bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative Hemorrhage after Endoscopic Sinus Surgery
Authors: Woodard Troy D. , Stankiewicz James A
Published: August 2008

Objective

1) Identify complication rates of patients that underwent endoscopic sinus surgery and developed postoperative hemorrhage. 2) Determine if there is a correlation of preoperative variables with the development of this complication.

Methods

Retrospectively review patients who had functional endoscopic sinus surgery and developed postoperative hemorrhage from 1987 to 2007 in an university tertiary care facility. Analyze baseline characteristics and preoperative clinical variables for significant correlations.

Results

29 of 5000 endoscopic cases resulted in postoperative hemorrhage (.58% complication rate). The mean age of the patients was 50 years old and there were equal proportions of male and female patients. While the extent of surgery demonstrated no significant difference among the patients, hemorrhage was most likely to occur in patients with previous surgery. An overwhelming majority of patients required a surgical procedure to control the bleeding. Hemorrhage was primarily isolated on the patient's right side and involved the sphenopalatine or posterior septal arteries.

Conclusions

Endoscopic sinus surgery has vastly increased in popularity. However, there still is a paucity of information in the literature on complications associated with endoscopic sinus surgery, particularly postoperative hemorrhage. The results from this study provide identifying characteristics that predispose patients to develop this complication and what methods can be successfully utilized to treat this complication.
Expansion SphincterPlasty & Multilevel OSA Surgery
Authors: Peter Pang Kenny , Mok Paul Kan‐Hwei , Woodson Tucker
Published: August 2008

Objective

To review multilevel surgery involving the Expansion SphincterPlasty (ESP) with tongue base surgery in the treatment of severe OSA.

Methods

Prospective non‐randomized collection of 39 consecutive patients with severe OSA. Patients were >18 years old, type II Fujita with lateral pharyngeal wall collapse, small tonsils, BMI <30. Mean follow‐up was 9.3 months.

Results

All 39 patients were male, with mean age of 44.1 years (range of 26 to 49 years), mean BMI was 25.7 (range of 21.1 to 29.1). 22 patients had ESP/Hyoid/RF Tongue Base procedure, while 17 patients had the ESP/Hyoid/Tongue Suspension procedure. The mean pre‐operative AHI for the entire group improved from 56.3 ± 18.1 to 19.2 ± 14.0 postoperatively. There was a greater AHI improvement in the ESP/Hyoid/TS group than the ESP/Hyoid/RFBOT group. The 17 patients in the ESP/Hyoid/TS group had a mean pre‐operative AHI that improved from 52.2 ± 18.7 to 18.0 ± 12.8 (p<0.05), compared to the ESP/Hyoid/RFBOT group, where AHI improved from 48.1 ± 17.9 to 25.6 ± 17.1 (p<0.05). Oxygen saturations also improved in both groups. When using the success criteria of a reduction in 50% of the pre‐operative AHI and an AHI <20, the overall success rate for both groups was 71.2%. The success rate for the ESP/Hyoid/TS group was 74.8%, while the success rate for the ESP/Hyoid/RFBOT group was 67.5%.

Conclusions

The use of the ESP with tongue surgery is effective in the management of patients with severe OSA.
Mod. Cautery‐Assisted Palatoplasty in OSA: 3‐Year Results
Authors: Pang Kenny Peter , Terris David J
Published: August 2008

Objective

To review the long‐term results of the Modified Cautery Assisted Palatoplasty (ModCAP) procedure for the treatment of OSA.

Methods

Prospective non‐randomized trial in 43 consecutive patients with OSA. All patients were >18 years old, type I Fujita, BMI <30, Friedman clinical stage II, with AHI from 1.0 to 30.0. The mean follow time was 32.4 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under GA if the tonsils were removed as well, and done under LA if the tonsils were small or not present.

Results

There were 41 men and 2 women, the mean age was 39.2 years old (range of 21 to 49), mean BMI was 25.7 (range of 20.7 to 26.8). All patients had pre‐operative PSG, only OSA patients had post‐operative PSG repeated. There were 15 snorers and 28 OSA patients. The AHI improved in the patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 (p<0.05). The overall success rate for this OSA group was 65.1% (at mean 32.4 months). The mean snore scores (VAS) improved from 8.4 to 3.5 (for all 43 patients). Post‐operative pain scores were fairly low, from a range of 4.5 to 6.6 (at 5th POD). Lowest oxygen saturation also improved in all the OSA patients. Subjectively, all the patients felt less tired.

Conclusions

This technique has been shown to be effective in the management of patients with OSA and simple snoring.
Pulse Arterial Tone and Airway Obstruction in Sleep Apnea
Authors: Barrera Jose E , Holbrook Andrew B. , Santos Juan , Popelka Gerald R
Published: August 2008

Objective

Determine if continuous pulse arterial tone (PAT) amplitude correlates with upper airway obstructions observed during simultaneous real‐time magnetic resonance imaging (RT‐MRI) in subjects with Obstructive Sleep Apnea (OSA).

Methods

A prospective series of 20 subjects diagnosed with mild to severe OSA by polysomnography, Fujita classification, Functional Outcomes of Sleep Questionnaire (FOSQ) and Epworth Sleepiness Score (ESS) underwent continuous RT‐MRI during a 90‐minute nap without sedation. The upper airway at the mid‐saggittal plane was visualized in real time (33 fps) using a sliding window algorithm (RTHawk system). Continuous pulse arterial tone amplitude was simultaneously monitored (Watch‐PAT, Itamar Inc, Israel).

Results

Changes in PAT amplitude were in phase with upper airway narrowing and obstruction from tongue, soft palate, and epiglottis movements. Airway obstructive events occurred coincident to 60% or greater decreases in PAT amplitude. The image sequence associated with each PAT amplitude decrease demonstrated the precise location of the obstruction. Pre‐surgical site of airway obstruction and post‐surgical cause of persistent obstruction was clearly identified.

Conclusions

RT‐MRI with simultaneous and continuous PAT signal recording during natural sleep is an innovative and improved method for more precisely characterizing airway obstructions in patients with mild to severe OSA. This approach may be valuable for planning surgical treatments, potentially improving the success of these procedures.
Reliability of Holter Oximetry for Home Sleep Apnea Testing
Authors: Stern Jordan C , Heneghan Conor , Shouldice Redmond
Published: August 2008

Objective

To test the reliability of the Holter Oximeter for home testing of obstructive sleep apnea. Previous reports have shown a 96% correlation with simultaneous polysomnography and Holter Oximetry in the sleep laboratory. This study was designed to measure reliability of data obtained at home, as well as to obtain information from patients regarding comfort of the device.

Methods

A prospective study of 120 consecutive patients (ages 5 to 85) presenting to an otolaryngology practice during a 4‐month period with complaints of snoring or sleep apnea symptoms. Device: The Holter Oximeter produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram and pulse oximeter. The reliability of the test was determined by the number of tests completed without interruption due to patient discomfort, electrode or device failure.

Results

There was 97% data recovery from the home testing device. Data failure was due to faulty memory cards in the device or surface electrode failure. All patients tolerated wearing the device at home, and there were no voluntary interruptions of the tests by patients. On a discomfort scale of 0 to 10 (0: no discomfort and 10: maximal discomfort), the average discomfort score was 2.

Conclusions

Holter Oximetry represents a new, easy to use, and reliable device for the home diagnosis of obstructive sleep apnea. It can also be used to measure outcomes for the surgical and non‐surgical treatment of obstructive sleep apnea in adults and children.
Surgical Volume Affects Outcomes in Laryngectomy Procedures
Authors: Mast Brenda , Petruzzelli Guy J , Johnson Tricia J
Published: August 2008

Objective

To determine whether statistical differences occur in total cost, length of stay, ICU days, and surgical complications, depending on the volume of laryngectomy procedures performed.

Methods

Secondary laryngectomy data from 108 hospitals participating in the University Health System Consortium was examined. All laryngectomy surgical cases occurring from July 1, 2001, through June 30, 2005, with an ICD‐9 code of 30.3 or 30.4 were analyzed (N=4,551). The cases were divided into 3 categories based on the number of surgical laryngectomy cases performed by hospital. Those volume categories were high, as defined by organizations with 100–233 cases (n=1712); medium, between 60–99 cases (n=1353); and low, between 4–59 cases (n=1458). 4 dependent variables were examined including total cost, length of stay, ICU days, and complications.

Results

The 4 dependent variables were analyzed for normality by performing a Kolmogorov‐Smirnov test. All 4 variables were non‐normally distributed. A Kruskal‐Wallis test was then performed on each variable to determine if a statistically significant difference appeared between the 3 volume categories. Each variable was found to have statistical significant differences between the groups, with the high volume hospitals having the lowest cost, shortest length of stay, shortest ICU days, and smallest complication rate.

Conclusions

This study showed that hospitals with higher surgeon volume for total laryngectomies had reduced total cost, length of stay, number of ICU days, and complication rate for their patients.
S103 – Mometasone Is Effective With or Without Oral Antihistamines
Authors: Marta Pimentel Joao Antonio
Published: August 2008

Objectives

Clinical trials have demonstrated the efficacy of monotherapy with intranasal corticosteroids (INSs) for symptoms of allergic rhinitis (AR). ARIA guidelines suggest adding oral antihistamines to INS monotherapy when severe symptoms do not improve. An open‐label multicenter study assessed efficacy and safety of mometasone furoate nasal spray (MFNS) alone or combined with an oral antihistamine in subjects with AR.

Methods

Subjects received MFNS 200 mcg QD for 56 days, with an oral antihistamine added at Day 28 or later if baseline symptoms (sneezing, nasal discharge/obstruction, tiredness, irritability) had not improved. Subjects rated individual symptom scores, daily routine and sleep limitations, and product attributes on Days 1, 28, and 56 on a scale of 0 to 10, and completed a compliance questionnaire on Day 56.

Results

Mean scores for AR symptoms and limitations on sleep and daily routines significantly improved from baseline to Day 28 and from Day 28 to 56 (P less than 0.001 for all). At Days 28 and 56, 47/60 and 45/56 subjects, respectively, were receiving MFNS monotherapy, and 13 required a concomitant oral antihistamine at Day 28 or later. By Day 56, symptom severity improved in 92% of subjects receiving concomitant therapy. At study end, 88% of subjects reported compliance with QD MFNS. Average product attribute scores ranged from 7.2 to 8.4. No severe adverse events were reported.

Conclusions

MFNS 200 mcg QD, alone or combined with an oral antihistamine, was safe and effective against AR nasal symptoms and limitations of sleep and daily activities.
S104 – Treatment of a Brown Recluse Spider Bite to the Face
Authors: Hamming Katherine K. , Hilger Peter A , Boyer Holly
Published: August 2008

Objectives

1) To raise awareness among otolaryngologists about the presentation, complications, and treatment options of brown recluse spider bites. 2) To present a case of a brown recluse spider bite to the face that was treated conservatively and had an excellent aesthetic result.

Methods

A 48‐year‐old woman was referred to the otolaryngology clinic with a dermonecrotic wound on the left upper lip from a brown recluse spider bite. The lesion consisted of a 4mm eschar with surrounding erythema, and the necrosis extended almost through the lip, sparing only the oral mucosa. She was given antibiotics and followed clinically. The eschar was left in place without debridement or topical treatments, and it fell off on day 40.

Results

After the eschar fell off on its own, the patient was left with complete healing of the necrotic area and a 1mm scar with mild erythema, giving her an excellent aesthetic result.

Conclusions

This case represents conservative management of a self‐limited dermonecrotic lesion of the upper lip that resulted from a brown recluse spider bite. Conservative management should be considered with brown recluse spider bites, especially on the face, which has an excellent blood supply and where good aesthetic outcome is crucial.
S105 – Congenital Absence of the Left Lower Lateral Cartilage
Authors: Karimi Kian , Adelson Robert T , Herrero Nicholas A
Published: August 2008

Objectives

Review the embryology of the cartilaginous nasal skeleton. Present an anatomic varient of the nasal skeletal anatomy not previously described.

Methods

Case report of an adult patient evaluated for nasal airway obstruction and suspected from clinical exam to have absence of the left lower lateral cartilage. Photographs document this first report of an absent lower lateral cartilage and surgical techniques to reconstitute the nasal tip.

Results

Surgical outcome of open structure rhinoplasty and photographs included. Patient pleased with functional and aesthetic results of procedure.

Conclusions

This previously unreported clinical entity extends the spectrum of congenital abnormalities of the nose and can be addressed successfully with open structure rhinoplasty techniques.
S109 – N‐2 MPG in Groin Flaps Subjected to Vein Occlusion
Authors: Gosselin Benoit J , Davies Louise
Published: August 2008

Objectives

In a prior communication, we showed that ischemic rat groin flaps exposed to the free radical scavenger N‐2 mercaptopropionylglycine (MPG) at the time of arterial and venous occlusion had a higher rate of survival than untreated flaps. In this study, the objective is to test the efficacy and timing of administration of MPG in salvaging rat groin flaps subjected to venous occlusion alone.

Methods

Randomized controlled trial. Main outcome is mean percentage of flap survival at 7 days. 30 mature Sprague‐Dawley rats were randomized to 3 groups based on timing of treatment with MPG: 1‐ flap raised, no MPG, no venous occlusion (sham group); 2‐ flap raised, no MPG, 10‐hour period of venous occlusion (control group); 3‐ flap raised, MPG after 10 hours venous occlusion (post‐reperfusion group).

Results

There was no statistical difference noted in mean survival of venous occluded flaps when comparing the control and post‐reperfusion groups, after 7 days. Specifically, the mean flap survival in the control group at 7 days was 10.9% (median 0%, range 0–100%). The mean flap survival in the post‐reperfusion group was 14.6% (median 0%, range 0–100%). The mean flap survival in the sham group was 90.0% (median 100%, range 0–100%).

Conclusions

Post‐reperfusion MPG administration is not helpful for flaps subjected to venous occlusion alone. The free‐radical scavenger activity of MPG is potentiated within the tissues prior to vein occlusion. Potential applications for free flap salvage would need further study.
S110 – Free Tissue Transfer Reconstruction of Fistula after ACDF
Authors: Rossmiller Sarah R. , Ghanem Tamer , Wax Mark K
Published: August 2008

Objectives

Pharyngeal injury post‐anterior cervical disc fusion (ACDF) repair is a well‐recognized postoperative complication. It can lead to abscess formation, pharyngocutaneous fistula, and esophageal diverticulum. Various reconstructive procedures have been proposed, including primary repair or pedicled muscle flaps. In recalcitant cases, free tissue transfer can be used. We review our experience with patients undergoing free tissue transfer for repair of pharyngeal defects.

Methods

Retrospective data review from January 2002 to February 2008 of patients undergoing pharyngeal repair following ACDF surgery.

Results

5 patients were identified for total of 6 reconstruction procedures. Presentation of the pharyngeal leak occurred from 8 days to 3 years after the ACDF procedure. 3 patients presented acutely with cervical abscesses requiring incision and drainage. 2 patients underwent hardware removal at the time of incision and drainage. 2 patients presented with dysphagia and a contained esophageal diverticulum. 4 of the patients underwent radial forearm fasciocutaneous free flap reconstruction, and 1 underwent anterolateral thigh musculocutaneous free flap reconstruction. One patient had a revision surgery for recurrent fistula formation after radial forearm free flap with rectus free flap reconstruction. There were no immediate postoperative leaks; however, on 1–51 months follow‐up, 4 out of 6 cases developed a diverticulum, with one of them developing a second fistula. 3 out of 5 patients had no evidence of diverticulum or fistula at last follow‐up, for a success rate of 60%.

Conclusions

Pharyngo‐esophageal perforation following an ACDF approach is difficult to repair even with free tissue transfer.
S112 – Fibula C‐Spine Reconstruction Following Retropharynx Abscess
Authors: Moche Jason , Gastman Brian
Published: August 2008

Objectives

1) Understand the pathogenesis and epidemiology of retropharyngeal abscess. 2) Appreciate the diagnostic dillema and rapid progression of untreated deep neck space infections. 3) Recognize the significance of free vascularized tissue grafting in the acute post‐infection setting of cervical osteomyelitis.

Methods

A 42‐year‐old man presented with rapidly progressive odynophagia, respiratory distress, and lower extremity muscle weakness. A large odontogenic retropharyngeal abc‐scess had rapidly progressed to cervical osteomyelitis. Diagnostic imaging revealed C2‐C6 level involvement. A review of the literature reveals the unusual progression of this case.

Results

Following drainage, debridement, and anterior as well as posterior stabilization, the patient underwent reconstruction. An early successful second‐stage reconstruction was performed with vascularized free fibula graft. The patient did well postoperatively with resolution of paresis, pain, and airway compromise.

Conclusions

We present the first reported use of vascularized free fibula graft for anterior cervical spine reconstruction from a complicated odontogenic retropharyngeal abscess leading to cervical osteomyelitis. A review of the literature highlights the dangers of untreated deep neck space infections and the role of the reconstructive surgeon in their management.
S114 – Thresholds for Visual Perception of Facial Asymmetry
Authors: Farrag Tarik Y , Chu Eugene , Boahene Kofi , Byrne Patrick
Published: August 2008

Objectives

To determine the degree of facial asymmetry which is required to trigger conscious perception in the observer.

Methods

A normal face was manipulated typical to facial paralysis changes, using advanced computer program to create progressive images of increasing asymmetry, in one millimeter increments, up to 10 mm. This was performed on 1) brow, 2) oral commissure, and 3) combined brow and oral commissure. The study included both altered and unaltered versions of the model face, in addition to other unaltered images. Images were presented to volunteer observers unaware of the purpose of the study.

Results

I) Oral commissure asymmetry: the threshold for visual perception was 3 mm by the majority of people (73%) when each image was presented for 10 seconds. When up to 4 mm of mouth angle asymmetry was noticed, it was perceived as “noticeable, but acceptable” by 83%, while 6 mm or greater of asymmetry was perceived as “unacceptable” by 60%. Presenting the images for 2 sec/image (quick look) demonstrated that 53% detected the asymmetry at 5 mm. II) Brow asymmetry: 70% perceived the asymmetry at 3 mm. III) Combined oral commissure and eye brow: 100% of people perceived the oral commissure asymmetry at a lower threshold than the brow asymmetry.

Conclusions

The pilot data and the discussion will provide insight into the processes of visual perception of facial asymmetry, and guidance for surgeons and patients sorting through their options. Further efforts are under way to pursue these concepts in 3‐dimensional, dynamic subjects.
S115 – A New Treatment for Post‐tympanostomy Tube Otorrhea
Authors: Cheng Jeremiah , Cheng David , Rebecca Cheng , Timothy Chen
Published: August 2008

Objectives

To discover whether tubes coated with antibiotic ointment can prevent the complication of post‐tympanostomy tube otorrhea.

Methods

Retrospective chart analysis was done of the last 344 consecutive ears for tube surgery without ointment, and tube surgery with ointment, from Dec. 2006 to Oct. 2007. Only surgery using 7mm flouroplastic tubes were reviewed.

Results

A total of 128 ears had no ointment during the operation. Of the 128 ears, 12 ears developed otorrhea within 1 week, or an incidence of 9.4%. A total of 216 ears had antibiotic ointment coated onto the fluoroplastic tube during the operation and at time of tube insertion. Of the 216 ears, 7 ears developed post‐tympanostomy tube otorrhea within 1 week, or an incidence of 3.2%. Our analysis using the chi‐square test was statistically significant, with a p value of 0.02.

Conclusions

Post‐tympanostomy tube otorrhea is a frequent complication of tympanostomy tube insertion, but by coating the tube with an antibiotic ointment at the time of surgery, we can decrease that incidence from 9.3% to 3.2%.
S119 – Tongue‐holding Maneuver Studied by High‐resolution Manometry
Authors: Umeki Hiroshi , Takasaki Kenji , Enatsu Kaori , Tanaka Fujinobu , Kumagami Hidetaka , Takahashi Haruo
Published: August 2008

Objectives

This study aimed to investigate the effects of a tongue‐holding maneuver (THM) during swallowing, using a novel high‐resolution manometry (HRM) system.

Methods

27 asymptomatic adult Japanese controls were studied. A solid‐state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the dry swallowing pressures at meso‐hypopharynx, the upper esophageal sphincter (UES) and the mean values at meso‐hypopharynx with and without THM were measured.

Results

The maximum values of dry swallowing pressures with and without THM were 195.0±77.2 (mmHg, mean ± standard deviation), and 178.1±53.0 at the meso‐hypopharynx, and 213.4±74.0 and 190.0±95.0 at the UES, respectively. The mean values with and without THM at meso‐hypopharynx were 47.4±11.9, and 44.0±11.2, respectively. The maximum value at UES (p=0.0347), and the mean value at the meso‐hypopharynx (p=0.0124) of dry swallowing pressures with THM were significantly higher than those without THM.

Conclusions

These findings indicate that the THM has a potential to facilitate compensatory swallowing power at the pharynx and upper esophagus. HRM will provide us with important information about the swallowing physiology, and pathophysiology along the velopharynx, and upper esophagus.
S122 – Cytotoxic T Lymphocytes Induced by HSCC Ag Derived Peptides
Authors: Peptides Ag Derived , Ono Takeharu , Nakashima Tadashi
Published: August 2008

Objectives

Previously, we attempted to identify SCCA‐derived HLA‐A24 restricted peptides (SCCA112–120 and SCCA215–224) able to induce peptide‐specific CTLs in lung, uterine cervix, and esophageal HLA‐A24 + cancer patients. However, in head and neck HLA‐A24+cancer patients, CTL induction using these peptides has not been investigated. We studied CTL induction by these peptides in head and neck HLA‐A24+ cancer patients.

Methods

Peripheral blood mononuclear cells of SCC‐cancer patients or healthy donors were stimulated in vitro with SCCA‐derived peptides, which were prepared based on the HLA‐A24 binding motif. The cytotoxity and peptide‐response to target cells was investigated by both 51Cr release assay and IFN‐gamma production.

Results

SCCA112–120‐specific CTLs were generated in PBMCs from 6 head and neck cancer patients, but not in PBMCs from healthy donors. SCCA215–224 peptide generated CTLs in PBMCs from 5 head and neck cancer patients, but not in PBMCs from healthy donors. SCCA112–120 and SCCA215–224 peptide were able to induce cancer‐reactive CTLs in the peripheral blood mononuclear cells of HLA‐A24+ head and neck cancer patients.

Conclusions

These SCCA‐peptides may thus be useful for specific immunotherapy for HLA‐A24+ head and neck cancer patients.
S123 – New Approaches to Infratemporal Fossa Foreign Body Removal
Authors: Scott Andrew R , Dodson Thomas B , Platt Michael P , Metson Ralph B
Published: August 2008

Objectives

1) To understand indications for removal of foreign bodies (FB) from the head and neck. 2) To be able to describe the use of new surgical technologies for FB removal from the head and neck region. 3) To understand the clinical applications of a novel, minimally‐invasive technique for removal of FB from the infratemporal fossa.

Methods

A retrospective review of 2 cases of infratemporal fossa foreign bodies, which were referred to a tertiary care facility for management utilizing a novel transoral, endoscopic, image‐guided approach.

Results

Both patients presented with pain and trismus following failed attempts to retrieve foreign bodies–1 broken hypodermic needle and 1 torn cottonoid sponge‐through open explorations. Use of endoscopic equipment for visualization and image‐guidance system for precise localization enabled both objects to be removed through a transoral approach. Surgical removal resulted in improvement in pain and trismus in both patients who were discharged within 24 hours.

Conclusions

A new approach is now available for the minimally‐invasive retrieval of radio‐opaque foreign bodies in the infratemporal fossa, which avoids the need for extensive surgical dissection or an external incision.
S124 – A New Mucoadhesive Tablet Effective for Xerostomia
Authors: Brama Israel , Zhuang Lei
Published: August 2008

Objectives

Evaluate the clinical effectiveness of a new mucoadhesive tablet for treating xerostomia. Xerostomia is not a disease but can be a symptom of certain diseases. It can produce serious negative effects on the patient's quality of life, affecting dietary habits, nutritional status, speech, taste, tolerance to dental prosthesis, and increases susceptibility to dental caries.

Methods

OraMoist, a new mucoadhesive tablet, was developed for patients with reduced salivary secretion. As active ingredients, this mucoadhesive tablet comprises of a combination of the natural lubricant tricaprin, xylitol, oral enzymes, buffering compounds, and saliva secretion inducers. 22 xerostomic patients took part in a randomized crossover clinical study using Biotene® mouthwash as a control. Each patient used a single tablet or mouthwash as often as needed during the 6 hours of monitoring. After a washout period of 1 week, each patient received the other treatment. Clinical assessment of xerostomia included evaluation of the saliva flow rate and the Total Xerostomic Score (TXS). Subjective assessment of each treatment was received by using a questionnaire.

Results

Patients treated with OraMoist showed an increase of saliva production of over 50% (p<0.05) compared to 10% among the control group. Both groups reported a statistically significant reduction in xerostomic sensation, but the moisturizing effect of OraMoist lasted longer than that of the mouthwash.

Conclusions

In conclusion, mucoadhesive tablet was superior or equal to Biotene® in improving xerostomia symptoms and in patients’ overall satisfaction.
S131 – Complicated Community‐Acquired MRSA Sinusitis: A Case Series
Authors: Stallworth Christian L , McMains K Christopher , Miller Frank
Published: August 2008

Objectives

Participants should 1) understand the similarities and differences between nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) and its community‐acquired counterpart (CA‐MRSA); 2) recognize MRSA as an evolving member of the bacterial pathogens responsible for acute bacterial rhinosinusitis (ABRS); and 3) raise suspicion of CAMRSA in the differential for cases of progressive sinusitis, with or without complications, despite conventional first‐line antimicrobial therapies.

Methods

Following the retrospective review of patients presenting to an urban tertiary care institution, those patients presenting with complicated sinusitis were identified. Data collected from chart review included age, sex, presenting signs and symptoms, onset of illness, therapy initiated prior to emergent presentation, operative procedures performed and operative findings, culture organisms and sensitivities, postoperative course, and final outcomes.

Results

9 patients presented with periorbital complications following an antecedent sinusitis. All 9 patients developed infectious orbital complications including periorbital cellulitis, lid abscess, orbital abscess, and 1 case of ipsilateral blindness. Cultures identified CA‐MRSA as the primary pathogen which was characteristically sensitive only to vancomycin, clindamycin, doxycycline, and trimethoprim/sulfamethoxazole. All patients were treated with vancomycin with subsequent transition to oral antibiotics. In addition, all patients required early surgical intervention to manage their disease.

Conclusions

While the vast majority of ABRS is easily treated using the guidelines established by the Sinus and Allergy Health Partnership, clinicians should consider CAMRSA sinusitis in those patients who fail to respond or who suffer disease progression. This presentation discusses the diagnosis and treatment of CA‐MRSA sinusitis with emphasis on bacterial resistance and appropriate antibiotic selection.
S132 – Toll‐like Receptors in Salivary Glands
Authors: Dezfoulian Farnaz , Ganesh Joshi Meghnad , Gert Henriksson , Holgersson Suchitra Sumitran , Stjarne Paer , Cardell Lars Olaf
Published: August 2008

Objectives

1) To understand pathophysiology of sialoadenitis. 2) To examine the expression of Toll‐like receptor 1–10 in human salivary glands, focusing on changes induced by sialoadenitis since recent research has given them a key role in the induction of various inflammatory disorders.

Methods

Biopsies from parotid and submandibular glands were obtained from patients undergoing surgery due to benign neoplastic tumours or chronic/recurrent inflammation caused by sialolithiasis. In the former, a normal part of the gland was excised as far away from the tumour as possible and was used as control. In the latter, a biopsy was taken close to the centre of the inflammation. The mRNA expression of TLR 1 to 10 was quantified using real‐time polymerase chain reaction and the corresponding proteins were assessed using immunohistochemistry.

Results

A constant expression of TLR 1, 2, 3, and 5 were found in all specimens and an up‐regulation of TLR2 was seen in biopsies from patients with chronic sialoadenitis. The immunohistochemistry revealed moderate expression of TLR 3, 5, and 6 in serous glands and an intense TLR 2 expression in mucous acini.

Conclusions

Our results suggest that a TLR‐mediated inflammatory component might be involved in the development of sialoadenitis, perpetuating lymphocytic infiltration and cytokine production.
S133 – Boron Neutron Capture Therapy for Melanoma in Nasal Cavity
Authors: Morita Norimasa , Teruhito Aihara , Uno Msako , Ono Koji , Harada Tamotsu
Published: August 2008

Objectives

Boron neutron capture therapy (BNCT) is one of the radiation therapies known to have a selective lethal effect on tumor cells. Thermal neutrons are captured by the 10B atom, resulting in the emission of linear recoiling Alfa particles and 7Li nuclei, with traveling ranges of ∼9 and ∼5 micrometers respectively. These particles are high linear energy transfer (LET) radiation and lethally damage DNA. BNCT for cutaneous melanoma, using 10B‐para‐boronophe‐nylalanine (BPA) as the boron delivery agent, was developed and successful BNCT treatment of 18 melanoma patients has been reported by Mishima et al.

Methods

Based on their treatment regimen and with the approval of the Nuclear Safety Bureau of the Japanese government and the Medical Ethics Committees of Kawasaki Medical School and Kyoto University, we have conducted BNCT clinical trials on patients with mucosal melanomas in head‐and‐neck at the Kyoto University Research Reactor (KUR) and the Japan Research Reactor No. 4 (JRR‐4) since 2005.

Results

To date, we have treated 6 patients with mucosal melanomas in the nasal cavity with BNCT. 4 patients showed a complete response (CR) by 6 months and 2 patients showed a partial response (PR) 3 months after BNCT. None of the patients showed any serious damage in normal tissue surrounding tumor site. One patient from this study died due to distant metastasis. However, no local recurrence of melanoma has been observed in all CR patients and no regrowth of melanoma in all PR patients.

Conclusions

BNCT thus is a promising treatment for achieving local control of mucosal melanomas.
S137 – Microsatellite Instability Analysis of Sinonasal Carcinomas
Authors: Llorente‐Pendas Jose‐Luis , Jorge Garcia‐Martinez , Pérez‐Escuredo Jhudit , Hermsen Mario , Alvarez‐Marcos Cesar , Suarez‐Nieto Carlos , Hermsen Mario
Published: August 2008

Objectives

Microsatellite instability (MSI) is a type of genetic instability due to errors in the mismatch repair system. In the respiratory mucosa of the nasal and paranasal cavities, the 2 major types of carcinoma are intestinal‐type sinonasal adenocarcinoma (ITAC) and squamous cell carcinoma (SCCNC). ITAC is histopathologically similar to colorectal adenocarcinoma. However, it is unknown if this similarity extends to the pattern of genetic abnormalities involved. The aim of this study was to investigate if these results could be related to a possible role of MSI in these 2 types of nasal carcinoma.

Methods

DNA was extracted from frozen tumor samples of 34 ITAC and 25 SCCNC as well as corresponding blood samples of these patients. 5 mononucleotide microsatellite loci that show very little polymorfism between different individuals were amplified by multiplex PCR and analyzed by capillary electrophoresis.

Results

The allelic patterns showed normality for all 34 ITAC studied, whereas 2 SCCNC revealed an allelic shift for one of the 5 loci, indicating microsatellite instability.

Conclusions

MSI does not appear to play a role in ITAC as in colorectal adenocarcinoma. This finding is supported by immunohistochemistry studies of MMR protein expression levels. It remains to be elucidated what genetic mechanism propels tumorigenesis in diploid ITAC without gross chromosomal aberrations. In SSCNC, however, it cannot be excluded that MSI is involved in (a subset of) cases. Interestingly, only 1 of the 2 positive cases had the characterizing absence of chromosomal changes; the other carried multiple abnormalities.
S139 – Intact Parathyroid Hormone as a Predictor of Hypocalcaemia
Authors: Ng Yuk Hui , Teo Dawn Tw , Li‐Chung Khoo Mark
Published: August 2008

Objectives

1) To investigate intact Parathyroid Hormone (ipth) as a predictor of hypocalcaemia in post‐total thyroidectomy patients. 2) To determine the sensitivity and specificity of ipth as a predictor of hypocalcaemia.

Methods

Prospective study involving 65 patients in a single institution accrued over 2 years. All patients scheduled for total thyroidectomy were empirically started on calcium and vitamin D replacement on the day of surgery. Intact Parathyroid Hormone (ipth) levels were taken 4–6 hours after completion of operation. Corrected calcium levels were also obtained 4–6 hours after completion of operation and 24 hours later. All patients were subsequently monitored for development of hypocalcaemia. Hypocalcaemia is defined as corrected serum calcium of < 1.9 mmol/L or clinical symptoms of cramps or peri‐oral numbness.

Results

18 of 65 patients developed hypocalcaemia. All patients who developed hypocalcaemia had a ipth level of < 0.6 pmol/L. Using 0.6 as a cut‐off value, ipth has a sensitivity of 100% and specificity of 76% in our study.

Conclusions

Using a cut‐off value of 0.6pmmol/L, early postoperative intact parathyroid hormone has a high sensitivity and good specificity in identifying patients who subsequently develop hypocalcaemia post‐total or completion thyroidectomy and can be used identify patients who need close calcium monitoring in the postoperative period.
S141 – Total Laryngectomy in Patients with Advanced Bulbar ALS
Authors: Garvey Chris , Kathleen Kennelly , Salassa John R
Published: August 2008

Objectives

1) Identify patients with Amyotrophic Lateral Sclerosis (ALS) who would benefit from a total laryngectomy (TL) and outline specific surgical indications. 2) Educate physicians about the surgical procedure, perioperative course, and benefits from having a TL. 3) Review the clinical course and results of patients with ALS who had a TL.

Methods

From January 1999 to January 2008, charts from the Mayo Clinic in Jacksonville, FL, were retrospectively reviewed. 3 patients who underwent TL for advanced bulbar symptoms related to ALS were identified and their clinical course reviewed.

Results

At the time of surgery, all patients were aphonic with a multitude of symptoms including: dysphagia, drooling, respiratory insufficiency, aspiration pneumonia, choking and coughing. Average surgical time was 103 minutes. No intraoperative complications occurred. 2 patients with pre‐existing respiratory insufficiency experienced postoperative pulmonary complications, resulting in a prolonged hospital course, median stay 17 days (range 6–29 days). One patient was lost to follow‐up postoperatively. The other 2 and their caregivers were pleased with the results of TL. Benefits reported were: elimination of choking spells, improved comfort with mechanical ventilation, safe and easy tracheostomy tube changing and cleaning, less traumatic tracheobronchial suctioning, increased oral intake, reduced anxiety of aspiration, and less coughing.

Conclusions

TL is a relatively safe, quick, and uncomplicated surgery that should be considered earlier and more frequently in the treatment plan of patients with advanced bulbar symptoms of ALS. Patients with preoperative respiratory insufficiency may experience prolonged recovery times.
S144 – Management of the Symptomatic Lingual Thyroid
Authors: Massick Douglas D , Chio Eugene G
Published: August 2008

Objectives

Understand management strategies for symptomatic lingual thyroid tissue.

Methods

Prospective evaluation of 6 patients undergoing transoral resection of symptomatic lingual thyroid tissue between 2002 and 2007, with analysis of the evolution of our technique and patient outcomes.

Results

6 patients underwent transoral resection of symptomatic lingual thyroid tissue. Operative time, duration of postoperative hospitalization, and blood loss were significantly reduced over the course of the study.

Conclusions

Symptomatic lingual thyroid tissue can be successfully treated via transoral excision with minimal morbity and excellent patient outcomes.
S145 – RAP1 Expression in Squamous Cell Carcinoma of Head and Neck
Authors: Huang Chao‐Cheng , Chen Ching‐Mei , Chien Chih‐Yen
Published: August 2008

Objectives

Rap1 has been shown to be activated in response to various growth factors, cytokines, and chemokines that act on receptor tyrosine kinases (RTKs) or G‐protein‐coupled receptors, and implicated in a wide range of biochemical pathways in all eukaryotic cells through a number of distinct effectors. This study was aimed to investigate the role of RAP1 in the tumorigenesis of squamous cell carcinoma of head and neck (HNSCC).

Methods

Immunohistochemical analysis was performed to study RAP1, CK 10, and E‐cadherin expressions on the paraffin‐embedded tissue of 198 HNSCCs. The relationship between RAP1 expression and the clinical prognosis was also investigated.

Results

RAP1 expression was readily detected in the normal epithelium and the well‐differentiated HNSCC, whereas its expression turned to be weak or undetectable in the poorly differentiated HNSCC (p < 0.001). When RAP1 expression was decreased, the expressions of CK 10 (differentiation marker) and E‐cadherin protein were also down regulated. In addition, patients with high RAP1 expression had significantly longer median survival than patients with low RAP1 expression (median = 51.21 vs. 13.14 months, p <0.001) by survival analysis based on the Kaplan‐Meier method.

Conclusions

RAP1 expression may be related to cell differentiation in HNSCC. In addition, RAP1 could be a useful biomarker for tumor progression and survival of HNSCC.
S149 – Sinonasal Mucosal Melanoma: A 12‐Year Experience
Authors: Narasimhan Kailash , Kucuk Omer , Mathog Robert , Carron Michael A
Published: August 2008

Objectives

1) Describe the Sinonasal Mucosal Melanoma patients (SNMM) our institution has treated. 2) Assess outcomes of surgical and adjuvant therapies for this disease.

Methods

Records of 18 patients diagnosed between 1995 and 2007 were reviewed, with a focus on patient characteristics, treatment outcomes, and modalities.

Results

Patients’ ages ranged from 31 to 85. Most common anatomic locations were maxillary sinus in 12 patients and lateral nasal walls in 6. 5 patients had cribriform plate involvement, and 3 had orbital involvement. Tumor thickness averaged 3.1 cm. 15 of the 18 patients had definitive surgical resection of their primary. Most common surgical procedure was medial maxillectomy. 6 patients were operated on despite disease in prognostically poor locations such as skull base, orbit, cribiform plate, and nasopharynx. Margins ranged from 0.5 to 4 cm. 10 patients received chemo‐ or immunotherapy, 11 received radiotherapy, and 6 received both. Recurrence rate was 10/18 (55%), while distant metastatic rate was 6/18 (33%), the lung being the most common metastatic location (4 patients). Average follow‐up was 38.6 months, with disease‐free intervals ranging from 8 to 39 months in patients with recurrences. After 2000, patients only received limited surgical resections, and were treated at stages I‐II.

Conclusions

Despite the poor prognosis of SNMM, over the past 13 years at our institution the trend has been towards patients being diagnosed and treated at an earlier stage and having less extensive surgical resections. Advances in imaging, negative margins, radiation, and the use of immunotherapy may have influenced patient outcomes and recurrence rates.
S153 – Radiological Balloon Dilatation of Neo‐Pharyngeal Strictures
Authors: Harris Robert L , Alan Grundy , Odutoye Tunde A
Published: August 2008

Objectives

Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post‐total laryngectomy and pharyngolaryngectomy neo‐pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy.

Methods

A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post‐total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure.

Results

5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation.

Conclusions

Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.
S154 – Primary TEP and Patch Free‐Flap Laryngectomy Reconstruction
Authors: Ghanem Tamer Abdel‐Halim , McLarty Justin , Ardeshirpour Farhad , Baranano Christopher F , Rosenthal Eben L , Wax Mark
Published: August 2008

Objectives

1. Assess speech outcomes for patients undergoing primary tracheoesophageal puncture (TEP) following total laryngectomy (TL) with patch free flap reconstruction. 2. Evaluate risk of fistulization following primary TEP vs. no TEP in patch free flap TL reconstruction.

Methods

Patients undergoing reconstruction with patch free‐flaps following TL were studied retrospectively. Demographic data, surgical procedures, speech outcomes, and postoperative complications were collected. Patients were divided in 2 groups depending on whether TEP was performed at the time of ablation (primary TEP). Voice outcomes were assessed by a speech therapist.

Results

77 patients underwent TL, mean age of 63 years. Glottis (60%), followed by hypopharynx (18%), and supraglottis (17%) were the most common tumor sites. Most patients had T3 and T4 disease (71%) on initial presentation, and there were 57% undergoing salvage total laryngectomy. The radial forearm fascioucutaneous free flap was used in 90% of the cases. Primary TEP was performed in 44 patients (57%), and only 1 of 33 patients underwent a TEP procedure secondarily. Voice outcomes for the TEP group were good. The overall fistula rate was 39%, half of which healed spontaneously. The fistula rate in the primary TEP group was 41%, and in the group not receiving primary TEP it was 36.7% (p=0.87).

Conclusions

Primary TEP performed at the time of free‐flap patch reconstruction after TL enhances speech outcomes for patients, and does not lead to an increased risk in fistula formation.
S155 – Spontaneous Regression of Mucosal Melanoma
Authors: Rajan Roy , Samant Sandeep
Published: August 2008

Objectives

Spontaneous regression of melanoma is a rare phenomenon, and it has yet to be described in the literature for mucosal melanomas, which ordinarily have a grim prognosis with a 10–15%, 5‐year survival rate. We present a case of a hard palate melanoma that spontaneously regressed.

Methods

We present a case report, review of the literature, and a discussion.

Results

A 49‐year‐old female presented with a pigmented lesion recently on her hard palate that was biopsy‐proven to be spindle‐cell type malignant melanoma with a depth of 2.3 mm. It stained positive for S‐100 and Melan‐A. Subsequent PET/CT imaging did not show hypermetabolic activity either at the lesion or elsewhere. A wide local excision of the lesion was performed. The histopathology showed oral mucosa with focal cicatrix formation, chronic inflammation, and pigmented macrophages, but no evidence of residual melanoma.

Conclusions

The case illustrates histopathologic findings in a mucosal melanoma undergoing spontaneous regression. These findings point to a potentially critical role for histiocytes in effecting tumor elimination. Analysis of spontaneous melanoma regression may help understand this phenomenon better and may lead to improved immunotherapy.