bluuebunny/crossref_metadata_2025 huggingface dataset:
Friedman Staging for Sleep Surgery: Meta‐analysis
Authors: Friedman Michael , Hamilton Craig S. , Samuelson Christian G.
Published: February 2015

Objective

1) Review the available literature reporting on the success of single and multi‐level sleep surgery in relation to Friedman Anatomical Staging (FAS). 2) Combine statistical outcomes of multiple studies (where appropriate) to determine surgical success rates (defined by postoperative apnea‐hypopnea index [AHI] <20 and 50% reduction) for each clinical stage.

Method

PubMed, MEDLINE, and Cochrane Trial Registry (through 12/2011) were searched, combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis of studies assessing the success of sleep surgery in relation to FAS were performed. Outcomes are reported as proportional success rates.

Results

Six studies met inclusion criteria and had data suitable for pooling (521 patients). Success rate (SR) for single‐level palatal surgery with FAS‐1 was. 806 (.630,. 910; P =. 002). Multi‐level surgical data for FAS‐1 yielded SR. 706 (.458,. 872; P =. 1). Single‐level surgery for FAS‐2 yielded SR. 379 (.224,. 564; P =. 197). Multi‐level surgical data for FAS‐2 yields SR. 647 (.527,. 751; P =. 017). Single‐level surgery for FAS‐3 yields SR. 081 (.037,. 169; P <. 001). Multi‐level surgery for FAS‐3 yields SR. 412 (.254,. 591; P =. 334). Analysis of publication bias yielded non‐significant Egger’s regression intercepts for studies reporting FAS‐2/3 success. Too few studies reported FAS‐1 success to allow statistical analysis of publication bias.

Conclusion

These findings demonstrate the utility of FAS in predicting the success of OSA surgery. Findings further reinforce the value of OSA surgery in patients with FAS‐1 regardless of disease severity. In addition, they add to the evidence that multi‐level surgery is often necessary to treat patients with more advanced staging.
Balloon Catheter Endoscopic Dacryocystorhinostomy
Authors: Ragab Sameh M.
Published: February 2015

Objective

Conduct the first prospective randomized controlled study investigating the safety and efficacy of endocanalicular high pressure 5‐mm balloon catheter endoscopic dacryocystorhinostomy (DCR) in adult patients with acquired complete nasolacrimal obstruction.

Method

This prospective randomized controlled study was conducted between 2004 and 2009 including 70 procedures of endoscopic dacryocystorhinostomy. They were prospectively equally randomized into 2 groups; endocanalicular high‐pressure 5‐mm balloon catheter endoscopic DCR (group I) and conventional endoscopic DCR (group II). Regular follow up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Statistical analysis was done using SPSS for Windows. The primary end point was determined to be the success of the surgery as defined by the subjective disappearance of symptoms.

Results

Both groups demonstrated a success rate of 91.4%. There was a shorter mean operative time (25.7 minutes) in the endocanalicular balloon catheter endoscopic DCR group.

Conclusion

The endocanalicular balloon catheter endoscopic DCR shares the benefits and success rate of conventional endoscopic DCR. In addition, it is simpler, requires less manipulation, consumes a shorter operative time, has a better safety profile, and can be totally utilized under local anesthesia with minimal sedation.
Endoscopic Surgery for Juvenile Nasopharyngeal Angiofibroma
Authors: Gao Xia
Published: February 2015

Objective

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. External or intraoral incisions are standard open approaches, now endonasal endoscope surgery is widely accepted for its low invasion and high success rate. The purpose of this article is to present our experience with 16 patients diagnosed with JNA who were resected with endonasal endoscope surgery.

Method

Records of 16 patients aged 11 to 32 with a mean age of 19.5 years treated by endoscopic surgery in our department between 2003 and 2010 were reviewed retrospectively. All patients were male. Preoperative radiological evaluation included both high resolution computed tomography with 1‐mm cuts, and magnetic resonance imaging (MRI). According to Radkowski’s classification, 4 patients were stage Ia, 5 patients were stage Ib, 4 patients were stage IIa, and 3 patients were stage IIb. The tumor stages, feeding vessels, operating time, complications, and recurrence were observed and recorded. Eight patients received preoperative angiographic embolization, and 3 patients received intraoperative external carotid artery clamping. Transnasal or transpterygoid and posterolateral wall of maxillary sinus approaches are used for tumor resection.

Results

The mean duration of the surgery was 2 hours. The mean intraoperative blood loss of patients who received preoperative hyperselective embolization was 470 mL, patients who received intraoperative external carotid artery clamping was 510 mL, and patients who did not receive arterial supply blocking was 930 mL. After surgery, CT scan or MR image showed total removal of the tumor was achieved in all patients. No postoperative complications were observed. All patients were followed‐up for 9 months to 3 years (mean 1.5 years), and no recurrence was founded.

Conclusion

Endoscopic resection of JNA is a difficult but effective operation. The key techniques to remove tumor are bleeding control, drilling‐out the bone that the tumor invaded. Endonasal surgery combined with a preoperative embolization of the arterial supply can control blood loss. For small and intermediate‐sized JNA (Radkowski Ia‐IIb), endoscopic surgery is an appropriate choice. If the tumor extends into lateral fossa infratemporalis or deep into the skull base,we do not recommend it.
Evidence‐Based Long‐term Outcomes in ESS
Authors: Hopp Martin L. , Vardanyan Narine , Nasseri Shawn
Published: February 2015

Objective

1) Analyze appropriateness of endoscopic sinus surgery. 2) Understand the long‐term results of endoscopic sinus surgery at an academic institution with an academic and private practice blend of patients using the Sino Nasal Outcome Test (“SNOT 22”) statistically validated tool.

Method

Included consecutive patients undergoing sinus surgery at CSMC since January 2009 who were able to complete SNOT‐22 prior to surgery. Three hundred fifty patients were included from 17 physicians. Patients mailed the postop form 3, 6, and 12 months following surgery. Patients ranged from 22 years to 67 years split between 220 females and 330 males.

Results

The results were quite impressive for patients from immediate to long‐term (12 month) postoperative results. The results were statistically significant in demonstrating an improvement of symptoms overall and in all 4 subcategories with a univariate analysis demonstrating P values of <.001. These results were very exciting due to the multi‐cultural and varied nature of the patients ranging from tertiary care academic referrals to community otolaryngology patients.

Conclusion

It was concluded that endoscopic sinus surgery was effective with results reaching statistical significance in demonstrating an improvement of symptoms overall and in all 4 sub‐categories with a univariate analysis demonstrating P values of <.001. Scientific findings demonstrate that patients had major improvement scores 3, 6, and 12 months after surgery.
HAART: Presence of Oral Warts in an HIV‐Infected Population
Authors: Mahmoud Ali , Miziara Ivan D. , Weber Raimar , Gil Julio M. , Costa Katia C.
Published: February 2015

Objective

To investigate whether the use of HAART for patients with HIV/AIDS was associated with increased prevalence of oral warts in a tertiary care hospital in Brazil.

Method

Approximately 1745 HIV patients (72.3% males) aged 2‐64 years (mean 33 years) treated at the Otorhinolaryngology department of a tertiary care hospital for a period of 12 years from 1993 to 2005. Patients were evaluated for the presence of oral lesions, recorded data about their medications, serum count of CD4+, and after 1996, plasma viral load. The diagnosis of oral warts was made through biopsy under local anesthesia, using 2% xylocaine. Polymerase chain reaction was used to detect and type HPV infection. Data were analyzed by dividing patients into 3 groups according to treatment: no treatment, antiretroviral therapy (ART), and HAART. The prevalence of oral warts was compared among groups using the chi‐square and Fisher exact tests.

Results

Approximately 77 patients (4.4%) had oral warts. About 2.8% of the 317 untreated patients, 4.0% of the 927 under ART, and 6.2% of 501 users of HAART had oral warts. The HPV infection rate of HPV6/11 was 45.2%.

Conclusion

There is an increased frequency of oral warts due to HPV, even under improved immune status after HAART, with a prevalence of a low risk HPV6/11 infection.
Modeling Nasal Physiology Changes due to Septal Perforations
Authors: Cannon Daniel E. , Frank Dennis O. , Kimbell Julia S. , Poetker David M. , Rhee John S.
Published: February 2015

Objective

Some surgical procedures intentionally create asymptomatic septal perforations or inadvertently produce problematic ones. The purpose of this study is to use computational fluid dynamics (CFD) technology to help providers understand 1) how septal perforations alter nasal physiology, and 2) how this is influenced by perforation size and location.

Method

Septal perforations of 1 and 2 cm were virtually created in a nasal cavity digital model in anterior, posterior, and superior (similar to a modified Lothrop procedure) locations. CFD technology was used to analyze airflow, conditioning, and wall shear stress.

Results

Total nasal resistance was not significantly altered by septal perforations. Airflow allocation changed, with more airflow through the lower‐resistance nasal cavity. This effect was less in the superior perforations compared to the other locations. There was less localized heat and moisture fluand wall shear stress in superior perforations compared to those in anterior or posterior locations. For anterior perforations, larger size (2 cm) correlated with 59% higher velocity and 22% greater wall shear, while the reverse relationship was seen in posterior perforations, with 5% higher velocity and 29% greater wall shear in the smaller perforation (1 cm).

Conclusion

Septal perforations may alter nasal physiology. Airflow allocation is changed as air is shunted through the perforation to the lower‐resistance nasal cavity. Superior perforations cause less alteration in nasal physiology than those in other locations. Larger anterior and smaller posterior perforations cause greater alterations in velocity and wall shear.
Posterior Turbinectomy in Turbinate Reduction Procedures
Authors: Ismail Ahmed S.
Published: February 2015

Objective

1) Evaluate the role of turbinoplasty and/or submucous diathermy in management of hypertrophied inferior turbinates. 2) Evaluate the role of posterior turbinectomy in combination with turbinoplasty and submucous diathermy for better, longer‐lasting results.

Method

Retrospective study on 205 patients who were divided into group A (120 patients who underwent turbinoplasty) and B (85 patients who underwent submucous diathermy). Each group was subdivided to subgroup 1 for those who had posterior turbinectomy and 2 for those with no posterior turbinectomy. The follow‐up period was 26‐38 months.

Results

In group A: (98.3%) of group A1 and (71.6%) of group A2 reported very good or good improvement after surgical procedure. (1.7%) of group A1 and (23.3%) patients of group A2, reported fair results and only 3.3% of group A2 reported bad or no change. In group B: (84.4%) of group B1 and (55%) of group B2 patients reported very good or good results after surgical procedure, (13.3%) of group B1 and (22.5%) of group B2 patients reported fair improvement. (2.3%) of group B1 and (22.5%) of group B2 patients reported bad or no change.

Conclusion

Turbinoplasty still shows better outcome than submucous diathermy. Furthermore, combining posterior turbinectomy with any of the turbinate reduction procedure gives better, longer‐lasting results.
Preventing Endotracheal Cuff Rupture during Tracheostomy
Authors: Joshi Arjun S. , Sood Amit J.
Published: February 2015

Objective

1) To demonstrate the importance of endotracheal tube (ETT) positioning in avoiding complications of ETT cuff penetration during tracheostomy. 2) To describe the author’s technique of ETT positioning. 3) To determine the probability of cuff penetration utilizing the technique in a 3D‐computed tomography model.

Method

From July 2008 to January 2012, 89 patients who had undergone tracheostomy using the mentioned technique in a tertiary hospital setting were evaluated. One hundred fifty random patient CT scans were chosen, measurements were taken, and probability of cuff penetration during virtual tracheostomy was generated. Primary outcome was ETT cuff penetration.

Results

Over the period studied, 85/89 patients underwent tracheotomy without ETT cuff rupture by positioning the ETT just proximal to the carina after neck extension. After evaluating 150 random 3D‐CT scans, it was determined that the average distance between the tracheotomy to superior aspect of cuff was 80 mm in males and 63.8 mm in females when a 6.5 sized ETT was utilized, and 70.2 mm in males and 54 mm in females when a 7.5 ETT was utilized. Virtual tracheotomy between the second and third tracheal rings resulted in no probability of inadvertent ETT cuff rupture.

Conclusion

ETT cuff rupture is a common occurrence that may result in disastrous intraoperative complications during tracheostomy. This study serves to underscore the importance of ETT positioning and provides radiologic evidence for the author’s approach. Distal ETT positioning should be strongly considered for avoiding problems of ETT cuff rupture during tracheostomy.
Smoking Cessation in Cancer Patients: A Systematic Review
Authors: Nayan Smriti , Gupta Michael K. , Sommer Doron
Published: February 2015

Objective

Comprehensive treatment plans for oncology patients including tobacco smoking cessation interventions are essential, as smoking after the diagnosis of a smoking‐related cancer negatively impacts many aspects of treatment in this patient population. The primary objective was to evaluate, through a systematic review, smoking cessation interventions and cessation rates in cancer patients.

Method

The literature was searched using Medline, EMBASE, Google Scholar, and the Cochrane Library (inception to September 2011) by 3 independent review authors. Included studies described tobacco smoking cessation interventions with patients randomized to usual care or an intervention. The primary outcome measure was cessation rates. Two authors extracted data independently, and disagreements were resolved by consensus.

Results

Eight randomized control trials (RCTs) investigating smoking cessation interventions in the oncology patient population were identified. Pooled relative risks were calculated from 2 groups of RCTs of smoking cessation interventions based on follow‐up duration. In both groups, the pooled relative risk did not suggest a statistically significant improvement in tobacco cessation compared to usual care. However, a subgroup analysis looking at newer combination interventions within the last 10 years yielded a statistically significant difference in smoking cessation rates.

Conclusion

Despite the importance of smoking cessation in oncology patients, there are a paucity of studies. The review suggests that newer combination interventions involving both nonphamacological and pharmacological approaches, in the last decade, yield a statistically significant difference in smoking cessation rates compared to usual care.
The HLA‐G and IL‐17A Expression in Nasal Polyposis
Authors: Avelino Melissa A. G. , Wastowski Isabela J. , Ferri Ricardo G. , Marinho Larissa C. , Batista Aline C. , Weckx Luc L. M.
Published: February 2015

Objective

The HLA‐G molecules are nonclassic class I antigens with anti‐inflammatory and tolerogenic properties, while interleukin‐17A (IL‐17A) is a key inflammatory cytokine in many disorders. Considering that, the aims of this study were: 1) to evaluate the HLA‐G molecule, and 2) to evaluate IL‐17A expression in patients presenting with nasal polyposis.

Method

Samples of patients presenting with nasal polyposis (n = 20) were subjected to immunohistochemistry technique. All patients were grouped into atopic and nonatopic patients according to skin prick test and IgE dosage. All statistical analyses were performed using the GraphPad Prism 5.0. The level of statistical significance was accepted at P <. 05.

Results

Our preliminary results showed the HLA‐G and IL‐17A expression in nasal polyposis. Immunohistochemical staining demonstrated a higher expression of HLA‐G molecule in samples of nonatopic patients when compared with atopic patients (P =. 04). The IL‐17A expression was also observed in both atopic and nonatopic patients; however, the numbers of IL‐17A positive cells were greater in nasal polyps of atopic patients than in those of nonatopic patients.

Conclusion

These preliminary results indicated that HLA‐G and IL‐17A may play an important role in the pathology of nasal polyposis. Considering the anti‐inflammatory properties of HLA‐G and inflammatory activities of IL‐17A, we suggest that HLA‐G could decreased the susceptibility to disease, while IL‐17 should be associated with more severe atopy.
Prospective Evaluation of Perioperative Errors and Delays
Authors: Dedhia Raj C. , Shwaish Kawa , Snyderman Carl H. , Monte Robert , Eibling David E.
Published: February 2015

Objective

1) Understand the leading causes for process errors and delays in the otolaryngology operating room. 2) Recognize the impact of process errors and delays on patient safety, hospital costs, and environmental waste.

Method

A 4‐week prospective, observational study was conducted in January 2012 evaluating 23 elective otolaryngology cases. A standardized data collection tool was developed and refined based on pilot observations. Two trained observers recorded relevant times and actions from patient check‐in in the preoperative holding area to the “wheels out” time.

Results

The mean case observation time was 220.0 ± 167.8 minutes with mean duration of operation length being 107.0 ± 146.2 minutes. The perioperative period was divided into 6 stages: patient holding, room preparation, preintubation, postintubation, intraoperative, postextubation. One hundred (average of 4.3 per case) process errors were recorded, 34% of which were due to communication failures. Forty delays were observed resulting in 336 minutes of standstill delay. Again, communication failures represented the most common etiology with 17 communication failures resulting in 146 minutes of standstill delay. The preintubation stage was most affected by delay with 1 in 6 minutes comprising standstill delay.

Conclusion

This is the first study in otolaryngology to examine perioperative process errors and delays. Preoperative team discussion and use of technology represent potential strategies in minimizing communication‐related process errors and standstill delays. Further work is currently being undertaken to study this critical perioperative issue in greater detail across specialties.
Treatment of Acute Rhinosinusitis by Otolaryngologists
Authors: Smith Stephanie Shintani , Evans Charlesnika T. , Kern Robert , Chandra Rakesh K.
Published: February 2015

Objective

Recent studies confirm that antibiotics are unnecessary for the vast majority of acute rhinosinusitis (ARS) cases. Guidelines advocate watchful waiting for mild‐moderate ARS, with initiation of antibiotics and inhaled nasal steroids (INS) if symptoms do not improve. This study assesses treatment for ARS by otolaryngologists on a national level.

Method

Ambulatory visits to otolaryngologists for ARS were extracted from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Care Survey (NHAMCS) for 2006‐2009. This survey is conducted annually by the US Department of Health and Human Services. Descriptive statistics were calculated to determine utilization of antibiotics and INS.

Results

Among an estimated 19.8 million adult visits for ARS, 955,000 visits were to otolaryngologists (mean age, 47.8 ± 2.5 years; 60.0 ± 7.1% female). Otolaryngologists prescribed intranasal steroids in 24.9 ± 6.2% of visits. Antibiotics were prescribed in 57.0 ± 6.5% of ARS visits to otolaryngologists, and 93.0 ± 4.6% of these prescriptions were for broad‐spectrum antibiotics (amoxicillin‐clavulanate, second/third generation cephalosporins, azithromycin, clarithromycin, or quinolones).

Conclusion

Otolaryngologists widely prescribe antibiotics for ARS, though current data suggest that the majority of ARS cases resolve without antibiotics. High rates of antibiotic prescribing, often with broad spectrum coverage, and relative scarcity of INS utilization suggest opportunities to improve prescribing patterns.
Treatment of Ranula by OK‐432: Pearls and Pitfalls
Authors: Ohta Nobuo , Fukase Shigeru , Suzuki Yusuke , Kakehata Seiji
Published: February 2015

Objective

Intralesional injection therapy with OK‐432 was developed as a therapy for operatively difficult lymphangioma (cystic hygroma) and is currently becoming a first choice treatment of this disease. The aim of this article was to evaluate the outcome and complications of the treatment of patients with ranula by OK‐432 therapy.

Method

We tried this therapy in 55 patients with ranula between January 2001 and February 2012. We injected OK‐432 solution into the lesion with a 27‐gauge needle to prevent the leak of the agent out of the cyst. We performed this treatment on an outpatient basis without hospitalization.

Results

Disappearance and marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity did not occur in any patients. As side effects, local pain at the injection site and fever (37 to 39°C) were observed in few cases of the patients who had this therapy, but such problems resolved within a few days. Dermoid cyst might be kept in mind to make differential diagnosis for ranula.

Conclusion

These results may allow us to speculate that intralesional injection therapy with OK‐432 is simple, easy, safe, and effective, and it can be used as a substitute for surgery in the treatment of ranula.
Ultrasound Findings after Submandibular Sialolithotomy
Authors: Joshi Arjun S. , Sood Amit J.
Published: February 2015

Objective

1) To demonstrate the utility of ultrasound in the assessment of the submandibular gland after endoscopic‐assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for assessment after submandibular sialolithotomy.

Method

From August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic‐assisted or purely open sialolithotomy in a tertiary‐level clinic setting. Pre‐ and immediate postprocedure ultrasound was performed. Examinations were analyzed for evidence of persistent obstruction.

Results

Twenty patients with symptomatic submandibular sialolithiasis underwent either endoscopic‐assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound characterized by acoustic shadowing immediately after sialolithotomy and were retreated in the same setting with success. Fifteen of 22 (68%) demonstrated proximal ductal dilatation after stone removal. Eighteen of 22 (81%) demonstrated trace hyperechogenic foci without shadowing indicating air bubbles or blood. At 2 weeks, all findings had resolved. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow‐up ranging from 6 months to 1 year.

Conclusion

Ultrasound can be used to assess for residual obstruction immediately after submandibular sialolithotomy. Only the presence of posterior shadowing reliably predicted pathology. The presence of proximal ductal dilatation and hyperechogenic foci without shadowing take longer to resolve after sialolithotomy, and should not be used to influence treatment decisions during procedures.
VH1 and CMT Web Surveys Reveal Music‐Listening Behavior
Authors: Pearce Elizabeth C. , Mainthia Rajshri , Tharpe Anne M. , Eavey Roland D.
Published: February 2015

Objective

Music‐induced hearing loss is a growing public health concern. Potential contributors include intentional exposure to loud music volume and lack of awareness about potential hearing damage. We wanted to evaluate current trends in music listening behaviors, perception of personal risk, and hearing loss education in 2 musically inclined demographics.

Method

An anonymous online 89‐question survey instrument was made available to a convenience sample of visitors on both VH1.com and CMT.com Web sites. Respondents were queried about attitudes and behaviors related to hearing protection and noise exposure. A P <. 05 value was used for independent t and z tests.

Results

Total respondents: 1601. The minority of respondents felt hearing loss created a personal problem (19%), yet 43% had experienced hearing related issues. Respondents under 21 displayed potentially more harmful listening behaviors and symptoms of hearing loss, particularly with MP3 player use (P <. 05). Popular media was the most informative source about hearing loss; 56% learned about hearing loss on television, 36% on the Internet, and 29% in a magazine. Most respondents reported willingness to adopt ear protective behaviors if educated by a clinician (71%) or informed that even limited exposure to excessively loud music can cause permanent damage (69%).

Conclusion

Respondents 21 years old or younger reported significantly less education about potential hearing damage and were more likely to engage in riskier listening behavior. Healthcare providers retain significant ability to influence individual listening health and the media.
Can Biometric Measures Predict TORS Feasibility?
Authors: Arora Asit , Garas George , Kotecha Jalpa , Acharya Amish , Khemani Sameer , Kotecha Bhik
Published: February 2015

Objective

1) Investigate whether subjective evaluation of patient suitability for Transoral Robotic Surgery (TORS) is reliable. 2) Establish if TORS feasibility can be assessed using anthropometric measures and Mallampatti grade. 3) Determine which biometric characteristics warrant further clinical evaluation.

Method

Cadaver study (n = 42) conducted between April 2010‐2012. Seven anthropometric measurements and Mallampati grade were recorded. Three head and neck surgeons assessed TORS feasibility. Adequate visualization of tonsil, tongue base, vallecula, and epiglottis were recorded using 2 TORS mouth gags. Significant anthropometric differences between full and suboptimal visualisation groups were identified.

Results

There was a negative correlation between subjective difficulty impression and actual transoral visualization for all anatomical regions (R2 = 0.32, P <. 05). Six anthropometric measures were identified whose mean values were significantly different between full and suboptimal transoral visualization groups. Suboptimal visualization of the tongue base was associated with shorter mean sterno‐mental (P <. 01) and cricoid‐mental (P =. 02) lengths and greater mean neck circumference (P =. 04). Suboptimal visualization of the vallecula and epiglottis were associated with a short ramus width (P =. 03) and long ramus length (P =. 05). The mean Mallampati grade was higher in the suboptimal visualization group for tongue base (P <. 01), vallecula (P <. 03), and epiglottis (P <. 04).

Conclusion

Subjective assessment is an unreliable predictor of TORS feasibility. Anthropometric measures of the neck, mandible, and Mallampati grade are valuable indicators which can potentially be used to devise a weighted predictive scale. Further clinical evaluation is warranted to determine the true predictive value of these anthropometric measures and Mallampati grade.
Comparative Study of Robotic versus Endoscopic Thyroidectomy
Authors: Tae Kyung , Bae Ji Yong , Jeong Jin Hyeok , Kim Kyung Rae , Choi Woong Hwan , Ahn You Hern
Published: February 2015

Objective

Robotic thyroidectomy and conventional endoscopic thyroidectomy have not been thoroughly compared. In this study, we compared the potential advantages of robotic versus endoscopic thyroidectomy.

Method

We analyzed 218 consecutive patients who underwent endoscopic (105 cases) or robotic (113 cases) thyroidectomy using a gasless unilateral axillo‐breast (GUAB) or axillary (GUA) approach.

Results

Because of the dexterity of robotic instruments and the improved surgical view, it was subjectively easier and took less time to perform a complete total thyroidectomy and central compartment neck dissections (CCND) in robotic thyroidectomy. In the case of unilateral lobectomy, endoscopic and robotic thyroidectomy had quite similar surgical outcomes. Cosmetic satisfaction was excellent in both groups.

Conclusion

Robotic thyroidectomy is superior to endoscopic thyroidectomy for performing total thyroidectomy and bilateral CCND. However, in terms of cost‐effectiveness, endoscopic thyroidectomy is comparable to robotic thyroidectomy in patients who undergo unilateral lobectomy.
Curcumin Inhibits UV Radiation–Induced Skin Cancer In Vivo
Authors: Phillips Jeffrey , Sonavane Kunal , Moore‐Medlin Tara , Ekshyyan Oleksandr , Clark Cheryl , Abreo Fleurette , Nathan Cherie‐Ann O.
Published: February 2015

Objective

As skin cancer incidence increases, research has focused on novel chemopreventive agents that inhibit tumor formation. In prior experimentation, curcumin, a naturally occurring food substance and anti‐carcinogenic agent, inhibited cutaneous squamous cell carcinoma xenograft growth. We hypothesize curcumin will inhibit UVB‐radiation–induced skin cancer growth in mice, approximating a human chemopreventive model.

Method

A randomized experimental animal and laboratory study is presented. SKH‐1 mice were pre‐treated with oral or topical curcumin, or oral or topical control (n = 22/group), for 14 days. Mice received UVB radiation 3 times weekly for 24 weeks or were not radiated. Tumor number, volume, and onset were compared.

Results

Time to tumor onset was significantly shorter in control mice compared to mice receiving either oral (P =. 025) or topical (P =. 015) curcumin. A significant difference in the average number of tumors formed per mouse was seen, as fewer tumors were formed in the oral curcumin (P =. 01) and topical curcumin (P =. 01) groups, compared with their respective controls. Once tumors formed, no significant difference in tumor volume was noted at 24 weeks.

Conclusion

Curcumin appears to inhibit skin cancer formation and prolong time to tumor onset when administered by either an oral or topical route. These data suggest that curcumin may have chemopreventive potential against skin cancer necessitating future experimentation with human subjects.
fMRI Cerebral Activation during Speech in Laryngectomies
Authors: Piccioni Lucia O. , Ferrario Fabrizio , Toma Salvatore , Vezzulli Paolo , Bussi Mario
Published: February 2015

Objective

We focused our attention on the localization of the laryngeal phonatory area in a somatotopic context. This study investigates brain modification consequent to partial or complete removal of the larynx.

Methods

From 2009 to 2011 we enrolled 18 patients, divided into 3 groups: 6 healthy volunteers, 6 subtotal laryngectomy patients, and 6 total laryngectomy patients. During fMRI recording, all subjects were trained to carry out 5 motor tasks.

Results

Analyzing group 1, we obtained: bilateral activation in prefrontal gyrus and in cerebellar lobule VI during the phonation of the vowel E; activation of the same areas in addition to basal ganglia, cerebellar lobule VI and VIII, insular lobe, 42 Brodmann area and basal gyrus bilaterally, Rolandic operculum, and the supplementary motor area intonating vowel E. Glottal adduction during forced expiration and phonatory task activated the same areas. Phonatory tasks determined the same activation in all groups, with an extension of these areas proportional to surgical damage. In lip and tongue tasks we observed the same results in all groups.

Conclusion

This study permitted the mapping of the human motor cortical areas that control intrinsic laryngeal muscles, differentiating them from those referable to the articulatory process. Studying subtotal and total laryngectomies, we identified an expansion of the laryngeal area activation, proportional to the degree of the laryngeal injury. We observed the functional recovery of brain regions considered evolutionarily ancient that are normally virtually quiescent.
Has Hypopharyngeal SCCa Survival Paralleled Laryngeal SCCa?
Authors: Newman John R. , Illing Elisa A. , Carroll William R.
Published: February 2015

Objective

To determine if: 1) the national trend of decreased survival of laryngeal cancer patients has also been seen in patients with squamous cell carcinoma of the hypopharynx, 2) to determine which subsets of hypopharyngeal cancer are most affected, and 3) to analyze factors that may contribute to survival.

Method

The Surveillance, Epidemiology and End Results (SEER) Database of the National Cancer Institute was analyzed for this study. Records of 6916 patients with squamous cell carcinoma (SCCa) of the hypopharynx between 1973 and 2003 were selected for review.

Results

Overall 5‐year survival rates for hypopharyngeal cancer have improved since 1973. Average survival of MO hypopharyngeal cancer patients was 83% in those diagnosed since 1990, compared to 75% before 1990 (P <. 0001). Since 2000, survival has averaged 86%. Since 1990, more patients have been treated with radiation only (1973‐89, 42.3% vs 1990‐2003, 49.9%) as opposed to combined surgical and radiation therapy (1973‐89, 43.6% vs 1990‐2003, 42.9%). Subsite analysis demonstrated that the majority of tumors (64%) originated in the pyriform sinus. The 5‐year survival for this subset of patients improved from 73% (1973‐89) to 82% (1990‐2003) (P <. 0002).

Conclusion

In contrast to the decreased trends documented for laryngeal cancer, survival has improved in patients with squamous cell carcinoma of the hypopharynx over the past 2 decades. Primary therapy for these patients has largely been with radiation or radiation/surgery, with an increasing number of patients being treated with radiation alone.
Human Papilloma Virus in Laryngeal Squamous Cell Carcinoma
Authors: Clayburgh Daniel , Sauer David , Schindler Joshua S.
Published: February 2015

Objective

1) To determine the incidence of human papilloma virus (HPV) expression in laryngeal squamous cell carcinoma (SCC). 2) To determine the subtypes of HPV associated with laryngeal SCC.

Method

Between 2006 and 2011, most new diagnoses of laryngeal SCC at our institution were sent for HPV PCR. A retrospective review was conducted on these patients. The results of this test, patient history, and tumor characteristics were collected. Descriptive statistics and Student’s t test were performed.

Results

Thirty patients with laryngeal SCC and an HPV PCR assay were identified. Three patients (10%) were positive for HPV. Subtypes 16, 31, and 59 were identified in these 3 patients. The HPV+ patients exhibited a trend towards less tobacco use (23 pack‐years versus 46 pack‐years in HPV– patients), although this was not statistically significant (P =. 18). There was no significant difference in age between HPV+ and HPV– patients (63.3 years vs 65.8 years, P =. 88).

Conclusion

Although not as common as in oropharyngeal SCC, a subset of laryngeal SCC is associated with HPV. Several subtypes of HPV may be found in this disease. Future prospective studies will be useful to more accurately determine the incidence of HPV in laryngeal SCC and its effects on disease outcomes.
Is Education Effective during Head and Neck Cancer Screenings?
Authors: Hapner Edie R. , Wise Justin C. , Bauer Kellie L. , Zhu Jiang Jason
Published: February 2015

Objective

This study measured the baseline knowledge of NASCAR fans regarding the risks, signs, and symptoms of head and neck cancer and examined the effectiveness of education efforts concerning head and neck cancer during a free, community‐based head and neck cancer screening.

Method

Adults touring the midway during a NASCAR race were recruited for the study. A survey regarding knowledge on head and neck cancer (HNCA) was administered before and after HNCA screening which included education on risks, signs, and symptoms of such malignancies. Participants were surveyed again 3 months after the race.

Results

Four hundred seventy‐eight NASCAR fans participated in the study. Of these, 34% reported being a current smoker and 10% reported being a current user of smokeless tobacco. Of the 478 participants, 106 were contacted at the 3‐month follow up. A univariate ANOVA indicated knowledge of head and neck cancer changed significantly over time, F(2, 204) = 18.66, P <. 001, η2 =. 16. Specifically, knowledge assessed after the educational component was significantly higher than at baseline. At the 3‐month follow‐up, knowledge was significantly higher than baseline, but significantly lower than after exposure to the educational component.

Conclusion

Participants demonstrated increased knowledge on the risks, signs, and symptoms of HNCA immediately following the educational session during the screening and at 3‐month follow‐up. While specific knowledge on HNCA was greater at the 3‐month follow‐up than baseline, it significantly diminished compared with post‐screening test results, suggesting poor long‐term knowledge retention.
Marginal Mandibular Nerve Palsy Incidence in Neck Dissection
Authors: Amin Nikul , Dixon Hannah , Gibbins Nicholas , Lew‐Gor Simione
Published: February 2015

Objective

The marginal mandibular nerve (MMN), a branch of the facial nerve, is at risk of damage during neck dissections. The resulting asymmetry of the mouth can cause distress as well as physical problems (dental lip trauma and fluid spillage) and is often not appreciated preoperatively. The authors wished to: 1) ascertain the incidence of marginal mandibular nerve (MMN) palsy during neck dissections, and 2) correlate risk of nerve palsy with level of nodal clearance.

Method

All neck dissections undertaken at a tertiary referral head and neck oncology center from the last 2 years 1/1/10‐1/1/12 were examined. Data collected include type of neck dissection, levels cleared, and pre‐ and postoperative MMN function.

Results

We collected data from 50 consecutive neck dissections. Seven of 50 (14%) patients had an MMN palsy postoperatively. Of these 100% were permanent. As expected, patients with level 1 clearance were those at highest risk of MMN palsy. The grade of the operating surgeon was not statistically significant.

Conclusion

The incidence of MMN palsy in neck dissections is high. Despite being a recognized complication of neck dissection surgery, there are limited data regarding rates of MMN palsy or correlation with levels of nodal clearance. The authors suggest that preoperatively the patient should be alerted to the incidence of MMN plasy, especially if level I is to be included in the dissection.
Microfluidic Techniques to Assess Radiosensitivity of HNSCC
Authors: Carr Simon , Green Victoria , Stafford Nicholas , Greenman John
Published: February 2015

Objective

The ability to predict tumor radioresistance would avoid unnecessary treatment with associated side effects and negate salvage surgery. Microfluidic techniques can be exploited to replicate the in vivo tumor microenvironment.This study demonstrates how such technology can determine the response of HNSCC to radiotherapy in an individualistic manner.

Method

Technique optimized using rat liver maintained in microfluidic devices, perfused with media for <17 days. Radiotherapy treatment (10‐20Gy): single and fractionated doses. Effluent analyzed for urea, albumin, and lactate dehydrogenase (LDH, cell death indicator) to assess response. Nine HNSCC biopsies (T1‐T3) were analyzed for LDH release following radiotherapy (2‐30Gy).

Results

Initial cell death decreased reproducibly to minimal levels in all tissues between 12‐24 hours. Tissue remained viable for up to 17 days. Rat liver: 0‐2 hours after 20Gy radiotherapy (single dose), an LDH surge with concomitant decrease in urea and albumin was observed. The tissue partly disintegrated. 2 × 10Gy fractionated doses resulted in effects after the second fraction. The tissue remained intact. HNSCC biopsies: Tongue base (n = 3), larynx (n = 3), lymph node metastases (n = 2) 30Gy: Larynx responded. Tongue base (postradiotherapy recurrence) did not. 10Gy: Tongue base responded, not larynx or lymph nodes. No response in any tissues with <10Gy.

Conclusion

A model to assess tissue response to radiotherapy was successfully established using rat liver. Preliminary results with HNSCC samples have shown that a response to radiotherapy can be elicited at different doses using this technique. Correlation with histology and clinical response will further validate this technique as a predictive tool.
Outcomes in Oropharyngeal Cancer
Authors: Titoria Puneet , Carswell Andrew , Repanos Costa , Parmar Amit , Tierney Paul
Published: February 2015

Objective

1) To assess outcomes, in terms of survival, quality of life (using EORTC CQOL and HN35), and swallowing in oropharyngeal cancer patients treated with transoral surgical techniques. 2) To compare these outcomes with those of patients treated with chemoradiotherapy.

Method

The study was conducted through 2011. Data were collated from the databases of 3 head and neck cancer units in the southwest of England. Patients diagnosed with oropharyngeal squamous cell carcinoma between 2006‐2008 were identified. Their medical records were reviewed and questionnaires looking in to the assessed outcome measures were sent.

Results

A total of 124 patients diagnosed with oropharyngeal squamous cell carcinoma during the years 2006‐2008 were identified. Of these 124 patients, 70 were still alive at the time of the study. Sixty‐three of 70 patients responded to the questionnaire. Notable findings included much reduced symptom scores for swallowing difficulties in those patients treated surgically compared to chemoradiation. The combined head and neck symptom scores for stage 3 and 4 disease was a median of 12 for the surgical group versus 27 for the chemoradiation group.

Conclusion

These data add to the available evidence that suggests that patients treated with modern, minimally invasive, transoral surgical techniques may have improved quality of life and swallowing function compared to those treated with chemoradiotherapy.
Percutaneous Dilatational Tracheotomy in Non‐ICU Wards
Authors: Hain Moshe , Adi Nimrod , Polishuk Yael , Lahav Yonatan , Halperin Doron
Published: February 2015

Objective

To retrospectively assess the feasibility of bedside PDT in nonintensive care wards using a novel joint Otolaryngology‐Intensive Care Team model. A control group composed of patients that underwent PDT in the ICU was used to assess the relative complication rate and outcome.

Method

A working protocol was constructed defining all stages of the process. All early and late complications were recorded. Other parameters analyzed were patient epidemiology, preprocedure morbidity, staff learning curve, duration of procedure, anesthetics administered, interval from ventilation to weaning, and interval to decannulation. Endpoints were hospital discharge, decannulation, and death.

Results

From September 2009 until July 2010 a total of 98 PDTs were performed; 48 PDTs were performed in the hospital wards, and 45 PDTs were performed in the ICU. No life‐threatening complications were encountered in the non‐ICU group and no significant difference in complication rate was observed between the 2 groups.

Conclusion

Percutaneous tracheotomy is an available, safe, low cost procedure which may be safely performed bedside in non‐ICU wards by a qualified team. This novel approach may greatly simplify the process of tracheotomy performance, eliminating much of the excess time, hassle, and cost without compromising safety and success rate.
Sentinel Node Biopsy in Cutaneous Squamous Cell Carcinoma
Authors: Hills Susannah E. , Raza Syed N. , McLean Scott A.
Published: February 2015

Objective

In cases of cutaneous squamous cell carcinoma (SCCa), early detection of regional metastases can greatly improve survival. The objective of this study is to explore the utility of sentinel lymph node biopsy (SLNB) for early detection of regional metastasis in patients with high‐risk cutaneous SCCa of the head and neck.

Method

Participants include patients with cutaneous SCCa of the head and neck with high‐risk prognostic features (size >2 cm, recurrence, depth >4‐5 mm, poor differentiation, perineural invasion, history of CLL/SLL/organ transplantation) but no nodal metastases. All patients underwent excision of the primary tumor with SLNB. Specimens were analyzed for evidence of regional metastases.

Results

Preliminary results include 19 patients who underwent excision of their tumor with SLNB, and 5 of 19 (26%) of these high‐risk patients developed regionally metastatic disease. SLNB demonstrated a sensitivity of 80%. There was a SLNB false omission rate of 20%. Of the 5 patients with regional metastases, 1 (20%) demonstrated perineural invasion, 3 (60%) demonstrated lymphatic invasion, 3 (60%) demonstrated vascular invasion, 4 (80%) demonstrated poor differentiation, and all 5 (100%) demonstrated depth >4 mm. One case of false omission occurred in a patient with CLL. All patients are currently living, and 2 (40%) have developed regional recurrence.

Conclusion

SLNB is capable of identifying early regional metastases in cutaneous SCCa. Preliminary data demonstrate that 26% of high‐risk patients developed regional metastases. SLNB effectively identified 80% of metastatic disease, with a 20% false omission rate. Regional metastasis was most strongly associated with lymphovascular invasion, poor differentiation, and depth >4 mm.
SMG Resection via Transoral vs Endoscopic RA approach
Authors: Hong HyunJun , Lee So‐Yoon , Kim Won Shik , Lee Hyoung Shin , Kim Se‐Heon , Choi Eun Chang , Koh Yoon Woo
Published: February 2015

Objective

Compare the efficacy and feasibility of alternative approaches: endoscopic resection via retro‐auricular (RA) approach and transoral (TO) approach for submandibular gland (SMG) resection.

Method

Retrospective analysis of surgical outcomes. We performed 21 endoscopic resections of benign lesions of SMG via RA approach and 11 resections via TO approach since 2010. The following variables were assessed: age, gender, tumor size, histopathologic type, operation time, length of hospital stay, scar satisfaction, and complications.

Results

There were no statistically significant differences in patient profiles, tumor size, and histopathologic type between 2 groups. The cosmetic result was generally excellent and all patients were satisfied with the outcomes. However, in the first endoscopic surgery which was done for a large tumor in SMG, temporary weakness in the marginal branch of facial nerve was observed. There was no permanent palsy. Five patients in TO approach group had complaints of limitations of movement of tongue and numbness for several days. Excision via TO approach had the benefit of length of hospital stay over RA approach. However, the operation time took longer in patients who had small space of mouth floor.

Conclusion

These 2 alternative approaches have distinct advantages. 1) Endoscopic resection of SMG via RA approach can be indicated for small benign tumors, sialadenitis and invisible or hiding scar. 2) Transoral approach for those who do not want an external scar, or do not have relatively small space of floor of mouth due to mandibular hypoplasia or narrow width of mandible body.