bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotype and Mucosal Disease in Skull Base Pneumatization
Authors: Seifert Clarice Marie , Mathews Joseph Wolfgang , Harvey Richard J. , Woodworth Bradford A. , Ahn Chadwick Neal , Meyer Ted A , Schlosser Rodney J
Published: August 2008

Objective

(1) Compare paranasal sinus pneumatization (PSP) and temporal bone pneumatization (TBP) in cystic fibrosis (CF), chronic rhinosinusitis (CRS) and normal patients. (2) Determine impact of genotype and inflammatory mucosal disease on development of skull base pneumatization.

Methods

A case‐control study using CF, CRS, and control patients from a tertiary rhinology clinic was conducted. TBP and PSP was assessed by computed tomography (CT) using a previously validated scale. Genotype data, including DF508 status, for CF patients was determined.

Results

186 temporal bones and paranasal sinuses from 93 adult patients were assessed. Mean age 43.4 ± 14.9yrs. Inter‐observer correlation for TB scoring was 0.86. TBP did not differ between CF, CRS, and normals (X2=6.93, p=0.38). PSP was significantly less in the CF group (X2=34.2, p<0.001). CRS and normals did not differ in PSP. 51.6% of CF patients were homozygous for DF508 and 16.1% were heterozygous. DF508 status was associated with poorer SP (X2=34.2, p<0.001) but greater TBP (X2=19.2, p=0.004).

Conclusions

PSP is significantly impaired in CF, and DF508 homozygosity is associated with poor development. Conversely, TBP is well preserved in the CF population, and DF508 homozygosity might even be related to enhanced TBP. Although this difference is striking, the underlying mechanisms are unclear. Genotype may play a significant role in the development of skull base pneumatization.
Radiologic Staging System for Allergic Fungal Rhinosinusitis
Authors: Rogers Gamwell A , Wise Sarah K , Ghegan Mark D , Harvey Richard J , DelGaudio John M , Schlosser Rodney J
Published: August 2008

Objective

(1) To develop an objective method for quantifying radiologic bone erosion in allergic fungal rhinosinusitis (AFRS). (2) To assess the utility of the newly developed AFRS CT staging system in differentiating AFRS patient groups.

Methods

Patients from two tertiary care rhinology practices with classic AFRS and available CTs (2001–2007) were included for retrospective review. CTs were scored by trained graders not involved in the patients’ care as the primary treating surgeon. The following novel assessment scale was used: Each paranasal sinus wall with expansion/erosion was scored 1 point, with a maximum of 3 points possible for each frontal sinus, 2 points for each ethmoid complex, 3 points for each sphenoid sinus, 3 points for each maxillary sinus, 1 point for the frontal intersinus septum, and 1 point for the sphenoid intersinus septum, yielding a maximum of 24 possible total points.

Results

111 CTs were reviewed. Mean score across all patients was 7.8 (range 0–24). Males scored significantly higher than females (mean 9.3 vs 5.6, p < 0.001). African Americans scored significantly higher than Caucasians (mean 9.6 vs 5.0, p < 0.001). There was also a trend towards younger patients exhibiting higher scores (p = 0.07).

Conclusions

A radiologic grading system for bone erosion/expansion in AFRS is presented, which is easy to apply and may objectively stratify disease severity. Males and African Americans with AFRS demonstrate significantly more bone erosion. Additional analysis of disease course will assess the potential utility of this staging system in predicting outcomes.
Surgeon Radiation Exposure in ESS Using Balloon Catheters
Authors: Albritton Ford D , Smith Joseph L. , Zahurullah Fazlur R. , Armstrong Michael , Duplan Don A , Gershow James A , Kuhn Frederick A
Published: August 2008

Objective

Less invasive instruments such as balloon catheters are now available to dilate sinus ostia during endoscopic sinus surgery (ESS). Currently, balloon catheter position is confirmed under fluoroscopic visualization, which emits ionizing radiation. Radiation exposure has long been an area of concern. This study was initiated to determine radiation exposure to surgeons who used fluoroscopy with balloon catheters during ESS.

Methods

A multi‐center, prospective evaluation of surgeon radiation exposure was conducted. For 3 months, each sinus surgeon (9 surgeons) wore 2 dosimeters to record radiation exposure when using C‐arm fluoroscopy during surgery utilizing balloon catheter instruments. One dosimeter was placed at collar level (chest badge), outside the lead surgical apron and another dosimeter was placed on a finger (extremity badge). These dosimeters were sent for readings. Deep, eye, and shallow radiation dose for each surgeon was calculated.

Results

9 chest badges recorded annualized averages of 104, 100, and 104 millirems for deep, eye, and shallow exposure respectively. 8 ring badges recorded 312 millirems.

Conclusions

A recent publication has reported low levels of surgeon radiation exposure during a clinical study. This study further validates that radiation exposure among experienced surgeons is well below the annual occupational radiation exposure limit (Shallow Dose Equivalent) of 50,000 millirem. With vigilant technique and education, reliance on fluoroscopy can be minimized.
Symptom Specific Outcomes of Endoscopic Sinus Surgery
Authors: Antisdel Jastin L , Sindwani Raj , Chester Alexander C
Published: August 2008

Objective

1) Learn the relative effectiveness of endoscopic sinus surgery (ESS) regarding improving individual major chronic rhinosinusitis (CRS) symptoms and headache. 2) Be able to more effectively counsel patients undergoing ESS.

Methods

A literature search of MEDLINE, EMBASE, Web of Science, Cochrane databases, and other Web‐based sources from 1980–2008 was performed. Additional articles were identified by reviewing relevant bibliographies. Studies with more than 10 adult CRS patients that used symptom severity scores to analyze at least 4 major criteria (facial pressure, congestion, nasal obstruction, nasal discharge, and hyposmia/anosmia) or 3 major criteria as well as headache were included. 265 studies were identified and reviewed. 22 of these met inclusion criteria and their data were analyzed. After conversion of the symptom severity scores used in each study to a relative percent value, symptom categories were averaged, and compared in aggregate.

Results

This analysis included 1641 CRS patients (average of 74 pts/study). The patients were followed an average of 19.4 months (range, 1 week to 76 months) postoperatively. All 6 evaluated symptoms showed non‐weighted, relative improvements in symptom scores. Overall, symptoms improved synchronously with a relative improvement over preoperative levels ranging from 27% to 36%. ESS provided the greatest relief from nasal obstruction (relative improvement of 36%), which was a significantly larger change than with facial pain (p<0.034) or nasal discharge (p<0.034).

Conclusions

The relative improvement in major CRS symptoms and headache after surgery is similar. Nasal obstruction improves slightly more than facial pain and nasal discharge.
Multicenter Study of Adjustable Tongue Advancement Device
Authors: Woodson B Tucker , Mickelson Samuel A , Huntley Tod C , Steward David L , Goldberg Andrew N
Published: August 2008

Objective

Surgical tongue advancement and stabilization is limited by morbidity and lack of adjustability. This study was designed to assess the feasibility and effectiveness of a novel titratable minimally invasive tongue advancement system. The objectives of the multicenter prospective study were to assess: 1) clinical effect on AHI, sleepiness and snoring, and 2) procedure morbidity.

Methods

Previously untreated patients (N=42) with evidence of tongue obstruction (BMI<32, AHI <60) underwent placement of a bone anchor attached to the mandible, tethered to a tissue anchor in the tongue base. Tissue anchor advancement was performed several weeks later under local or sedation anesthesia. Outcome measures included baseline and follow‐up PSG, home sleep testing, and questionnaire data.

Results

Titration advanced the anchor up to 1.5 cm. There were no acute or long‐term significant effects in speech, swallowing or taste. In 13 patients, tissue anchor barb fractures were observed on x‐ray. AHI significantly decreased in the total group (29.1 to 23.1, p<0.01). The barb‐intact group improved (29.6 to 22.1, p<0.01) but no change was observed in the barb fracture group (28.1 to 25.3, p = 0.17). Improvements were observed in snoring (7.3 to 3.6, p < 0.01), ESS (11.5 to 7.5, p < 0.01). Postoperative average pain scores decreased from 4.4 to 1.5 on day 5 (10 point scale).

Conclusions

Soft tissue anchor failure occurred and was associated with less effect and warrants correction prior to widespread application. Titrable tongue suspension is feasible, well tolerated, and significantly improves multiple measures of sleep apnea.
S100 – Mometasone Furoate Reduces Ocular Symptoms of Seasonal AR
Authors: Prenner Bruce , Shekar Tulin , Teper Ariel
Published: August 2008

Objectives

To demonstrate clinical efficacy in reducing the ocular symptoms of SAR using mometasone furoate nasal spray (MFNS).

Methods

A phase III, double‐blind, randomized, placebo‐controlled, multi‐center study compared the efficacy of MFNS 200 mcg QD, dosed in the morning (AM), for treatment of ocular symptoms associated with SAR. Subjects were at least 12 years old with at least a 2‐year history of SAR. In daily diaries, subjects evaluated AM ocular symptom severity on a scale of 0 (none) to 3 (severe) on treatment Days 1 to 15. Co‐primary endpoints included change from baseline in average instantaneous (AM) total nasal symptom score (sum of individual nasal symptom scores for congestion, rhinorrhea, sneezing, and itching) and instantaneous (AM) total ocular symptom score (iTOSS) (sum of individual eye symptom scores for itching/burning, tearing/watering, redness), Days 2 to 15.

Results

Subjects (429) with similar baseline characteristics and moderate‐to‐severe ocular symptoms received MFNS 200 mcg QD or placebo. MFNS 200 mcg QD demonstrated superiority over placebo in least squares mean changes from baseline in subject‐rated, average AM iTOSS from Day 2 to 15 (−1.71 [−25.1%] and −1.37 [−20.1%], respectively; P equal to 0.026). MFNS was well tolerated.

Conclusions

MFNS 200 mcg QD demonstrated statistically significant improvements in AM iTOSS associated with SAR. These are the first prospective results demonstrating that MFNS significantly reduces ocular symptoms in subjects with SAR.
S102 – Mometasone Furoate Reduces Severity of Adenoidal Hypertrophy
Authors: Nsouli Talal
Published: August 2008

Objectives

Allergic rhinitis (AR) is a risk factor for adenoidal hypertrophy—the adenoids are the lymphoid tissue closest to the nasal mucosa—and results in upper airway obstruction and snoring. The efficacy of mometasone furoate nasal spray (MFNS) in reducing gland size and degree of snoring in subjects with adenoidal hypertrophy and concomitant AR was assessed.

Methods

Children 5 to 10 years old with adenoidal hypertrophy and a history of chronic nasal obstruction and snoring received MFNS 50 mcg QD in each nostril. 16 subjects with AR diagnosed by positive skin prick test to environmental allergens comprised the treatment group, and 8 subjects with no history of AR and a negative skin prick test comprised the control group. Efficacy variables, assessed at Weeks 0 (baseline), 4, and 8, were change in size of the adenoid gland, evaluated by flexible fiber‐optic and graded as a percentage according to degree of obliteration of the choanae, and change in degree of snoring, evaluated on a 3‐point scale (0 absent, 1 intermittent, or 2 continuous).

Results

Significant improvements in the treatment group vs. baseline at Week 8 were an 84% decrease in mean average adenoidal‐tissue size, compared with a 5% decrease in the control group (P less than 0.05) and an 80% decrease in snoring compared with a 5% decrease in the control group (P less than 0.05).

Conclusions

Once‐daily MFNS 50 mcg is beneficial in the treatment of adenoidal hypertrophy and in reducing snoring in pediatric patients with AR.
S107 – Management of Noma in Third World Mission Trips
Authors: Pierce Brendan , Sidman James D
Published: August 2008

Objectives

We describe the experiences of the volunteer physicians treating Noma patients in two West African nations. Included is an extensive literature review describing preoperative methods, the pathogenesis of lesions, symptoms of the disease, and surgical repair techniques. Finally, we discuss consequences of the disease, specifically severe trismus secondary to temporomandibular joint ankylosis causing complications related to the delivery of anesthesia.

Methods

Description of 4 Noma patients treated in Liberia or Ghana at distinct stages. 1) Treatment of malnutrition and correction of electrolyte disturbances; 2) Treatment of underlying infections with antibiotics and debridement of lesions; 3) Surgical repair of necrotic areas and closure of the open wounds with appropriate anesthetic management; 4) Observation following surgical repair.

Results

We discuss in detail 4 illustrative patients who were encountered at varying stages of treatment. We describe extensive reconstruction under local anesthesia and other treatment options available to teams with resources such as micro‐surgical techniques and the use of single‐stage reconstruction. Fiberoptic intubation techniques were unavailable, and thus intubation was not attempted on patients with ankylosis.

Conclusions

Noma continues to grotesquely disfigure the poor malnourished children of Africa at an incidence of 4 per 1000, a 10‐fold greater incidence than cleft lip. Untreated, Noma has a mortality rate up to 80%, with proper treatment that can be lowered to 10%. We demonstrate that remarkable results can still be accomplished without intubation with only local anesthesia. We acknowledge these limitations but illustrate the benefit is overwhelming to these patients.
S108 – Close Margin Excision Outcomes in Head and Neck Skin Cancer
Authors: Barnes Martyn Lawrence , Ross Steven , Barnes Alison Jayne , McClymont Leo George
Published: August 2008

Objectives

1) Determine clinical and histological outcomes for patients following close margin excisions of head and neck skin cancer. 2) Guide decisions regarding further intervention and follow‐up.

Methods

Retrospective review of Otolaryngology department skin excisions from 1991 to 2008. Pathology reports and casenotes were reviewed to identify lesions excised with less than 1mm margins and determine their further management and outcome. Kaplan‐Meier survival analysis was used to obtain the number needed to follow up for 2 years (NNFU) to detect a recurrence.

Results

Of 1223 skin cancers, 1207 histology reports were obtained‐24% were squamous cell carcinomas, 76% were basal cell carcinomas. 1060 had histological (lateral and deep) margin assessments. Of these, 72.4% were complete, 16.1% close (<1mm) and 11.5% incomplete. 112 closely excised lesions were identified and 107 casenotes were obtained. 2 underwent ‘immediate’ further excision, both demonstrating no residual tumour. Of the remaining 105 subjects, 8 developed clinically suspected recurrence, but 5 were disproved histologically. During follow‐up, 10 subjects had a new lesion diagnosed (9 malignant). 12 patients had new lesions diagnosed beyond follow‐up; 6 were malignant. 104 (97%) of the original closely excised lesions did not require further excision within the study's 4.1 years of observation (mean) following the initial procedure (range 1.5–12.1). The NNFU following close margin excisions was 34 (95% CI 16 to infinity).

Conclusions

In similar cases, close surgical margins will rarely indicate a need for further surgery or follow‐up. Good quality patient advice leaflets and self‐monitoring is advised.
S118 – Study of Pharyngeal Swallowing by High‐resolution Manometry
Authors: Takasaki Kenji , Hiroshi Umeki , Enatsu Kaori , Tanaka Fujinobu , Kumagami Hidetaka , Takahashi Haruo
Published: August 2008

Objectives

This study aimed to demonstrate the feasibility of a novel high‐resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.

Methods

33 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 swallowing (dry and 5 ml of water) pressures at velo, meso‐hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above‐mentioned points of pressure were also measured.

Results

The maximum value of dry and water swallowing pressures at the velopharynx, meso‐hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid‐point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively.

Conclusions

The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.
S121 – Balloons in Management of Epistaxis: In‐Vitro Study
Authors: Sivaji Nagaraj , Basavaraj Sreeshyla , Duvvi Shyam , Sanjeevan N
Published: August 2008

Objectives

Aim of the study was to access the rate of deflation of 2 commonly used inflatable balloons in management of epistaxis at human body temperature.

Methods

This in‐vitro experimental study was conducted at the department of Otolaryngology in Warrington Hospital, UK. 20 randomly selected Foley's and Brighton balloon catheters each were inflated with 10 mls of air or water and kept at 37 degree centigrade in culture room of the Microbiology department. The rate of deflation at human body temperature in both balloons inflated with air and water at 24 hours & 48 hours in terms of pressure, volume, and diameter were accessed.

Results

Foley's catheters inflated with air deflated completely within the first 24 hours of the study. The rate of deflation in Foley's inflated with water was faster, when compared to same group of Brighton balloon (paired t‐test P<0.05). The pressure in these balloons was much higher than capillary pressure of lining mucosa of post‐nasal space.

Conclusions

If the pressure in post‐nasal balloons has to be maintained for more than 24 hours, it is better to use saline/water for inflation. Brighton balloons maintain both pressure and volume for a much longer period than Foley's at human body temperature.
S125 – Local Anesthetic Method: PE Tube Insertion & TM Perforation
Authors: Craig Catherine A , Richardson Brynn E , Moore Gary
Published: August 2008

Objectives

Our hypothesis was that the rates of persistent tympanic membrane (TM) perforation following pressure equalization (PE) tube removal were not higher with topical phenol application. 1) Determine perforation rates using topical phenol. 2) Compare perforation rates using infiltration of lidocaine with epinephrine vs. topical phenol application.

Methods

This was a retrospective review of all patients undergoing insertion of Silverstein tube and microwick placement for dexamethasone infusion. The procedure was completed in an outpatient setting using either infiltration of lidocaine with epinephrine (control) or topical phenol (experimental). Dexamethasone (10mg/ml) drops were administered 3 times a day for 6 weeks, at which time the tube and wick were removed. All subjects were followed for 6 months for evidence of perforation or surgical repair. Fisher's exact test was used for statistical analysis.

Results

A total of 79 patients were identified. 27 underwent lidocaine infiltration and 52 had topical phenol application. At 3 months, the perforation rate for the lidocaine group vs. the phenol group was 11% and 21%, respectively (p=0.21). 5 total perforations were surgically repaired (2 from the lidocaine group and 3 from the phenol group, p=0.27). At 6 months, there was complete resolution of perforations in the lidocaine group and only 4% of the phenol group persisted (p=0.43).

Conclusions

Topical phenol appears to be a safe method of local anesthesia for PE tube insertion without significant increased risk of persistent perforation. Phenol also offers a cost‐effective, less painful, and less time‐consuming option in an outpatient setting.
S128 – Diagnosis and Treatment of 703 Patients with Taste Disorder
Authors: Miuchi Shinya , Umemoto Masanori , Negoro Atsushi , Oka Hideki , Nin Tomomi , Sakagami Masafumi
Published: August 2008

Objectives

As life spans increase, the number of patients with taste disorder consulting in our taste clinic has increased. This study prospectively examined patients’ history, causes of taste disorder, and treatment outcomes.

Methods

Subjects consisted of 703 patients with taste disorder who consulted our taste clinic at the department of Otolaryngology, Hospital of Hyogo College of Medicine, between 1999 and 2007. There were 284 men and 419 women, and patient ages ranged from 12 years to 88 years with a mean age of 59.7 years. Electrogustometry (EGM) and filter paper disk method (FPD) were used to assess taste function. We also asked each patient to indicate the severity of symptoms using a visual analog scale (VAS). Patients were treated mainly with zinc sulfate (ZnSO4 300 mg/day, or polaprezinc 150 mg/day), and in some cases with iron supplement, herbal medicine, and minor tranquilizers.

Results

Idiopathic taste disorder was the most common cause (271 cases, 38.5%), followed by drug‐induced (131 cases, 18.6%), post‐common cold (83 cases, 11.8%), psychogenic (73 cases, 10.4%), iron‐deficiency (37 cases, 5.3%) and others. Deficiency of serum zinc (less than 70 ?g/dl) was found in 50–70% of cases. The recovery rate was 130/183 (71.0%) in idiopathic, 41/61 (67.2%) in post‐common cold, and 24/29 (82.8%) in iron deficiency. The recovery period in drug‐induced (39.7 weeks) was longer than that in other cases (20.4 weeks). Results of EGM and FPD were not always associated with the severity of symptoms.

Conclusions

Treatment with zinc supplement may be useful for taste disorder.
S135 – Head and Neck Paragangliomas and von Hippel‐Lindau Disease
Authors: Boedeker Carsten Christof , Ridder Gerd Jurgen , Maier Wolfgang , Neumann Hartmut Ph
Published: August 2008

Objectives

To review our experience with head and neck paragangliomas (HNPs) in patients with von Hippel‐Lindau disease (VHL). HNPs are rare tumors, 30% of which have been shown to be hereditary neoplasms. Since 2000,4 different paraganglioma syndromes (PGL 1–4) have been described. VHL is characterized by retinal angiomas, haemongioblastomas of the central nervous system, kidney tumors, pancreatic cysts, and pheochromocytomas. Only 4 cases of VHL patients with HNPs have been published in the international medical literature. We systematically reviewed our VHL registry for patients with HNPs.

Methods

In 1983 we founded a registry for VHL patients. Until 2008, 395 index cases could be registered. First‐degree relatives were offered genetic screening as well.

Results

Three VHL patients presented with HNPs. One boy (mutation VHL 505 T>C) developed a metastatic pheochromocytoma at age 7. 8 years after treatment, he presented with a right‐sided carotid body tumor. Another male patient was diagnosed with a tumor of the right carotid body at age 33 (VHL 404 T>A). Interestingly, there have been no other tumors so far. The third patient was diagnosed with a left carotid body tumor at age 33 (VHL 505 T>C). Currently, she has multiple haemangioblastomas of the spinal cord.

Conclusions

The 3 cases presented demonstrate the importance of awareness of HNPs as one of the manifestations in VHL. So far this rare association has found very little attention in international medical literature. We suggest that VHL patients should undergo a thorough otolaryngological examination of the head and neck.
S136 – Recurrent Genetic Changes in Sinonasal Adenocarcinoma
Authors: Llorente‐Pendas Jose‐Luis , Escuredo Jhudit Pérez , Scavo Vincent J , Jorge Garcia‐Martinez , Alvarez‐Marcos Cesar , Nunez Faustino , Llorente Jose L.
Published: August 2008

Objectives

Intestinal‐type adenocarcinomas of the nasal cavity (ITAC) are histopathologically similar to colorectal adenocarcinoma. Professional exposure to wood dust is a strong etiological factor, although the mechanism is not understood. Little is known about the genetic changes in sinonasal adenocarcinomas. Our goals were: 1) Identify genome‐wide recurrent DNA copy number changes, and 2) Evaluate their relation to clinico‐pathological characteristics.

Methods

44 ITAC, 36 of wich related to professional exposure to wood dust, were studied by microarray CGH analysis using a 30,000 oligonucleotide set. In addition, MLPA was applied to identify copy number changes of 60 different tumor‐related genes.

Results

The most frequent chromosome gains were, in descending order: 5p15,20q13, 8q24, 20q11 and 8q21. Losses occurred most frequently at: 4q31‐qter, 18q12‐22, 8p12‐pter, 5q11‐qter, 10q22‐23 and 17p13. Recurrent high level amplifications were detected at 7p11, 8p11 and 8q24. MLPA confirmed the overall pattern of gains and losses found by array CGH. Frequent gains were found of genes in 8q (PTP4A3, RECQL4, MYC) and 20q (BCL2L1, PTPN1) and deletions of genes in 18q (BCL2, CDH2), 8p (CTSB, N33, MFHAS1) and 17p+q (CRK, TP53, TIMP2). Gains of MYC and PTPN1 were more frequent in the more aggressive solid and mucinous type ITACs. Loss of TIMP2 was associated with advanced tumor stage and worse survival.

Conclusions

This study confirmed a pattern of chromosomal aberrations unique to ITAC and not related to the pattern known in colorectal adenocarcinoma. The results suggest a role for TIMP2, MYC and PTPN1 in ITAC tumor progression.
S138 – Treatment Controversy Incidental Micro‐Medullary Carcinoma
Authors: Swartz Jamie M. , Nowlin Thomas Peyton
Published: August 2008

Objectives

1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature.

Methods

This case is a 33‐year‐old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery.

Results

The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease‐free.

Conclusions

Medullary thyroid carcinoma is a well‐described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.
S140 – The Fibula Flap for Through and Through Oral Cavity Defects
Authors: Jones Kristin , Gal Thomas J , Valentino Joseph
Published: August 2008

Objectives

1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances.

Methods

A retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined.

Results

7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator‐based skin paddle with a de‐epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post‐debridement with a PM flap.

Conclusions

While the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.
S142 – Circulating Levels of CD105 and VEGF in Oral Cancer
Authors: Chien Chih‐Yen , Huang Chao‐Cheng
Published: August 2008

Objectives

To evaluate the circulating levels of CD105 and VEGF in patients with oral cancer and analyze the correlation between these circulating levels and clinicopathological features.

Methods

Between 2006 January and 2007 December, 28 healthy volunteers and 68 patients with squamous cell carcinoma of oral cavity (OSCC) were enrolled in this study. The serum level of VEGF and plasma level of CD105 were determined by ELISA method, respectively, from the frozen stored blood before treatment. ANOVA analysis was used to evaluate the difference of circulating levels of CD105 and VEGF between normal control group and OSCC group. The difference between nodal status (positive versus negative), tumor stage (T1, T2 versus T3, T4) and TNM stage (stage I, II vs. stage III, IV) were also evaluated.

Results

The circulating levels of CD105 and VEGF in normal control group were 1.457 ± 0.46 ng/ml and 44.89 ± 20.4 pg/ml, respectively. The circulating levels of CD105 and VEGF in OSCC group were 7.056 ± 3.44 ng/ml and 292.94 ± 117.3 pg/ml, respectively. Both circulating levels of CD105 and VEGF in patients with OSCC were significantly higher than those of normal control group (both p<0.001). In addition, the patients with positive nodal status (p<0.001), advanced tumor stage (T3, T4 versus T1, T2) (p<0.001), and advanced TNM stage (stage III, IV versus stage I, II) (p<0.001) had significantly higher circulating levels of CD105 and VEGF.

Conclusions

Both circulation levels of CD105 and VEGF are useful markers to evaluate the disease progression of OSCC.
S148 – Botulinum Toxin A for the Management of Gustatory Sweating
Authors: Sen Purushotam , Papesch Michael
Published: August 2008

Objectives

To review systematically the evidence currently available on the use of botulinum toxin A in the management of gustatory sweating.

Methods

We conducted a systematic search of databases including PubMed (1950‐December 2007), EMBASE (1966–2007), MEDLINE (1950–2007) and Cochrane library (up to December 2007). The terms used in the search included treatment, Frey's syndrome, gustatory sweating, Botulinum toxin, Botox, Dysport. Data extraction and study evaluation were performed independently by 2 reviewers and results were pooled quantitatively. Data collected included demographic details of patients, aetiology of Frey's syndrome (parotid pathology), duration of symptoms, units of injection, number of injections, commercial types of Botulinum toxin A, rate of recurrence, complications, and length of follow‐up.

Results

There are 2 prospective studies that compared doses of Botulinum toxin (one randomized and the other non‐randomized) in the management of gustatory sweating (Frey's syndrome). The other studies included prospective and retrospective case series and case reports. Pooled results from these studies on a total of 239 patients showed that the rate of recurrence or incomplete resolution of symptoms were dose‐dependent. Response to treatment did not vary with the size of the affected area or parotid pathology. The demographical details did not differ in the patients with recurrence compared to those patients who were symptom‐free. Complications were also not dose‐related.

Conclusions

Botulinum toxin A is a highly effective, minimally invasive, and safe procedure for the treatment of gustatory sweating.
S152 – Injury Predictive Value of Nerve Monitoring in Thyroidectomy
Authors: Cernea Claudio R , Brandão Lenine , Hojaij Flávio , Brandao Neto Jose De Souza , DeCarlucci Dorival , Cavalheiro Beatriz , Sondermann Adriana
Published: August 2008

Objectives

1) To evaluate the efficacy of a nerve monitoring(NM) system in a series of patients submitted to thyroidectomy; 2) To critically analyze the negative‐predictive‐value(NPV) and positive‐predictive‐value(PPV) of the method.

Methods

NIM® system efficacy was prospectively analyzed in 447 patients submitted to thyroidectomy between 2001 and 2008(366 female/81 male; 420 Caucasian/47 non‐Caucasian; 11‐ to 82‐years‐old, median: 43 year‐old). There were 421 total thyroidectomies and 21 partial thyroidectomies leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings.

Results

At the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features postoperatively. 10 paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 1 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 2 unexpected bilateral paralysis and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralysis were noted (0.2%), with an ultimate result of 99.8% functioning nerves. NM showed absent or markedly reduced electrical activity at the end of the operations in 25/858 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false‐negative nerves. There were no false‐positive nerves. Therefore, NPV was 40.0% and PPV was 100%.

Conclusions

In the present series, NM had a very high PPV, but a low NPV for the detection of recurrent nerve injury.
S157 – A Novel Approach to Managing Nasopharyngeal Stenosis
Authors: Vakharia Kalpesh T , Richmon Jeremy D , Deschler Daniel
Published: August 2008

Objectives

Nasopharyngeal stenosis is a rare and challenging problem that is difficult to treat successfully. We present a novel solution in a patient with idiopathic inflammatory nasopharyngeal stenosis by using a tracheoesophageal puncture prosthesis.

Methods

Case report and review of the literature.

Results

We present the case of a 51‐year‐old man with an aggressive idiopathic inflammatory process of the nasal cavity resulting in complete nasopharyngeal stenosis. Despite numerous surgical interventions and obturator placement, stenosis recurred. Eventually, a tracheoesophageal voice prosthesis was placed through a controlled puncture in the nasopharyngeal stenosis which has successfully relieved his symptoms. Various treatments within the literature are discussed.

Conclusions

The use of a tracheoesophageal puncture voice prosthesis in treating nasopharyngeal stenosis is a novel solution to a difficult problem and may be considered in recalcitrant cases.
S158 – Surgical Outcomes in Olfactory Neuroblastoma
Authors: Petruzzelli Guy J , Somenek Michael T , Origitano Thomas
Published: August 2008

Objectives

To report experience and oncologic outcomes of surgical resection and adjuvant therapy in the treatment of olfactory neuroblastoma.

Methods

A retrospective chart review of 31 patients with a histologic diagnosis of olfactory neuroblastoma presenting to the senior author between February 1994 and August 2007.

Results

3 of the 31 patients presenting with altered mental status were found to have tumors with either advanced or metastatic tumors and were excluded from analysis. One patient opted for treatment elsewhere and 1 patient received neoadjuvant chemo‐radiation therapy and died prior to surgery, leaving 26 patients available for study. 3 patients received primary radiation and 23 had primary surgery. 2 patients had limited disease and were treated with solely with medial maxillectomy. 24 patients had surgical resection with an anterior craniofacial, either open (17) or endoscopic (5). Negative margins achieved in 8.2%. Adjuvant radiotherapy was performed in 19 patients, 5 of which received concurrent chemotherapy. Only 1 patient presented with clinically positive neck disease and delayed neck failure was observed in 11.5% of patients with a majority of failures being advanced disease. Median and median follow‐up were 56.42 and 42.6 months respectively. 21 patients (21/26 or 81%) are alive with no evidence of disease; 1 is alive with disease, and 4 patients are dead of disease.

Conclusions

The anterior craniofacial approach with adjuvant therapy used in this study has provided promising long‐term results for the patients involved. Given the high propensity for olfactory neuroblastoma to recur, long‐term follow‐up is indicated.
S159 – Inter‐capsular Resection of Cervical Schwannomas
Authors: Hashimoto Sho , Chiba Toshihiko , Katori Yukio , Yahata Izumi
Published: August 2008

Objectives

To present a new concept of surgical procedure for total removal of cervical schwannomas with neural function preservation, and the outcomes of this procedure in a series of tumors, with special reference to postoperative function of the nerve of origin.

Methods

A retrospective case study of consecutive 18 patients seen from January 2003 to December 2007 who underwent inter‐capsular resection of cervical schwanomas derived from the nerve of vagus, hypoglossus, sympathetic trunk, accesorius, etc. was performed. During the procedure, motor fibers were confirmed and located on the surface of the tumor using nerve stimulator. Avoiding motor fibers, nerve sheath (epineurium and perineurium) is cut with a scalpel and the true capsule of the tumor is recognized. By the dissection between nerve sheath and true capsule, tumor is completely removed. The senior author named this procedure “Inter‐capsular resection.”

Results

All tumors were resected completely, being proven by pathological study. No motor function deficit resulted, but mild Horner's symptom was experienced in a case with the tumor of superior cervical ganglion origin. In a case of cervical plexus schwannoma, nerve fibers were seen in the tumor pathologically.

Conclusions

Cervical schwannoma can be totally removed by inter‐capsular resection without postoperative motor function deficit.
S160 – Salvage Operations after Chemoradiotherapy for SCCHN
Authors: Tokumaru Yutaka , Masato Fujii , Noboru Habu , Yoko Yajima
Published: August 2008

Objectives

Concurrent chemoradiotherapy (CCRT) is one of recent emerging modalities for squamous cell carcinoma of the head and neck (SCCHN), because of its good efficacy and functional preservation. However, some patients treated by CCRT have residual tumor or recurrence in primary sites and/or cervical lymph nodes. This study aims to analyze usefulness of the salvage operations after CCRT for SCCHN.

Methods

The medical records of 111 consecutive patients (stage II: 17%, stage III: 6%, stage IV: 77%) treated with CCRT for SCCHN from 2003 through 2008 were reviewed. 76 patients were treated with 2 cycles of CDDP (60mg/m2), 5‐FU (600mg/m2 ⋉ 4 days), and RT (2.0 Gy daily; total dose, 66–70Gy). 35 patients were treated with 6 cycles of weekly decetaxel (10mg/m2) and RT.

Results

The overall clinical response rate was 93% (59% complete, 34% partial). 16 patients underwent 23 surgical procedures. The types of procedures performed are as follows: selective neck dissection, 16; total laryngopharyngectomy, 3; total laryngectomy, 3; partial glossectomy, 1. All 16 patients with salvage operations had good locoregional controls as of 2007. Major wound complication (pharyngocutaneous fistula after total laryngectomy) occurred in 1 (6%) of 16 patients and successfully closed using deltopectoral flap. There were few other minor complications such as wound infection and laryngeal edema.

Conclusions

Salvage operations can be safely performed and considered to be useful in the point of locoregional control after intensive CCRT.
S166 – Partial Parotidectomy for Benign Parotid Tumors
Authors: Plaza Guillermo , Hernando Monica , Urbasos Maria , Martin Luz , Montojo Jose , Garcia‐Peces Victoria , Onrubia Tomas
Published: August 2008

Objectives

1) To evaluate our results and complications after partial parotidectomy vs. superficial parotidectomy, as primary treatment of benign parotid tumors. 2) To present an evidence‐based review on partial parotidectomy as the method of choice of treatment of benign parotid tumors.

Methods

A case‐control study is presented on parotidec‐tomy, comparing a group of 25 patients treated by partial parotidectomy vs. a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow‐up of 12 months in a university hospital. Independent variables included sex, age, medical history, intraoperative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine‐needle aspiration, CT findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. Comparison of both groups was done by Chi‐squared and non‐parametric analysis, after a. 05 significance level, and multivariate regression analysis.

Results

Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Facial paresis was found in 24% of partial surgeries, vs. 36% of superficial ones (a significant difference); 3 months after surgery, only 1 patient has a persistent marginal nerve paresis. By contrast, only seroma was more common after partial parotidectomy (28% vs 16%).

Conclusions

Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.
S167 – Supportive Physical Therapy on Head and Neck Cancer Patients
Authors: Targino Costa Márcia G. S. , Lima Roberto A. , Rabello Claudia , Lucena Rosana , Bacelar Silvia , Luiz Dias Fernando , Barbosa Mauro
Published: August 2008

Objectives

1) The aim of this paper is to identify the supportive profile of physical therapy attendments at Brazilian National Cancer Institute. 2) Look for patients’ main demands and their dysfunctional characteristics.

Methods

The physiotherapeutic consultations for head and neck cancer patients performed between 02/01/2007 and 12/31/2007 were retrospectively analyzed in their quantitative and qualitative aspects.

Results

1405 attendments were reviewed including 15% of first‐time patients. 60% of the consultations were to male patients. The main dysfunctions identified were on accessory nerve (27, 7%), followed by TMJ disorders (27, 6%), breathing complications (10, 6%), and restricted neck movement (10, 5%). The less frequent complications were paresis of facial nerve mandibular branch (4, 7%) and donor site dysfunctions (2, 5%). Pain was a complaint present in 39 (7%) of these attendments, and analgesia was responsible for 21 (2%) of the total procedures performed. In 24% of realized consults, 3 or more procedures were necessary, representing multiple dysfunctions on each patient.

Conclusions

Secondary dysfunctions caused by head and neck cancer and/or its indicated treatment are important and quite frequent. Shoulder and TMJ dysfunctions as well as breathing disorders were the most frequent complications observed. Pain was seen in a significant number of patients under physical therapy. Patients’ total care has the intention of preventing known complications, and to allow early rehabilitation and sequelae management of installed dysfunctions.
S168 – The Use of a Harmonic Scalpel in Head & Neck Surgery
Authors: Janjanin Sasa , Prgomet Drago , Mario Bilic , Ratko Prstacic
Published: August 2008

Objectives

The harmonic scalpel cuts and coagulates simultaneously using a mechanical vibration. We present our 1‐year experience in the use Harmonic ACE(tm), Harmonic FOCUS(tm) and harmonic scalpel with 5 mm curved blade in head and neck surgery (Ethicon Endo‐Surgery).

Methods

Over period of 1 year we performed 295 thyroidectomies, 23 parotidectomies, and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies, and 30 tonsillectomies that were performed over previous 5 months with the use of conventional hemostatic techniques (electrocautery and knot tying).

Results

The use of the harmonic scalpel shortened the duration of thyroid and parotid surgery by 20–30% as compared with the conventional techniques (p<0.05). The average skin incision length for those undergoing thyroidectomy with the harmonic scalpel was 1.8 cm shorter as compared with the conventional thyroidectomy group (p<0.05). Because of small skin incisions in thyroidectomy we preferred Harmonic ACE(tm) over Harmonic FOCUS(tm) due to longer shaft of scalpel, while Harmonic FOCUS(tm) was more suitable for parotidectomy. The use of Harmonic ACE(tm) shortened average duration of tonsillectomy by 5.5 minutes, while use of 5 mm curved blade (HF 105) did not affect significantly the average duration of tonsillectomy. Postoperative pain and complication rate were comparable for both groups (p>0.05).

Conclusions

The use of the harmonic scalpel reduces surgical time and intraoperative blood loss in head and neck procedures, and enables shorter incision length in thyroid surgery.
S170 – Neck Recurrences in T1 Oral Carcinomas
Authors: Lehn Carlos Neutzling , Porsani Alex Freitas , Costa Ana Carla
Published: August 2008

Objectives

To evaluate the regional recurrences in 48 cases of T1 SCC of tongue and floor of mouth.

Methods

Retrospective review of 48 cases of T1 SCC of tongue and floor of mouth treated primarily with local resection of the tumor. All the cases were reviewed concerning the tumor site, size and thickness, presence of perineural invasion, desmoplastic reaction, outcome and follow‐up.

Results

There was a predominance of male patients (83.3%) with a mean age of 55.4 years old. All but 7 cases were tobacoo consumers and only 10 patients did not use alcohol. The floor of mouth was the primary site in 54.20% of cases. The mean diameter of tumors was 0.86cm and the mean thickness were 0.6mm. Neck recurrences occurred in 10 cases (20.83%) and in 2 of these cases there were local recurrence. All but 1 recurrent cases were treated with salvage surgery and 4 cases died of disease in a mean time of 11.7 months.

Conclusions

The high rate of neck recurrences in early oral carcinomas must be considered during the treatment planning of these cases and the need of neck dissection should be considered, even in tumors with less than 2.0cm.