 21% of cases, respectively. The most common intracranial complication was subdural empyema in the frontal lobe region. The mortality rate was 21% (3 of 14). The remaining 11 patients remained alive at latest follow-up. The average follow-up period after hospital discharge was 19 months (median, 15 months; range, 6 to 64 months). No significant complications were noted in 4 patients, who had returned to normal daily activities at 6 months of follow-up. A significant proportion of patients who survived have some form of neurologic sequelae, although 64% of cases became asymptomatic in the 12 months following hospital discharge.

Conclusions:

The significant risk of morbidity and mortality of this disease requires a multidisciplinary approach that is best delivered at a tertiary referral center.
Airway Complications of Pediatric Extracorporeal Membrane Oxygenation
Authors: Agar Nicholas J. M. , Berkowitz Robert G.
Published: October 2014

Objectives:

Prolonged intubation is a risk factor for the development of laryngotracheal stenosis. Children who undergo extracorporeal membrane oxygenation (ECMO) usually remain intubated for an extended period. It is unclear whether the impaired cardiorespiratory status that necessitated ECMO places these children at a higher risk of laryngotracheal stenosis. This study was performed to assess the incidences of laryngotracheal stenosis and tracheostomy in children who undergo ECMO.

Methods:

We identified all patients under 18 years of age who underwent ECMO over a 10-year period concluding July 1, 2009, by use of the extracorporeal life support database of Royal Children's Hospital, Melbourne. All children in this database who underwent either a diagnostic or a therapeutic surgical procedure on the airway were identified.

Results:

The 218 patients included in the study had an overall survival rate of 51.4%. A total of 14 patients (6.4%) required a surgical procedure on the airway, and 11 of these (5.0%) needed tracheostomy. Ten of these 14 patients (71.4%) survived; of these, 2 presented with congenital laryngotracheal stenosis, 3 developed clinically significant laryngotracheal stenosis as a likely consequence of ECMO, and 5 required tracheostomy alone for long-term ventilation. The rate of airway stenosis was 2.7% in survivors.

Conclusions:

The rate of laryngotracheal stenosis in children who require ECMO is acceptably low.
Concurrent Superselective Intra-Arterial Chemotherapy and Radiotherapy for Late-Stage Squamous Cell Carcinoma of the Temporal Bone
Authors: Sugimoto Hisashi , Ito Makoto , Yoshida Shinya , Hatano Miyako , Yoshizaki Tomokazu
Published: October 2014

Objectives:

This study evaluated the efficacy of concurrent superselective intra-arterial chemotherapy and radiotherapy without surgery for late-stage squamous cell carcinoma of the temporal bone, which typically has a poor prognosis.

Methods:

The subjects were 5 patients treated at our hospital between 2007 and 2010 for primary cancer of the temporal bone. One patient had a stage T3 tumor, and 4 patients had T4 tumors, according to the Pittsburgh staging system. All patients received irradiation with a conventional once-daily fraction of 2 Gy, and the total dose ranged from 60 to 66 Gy. Intra-arterial cisplatin via transfemoral catheterization and intravenous sodium thiosulfate were administered. The contribution of each vessel in supplying blood to the primary tumor was determined by real-time computed tomographic angiography.

Results:

Three patients obtained a complete response. The same 3 patients remain alive without local recurrence (mean survival, 28 months), 1 patient died of distant metastasis without local recurrence after 19 months, and 1 patient remains alive with local recurrence.

Conclusions:

Although the small number of patients prevents comparisons with other treatments, the present study obtained good results. This may become an effective treatment for patients with late-stage squamous cell carcinoma of the temporal bone.
Comparison of Nasal Sound Spectral Analysis and Peak Nasal Inspiratory Flow before and after Decongestion in Patients with Nasal Obstruction
Authors: Choi Hyuk , Park Il-Ho , Yoon Hu Geun , Lee Heung-Man
Published: October 2014

Objectives:

We compared the results of nasal sound spectral analysis (NSSA) with the results of peak nasal inspiratory flow (PNIF) testing and use of a visual analog scale in patients with allergic rhinitis with nasal obstruction.

Methods:

We performed NSSA and PNIF testing on 38 patients with allergic rhinitis and 35 healthy subjects. A diagnostic decongestion test was performed on the patients (not on the control subjects). Twenty minutes after decongestant was sprayed into the nostrils, NSSA and PNIF testing were performed again.

Results:

There was a significant difference in the PNIF values and the nasal inspiratory sound intensities before and after decongestion (p < 0.001). There was a correlation between the NSSA results at the frequency range of 2 to 4 kHz and the PNIF results. The calculated cutoffs between normal and pathological values were 14.8 dB (2 to 4 kHz) for NSSA and 116 ± 14.1 L/min for PNIF testing. No significant differences were computed between NSSA and PNIF testing in terms of sensitivity (0.71 versus 0.76) or specificity (0.74 versus 0.80).

Conclusions:

Use of NSSA and PNIF testing together for assessment of nasal obstruction in allergic rhinitis provides clinical relevance in that it allows a fair degree of reliability. Such testing can be performed as a surrogate for rhinomanometry.
Orbitocranial Approach for Treatment of Adenoid Cystic Carcinoma of the Lacrimal Gland
Authors: Wilson Kevin F. , Ward P. Daniel , Spector Matthew E. , Marentette Lawrence J.
Published: October 2014

Objectives:

Multiple treatment options exist for management of adenoid cystic carcinoma of the lacrimal gland. Our objective was to perform an analysis of outcomes in a cohort of patients with adenoid cystic carcinoma of the lacrimal gland treated identically with an orbitocranial approach.

Methods:

We performed a retrospective review of 7 consecutive patients who presented to a tertiary care academic medical center between 1995 and 2009 with adenoid cystic carcinoma of the lacrimal gland.

Results:

All patients were treated with an orbitocranial approach to tumor resection followed by postoperative radiotherapy. The mean and median follow-up times were 39 and 19 months, respectively (range, 7 to 138 months). Six patients had orbital reconstruction using free tissue transfer, and 1 patient had a split-thickness skin graft to line the orbital cavity. Two patients developed distant metastases 18 months and 29 months after surgery and ultimately died with disease. Five patients are alive without disease.

Conclusions:

The orbitocranial approach followed by postoperative irradiation achieves excellent local and regional control rates for adenoid cystic carcinoma of the lacrimal gland, although patients remain at risk long-term for distant metastases. Orbital bone removal to obtain adequate margins should be a routine part of tumor resection for these malignancies.
Obstructing Encephaloceles Presenting as Chronic Rhinosinusitis: Lessons Learned from a Case Series
Authors: Jaber James J. , Hawbaker Nicolaus , Stankiewicz James A.
Published: October 2014

We present a unique anatomic cause of encephalocele, and describe appropriate diagnosis. Two patients underwent stereotactic image-guided sinus surgery for presumed chronic rhinosinusitis with intraoperative findings of a sinus encephalocele. The first patient underwent a conservative 2-stage management that included an initial cerebrospinal fluid (CSF) leak repair followed by encephalocele resection. The second patient underwent a 1-stage encephalocele resection and CSF leak repair with a septal graft. The sinus surgeon needs to consider the possibility of encephalocele when the ethmoid, sphenoid, or, rarely, frontal sinuses present with an isolated opacification that does not improve with conservative medical therapy.
Management and Outcomes of Laryngeal Injuries in the Pediatric Population
Authors: Sidell Douglas , Mendelsohn Abie H. , Shapiro Nina L. , St. John Maie
Published: October 2014

Objectives:

Pediatric laryngeal trauma is an uncommon event. The purpose of this study was to identify outcomes following surgical procedures for pediatric laryngeal trauma, and to provide an in-depth review of the literature.

Methods:

The National Trauma Data Bank was utilized to identify pediatric laryngeal trauma incidents with admission years 2002 through 2006. Patient demographics, injury type, surgical procedures, hospital and intensive care unit durations, ventilator duration, and discharge disposition were abstracted.

Results:

There were 69 laryngeal trauma incidents identified, with a median patient age of 12.8 years and an overall mortality rate of 8.7%. Laryngeal injury was frequently blunt-force in nature (82.8%) and often occurred in conjunction with trauma to multiple organ systems (76.8%). Tracheotomy (16 procedures), laryngeal suturing (13 procedures), and laryngeal fracture repair (10 procedures) were the most frequent procedures identified. Laryngeal fracture repair was noted to increase the overall hospital duration (p = 0.040). The communication scores were affected only by tracheotomy (p = 0.013). Surgical intervention did not significantly affect the frequency of home discharge.

Conclusions:

Pediatric laryngeal trauma is an uncommon event that can be evaluated with the National Trauma Data Bank. Although patients who undergo laryngeal fracture repair appear to have an increased duration of hospitalization, patients who undergo tracheotomy or laryngeal suturing do not have increased durations of ventilator dependence, stay in an intensive care unit, or hospitalization.
Congenital Laryngomalacia: Symptom Duration and Need for Surgical Intervention
Authors: Wright Charles T. , Goudy Steven L.
Published: October 2014

Objectives:

We undertook to characterize the natural course and duration of stridor and other symptoms associated with laryngomalacia and determine the need for surgical intervention.

Methods:

A retrospective observational study was performed at a tertiary children's hospital of 120 consecutive cases of congenital laryngomalacia diagnosed and treated by the senior author between July 2005 and June 2009. The patients' symptoms, associated symptoms, and required interventions were recorded.

Results:

In 115 cases that were managed without surgery, stridor resolved at a mean patient age of 7.6 months. Five patients (4.2%) required supraglottoplasty to resolve their airway obstruction. The patients who required surgery presented emergently to the hospital 80% of the time, and at a younger mean age (45 days) than did patients who did not require surgery (95 days; p = 0.13); these findings suggest the severe nature of their symptoms. Presenting symptoms of dyspnea or accessory muscle use, feeding difficulties, apnea, cyanosis, oxygen desaturation, and failure to thrive were significantly associated with the requirement for operative intervention (all p values less than 0.02). Nonoperative management included placement of a nasogastric tube due to aspiration in 3 patients.

Conclusions:

The stridor resolved at an average age of 7.6 months of age in patients with laryngomalacia managed without surgery. A young age at presentation and emergent evaluation in the hospital are associated with a higher degree of symptom severity and a higher rate of surgical intervention. Surgical intervention was necessary to treat laryngomalacia in 4.2% of patients in this study population.
Nasal Floor Free Mucosal Graft for Skull Base Reconstruction and Cerebrospinal Fluid Leak Repair
Authors: Suh Jeffrey D. , Ramakrishnan Vijay R. , DeConde Adam S.
Published: October 2014

Objectives:

Donor sites for free mucosal grafts for endoscopic endonasal reconstruction of the skull base have traditionally included the middle turbinate, the inferior turbinate, and the nasal septum. The aim of this study was to demonstrate a free mucoperiosteal graft from the nasal cavity floor as a simple alternative donor site for mucosal grafts.

Methods:

In a cadaver study with clinical correlation, we performed endoscopic endonasal harvest of the nasal floor free mucosal graft on two sides of a cadaveric nasal cavity. We also describe the cases of two patients in whom a nasal floor free mucosal graft was used to repair a skull base defect.

Results:

The harvest of a nasal floor free mucosal graft is a quick, potentially less morbid method of obtaining free mucosal grafts. In the cases examined, use of this graft carried minimal morbidity and allowed for successful reconstruction of a skull base defect.

Conclusions:

Harvest of nasal floor mucosa is a technically simple method of obtaining free mucoperiosteum for reconstruction of the skull base.
Assessment of a Neurophysiological Model of the Mandibular Branch of the Facial Nerve in Rats by Electromyography
Authors: Salomone Raquel , Costa Heloisa Juliana Zabeu Rossi , Rodrigues José Ricardo Ferreira , Reis e Silva Samanta Marques , Orando Patricia Camacho , Bento Ricardo Ferreira
Published: October 2014

Objectives:

Our objective was to develop an experimental model for the noninvasive and objective evaluation of facial nerve regeneration in rats using a motor nerve conduction test (electromyography).

Methods:

Twenty-two rats were submitted to neurophysiological evaluation using motor nerve conduction of the mandibular branch of the facial nerve to obtain the compound muscle action potentials (CMAPs). To record the CMAPs, we used two needle electrodes that were inserted into the lower lip muscle of the rat. A supramaximal electrical stimulus was applied, and the values of CMAP latency, amplitude, length, area, and stimulus intensity obtained from each side were compared by use of the Wilcoxon test.

Results:

There was no significant difference (all p > 0.05) in latency, amplitude, duration, area, or intensity of stimuli between the two sides. The amplitudes ranged between 1.61 and 8.30 mV, the latencies between 1.03 and 1.97 ms, and the stimulus intensities between 1.50 and 2.90 mA.

Conclusions:

This is a noninvasive, easy, and highly reproducible method that contributes to an improvement of the techniques previously described and may contribute to future studies of the degeneration and regeneration of the facial nerve.
Modified Osteoplastic Flap Approach for Frontal Sinus Disease
Authors: Al-Qudah Mohannad , Graham Scott M.
Published: October 2014

Objectives:

We review the use and outcomes of osteoplastic flap surgery in the current era of almost entirely endoscopic management of frontal sinus disease.

Methods:

A retrospective review was performed of 312 consecutive sinus surgeries performed for frontal sinus disease at the University of Iowa Hospitals and Clinics from July 2002 to July 2008.

Results:

Seventeen subjects (10 men and 7 women; mean age, 56 years) were identified. The indications for osteoplastic flap surgery were laterally located mucoceles in 8 patients, tumors in 7 patients, and osteomyelitis in 2 patients. Ten patients had skull base erosion, and 5 underwent cranialization for large posterior frontal bone defects. The average blood loss was 175 mL, and the average hospital stay was 3 days. There were no major intraoperative or perioperative complications. Two patients with mucoceles required revision surgery for disease recurrence. The mean follow-up was 25 months (range, 6 to 66 months).

Conclusions:

Osteoplastic flap surgery is an uncommon procedure in the modern endoscopic era of sinus surgery. In our series it was most commonly indicated for laterally located disease. Osteoplastic flap surgery is relatively safe and effective for a wide range of recalcitrant and complicated frontal sinus disorders.
DFNA5, a Gene Involved in Hearing Loss and Cancer: A Review
Authors: Op de Beeck Ken , Van Laer Lut , Van Camp Guy
Published: October 2014

Objectives:

The DFNA5 gene was identified in 1998 as a gene that causes an autosomal dominant form of hearing impairment. Five different DFNA5 mutations have been found; each results in skipping of exon 8 at the messenger RNA level. This finding indicates that DFNA5-associated hearing loss is attributable to a highly specific gain-of-function mutation. Interestingly, later reports revealed that DFNA5 also plays a role in tumor biology.

Methods:

Recent data have shed more light on the biological function of DFNA5. Through a literature search, the current knowledge of this gene is reviewed.

Results:

DFNA5 is the first gene for monogenic deafness that is known to involve apoptosis as a disease mechanism — A mechanism that was shown to be involved in frequent types of hearing loss caused by age, noise, or drugs. In line with its apoptosis-inducing properties, DFNA5 is a tumor suppressor gene with an important role in major types of tumors.

Conclusions:

DFNA5 is a tumor suppressor gene that is involved in apoptosis pathways and as such performs a basic role in cell survival. In view of the known role of apoptosis in several forms of hearing loss, DFNA5 may be a player in the underlying disease mechanisms.
Vocal Fold Vibratory Behavior Changes following Surgical Treatment of Polyps Investigated with High-Speed Videoendoscopy and Phonovibrography
Authors: Kunduk Melda , Döllinger Michael , McWhorter Andrew J. , Švec Jan G. , Lohscheller Jörg
Published: October 2014

Objectives:

The goal of this study was to objectively quantify the changes in vocal fold vibratory characteristics before and after surgery with high-speed videoendoscopy and the image analysis tool phonovibrography.

Methods:

High-speed videoendoscopic data, audio recordings, and Voice Handicap Index scores were collected from 8 subjects with a diagnosis of unilateral vocal fold polyps, before operation and at 1 week and 1 to 3 months after operation. We then analyzed the objective phonovibrographic patterns and parameters describing the vocal fold vibratory behavior.

Results:

On phonovibrography, the visual representations of the vocal fold vibratory characteristics, from both the individual and the group data, demonstrated very different patterns before surgery and both 1 week and 1 to 3 months after surgery. The individual phonovibrograms obtained from the left and right true vocal folds clearly demonstrated the lesion site and its effects on the vocal fold vibratory characteristics for each subject. The improvements in amplitude and symmetry (relative vibratory amplitude and vibration amplitude symmetry) of vocal fold vibration were quantified; the difference was greatest between data from before surgery and data from 1 week after surgery.

Conclusions:

The visual phonovibrographic patterns and quantitative data revealed marked changes in vocal fold vibratory patterns after operation and continued improvement at 1 to 3 months.
Transoral Laser Microsurgery of Recurrent Early Glottic Cancer after Radiation Therapy: Clinical Feasibility and Limitations
Authors: Han Young Jin , Lee Hyoung Shin , Kim Sung Won , Hong Jong Chul , Kim Seung Tae , Park Hyo Sang , Lee Kang Dae
Published: October 2014

Objectives:

Transoral laser microsurgery (TLM) is an accepted alternative to open partial laryngectomy for selected glottic cancers, but its role in salvage of radiation failure is debated.

Methods:

The records of 18 patients treated by TLM for rT1 and rT2 glottic cancer after curative radiation therapy from 2002 to 2007 were retrospectively analyzed.

Results:

Of the 18 patients, 10 (56%) remained free of disease after the first TLM. The 5-year local control and laryngeal preservation rates showed better outcomes in rpT1 tumors than in rpT2 tumors (87.5% versus 16.6%, p = 0.02; and 87.5% versus 33.3%, p = 0.03, respectively). However, the 5-year overall survival and disease-specific survival rates showed no significant difference between rpT1 and rpT2 tumors.

Conclusions:

TLM can be a relatively safe and effective salvage option for rT1 glottic cancer. However, because of its high local recurrence rate, TLM may not be generally recommended for rT2 glottic cancer.
Bilateral Vestibulopathy with Dissociated Deficits in the Superior and Inferior Vestibular Systems
Authors: Fujimoto Chisato , Murofushi Toshihisa , Sugasawa Keiko , Chihara Yasuhiro , Ushio Muentaka , Yamasoba Tatsuya , Iwasaki Shinichi
Published: October 2014

Objectives:

The aim of this study was to reveal the clinical characteristics of dissociated bilateral vestibulopathy (BV) affecting the superior vestibular nerve system on one side and the inferior vestibular nerve system on the other side. It is probable that BV does not always show bilateral deficits of the same vestibular nerve system.

Methods:

In a retrospective study of 2,752 consecutive new patients, 1,560 patients had undergone both caloric testing and cervical vestibular evoked myogenic potential testing. All 1,560 patients had also undergone a battery of tests including standardized neurologic, neuro-otologic, neuro-ophthalmologic, and audiological examinations.

Results:

Forty-three patients (2.8% of 1,560 patients) were given a diagnosis of dissociated BV. Among them, 10 patients (23%) had Meniere's disease and 6 patients (14%) had vestibular neuritis. Eighteen patients (42%) did not have any identifiable disease involving the peripheral vestibule, and 9 patients (21%) could be regarded as having a novel subtype of idiopathic BV.

Conclusions:

Although dissociated BV might be induced by some of the same causes that provoke bilateral vestibular dysfunction, a definite proportion of the patients did not have any identifiable causes of dissociated vestibular dysfunction. Idiopathic cases could be categorized into a novel subtype of idiopathic BV.
Outcomes of Balloon Dilation in Pediatric Subglottic Stenosis
Authors: Whigham Amy S. , Howell Rebecca , Choi Sukgi , Peña Maria , Zalzal George , Preciado Diego
Published: October 2014

Objectives:

We report outcomes of balloon dilation in the endoscopic management of pediatric subglottic stenosis (SGS) and discuss the role of balloon dilation in both primary and adjuvant therapy.

Methods:

We performed a retrospective review of treatment with noncompliant, high-pressure balloons for SGS in the past 2 years at a tertiary pediatric hospital. Fifty-one dilations were performed in 28 children with SGS. The children's mean age was 42 months. The mean SGS grade was 2.46.

Results:

Fifteen children had primary balloon dilation, and 13 had adjuvant balloon dilation. Overall, 16 children (57.1%) had successful balloon dilation. Of those who underwent primary dilation, 9 (60.0%) were able to avoid open reconstruction or tracheotomy and 6 had their symptoms temporarily improved (average, 36 days) until definitive open reconstruction. Of the patients who underwent adjuvant dilation, 7 (53.8%) were successfully decannulated. Nine of the 12 failed balloon dilations were in children who had concomitant airway disorders; in contrast, only 6 of 16 children in whom treatment was successful had concomitant airway disorders (p = 0.048). There was no statistical association between successful versus failed treatment and age (51.6 versus 27.9 months; p = 0.23), degree of stenosis (grade 2.3 versus grade 2.6; p = 0.41), presence of lung disease (33.3% versus 70%; p = 0.07), or soft versus firm stenosis (60.0% versus 53.1%; p = 0.71).

Conclusions:

Balloon dilation plays an important role in the primary and adjuvant management of pediatric SGS. The presence of concomitant airway lesions is significantly associated with failure of balloon dilation treatment. Meticulous surveillance of the dilated airway is necessary, given this failure rate.