bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of Life in Early‐Stage Oral Cancer: Interim Results from the COOLS Trial
Authors: Cromwell Ian , Cressman Sonya , Poh Catherine , Durham Scott , Rosin Miriam P. , Peacock Stuart
Published: August 2013

Objectives:

1) Describe the quality of life experienced by oral cancer patients over time. 2) Explore subdimensions of quality of life over time.

Methods:

The pan‐Canadian Optically‐guided Oral Lesions Surgical (COOLS) Trial is a multi‐center randomized control trial evaluating a novel surgical staging method for the treatment of early‐stage oral cancer. Surveys were given to 92 participants at baseline, 6 weeks, and 3 months after surgery, collecting data on self‐reported quality of life (QoL).

Results:

Aggregate survey scores (EQ‐5D, FACT H&N) did not show much difference before or after surgery. Subscale analyses, however, revealed important differences in self‐reported pain, anxiety, and head/neck specific symptoms over time. Results are indicative of a recovery that happens over time, but it remains to be seen if this effect extends to the 12‐month follow‐up stage. QoL trajectory differs by surgical site, and the presence/absence of neck dissection. Selected relevant comparisons will be presented.

Conclusions:

At an aggregate level, surgery does not either improve or worsen QoL in early‐stage oral cancer patients; however, deeper examination of the data suggests that there are trends that will be clinically meaningful to patients and their families. These findings may help clinicians to better prepare their patients before surgery. Recovery to baseline QoL is achieved around 3 months, which suggests that surgery may improve long‐term (>12 month) QoL.
Relationship between Ultrasonographic Echogenecity and Intratumoral Fibrosis and Growth Pattern in Papillary Thyroid Carcinoma
Authors: Lim Yun‐Sung , Mun Mi‐Jin , Park Young‐Min , Lee Won‐Yong , Lee Jin‐Choon , Lee Byung‐Joo , Wang Soo‐Geun
Published: August 2013

Objectives:

Ultrasonography (USG) is a powerful tool for evaluation of papillary thyroid cancer (PTC). Preoperative USG characteristics correlated with several prognostic factors for PTC. Tumor fibrosis is known to be an important histologic prognostic features in head and neck cancer. However, there is a lack of studies for tumor fibrosis in PTC. This study aimed to evaluate the relationship between ultrasonographic finding and intratumoral fibrosis and growth pattern in PTC.

Methods:

In all, 170 fresh cases with PTC patients underwent total thyroidectomy with central neck dissection (CND). Lateral neck dissection was performed in case of lateral neck metastasis. Retrospective analysis for USG finding such as echogenicity and pathologic characteristics including intratumoral fibrosis and tumor growth pattern were conducted.

Results:

Ninety (53%) patients had USG finding with marked hypoechogenecity. According to histologic characteristics, group with marked hypoechogenecity had more tumor fibrosis and more invasive growth pattern than the group with iso‐ or hypoechogenecity. There was no significant difference in age, sex, tumor size, extrathyroidal extension, and presence of central or lateral neck metastasis between the two groups. In univariate and multiple regression analysis, tumor fibrosis and growth pattern were significantly associated with USG echogenecity.

Conclusions:

These findings suggest that intratumoral fibrosis and tumor growth pattern are important determinants of preoperative ultrasonographic echogenecity in PTC.
Risk Factors for Cervical Lymph Node Metastasis of Tongue Carcinoma to the Unaffected Side
Authors: Kida Kota , Terada Tomonori , Uwa Nobuhiro , Sagawa Kosuke , Sakagami Masafumi
Published: August 2013

Objectives:

Investigate the relationship between cervical lymph node metastasis of tongue carcinoma in unaffected and affected sides and factors related to the primary site.

Methods:

Between January 2000 and December 2009, 248 patients with primary N0 tongue carcinoma in the unaffected side were treated radically at the Department of Otolaryngology, Osaka Medical Center for Cancer and Cardiovascular Diseases. We evaluated clinical T stage, tumor size, tumor extension (oral floor, anterior part of the tongue, root of the tongue, depth into the tongue) and clinical N stage for risk factors influencing cervical lymph node metastasis to the unaffected side.

Results:

Fourteen of 248 patients (5.6%) showed cervical node metastasis in the unaffected side. The rate of metastasis to the unaffected side was 17% in patients with primary site extending to the anterior part of the back of the tongue (P < 0.01). The rate was 16% in patients with primary site extending to more than half of the tongue depth (P < 0.05). The rate was 14% in patients with cN+ in the affected side (P < 0.01). Other factors were not associated a significant difference.

Conclusions:

Extending to the anterior part of the back of the tongue, more than half of the tongue depth and cN+ in the affected side were high risk factors of cervical lymph node metastasis to the unaffected side.
Robotic‐Assisted Neck Dissection via Facelift Incision: Preliminary Findings in North American Patients
Authors: Byrd James K. , Albergotti William G. , Kim Seungwon , De Almeida John , Duvvuri Umamaheswar
Published: August 2013

Objectives:

Describe the technique and lymph node yield of robotic‐assisted neck dissection (RAND) via facelift incision in a North American cohort.

Methods:

Patients with squamous cell carcinoma of the head and neck at a tertiary hospital in 2012 were offered selective neck dissection via facelift incision. Operative time, estimated blood loss, complications, and lymph node yield were collected. Additionally, seven sequential open selective neck dissections were retrospectively reviewed for lymph node yield. A two‐tailed t‐test was used to compare nodal yield between the two groups (RAND vs open).

Results:

Four patients underwent five RANDs, including a simultaneous transoral robotic surgery base of tongue resection and one partial glossectomy. Four lateral neck dissections and one supraomohyoid neck dissection were performed. Mean operative time for the cohort was 4:29 +/‐ 1:33 (including extirpation); the average time for the three RAND only was 3:29 +/‐ 0:55. Average blood loss was 77 +/‐ 68 ml. The only complication was an intraoperative internal jugular vein injury, which was repaired with surgical clipping and suturing. The average number of lymph nodes removed was 29 in patients undergoing level 2‐4 RAND, compared to 35.9 in the open group (P = 0.28).

Conclusions:

Our preliminary experience suggests that RAND is feasible and safe in the North American population. Our data is also the first to demonstrate that nodal yield is the same between robotic‐assisted and open lymphadenectomy. Further study will determine the learning curve for the procedure, and long‐term oncologic follow up is needed.
Role of Bcl‐2 and Ki‐67 Expressions in Predicting the Response to Radiotherapy in Cancer Larynx
Authors: Gamea Ahmed , Eltatawi Faika
Published: August 2013

Objectives:

Study of Bcl‐2 protein and nuclear antigen Ki‐67 expressions in laryngeal squamous cell carcinoma and its importance in predicting the tumor response to radiotherapy.

Methods:

Retrospective and prospective study. This study was conducted on 60 paraffin blocks of patients with laryngeal squamous cell carcinoma (T1 and T2 N0M0) who were treated with radiotherapy between 2003 and 2009. Thirty blocks were collected from patients who failed radiotherapy and thirty blocks from patients who successfully improved by radiotherapy. The response to radiotherapy was assessed during the follow up period by direct laryngoscopy and biopsy every 3 months. Sections (4um) were cut to be stained with H&E and for immunohistochemical staining for Bcl‐2 and nuclear antigen Ki‐67.

Results:

Immunohistochemical study of Bcl‐2 revealed positive expression in 70% of radioresistant cases compared with 10% of radiosensitive cases. Negative expression of B‐cl2 occurred in 30% of radioresistant cases compared with 90% of radiosensitive cases. Bcl2 is 70% sensitive and 90% specific and has a 80% accuracy in predicting patient response to radiotherapy. On the other hand, the study revealed non significant expression of the proliferative marker Ki‐67 between radioresistant and radiosensitive group.

Conclusions:

Bcl‐2 predicts radioresistance in patients with squamous cell carcinoma of the larynx. It can be used as a marker of poor radiotherapy outcome. Bcl‐2 positive patients could be offered an established and equally effective alternative treatment to radiotherapy, eg, partial laryngectomy, resulting in improved patient survival and quality of life.
The Role of the Parotid Fascia in Identification of the Facial Nerve during Parotidectomy
Authors: Song Tara E. , Rasgon Barry M.
Published: August 2013

Objectives:

At the conclusion of the presentation, participants should be able to appreciate that performing a safe parotidectomy requires identification and preservation of the facial nerve. Participants will demonstrate understanding of the relationship between the parotid fascia and the location of the facial nerve trunk. Multiple standard anatomic landmarks have been used to help the surgeon identify the general location of the facial nerve trunk. To our knowledge, no study has evaluated the use of the parotid fascia that immediately overlies the trunk as a landmark.

Methods:

Prospective cadaver study. Dissection of the parotid fascia and identification of the facial nerve trunk was carried out in 8 fresh cadaveric parotid glands. The attachments of the parotid gland were evaluated, with special attention to the fascia overlying the facial nerve trunk.

Results:

The parotid fascia envelops the posterior aspect of the gland in an open book fashion. Posteriorly, it connects to the anterior and medial aspect of the mastoid tip. Postero‐superiorly it attaches to the inferior aspect of the tragal pointer. Directly medial to the fascia lies the facial nerve trunk.

Conclusions:

The parotid fascia can be used as an additional landmark, in conjunction with other commonly used standard anatomic landmarks to identify the facial nerve trunk. It is useful as a landmark of depth of the facial nerve trunk. It can be palpated from the mastoid to the parotid gland. Deep to this sling of fascia, the facial nerve trunk is identified.
The Safety of Outpatient Total Thyroidectomy
Authors: Khichi Sunny S. , Newman John R. , Peters Glenn E.
Published: August 2013

Objectives:

Establish whether total thyroidectomy can be performed safely in the outpatient setting.

Methods:

This was a retrospective review of 410 total thyroidectomies performed by a single surgeon between 2009‐2012. Of these, 241 were performed as an outpatient surgical procedure. Outcome measures included symptomatic hypocalcemia, readmission for hypocalcemia, true vocal cord paralysis/paresis, hematoma, and overall readmission rate.

Results:

Of the total thyroidectomies performed by a single‐surgeon between 2009‐2012, 241/410 (59%) were outpatient procedures. Symptomatic hypocalcemia occurred in 12/241 (4.9%) and readmission for hypocalcemia occurred in 4/241 (1.6%). True vocal cord paralysis was not observed, however 5/241 (2.1%) did have transient vocal cord weakness that resolved without further intervention. Hematoma requiring surgical intervention occurred in 2/241 (0.8%). Overall readmission rate was 5/241 (2.1%).

Conclusions:

Though traditionally an inpatient procedure; our experience indicates that outpatient thyroidectomy is a safe and reasonable option.
Sentinel Lymph Node Biopsy for Cutaneous Squamous Cell Carcinoma of the Head and Neck
Authors: Yan Jennifer , Gernon Thomas J. , Glazer Evan , Warneke James , Krouse Robert , Erman Audrey
Published: August 2013

Objectives:

Determine the safety and reliability of sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma, the second most common skin cancer in the United States.

Methods:

One hundred four patients with cutaneous squamous cell carcinoma of the head and neck underwent sentinel lymph node biopsy at the University of Arizona Medical Center and the Southern Arizona Veterans Affairs Health Care System from 2001‐2012. Detailed histological and clinical data was extracted from a retrospectively collected, institutional review board–approved data set.

Results:

This is the largest series to date of patients with cutaneous squamous cell carcinoma of the head and neck who have undergone sentinel lymph node biopsy. In this series, a sentinel lymph node was positive for metastatic disease in 6.7% of patients. The negative predictive value, the false negative rate, and the false omission rate will be reported. Correlations between sentinel lymph node status and various clinicopathologic properties including size, patient age, comorbidities, rate of growth, differentiation at biopsy, outcome, patterns of failure, and nodal burden will be described.

Conclusions:

Sentinel lymph node biopsy in patients with cutaneous squamous cell carcinoma of the head and neck is a safe and reliable strategy to identify those patients who may benefit from therapeutic lymph node dissection and adjuvant therapies.
Recipient Artery Rupture in Free Tissue Transfer in Heavily Radiated Beds
Authors: Howard Brittany E. , Nagel Thomas H. , Donald Carrlene B. , Hayden Richard E.
Published: August 2013

Objectives:

Report a patient series of microvascular arterial rupture in fibula free flap tissue transfer for osteoradionecrosis of the mandible. 1) Evaluate the risk factors for arterial anastomotic rupture in free tissue transfer. 2) Evaluate management strategies and outcomes of these rare cases.

Methods:

Retrospective review of the senior surgeon's experience at a tertiary referral center for reconstruction of mandibulectomy defects for osteoradionecrosis with free tissue transfer from 2004 through 2013. Data collection included oncologic history, surgical resection and reconstructive details, postoperative course, complications, and outcomes.

Results:

Over a 10‐year period 38 patients underwent free fibula osseocutaneous flap reconstruction for a diagnosis of osteoradionecrosis of the mandible. There was a prevalence of 11% (4/38) that suffered delayed rupture of the recipient artery proximal to the microvascular anastomosis. Histopathology of the anastomotic segment demonstrated acute arteritis with acute inflammatory cells and pseudoaneurysm formation of the native vessel. The recipient artery of the anastomosis was the facial artery in 3 cases and the internal maxillary artery in 1 case. Timing to initial rupture ranged from 7 to 17 (median 8.5) days. In 2 of the 4 cases the anastomosis was revised, only to suffer repeat rupture. Ultimately all anastomoses required ligation, timing ranging from 10 to 20 (mean 15) days. There was 100% flap survival.

Conclusions:

Recipient arterial rupture is a rare occurrence, and in our experience heavily radiated tissue is the greatest risk factor. If salvage anastomosis with the same artery is undertaken, a high risk for repeat rupture exists.
Severe Prolonged Dysphagia following Transoral Resection of Bilateral Synchronous Tonsillar Carcinoma
Authors: Patel Alpen B. , Pollei Taylor R. , Hinni Michael L. , Moore Eric J. , Hayden Richard E.
Published: August 2013

Objectives:

1) Describe the complication of severe dysphagia following transoral surgical resection for bilateral simultaneous or synchronous tonsillar squamous cell carcinoma. 2) Analyze the incidence of bilateral simultaneous or synchronous tonsillar squamous cell carcinoma, as well as tumor multifocality in the setting of human papillomavirus.

Methods:

A retrospective review of four patients who presented to an academic, tertiary referral center between 2008‐2012 were reviewed; two treated with transoral laser microsurgery (TLM) and two with transoral robotic surgery (TORS) for biopsy proven previously untreated bilateral primary squamous cell carcinoma (SCCA). Main outcome measures included functional swallowing determined by the Functional Outcome Swallowing Scale (FOSS). The incidence of significant postoperative complications was recorded.

Results:

Two patients had surgery for discontiguous involvement of bilateral palatine tonsils with SCCA, while two patients had surgery for bilateral tonsillar SCCA with unilateral extension into the base of tongue. Complete swallowing failure as characterized by the FOSS was seen postoperatively in 3/4 patients who underwent TLM or TORS for bilateral simultaneous tonsillar carcinoma, while one patient was lost to follow‐up.

Conclusions:

Severe dysphagia in the setting of bilateral oropharyngectomy for simultaneous or synchronous tonsillar SCCA is rarely described but a significant concern. In an era with increased use of transoral surgery, along with increased human papillomavirus incidence, this unusual complication warrants discussion.
Socioeconomic Disparities in Mississippi Head and Neck Cancer Patients
Authors: Richardson Matthew A. , Tarsi Elizabeth J. , Replogle William H. , Jefferson Gina D.
Published: August 2013

Objectives:

Analyze the socioeconomic characteristics of head and neck cancer patients in Mississippi.

Methods:

Using a cross‐sectional study design, 1435 patients with squamous cell carcinoma of the upper aerodigestive tract who were treated at the single tertiary care center for the state of Mississippi and diagnosed between 1991 and 2012 were analyzed for correlation between overall cancer stage at presentation, race, sex, and several socioeconomic data points within their zip code, including median household income, percent population with less than a 9th grade education, and percent population with yearly income less than $10,000.

Results:

There were significant (P = 0.001) Spearman correlations between overall tumor stage and median household income, percent population with less than a 9th grade education, percent population with income less than $10,000, race of patient, and sex of patient. As median income increased, tumor stage tended to decrease. As the percentage making less than $10,000 and percentage below 9th grade education increased, tumor stage tended to increase. Controlling for sex and race, African‐Americans tended to have more advanced tumors than Caucasians, and males tended to have more advanced tumors than females. African‐American males had significantly advanced cancer stages at presentation than all other groups.

Conclusions:

To our knowledge, this study is the first to directly correlate overall stage of head and neck cancer patients with socioeconomic status and illustrates that patients with more advanced cancers are more likely to be African‐American males and live in economically disadvantaged areas.
Stretch of the Minimally Invasive Incision during Thyroid and Parathyroid Surgeries
Authors: Chen Nan , Zitsch Robert P.
Published: August 2013

Objectives:

1) Identify and quantify changes in length of the skin incision following minimally invasive thyroid and parathyroid surgery. 2) Determine whether these changes persist on follow‐up.

Methods:

Preliminary analysis of this ongoing prospective study is presented. Patients undergoing open minimally invasive thyroidectomy (open cervical approach through an incision <6 cm) and parathyroidectomy (incision <3 cm) were included. The length of the skin incision was measured at the start and end of each operation, and on postoperative follow‐up.

Results:

Data from 27 patients are available. Initial incision lengths ranged from 2 to 6 cm. The skin incisions on average lengthened by 3.9 mm during the surgery (95% confidence interval [CI] 2.6 to 5.0 mm), representing an average intraoperative stretch of 10.3%, P = 0.00. The lengths of the incision remained stable on 2‐week follow‐up. 6 of the 27 patients have returned 10 weeks following surgery. The lengths of the incisions have reduced by 4.8 mm on average from the 2‐week to the 10‐week measurement (95% CI ‐3.3 to ‐6.3 mm, P = 0.00).

Conclusions:

Preliminary data suggest the skin incision stretches during minimally invasive thyroid and parathyroid surgery. Based on available follow‐up data, the increase in incision length does not appear to be permanent.
The Submental Myocutaneous Flap for Circumferential Neopharyngeal Reconstruction: A Novel Technique
Authors: Tomblinson Courtney M. , Cervantes Sergio S. , Landry April M. , Hinni Michael L.
Published: August 2013

Objectives:

1) Describe a novel technique for circumferential neopharyngeal reconstruction utilizing a submental myocutaneous flap following total laryngopharyngectomy. 2) Discuss surgical planning and peri‐operative management for reconstruction. 3) Evaluate this technique's benefit over existing techniques.

Methods:

We describe a patient who underwent total laryngopharyngectomy with immediate neopharyngeal reconstruction using a myocutaneous submental flap. This is the first report of successful repair using this technique in the United States, according to our literature review. We compare this novel method with current techniques for repairing circumferential pharyngectomy defects.

Results:

Total laryngopharyngectomy was required for a recurrent squamous cell carcinoma of the hypopharynx, which involved the left arytenoid, pyriform sinus, and past midline posteriorly. The pharyngeal defect was circumferential measuring 8cm in length. A submental flap 8cm wide by 15cm long was elevated and tubed to form a neopharynx, was sutured longitudinally at one vertical seam, and attached to the superior and inferior borders of the native pharynx. A nasogastric tube remained in place for nine days to serve as a conduit in the newly formed pharyngeal construct. A swallow study did not demonstrate contrast extravasation or fistula. The patient completed adjuvant radiotherapy and is undergoing surveillance monitoring.

Conclusions:

The myocutaneous submental flap is a practical, regional option for immediate neopharyngeal reconstruction after total laryngopharyngectomy. Adequate time for wound healing before initiation of oral feeding is essential to prevent fistula formation. Functional recovery of swallowing is possible with the tubed submental flap and spares the patient morbidity associated with more complex reconstructions.
Survival and Functional Outcomes following Total Glossectomy
Authors: Shockley Ross , Johnston Benjamin , Netterville James L. , Rohde Sarah L.
Published: August 2013

Objectives:

Total glossectomy is a morbid procedure offered to patients with advanced tumors of the oral cavity and oropharynx. Reconstruction of the resultant defect is typically performed immediately after resection, with regional and free tissue transfer being most commonly used. The goals of this study are to demonstrate: 1) long‐term survival, 2) long‐term swallowing outcomes, 3) rate of tracheostomy dependence, and 4) reconstructive techniques utilized after total glossectomy.

Methods:

Retrospective chart review of patients who received total glossectomy at Vanderbilt between 2000 and 2010. Survival and functional outcomes were followed from the day of the surgery to the last outpatient note.

Results:

22 patients were included in this study, and 15 patients were alive 1 year post‐surgery. Average length of survival after the operation was 715 days. 4 patients received concomitant total laryngectomy. 14 of 18 patients that received tracheostomy were able to be decannulated, with an average time to decannulation of 23 days. 6 of the 22 patients were able to maintain 100% of their nutrition with PO feedings at 12 months post‐surgery. Reconstructive methods included 8 anterolateral thigh free flaps, 4 pectoralis flaps, 4 radial forearm free flaps, 2 scapular free flaps, 1 latissimus free flap, 2 lateral arm free flaps, and 1 jejunal free flap.

Conclusions:

Total glossectomy can significantly extend the lives of patients with advanced tongue cancer. However, this operation carries significant morbidity in regards to swallowing, and potentially the need for long‐term tracheostomy.
Survival Outcomes of Early Stage Oral Cavity Squamous Cell Carcinoma: A Multi‐institutional Analysis
Authors: Zhang Han , Biron Vincent L. , Dziegielewski Peter T. , Al‐Qahatan Khalid H. , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi
Published: August 2013

Objectives:

Surgical resection is the standard of care in early stage oral cavity squamous cell carcinoma (OCSCC). Recent literature has shown, however, that adverse pathologic features are potential indications for adjuvant radiotherapy. Objective: 1) Evaluate survival outcomes of early‐stage OCSCC patients. 2) Determine whether a subgroup of patients may benefit from adjuvant radiotherapy.

Methods:

The setting for this study was the two tertiary cancer centers in the province of Alberta and was designed as a prospective population‐based multi‐institutional review. Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with early stage OCSCC from 1998 to 2010. Survival outcomes were calculated using Kaplan‐Meir and Cox‐Regression analysis.

Results:

A total of 343 patients were analyzed. Five‐year survival according to treatment modality were surgery, 83.3 %; surgery + radiation, 94.7 %; radiation, 56.4 %. Cox regression analysis did not show any significant differences between groups when considering age, gender, and CCI/ECOG score.

Conclusions:

Patients with early stage OCSCC have excellent survival when treated by primary surgical resection. A subgroup of patients may benefit from post‐operative radiotherapy.
Trigeminal Trophic Syndrome: Presentation of a Case in Its Early Stages
Authors: Schimelmitz‐Idi Jose , Bross‐Soriano Daniel , Valle Carlos
Published: August 2013

Objectives:

Be able to recognize and treat trigeminal trophic syndrome at an early stage.

Methods:

Case presentation.

Results:

The trigeminal trophic syndrome is a rare condition that arises after damage, induced or not, to the sensory part of the trigeminal root or nerve. After the nerve is damaged the patient experiences hemifacial anesthesia and paresthesias, mainly itching and burning that causes continuous touching, rubbing, and picking to relieve the perceived paresthesias. The repetitive trauma leads to an ulcer. If untreated or misdiagnosed, the ulcer may grow and cause disfigurement. In this case we presented a 43‐year‐old female with trigeminal neuralgia who underwent thermocoagulation of the second and third portions of the trigeminal nerve 6 months prior to her initial visit. She visited 4 other specialists before coming to us. She presented with the typical symptomatology and an ulcer of about half an inch in the left nasal vestibule. After explaining and educating the patient about the underlying causes of the ulcer (self‐induced trauma) we excised the ulcer and advanced a local island flap. The patient started with carbamazepine 200 mg daily and reported reduced paresthesias. One year after the reconstruction the ulcer has not returned.

Conclusions:

Trigeminal Trophic Syndrome is a rare entity that can be encountered by otolaryngologists. The unfamiliarity with the condition leads to misdiagnosis and delay of treatment that can result in disfigurement. Treatment encompasses surgical reconstruction, medical therapy, and education of the patient.
Trans‐axillary Robotic Thyroidectomy and Parathyroidectomy: A Preliminary Single Institution Experience
Authors: Wilson Meghan N. , Dileo Michael D. , Walvekar Rohan R.
Published: August 2013

Objectives:

1) Review our first 13 robotic assisted trans‐axillary thyroidectomy and parathyroidectomy (TART/TARP) cases, looking at the clinical and pathological data as well as technical challenges associated with this approach. 2) Examine and discuss complications associated with this approach.

Methods:

Retrospective series of 13 patients who underwent TART/TARP at our institution. Patient demographics, pathology and size of thyroid glands removed, intraoperative details, length of stay, and postoperative complications were recorded.

Results:

Over a 14‐month period from October 2011 to December 2012, 11 patients (12 female, 1 male) underwent TART, and 2 patients underwent TARP. Mean age was 54 years (range, 29‐76 years). All thyroidectomies were partial. Both left‐sided parathyroid adenomas had been localized with preoperative imaging to fit criteria for single gland exploration. The largest thyroid lobe removed was 6.5 x 3.5 x 2.8 cm. Pathology was benign thyroid disease in 9 and well differentiated papillary thyroid cancer in 2. Complications included a brachial plexus neuropraxia (n = 1), recurrent laryngeal nerve paresis (n = 1), and inadvertent parathyroid gland removal (n = 1). Both nerve injuries resolved completely in follow up. All patients were discharged within 2 days of surgery, most within 23 hours. Long‐term follow up suggest good patient outcomes and patient satisfaction.

Conclusions:

Robot‐assisted trans‐axillary thyroidectomy and parathyroidectomy are feasible procedures with good outcomes. Patient selection is key to successful outcome. Surgeons should recognize distant‐access related risks including brachial plexus injury and chest paresthesias in addition to conventional thyroidectomy risks and understand how best to diagnose, prevent, and manage these complications.
Ultrasound‐Guided Fine‐Needle Aspiration of Thyroid Nodules: Does Size Matter?
Authors: Zawawi Faisal , Varshney Rickul , Hier Michael P. , Mlynarek Alex M. , Forest Veronique‐Isabelle , Tamilia Michael , Payne Richard J.
Published: August 2013

Objectives:

Evaluate the accuracy and predictive values of ultrasound guided fine‐needle aspiration (USFNA) of nodules ≥4cm compared to smaller nodules. Authors have reported that fine‐needle aspiration (FNA) biopsies of thyroid nodules ≥4cm are unnecessary since they often yield inaccurate results compared to nodules <4cm. They therefore recommend diagnostic thyroid lobectomies for nodules ≥4cm and FNA for smaller nodules.

Methods:

A retrospective study at the McGill University Thyroid Cancer Center was performed on patients between 2006‐2012 comparing the USFNA and post‐operative pathology diagnoses of nodules ≥4cm versus those <4cm. Pre‐operative USFNA results were divided into benign, indeterminate and malignant/suspicious for malignancy subgroups. Postoperative results were separated into benign and malignant groups. SPSS was used for data analysis using the chi‐square method.

Results:

There were 225 patients with nodules ≥4cm and 773 patients with nodules <4cm. The sensitivity, specificity, positive predictive value, and negative predictive value for USFNA of nodules ≥4cm were 84.62% (confidence interval [CI] 71.91‐93.10), 91.49% (CI 79.6‐97.58), 91.67% (CI 80.0‐97.63) and 84.31% (CI 71.4–92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4cm were 90.48% (CI 86.1‐93.8), 85.92% (CI 75.6‐93.02), 95.8% (CI 92.41‐97.96) and 71.76% (CI 60.95‐81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant (P > 0.05).

Conclusions:

This study shows that USFNA of nodules ≥4cm is as accurate as smaller nodules. It is therefore suggested that these nodules be managed similarly to their smaller counterparts.
Comparison between OperaVOX™ and MDVP: Preliminary Results
Authors: Baki Marina Mat , Wood Gary , Alston Marion , Ratcliffe Philippa , Sandhu Guri , Rubin John S. , Birchall Martin A.
Published: August 2013

Objectives:

Objective evaluation of voice, such as acoustic analysis, provides additional evidence in treatment monitoring. Currently, it is only possible in voice laboratories in hospitals. OperaVOX™ (On Person RApid VOice eXaminer), a portable voice analysis running on an Apple™ iPod, iPhone, and iPad, was developed to enable remote voice assessment. Our goal was to evaluate the agreement between OperaVOX™ and Multidimensional Voice Program (MDVP, KayPentax, NJ, USA).

Methods:

A group of 16 healthy volunteers without voice complaints were recruited from the University College London Hospital NHS Trust from December 2012 until January 2013. Supervised recordings were performed in a quiet room. A five‐second recording of a sustained vowel /a/ was used to measure fundamental frequency (F0), jitter, shimmer, and noise‐to‐harmonic ratio (NHR). The audio files recorded using OperaVOX™ were also analyzed using the MDVP. 95% limit of agreement (LOA) between software was analyzed using the Bland Altman method.

Results:

The mean difference (SD) of F0, jitter, shimmer, and NHR between OperaVOX™ and MDVP measurements was ‐0.14 (1.28) Hz, ‐0.06 (0.32)%, ‐0.26 (0.67)%, and 0.12 (0.02) respectively. The 95% LOA of OperaVOX™„ to MDVP for F0 was ‐2.67Hz to +2.39Hz; jitter was ‐0.57% to +0.68%; shimmer was ‐1.6% to +1.09%; and NHR was +0.08 to +0.12 compared to MDVP.

Conclusions:

OperaVOX™ at this stage has been shown to be a promising portable voice analysis tool for measuring the F0, jitter, and shimmer of voice since the 95% LOA were within clinically acceptable levels. Agreement with PRAAT is currently being tested.
Development of 2D Scanning Videokymography
Authors: Wang Soo‐Geun , Lee Byung‐Joo , Lee Jin‐Choon , Lim Yun‐Sung , Park Young‐Min , Lee Won‐Yong
Published: August 2013

Objectives:

Videolaryngostroboscopy, electroglottography, and high‐speed video systems are now in use to evaluate vocal cord vibration, which is crucial for voice production. The limitations of videolaryngostroboscopy are 1) the images captured from stroboscopy are not a real vocal cord vibration, and 2) it is difficult to identify each vocal cord mucosal wave in aperiodic dysphonia. The line scanning videokymography was developed to overcome the limitations of stroboscopy, but it only selects one active horizontal line from the whole laryngeal image. The aims of this study are to evaluate the whole laryngeal mucosal wave simultaneously in real time, to overcome the distortions caused by patient movements, to quantify parameters from images using software, and to compare both vocal cord movements and mucosal wave.

Methods:

We developed 2D scanning videokymography using high brightness continuous light source, full HD camera, capture board, and analyzing software. The system makes it possible to observe fundamental frequency, amplitude, regularity, mucosal wave, phase difference, etc.

Results:

We can analyze whole vocal cord movement in real‐time and mucosal wave in any area. We can objectively measure specific parameters of vocal cord vibration.

Conclusions:

2D scanning videokymography is a very effective diagnostic tool for aperiodic vocal cord vibration case. It does not require post‐processing procedure. 2D scanning videokymography can prevent distortion of images from patient motion resulting from line scanning videokymography.
Four Cases of Multiple Cranial Nerve Involvement with Varicella‐Zoster Virus
Authors: Sakagami Tomohumi , Asako Mikiya , Tomoda Koichi
Published: August 2013

Objectives:

We report 4 cases of unilateral paralysis of the 7th, 8th, 9th, and 10th cranial nerves caused by varicella‐zoster virus.

Methods:

Retrospective study with 4 cases from May 2008 to May 2012. The patients were 58, 69, 72, and78 years old. There were 2 male patients and 2 female patients.

Results:

Every case confirmed 9th or 10th cranial nerve paralysis preceding 7th or 8th cranial nerve paralysis. Every case was treated by antiviral medicine and high‐dose prednisolone.

Conclusions:

There are various theories of the mechanisms involved in the spread of cranial nerve palsy. Our cases confirmed only 7th, 8th, 9th, or 10th cranial nerve paralysis. If cranial neuropathy spread via cerebrospinal fluid, lymph nodes, or by blood, other cranial nerves may be paralyzed. If cranial neuropathy spread by revitalization of every nerve ganglion, we cannot explain these systematic conditions. We discussed the spreading mechanisms of cranial neuropathy via intervention nerve (for example, tympanic nerve, less petrosal nerve).
Ho: YAG Laser‐Application to Laryngeal Microsurgery
Authors: Makiyama Kiyoshi , Matsuzaki Hiroumi , Hirai Ryoji
Published: August 2013

Objectives:

The Holmium:YAG (Ho:YAG) laser can perform evaporation, incision, and coagulation simultaneously. It enables the treatment of target tissue only, making surgery less thermally damaging to surrounding tissue. It provides a different range and depth of evaporation depending on the distance between the laser fiber tip and the mucosa. Clinical cases are presented, and the potential for treatment of laryngeal diseases is discussed.

Methods:

We designed the following three ways of irradiation. 1) Non‐contact irradiation: Evaporation occurs only at the mucosal surface. 2) Contact irradiation: When irradiated with light contact with the mucosa, the area of evaporation on the mucosal surface is smaller than in 1. 3) Shooting irradiation: When irradiated with pressing the tip of the fiber on the mucosa, only spots of evaporation are left on the mucosal surface. On the other hand, evaporation can be up to a depth of approximately 2 cm with irradiation for approximately 3 seconds.

Results:

Cases of hemorrhagic vocal cord polyp, laryngeal papillomatosis, and vocal cord cancer were presented. For evaporation of a narrow area and point evaporation, contact irradiation was suitable. Irradiation experiments on chickens showed that shooting irradiation can evaporate up to a depth of 2 to 3 cm despite the narrow area of evaporation at the shooting site. It is believed to have been proven by the experiences of treating patients with recurrent laryngeal cancer.

Conclusions:

Application of this technique to laryngeal surgery is expected.
Implantation of Contralaterally Harvested Nerve‐Muscle Pedicle Flap Combined with Arytenoid Adduction for Paralytic Dysphonia
Authors: Yumoto Eiji , Sanuki Tetsuji , Kumai Yoshihiko , Nishimoto Kohei , Kodama Narihiro
Published: August 2013

Objectives:

1) Describe operative procedures to reinnervate the thyroarytenoid muscle (TA) on the paralyzed side using a modified nerve‐muscle pedicle (NMP) flap implantation harvested on the contralateral side combined with arytenoid adduction (AA). 2) Assess time‐dependent improvement in vocal function during postoperative follow‐up.

Methods:

Prospective case series. Four patients underwent modified NMP flap implantation combined with AA for paralytic dysphonia between August 2009 and January 2013. The NMP flap was harvested on the contralateral side because of scar formation on the paralyzed side and was secured to the TA under microscopic control. Three of them were followed over one year, and their voice outcomes, determined by 5 objective and 2 subjective parameters, were evaluated preoperatively and at 4 different time points after surgery.

Results:

On average, maximum phonation time and mean airflow rate improved from 5.4s and 569mL/s preoperatively to 24.2s and 116mL/s 12 months postoperatively, respectively. Jitter, shimmer, and harmonics‐to‐noise ratio also improved from 10.5%, 16.4%, and 4.2dB preoperatively to 1.7%, 11.2%, and 6.8dB postoperatively, respectively. Grade overall and breathiness of GRBAS scale became much better from 2.6 and 2.4 preoperatively to 0.2 and 0.0 12 months postoperatively, respectively. Stroboscopic images together with voice during follow‐up period will be presented.

Conclusions:

Combination of AA and a modified NMP flap implantation harvested on the contralateral side improves long‐term voice outcomes of paralytic dysphonia. Therefore, patients in whom the ansa cervicalis nerve is unavailable due to high level scar formation could have a great benefit by these operative methods.
Indications and Outcomes of Montgomery Cannulas
Authors: Bayan Semirra L. , Hoffman Henry T.
Published: August 2013

Objectives:

1) Analyze the use and outcomes of Montgomery cannulas to manage the compromised airway. 2) Identify appropriate patient selection criteria for use of the Montgomery cannula.

Methods:

A retrospective chart review was performed on patients who had a Montgomery cannula inserted from 2003‐2012. Patient variables and outcomes analyzed included: BMI, medical comorbidities, indications for a Montgomery cannula, recorded reasons for cannula failure, and complications.

Results:

Indications for Montgomery cannula placement included glottic stenosis (n=7), obstructive sleep apnea (n=5), bilateral vocal cord paralysis (n=4), subglottic stenosis (n=4), supraglottic swelling after radiation or chemoradiation (n=4), bulbar dystonia with paradoxical vocal cord motion (n=1), vocal cord fixation secondary to arthritis and GERD (n=1), and seizure disorder associated with airway obstruction (n=1). 75% of patients (n=15/20) had successful use of a Montgomery cannula. 25% (n=5/20) required replacement with a Jackson tracheostomy due to persistent tracheostomal granulation tissue (n=2), patient sense of greater safety with the Jackson tracheotomy tube (n=1), a posterior scar band causing airway obstruction not adequately bypassed by the cannula (n=1), and inability to care for the cannula secondary to manual dexterity issues from rheumatoid arthritis (n=1). The Montgomery cannula was used as a successful decannulation tool in four patients.

Conclusions:

This case series is the first to analyze use of the Montgomery cannula as an airway management tool for indications other than obstructive sleep apnea. We identify features associated with successful use of the cannula and identify the additional indication for use of a Montgomery cannula as a step down management tool leading to decannulation.
Laryngeal Amyloidosis
Authors: Nadig Shrinath , Gurunathan Ramesh K. , Rao Trushna
Published: August 2013

Objectives:

Amyloidosis constitutes less than 1% of benign laryngeal tumors and may occasionally be associated with systemic disease. It commonly presents with long‐standing hoarseness or dyspnea. Diagnosis is established with histological features of acellular, amorphous, eosinophilic deposits which react positively with Congo red. We present 2 such cases of laryngeal amyloidosis, one localized and one with systemic involvement. Literature review, diagnostic work‐up, and treatment options are discussed.

Methods:

Case 1: A 63 year old non‐smoking male presented with hoarse voice for 2 months. Flexible laryngoscopy showed diffuse fullness on left hemilarynx. Microlaryngoscopy revealed submucosal lesion in anterior left vocal cord, which on deep biopsy confirmed AL type amyloid. Detailed work‐up by a hematologist ruled out systemic disease. Case 2: A 74 year old moderate smoker presented with 6 months of hoarse voice and burning sensation in the tongue. He had a mucosa‐covered growth in the right false vocal cord, which on biopsy confirmed amyloidosis (AL type). Further work‐up revealed systemic disease with elevated serum free light chains, IgG Kappa paraprotein, and positive abdominal fat biopsy.

Results:

Patient 1 is under follow‐up with no clinical recurrence. Patient two had treatment with CDT chemotherapy and is under hematologist surveillance. Past history includes carpal‐tunnel decompression. Localized laryngeal amyloidosis is best treated with cold steel resection or CO2 laser excision and may require repeated removal in some patients. Systemic amyloidosis is caused by plasma‐cell dyscrasia and treated with chemotherapy and or radiotherapy.

Conclusions:

Endolaryngeal treatment is sufficient with localized disease. Systemic disease needs more extensive treatment, and those with associated myeloma have poor prognosis.
Laryngeal Mucormycosis
Authors: Khichi Sunny S. , Morgan Charles E. , Newman John R.
Published: August 2013

Objectives:

Report our experience with mucormycosis of the larynx, an extremely rare clinical entity.

Methods:

A single case of laryngeal mucormycosis was reviewed. Data and history reviewed include initial presentation, operative reports, operative photographs, pathology reports, outpatient clinic data, and follow‐up reports.

Results:

In September of 2011, an individual presented to UAB with acute airway obstruction. An operative airway evaluation revealed mucosal necrosis and ischemia that on biopsy revealed non‐septate hyphae consistent with mucor. Despite appropriate pharmacologic therapy, his disease progressed. Ultimately total laryngotracheal involvement prevented surgical cure. He later succumbed to pulmonary manifestations of his disease.

Conclusions:

Mucormycosis is an aggressive disease that requires multi‐modality therapy and a high index of suspicion. Though the larynx is a rare subsite, the relative paucity of laryngotracheal blood supply makes mucor a diagnostic consideration in the immunocompromised patient.
Laryngeal Schwannoma in a Patient Presenting with Dysphonia
Authors: Taormina Yula A. , Yelverton Joshua C. , Reiter Evan R. , Powers Celeste N.
Published: August 2013

Objectives:

1) Describe a case of laryngeal schwannoma in a young male presenting with gradual voice changes. 2) Review the latest literature on laryngeal schwannomas, diagnosis, and treatment.

Methods:

Chart review and literature search.

Results:

A 21 year old previously healthy male nonsmoker presented with a 5 year history of worsening dysphonia without dysphagia or dyspnea. On exam, his voice was breathy, raspy, and weak. Fiberoptic laryngoscopy demonstrated a smooth, lobulated exophytic mass of the left false vocal fold extending into the true vocal fold and anterior commissure. Pre‐operative magnetic resonance imaging (MRI) demonstrated a T2‐enhancing mass with considerable transglottic extension. The patient underwent microsuspension direct laryngoscopy with en bloc excision of the lesion. Post‐operatively the patient reported significant improvement in voice with no dysphagia, despite left sided hypomobility.

Conclusions:

Laryngeal schwannoma is a rare tumor of the larynx. Although typically benign and slow‐growing, it can cause airway obstruction or compressive symptoms, manifesting as voice changes, as in our patient. Symptoms may resolve completely after complete excision.
A Modified Frontolateral Partial Laryngectomy with Laryngeal Framework Reconstruction
Authors: Sawatsubashi Motohiro , Umezaki Toshiro , Adachi Kazuo , Komune Shizuo
Published: August 2013

Objectives:

Endoscopic resection and radiotherapy are organ‐preservation strategies for glottic cancer because of the high local control and quality of voice after the therapy. However, frontolateral partial laryngectomy is still needed in some cases. This procedure has the complication of hoarseness. Therefore, we applied the theories of laryngeal framework surgery to partial laryngectomy with reconstruction using strap muscles and skin flap in order to improve postoperative voice qualities.

Methods:

We performed a modified frontolateral partial laryngectomy in three selected cases (rT1a, T3 cases). The retrospective analysis of voice qualities (PPQ, APQ, NHR, MPT) was performed in 10 frontolateral partial laryngectomy cases (7 conventional and 3 modified methods). Surgical procedure: Frontolateral vertical partial laryngectomy with tumor‐free margin was performed via laryngofissure approach. After tumor resection, approximation laryngoplasty was performed using sternothyroid muscle flap that was inserted into posterior dead space to gain better contact of the posterior vocal fold on the reconstructed vocal ridge. After these procedures, a reverted sternohyoid muscle was placed inside the preserved outer perichondrium to reduce dead space and externally medialize cervical skin flap, which shaped new vocal fold.

Results:

No recurrence was observed in any case. No aspiration and laryngeal stenosis were observed in any case. The postoperative voice qualities were improved over pretreatment qualities in modified cases. PPQ after modifying this method was better than conventional methods.

Conclusions:

It is better for voice quality to treat selected glottic cancers with this modified frontolateral partial laryngectomy.