bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypothyroidism following Hemithyroidectomy
Authors: Merchavy Shlomo , Marom Tal , Forest Veronique‐Isabelle , Wolff Benjamin M. , Mlynarek Alex M. , Hier Michael P. , Payne Richard J.
Published: September 2014

Objectives:

Assess the rate of hypothyroidism following hemithyroidectomy.

Methods:

A retrospective study in adult patients undergoing hemithyroidectomy at the McGill University Thyroid Cancer Centre, during the years 2007 through 2012. Patients with preoperative hypothyroidism were excluded. Patients were followed 12 to 60 months after the primary surgery, and preoperative thyroid stimulating hormone (TSH) and free T4 levels were compared before and after the surgery. Hypothyroidism was defined as TSH levels >4.5 mU/L.

Results:

Of the 181 eligible patients in this study, 137 (75%) were females, with a mean age of 49.1 ± 14.3 years. The most common indication for surgery was follicular lesion. Hypothyroidism occurred in 65 (35%) of the patients, and was diagnosed at 1 to 36 months after surgery. Age and sex were not found to be risk factors for post‐hemithyroidectomy hypothyroidism.

Conclusions:

In this study 35% of patients undergoing hemithyroidectomy develop postoperative hypothyroidism. Upon preoperative patient counseling, hypothyroidism is a major morbidity that should be thoroughly discussed.
Learning Curves of Syllabus Head and Neck Procedures; Monitoring Trainees Performance and Progress
Authors: Awad Zaid , Hayden Lindsay , Muthuswamy Keerthini , Ziprin Paul , Darzi Ara , Tolley Neil S.
Published: September 2014

Objectives:

Otolaryngology trainees undergo regular procedure‐based assessments (PBAs) throughout training; however, these are rarely used to analyze performance and monitor progress. The aim of the study was to validate PBA in assessing otolaryngology trainees in head and neck surgery (HNS) and identify the pattern by which trainees progress in syllabus HNS procedures.

Methods:

We analyzed all PBAs from North‐Thames otolaryngology trainees, during early years or core (CT) and more senior specialty training (ST) years from 2008 to 2013. We used mean scores and standard deviations to draw procedure‐specific learning curves. The PBA tool is procedure‐specific. It is produced by the Joint Committee of Surgical Training and is used in assessing UK surgical trainees performance in all specialties. The tool is composed of 6 main domains: consent, planning, preparation, exposure/closure, technique, and postoperative care.

Results:

A total of 3306 PBAs from 46 trainees were identified; 1806 were HNS. PBA reliability was shown by high internal consistency (Cronbach's Alpha:0.921) and discriminated between grades (CT and ST, Mann‐Whitney U: P <. 001) and levels (CT1‐2 and ST3‐8, Kruskal Wallis: P <. 001). All domains correlated with overall performance, but the best predictor was technical skills. A total of 7 HNS procedures achieved sufficient power to draw learning curves (n > 100, 90% confidence): tonsillectomy: 309, pan‐endoscopy: 186, microlaryngoscopy: 174, thyroidectomy: 152, tracheostomy: 137, adenoidectomy: 129, and lymphadenectomy: 101.

Conclusions:

Procedure‐specific learning curves can be drawn to set milestones and deliver targeted training. Curves of various HNS procedures plateau at different stages in training. This method is more robust and should replace arbitrary numbers as a measure of competence.
Limitations of 8F1 Biomarker for Platinum‐Resistance in HNSCC Are Explained by Co‐detection of PCYT1A
Authors: Kass Jason I. , Sheth Siddharth , Gooding William , Wang Lin , Vaezi Alec E. , Austin Melissa C. , Bauman Julie E.
Published: September 2014

Objectives:

(1) Recognize how ERCC1 biomarker development in HNSCC has been impaired by use of 8F1, a nonspecific ERCC1 antibody, which also recognizes PCYT1A, a protein unrelated to DNA repair capacity. (2) Verify that specific ERRC1 antibodies, 4F9 and FL297, were more useful than 8F1 for prognosis of HNSCC patients undergoing cisplatin‐radiation on a phase II trial. (3) Demonstrate the relative contribution of PCYT1A and ERCC1 in variation of 8F1 expression.

Methods:

We hypothesized that co‐detection of PCYT1A could explain variation in 8F1 expression, and account for lost prognostic performance as compared with 4F9 and FL297. Pre‐treatment tissue from 75 trial patients with previously characterized 4F9, FL297, and 8F1 expression was stained for PCYT1A. Quantitative digital IHC was performed, blinded to clinical outcomes. Expression was compared among the 4 antibodies.

Results:

High expression of 4F9 (hazard ratio [HR] 3.12; P =. 02) and FL297 (HR 2.45; P =. 025) were associated with poor progression‐free survival (PFS). Neither 8F1 (HR 1.55; P =. 29) nor PCYT1A expression (HR 1.89; P =. 13) was associated with PFS. 4F9 and FL297 demonstrated high correlation (0.878). 8F1 demonstrated moderate correlation with 4F9 (0.55) and FL297 (0.467), and high correlation with PCYT1A (0.725). In a three‐dimensional regression analysis, both 4F9 (T = 4.26, P <. 001) and PCYT1A (T = 4.58, P <. 001) were significant predictors of 8F1 variation, suggesting equivalent influence from ERCC1 and PCYT1A detection in 8F1 scoring.

Conclusions:

ERCC1 expression by specific antibodies is a resistance biomarker for platinum‐based therapy in HNSCC. Although 8F1 detects ERCC1, cross‐reactivity with PCYT1A confounds 8F1 scoring. Because of nonspecificity, 8F1 should be abandoned.
Metabolic Tumor Volume as a Prognostic Factor for Oral Cavity Cancer Treated with Primary Surgery
Authors: Zhang Han , Abele Jonathan T. , Jeffery Dean T. , Seikaly Hadi , Harris Jeffrey R. , O'Connell Daniel A.
Published: September 2014

Objectives:

Metabolic tumor volume (MTV) obtained from pretreatment 18F‐fluorodeoxydeglucose positron emission tomography with computed tomography (PET‐CT) has been validated as an independent predictive factor of outcomes in head and neck cancer patients (HNC) treated with primary chemoradiotherapy (CRT). However, its role in patients treated with primary surgery has not yet been studied. The aim of the study was to evaluate the prognostic value of MTV in patients treated with primary surgery for oral cavity squamous cell carcinoma (OCSCC).

Methods:

Demographic and survival data were obtained from patients diagnosed with OCSCC from 2008 to 2012 in Alberta, Canada. All patients included in the study had positron emission tomography–computed tomography (PET‐CT) scan before curative surgical resection. MTV and maximum standardized uptake value (SUVmax) was delineated from pretreatment PET‐CT scans using Segami Oasis software (Columbus, OH).

Results:

A total of 80 patients were analyzed using SPSS (SPSS Inc, Chicago, IL). Five‐year overall, disease‐specific, and disease‐free survival using Kaplan‐Meier curves were 72%, 79%, and 78% respectively. An increase in MTV of 17.5 mL (difference between the 75th and 25th percentile) was associated with a 1.9‐fold increase in risk of disease recurrence (P <. 001) and a 2.0‐fold increase in the risk of death (P <. 05). SUVmax was not associated with either outcome. Cox‐Regression analysis showed MTV predicted overall (hazard ratio [HR] = 1.22; P <. 0001), disease‐specific (HR = 1.62; P <. 0001), and disease‐free (HR = 1.97; P <. 0001) survival.

Conclusions:

This study shows that MTV is an adverse prognostic factor for death and disease recurrence in OCSCC treated with primary surgery.
Multimodality Management of High‐Risk Head and Neck Basal Cell Carcinoma Requiring Free Flap Reconstruction
Authors: Burch Major B. , Chung Thomas K. , Schmalbach Cecelia E. , Rosenthal Eben L.
Published: September 2014

Objectives:

(1) Determine the impact of adjuvant radiotherapy on high‐risk head and neck basal cell carcinoma (H&N BCC). (2) Analyze risk factors associated with recurrence and survival.

Methods:

Case series with planned chart review (2002‐2013) in an academic tertiary care center. A total of 431 consecutive patients presented with H&N defects requiring free flap reconstruction, 38 specifically for aggressive BCC. Cases were classified as high risk based on National Comprehensive Cancer Network (NCCN) criteria. Overall and disease‐free survival were examined using Kaplan‐Meier analysis. Independent variables included: site, recurrent tumor, radiation, bony involvement, and perineural invasion. Complications were reported.

Results:

Nineteen (50%) lesions were recurrent. Mean tumor diameter was 5.17 cm (1.2‐15.0cm). Mean follow‐up was 19.9 months. Overall 2‐year survival was 80%, falling to 66% at 5 years. Two‐year disease‐free survival was 72%. Six patients recurred (5 local; 1 distant). Adjuvant radiotherapy was utilized in 17 (44.7%) and did not significantly impact recurrence (P =. 15) or survival (P =. 48). Tumors >2.5 cm did not impact survival (P =. 09), regardless of subsite. Bony involvement was identified in 17 (44.7%) cases, but did not correlate with survival (P =. 18). Complication rates: 4 exposed bone, 4 hematoma/seroma, 3 infection, 2 osteoradionecrosis, 2 donor site evisceration, 2 ear canal stenosis, 1 severe trismus, 1 flap arterial insufficiency, 1 nasal obstruction.

Conclusions:

Larger H&N BCC do not confer worse outcomes, independent of subsite. Adjuvant radiotherapy does not improve survival or recurrence. Bony involvement does not correlate with survival and should not preclude surgical intervention, even in advanced cases.
The Impact of Physician Extenders in an Academic Otolaryngology Residency Program: Initial Experiences
Authors: Rajasekaran Karthik , Benninger Michael S. , Kominsky Alan , Bryson Paul C.
Published: September 2014

Objectives:

A physician extender is a licensed health care provider who performs medical activities typically performed by a physician. The term encompasses highly trained health care professionals such as physician assistants, nurse practitioners, and midlevel practitioners. In our academic, tertiary care otolaryngology residency‐training program, a physician extender was recently hired. The objective of this study was to evaluate his impact on resident quality of life and education as well as his productivity.

Methods:

All otolaryngology residents at an academic tertiary care medical center were issued a questionnaire that they answered anonymously. All inpatient consults seen by the physician extenders and residents over an 18‐month period between June 2012 and December 2013 were prospectively captured and evaluated.

Results:

The results of the survey indicated that all residents unanimously agreed that a physician extender had a positive impact on resident education, patient care, and quality of life. There was no statistically significant difference in the types of consults seen by a physician extender and those seen by a resident. The physician extender enhanced departmental productivity on the inpatient consultation service.

Conclusions:

Physician extenders are valuable assets to academic otolaryngology residency programs. Their presence enhances patient access, care, and departmental productivity. They have a positive impact on resident quality of life and augment resident education.
Impact of Thyroid Molecular Testing with Surgeon Performed FNAC and Immediate On‐Site Cytopathological Interpretation
Authors: Sukumor Ray , Witt Robert L. , Gerges Fady
Published: September 2014

Objectives:

(1) Describe how thyroid molecular testing affects surgeon‐performed ultrasound‐guided fine‐needle aspiration (FNA) with immediate on‐site cytopathological interpretation. (2) Analyze percentage of inadequate FNA cytology (FNAC) and number of aspirations, comparing with and without surgeon‐performed ultrasound guidance.

Methods:

Retrospective cohort comparison. A cytopathologist is present for on‐site staining (Diff‐Quik) adequacy evaluation and molecular testing triage. This is followed by pap stain, cell block, and liquid‐based cytology. Cytological adequacy and number of aspirations for 200 consecutive patients undergoing surgeon‐performed ultrasound‐guided FNA are compared with a series from the same surgeon without ultrasound guidance. A questionnaire subjectively scoring anticipated and actual pain from 1 through 10 (10 severe) was recorded immediately before and after FNAC.

Results:

Patients with an inadequate FNAC, with and without ultrasound guidance, were 0% and 3% (P >. 05). The mean number of aspirations with and without ultrasound guidance were 1.7 and 4.0 (P <. 05). Using ultrasound guidance, benign, indeterminate, and malignant FNA results were 173 out of 200 (87%), 18 out of 200 (9%), and 9 out of 200 (4%). All indeterminate cytology (9%) underwent BRAF testing. Six out of 200 (3%) indeterminate FNAC underwent multigene expression testing. The mean anticipated versus actual discomfort experienced with surgeon‐performed ultrasound‐guided FNA was 5.3 and 1.9 (P <. 05).

Conclusions:

Surgeon‐performed ultrasound‐guided FNAC with on‐site cytopathology can largely eliminate inadequate FNA, potentially reducing the number of aspirations. Indeterminate FNAC can be triaged for molecular testing, performed in 9% of patients, potentially improving patient selection for surgery. The cytological interpretation can often be immediately communicated to the patient. Discomfort experienced is minimal.
Interest of the Parathyroid Hormone Assay: An Early Predictor of Post‐thyroidectomy Hypocalcemia
Authors: La Croix Candice , Potard Gael , Valette Gerald , Marianowski Remi
Published: September 2014

Objectives:

Hypocalcemia linked to a diminished circulating intact parathormone (iPTH) is the most common complication after total thyroidectomy. The outcome of our single‐center prospective study is to determine the interest of iPTH as a predictor of post‐thyroidectomy hypocalcemia.

Methods:

One hundred eight patients who underwent total thyroidectomy were included. Blood samples (iPTH, calcium, and albumin) were performed at different times: preoperatively (H0), after removal of the gland (Hdrop), 6 hours (H6) after surgery, and one day (D1) after surgery. A measurement of calcium and albumin was performed on the second postoperative day (D2). The area under the receiver‐operating characteristic (ROC) curve (AUC) was used to determine the best cutoff value and predictability of iPTH for hypocalcemia in terms of absolute value (ng/L), decrease in the slope (ng/L), and decline (%) between 2 times.

Results:

Seven patients were excluded. Of the remaining 101 patients, 39 had hypocalcemia (38.6%). At H6, an iPTH absolute value less than 14.35 ng/L (Se = 0.706; Sp = 0.917) and a decline from the preoperative time of more than 59.5% (Se = 0.850; Sp = 0.820) were predictive of hypocalcemia. Other absolute values, decrease in the slope, and decline between preoperative and postoperative values are less efficient.

Conclusions:

The iPTH 6 hours after total thyroidectomy is predictive of hypocalcemia. It could be used to identify patients not at risk of hypocalcemia, and earlier discharge could be considered.
Intraoperative Detection of Parathyroid Glands: A Systematic Review and Novel Low‐Tech Alternative
Authors: Sebelik Merry E. , Allen Shawn M.
Published: September 2014

Objectives:

(1) Perform systematic review of the literature discussing methods of intraoperative detection of parathyroid glands. (2) Determine the feasibility of a low‐cost visual identification method using cell phone camera and photographic color analysis.

Methods:

A systematic review of the literature was undertaken to characterize experimental and existing techniques for real‐time, intraoperative detection of parathyroid glands, a quest meant to reduce the incidence of post‐thyroidectomy hypoparathyroidism. As an alternative to published techniques, photographs were taken during thyroid and other central neck surgery, using a variety of cell phone‐based cameras, under variable lighting conditions. An app used for red‐green‐blue (RGB) color analysis was employed to stratify known parathyroid tissue and surrounding fat and thyroid gland by RGB content.

Results:

The majority of published techniques were dependent on specialized, high‐tech, and high‐cost imaging equipment such as optical coherence tomography, or patient exposure to chemicals such as methylene blue. RGB analysis of camera phone photographs revealed a consistent pattern of red saturation in parathyroid tissue, regardless of lighting conditions or camera type. Using the same app to subtract red from the photograph visually enhanced the difference between parathyroid and surrounding fat and thyroid and confirmed the RGB findings.

Conclusions:

Photographic RGB analysis used by the amateur photographer at little cost shows promise as an intraoperative parathyroid detection method. Cell phone photography is universally available, and this technique can be employed in a low‐resource setting to prevent inadvertent removal of parathyroid tissue.
Intraoperative Frozen Biopsy for the Evaluation of Extrathyroidal Extension in Papillary Thyroid Cancer
Authors: Park Young Min , Park Young Dae , Lee Won Yong , Lee Jin‐Choon , Wang Soo‐Geun , Lee Byung‐Joo
Published: September 2014

Objectives:

We investigated extrathyroidal extension (ETE) through frozen biopsy for intraoperative decision‐making in patients with papillary thyroid cancer (PTC).

Methods:

During the period of the study an operation was performed in 268 patients with PTC and ETE was evaluated using intraoperative frozen biopsies of thyroid tissue.

Results:

ETE was confirmed in 54 patients (20%) on frozen biopsy. Fifty‐three patients among 54 patients showing ETE on frozen biopsy were confirmed on permanent pathologic analysis. Accordingly, frozen biopsy had a sensitivity of 66%, a specificity of 99%, a positive predictive value of 98%, and a negative predictive value of 87%. Tumor size (odds ratio 4.373; confidence interval 2.257‐8.475, P <. 001) was an independent factor for predicting ETE on frozen biopsy.

Conclusions:

Intraoperative frozen biopsy can be a useful tool in identifying the presence of ETE. It can also help the operator decide the extent of surgery and central neck dissection in patients with PTC.
Fistula Rate after Primary Repair of Cleft Palate: Novel Exposed Inverted Horizontal Mattress Nasal Closure
Authors: Hyde Blake J. , Steffen Caleb M. , Miller Jason J.
Published: September 2014

Objectives:

Discuss options for midline nasal suture during 2‐flap palatoplasty (2FPP). Compare effects of patient demographics, Veau class, associated syndromes, surgeon experience, and use of a previously unreported exposed inverted horizontal mattress suture for nasal mucoperiosteal closure on fistula rates and velopharyngeal insufficiency (VPI).

Methods:

Retrospective case series review of all children who underwent 2FPP by the attending surgeon (J.J.M.). Fifty‐five consecutive patients were analyzed over a 5.5‐year period. Study variables were obtained from multidisciplinary craniofacial/cleft records. All patients underwent 2FPP with intravelar veloplasty using the suture technique described herein. No patients were excluded from primary review and statistical analysis.

Results:

Eighty‐nine percent of patients were Veau class 2 or 3. Twenty‐four (44%) patients had an associated syndrome. Patients with a lower Veau class were 3.6 times more likely to have an associated syndrome (P =. 0001). Two (3.6%) patients developed a fistula. There was no association between Veau class, presence of an associated syndrome, or use of dermal allograft with the development of a fistula (P = 1.0, all). Postoperative VPI was noted in 11 (20%) patients, without association between Veau class, syndrome, or dermal allografting (P = 1.0,. 74, and. 45, respectively). Repairs in the first half of the patient sample had a 10‐fold increased risk of postoperative VPI (P =.0024).

Conclusion:

Our use of an exposed inverted horizontal mattress suture for nasal mucoperiosteal closure during 2FPP appears safe and is comparable with the lowest published rates of postoperative fistula and VPI. Further standardized studies are needed in this area.
Issues in Oncologic Surveillance of Patients with Maxillectomy Defects
Authors: Likhterov Ilya , Fritz Michael A. , El‐Sayed Ivan H. , Seth Rahul , Rayess Hani , Knott Daniel
Published: September 2014

Objectives:

(1) Describe locoregional and distant disease recurrence patterns among patients undergoing maxillectomy from 2001‐2011 at Cleveland Clinic and UCSF Medical Center. (2) Analyze the pattern of recurrence in this cohort in order to evaluate whether microvascular reconstruction may delay clinical detection of early cancer recurrence.

Methods:

Retrospective review of patients undergoing inferior, subtotal, or total maxillectomy, with or without reconstruction, for control of malignant disease from 2001‐2011 from 2 tertiary centers (Cleveland Clinic and University of California, San Francisco).

Results:

A total of 76 patients across the 2 institutions met the inclusion criteria for the study. Squamous cell carcinoma was the most prevelant pathologic diagnosis with overall disease progression of 29%. Recurrence at the skull base and regional lymphatic spread were the most common patterns identified (18 and 32%, respectively). Surveillance imaging, rather than direct observation on physical examination, raised suspicion for disease progression in the majority of cases. A total of 9 patients were found to have disease recurrence that could be surgically salvaged, with only 4 patients requiring modification to their reconstruction as part of the salvage operation.

Conclusions:

Locoregional recurrence of malignancy after partial or total maxillectomy is uncommon, and the suspicion for disease recurrence is significantly more commonly raised on surveillance imaging, rather than on physical examination. Further, locoregional recurrence is rarely amenable to successful surgical salvage. This suggests that primary microvascular reconstruction of maxillectomy defects does not delay diagnosis or treatment of disease recurrence.
Management of Primary Hyperparathyroidism in a VAMC Health System: Evidence‐Based Management Protocol and Future Directions
Authors: Wood Joshua W. , Rosen Philip , Sebelik Merry E.
Published: September 2014

Objectives:

(1) Establish a best practices guideline for the surgical treatment of primary hyperparathyroidism within the context of single hospital system. (2) Stratify the group of patients who underwent directed excision by the accuracy of preoperative localization studies, and whether intraoperative techniques impacted cure, and at what resource costs.

Methods:

In this retrospective chart review, patients were identified by searching all parathyroid‐related procedures that took place at our institution from January 1, 2002, to December 31, 2013. Information related to the aims of the study, including demographics, operative details, and laboratory values were recorded, and imaging studies were reviewed by the senior investigator.

Results:

Of those patients with preoperative localization and directed excision, the preoperative studies most predictive of cure were a combination of Sestamibi parathyroid scan and surgeon‐performed ultrasound. When these were in disagreement, surgical findings supported the ultrasound results. Intraoperative parathyroid hormone rapid assay was helpful in predicting cure, but added 68 minutes to the operating time on average. Most patients were surgically cured, and of the few patients with persistent high parathyroid hormone levels, vitamin D deficiency was the primary associated lab abnormality.

Conclusions:

Analysis of techniques that predict a surgical cure allowed the development of a best practices algorithm that includes the following: (1) Obtain 2 preoperative localization studies, including a surgeon‐performed ultrasound; (2) Obtain preoperative vitamin D levels and supplement as indicated; and (3) Reserve intraoperative parathyroid hormone assay only for those patients who do NOT have 2 corroborating localization studies.
Oncologic Outcomes in Patients with Oropharyngeal Squamous Cell Carcinoma Treated with TORS versus Definitive CRT
Authors: Ling Diane C. , Vangara Bhavana S. , Kabolizadeh Peyman , Clump David A. , Ferris Robert L. , Kim Seungwon , Duvvuri Umamaheswar
Published: September 2014

Objectives:

It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for patients with oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic outcomes between OPSCC patients treated with definitive CRT and those treated with TORS only.

Methods:

An observational comparison study was performed on 23 patients treated with TORS without adjuvant therapy and 33 patients treated with definitive CRT between July 2005 and December 2013. All patients had early stage disease with T0‐T2 and N0‐N2. Median age was 57 (range: 36‐82) years and 80.4% of patients were male, which was similar between groups. Human papillomavirus (HPV)+ disease was present in 70.0% of TORS and 33.3% of CRT patients, although HPV status was not tested in 63.6% of the CRT patients.

Results:

Median follow‐up was 22.5 months (range, 0.33‐83.4 months). Local failure rate for the entire cohort was 7.1% (9.1% for definitive CRT, 4.3% for TORS, P =. 85). Overall regional failure rate was 3.6% (3.0% for definitive CRT, 4.3% for TORS, P =. 48). Overall distant failure rate was 5.4% (9.1% for definitive CRT, 0.0% for TORS, P =. 24). Two‐year actuarial disease‐free survival (DFS) was 86.7% for definitive CRT patients and 80.0% for patients treated with TORS alone (P =. 69).

Conclusions:

Definitive CRT and TORS alone offer similar rates of locoregional control, distant control, and DFS in patients with early stage OPSCC. Further studies are needed to assess the effect of CRT and TORS on quality of life in this patient population.
Oropharyngeal Carcinomas Harboring HPV‐E6 Display Resistance to Liberation of P53 and Sensitivity to Oxidative Stress
Authors: Lau Andrew S. , Jones Terence M. , Boyd Mark T.
Published: September 2014

Objectives:

Analyze the effect of (1) Nutlin‐3, a small molecule liberator of p53, on human papillomavirus (HPV) E6 protein‐driven oropharyngeal squamous cell carcinoma (OPSCC) cell lines and (2) the response of such cell lines to oxidative stress.

Methods:

Reproducible drug sensitivity (MTT) and clonogenic assays were performed, with treatments with Nutlin‐3 and hydrogen peroxide. Western blots were performed for p53 and MDM2 expression.

Results:

Our data show that UM‐SCC‐47, an oropharyngeal cancer cell line harboring HPV E6, displays no growth or radiation sensitivity to Nutlin‐3. As expected from previous work UM‐SCC‐74A, an oropharyngeal cancer cell line not driven by HPV and harboring wild‐type p53, displayed both growth and radiation sensitivity. Similarly, UM‐SCC‐4, an oropharyngeal cancer cell line not driven by HPV but harboring mutant p53, displayed minimal growth or radiation sensitivity. Early results show that UM‐SCC‐47 displays significantly greater sensitivity to oxidative stress than cell lines negative for HPV and harboring wild‐type p53.

Conclusions:

We have shown for the first time that Nutlin‐3 has no effect in cells expressing HPV E6. We have also shown that p53‐deficient cells have an impaired response to oxidative stress. Such impaired regulation of oxidative stress and metabolism could be exploited in a number of different ways and may have implications for the targeting of cancers that have mutant or no p53, which typically carry a worse prognosis.
Parapharyngeal Space Neoplasms: A 50‐Year Experience
Authors: Modest Mara C. , Van Abel Kathryn M. , Moore Eric J. , Janus Jeffrey R. , Price Daniel L. , Kasperbauer Jan L. , Olsen Kerry D.
Published: September 2014

Objectives:

(1) Describe the presentation, histopathology, and workup for parapharyngeal space (PPS) neoplasms. (2) Analyze management and long‐term oncologic outcomes.

Methods:

A chart review was performed from 1960‐2010 on patients with primary PPS neoplasms treated at a tertiary center with intent‐to‐cure.

Results:

A total of 381 patients were included (160 males; mean, 50.9 years; range, 2 days‐89 years). The most common symptom was a neck mass (182/381, 48%). Of the patients, 78.7% (300/381) had preoperative imaging: 44% (167/381) had computed tomography and 41% (156/381) had magnetic resonance imaging. Of the patients, 20.2% (77/381) underwent fine‐needle aspiration biopsy. A total of 299 tumors were benign (78.5%), pleomorphic adenomas comprising the majority (151/299, 50.5%). Eighty‐two were malignant (21.5%), adenocarcinomas (16/82, 19.5%) being the most common. All patients underwent primary surgical management ± adjuvant therapy. The cervical‐parotid approach was the most common (253/381, 66.4%), with mandibulotomies required in 4.5% (17/381). Postoperative cranial neuropathies were identified in 18.7% (70/374); 48.5% (34/70) were related to neurogenic tumors. No perioperative mortalities were reported. Mean follow‐up was 89.9 months (N = 345; range: 1 month‐42 years). The 5‐/10‐/ 20‐year recurrence‐free survival was 93.2%/86.3%/77.9% for benign and 48.2%/38.3%/21.3% for malignant lesions (P <. 0001). The 5‐/10‐/20‐year cancer‐specific survival was 98.7%/97.9%/96.2% for benign and 59.0%/52.3%/14.0% for malignant lesions (P <. 0001). The 5‐/10‐/20‐year overall survival was 96.4%/89.3% /70.0% for benign and 56.0%/46.0%/7.3% for malignant lesions (P <. 0001).

Conclusions:

While the rate of recurrence for benign PPS lesions is low, these patients remain at risk for recurrence >20 years following surgery. Long‐term surveillance should be considered. Patients with malignant lesions are at higher risk for recurrence and have a poor oncologic prognosis. The cervical‐parotid approach remains safe and effective for most PPS neoplasms.
Patient Outcomes in Total Rhinectomies
Authors: Bayrak Sinehan , Vural Emre A.
Published: September 2014

Objectives:

(1) Evaluate the outcomes of patients who underwent total rhinectomies. (2) Give physicians a better understanding of prior treatment modalities, postoperative survival outcomes, and rehabilitation options.

Methods:

Retrospective chart review of patients who underwent a total rhinectomy during the past 17 years. The variables collected included age, sex, presenting symptoms and signs, tumor size, tumor location, tumor histology, incorrect initial diagnoses, initial treatments, postoperative chemoradiation, and any recurrence of disease, as well as outcomes of prosthetic rehabilitation.

Results:

Seventeen patients had squamous cell carcinoma (SCC), 13 patients had basal cell carcinoma, and 2 patients had adenoid SCC. Nineteen patients had postoperative chemoradiation. Eleven patients had recurrence of their disease with an average recurrence time of 20 months. Of the 26 patients fitted with prosthesis, half had specific complaints, the most common of which were bad fit and irritation. At the time of this study, 17 patients were dead, 9 patients were alive, and 6 patients had been lost to follow‐up.

Conclusions:

Only 8 out of 32 patients had no record of other prior treatment, which speaks to the importance of appropriately managing nasal malignancies. Most patients fitted with a prosthesis were ultimately unhappy in terms of both appearance and comfort, suggesting a need for better rehabilitation options.
Patient Priorities in Decision Making for Laryngeal Cancer Treatment
Authors: Shuman Andrew G. , Larkin Knoll , Thomas Dorothy , Palmer Frank L. , Shah Jatin P. , Patel Snehal , Fagerlin Angela
Published: September 2014

Objectives:

(1) Ascertain the priorities of laryngeal cancer patients concerning oncologic and functional outcomes. (2) Describe how these priorities and professional referral patterns might influence treatment‐related decision making.

Methods:

This cross‐sectional survey‐based pilot study explored patient preferences and priorities regarding treatment‐related decision making for laryngeal cancer using a validated survey instrument. Other questions assessed patient priorities concerning the desired outcomes of their laryngeal cancer treatment and how professional referral patterns (ie, order in which they are seen by different specialists) and desired provider input affect their decisions. Adults with biopsy‐proven laryngeal carcinoma were eligible to participate (n = 57; 46% treated surgically, 54% treated nonsurgically).

Results:

The 4 most important priorities for patients with laryngeal cancer are oncologic cure (91%), maximizing survival (66%), being able to swallow (44%), and maintenance of natural voice (41%). When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients thought that the specialist who they saw first was most involved in deciding how to treat their cancer (Fisher's exact, ~χ2(6) = 14.2, P =. 01). Similarly, patients were more likely to believe the specialist who they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ2(6) = 16.2, P =. 02).

Conclusions:

Patient priorities and attitudes coupled with professional referral patterns influence how patients contemplate choices regarding management of their laryngeal cancer. Better understanding of these variables may assist in ensuring that patients’ voices are integrated into individualized laryngeal cancer treatment planning.
PET‐CT for Detecting Nodal Metastasis in cN0 Early‐Stage Oral Cavity Squamous Cell Carcinoma
Authors: Jeffery Caroline C. , Biron Vincent L. , Zhang Han , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi
Published: September 2014

Objectives:

To determine if positron emission tomography (PET)‐computed tomography (CT) offers any diagnostic advantage over traditional CT neck in assessing the clinically N0 neck in patients with T1 and T2 squamous cell carcinoma (SCC) of the oral cavity.

Methods:

We performed a retrospective review of patients in the Alberta Cancer Registry who were diagnosed with cT1 or T2N0M0 disease who underwent elective unilateral or bilateral neck dissections. Results of preoperative PET‐CT and CT necks were reviewed for number of “suspicious” lymph nodes. Surgical pathology reports were reviewed to obtain the total number of nodes sampled and number of malignant nodes.

Results:

Between 2009 and 2011, 148 patients were diagnosed with cT1 or T2N0M0 SCC of the oral cavity. Of these, 62 patients underwent elective neck dissections. Fourteen patients underwent preoperative PET‐CT while 48 patients underwent CT neck alone. Based on final surgical pathology, 6 nodes out of 499 nodes sampled were falsely fludeoxyglucose‐avid in the PET‐CT group while 3 nodes out of 1800 were falsely identified as suspicious on CT neck alone. The overall false positive rate of PET‐CT was significantly higher than CT alone (1.2% vs 0.2%, P <. 001). Both modalities had excellent specificity of >98% for benign nodes in these patients.

Conclusions:

In patients with cT1 and T2 of the oral cavity and no palpable lymphadenopathy, PET‐CT is no better than CT alone for ruling out nodal metastasis and may have a higher false positive rate.
Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy
Authors: Sethi Rosh K. V. , Kozin Elliot D. , Lam Allen C. , Emerick Kevin S. , Deschler Daniel G.
Published: September 2014

Objectives:

(1) Describe our perioperative experience of primary tracheoesophageal puncture (TEP) with intraoperative placement of voice prosthesis for patients undergoing total laryngectomy (TL) or laryngectomy with partial pharyngectomy requiring supraclavicular artery island flap (SCAIF) reconstruction. (2) Assess TEP voice outcomes in this patient group.

Methods:

Retrospective chart review of all patients undergoing SCAIF reconstruction following TL or laryngectomy with partial pharyngectomy at a single institution between 2011 and 2013 (N = 14). There were no exclusion criteria.

Results:

We identified 7 patients who underwent primary TEP with intraoperative placement of voice prosthesis (mean age = 64.1, 5M:2F). Six patients had prior chemoradiation for laryngeal squamous cell carcinoma. One patient had a dysfunctional larynx from radiation treatment for tonsillar squamous cell carcinoma. Five patients underwent TL and 2 patients underwent TL with partial pharyngectomy. Indwelling 16 French Blom‐Singer prosthesis was placed intraoperatively prior to SCAIF reconstruction. There were no TEP‐related complications, such as prosthesis displacement or leakage, intraoperatively or in the perioperative period. One patient developed a peristomal pharyngocutaneous fistula. In terms of voice outcomes, 6 patients achieved tracheoesophageal voice production within 10 months after TEP placement, and most occurred earlier (mean time = 2.9 months, SD= 3.1). One patient remained aphonic. Of the 6 patients who achieved successful voice acquisition, 2 required cricopharyngeal segment Botox injections with good response.

Conclusions:

Similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective. Six of 7 patients had successful voice acquisition within 10 months.
Prophylactic Tracheal Stenting for the Palliation of Anaplastic Thyroid Carcinoma
Authors: Mathew Rajeev , Varadharajan Kiran , Hay Ashley , Williamson Peter A. , Odutoye Babtunde , Madden Brendan
Published: September 2014

Objectives:

(1) Determine if airway stenting in patients with anaplastic thyroid carcinoma (ATC) is effective in preventing and treating shortness of breath. (2) Analyze whether this procedure affects survival.

Methods:

Retrospective case note analysis of patients diagnosed with ATC from 2003 to 2013 at a tertiary head and neck unit. Patients diagnosed with ATC were stented with an expandable covered metallic stent, irrespective of airway symptoms, provided they were medically fit and the tumor was >1 cm distal to the vocal cords. Outcome measures were development of dyspnea and survival.

Results:

Twelve patients were identified. Tracheal stenting was performed successfully in 4 out of 5 patients; the procedure was abandoned in 1 case due to gross airway distortion. Three of the 4 stented patients did not have airway compromise at the time of stenting; of these 3 patients, 1 did not develop airway compromise at all. The other 2 later developed acute dyspnea due to stent migration as a result of tumor in‐growth; these were successfully managed with stent exchange. All nonstented patients died with or from dyspnea. Mean survival postdiagnosis in stented patients was 89 days (n = 4; range, 39‐189 days) and in nonstented patients was 91 days (n = 9; range, 8‐233).

Conclusions:

Tracheal stenting is safe and effective at treating and preventing distressing airway symptoms in patients with ATC. It does not, however, confer any survival benefit.
Reoperative Parathyroid Surgery: Role of the Overly‐Descended Superior Adenoma in Persistent Disease
Authors: Vernon Hampton , Duke William S. , Terris David J.
Published: September 2014

Objectives:

(1) Recognize that failure to identify an ectopic, overly‐descended superior parathyroid adenoma may contribute to failed parathyroid exploration. (2) Understand the prevalence of an ectopic, overly‐descended superior parathyroid adenoma in both primary and reoperative parathyroid surgery in patients with single‐gland primary hyperparathyroidism. (3) Describe the findings that should lead the clinician to suspect the presence of an ectopic, overly‐descended superior adenoma.

Methods:

A retrospective review of patients undergoing curative surgery for single‐gland parathyroid adenomas at a single institution was performed. Clinical records, imaging studies, operative reports, and pathology findings were evaluated, and all instances of an ectopic, overly‐descended superior parathyroid adenoma were identified. The prevalence of this entity in both primary and revision surgeries was calculated.

Results:

There were 270 cases of curative surgery for single‐gland parathyroid adenomas during the study period. There were 251 primary operations and 19 re‐operative procedures referred from outside institutions. An ectopic, overly‐descended superior parathyroid adenoma was present in 9.2% of primary cases and in 21.1% of reoperative cases. While this condition was more common in the reoperative setting (as expected) the incidence in the primary setting was higher than anticipated, and in fact the difference did not reach statistical significance (P =. 1).

Conclusions:

An overly‐descended superior parathyroid adenoma is common in both the reoperative and primary settings. Recognition and proper treatment of this entity at the initial operation will reduce the need for revision surgery.
The Serratus Anterior Free Tissue Transfer for Total Laryngectomy and Craniofacial Defect Reconstructions
Authors: Khan Mohemmed , Olarte Lucia S. , Giraldez‐Rodriguez Laureano A. , Miles Brett A.
Published: September 2014

Objectives:

(1) Describe the method of harvesting and recognize the versatility of the serratus anterior free flap. (2) Review the use of the serratus anterior free flap for reconstruction after total laryngectomy and for craniofacial defects.

Methods:

Retrospective case review of 7 cases performed at a single tertiary care institution. PubMed literature review of serratus anterior free flap reconstruction from 1966 to present.

Results:

In the 4 patients in whom the serratus anterior free flap was used to reconstruct a total laryngectomy defect, no postoperative wound infections or salivary leaks were identified. The serratus free flap proved to be an effective means of reconstructing the skull base in 2 cases as well as covering a large scalp defect in a third case.

Conclusions:

This case series illustrates the benefit of muscle coverage in head and neck reconstruction in both the isolation of the nasal cavity from the intracranial cavity after craniofacial resection and in patients at risk of fistula formation after total laryngectomy. The serratus anterior flap was selected because of its ease of harvest, relatively low donor site morbidity, and adequate bulk. The patients who underwent total laryngectomy did not have evidence of leak, and adequate carotid artery coverage was achieved. Similarly, the craniofacial resection patients achieved adequate cranio‐nasal separation and effective coverage of a large scalp defect. The use of a serratus anterior free flap proved to be an excellent choice in the reconstruction of the defects in this series with minimal postoperative morbidity related to both the reconstructive and donor sites.
Surgical Outcomes of Primary versus Flap Closure of Postradiation Laryngectomy Defect
Authors: Rubin Samuel J. , Nene Prachi S. , Salama Andrew R. , Grillone Gregory A. , Ezzat Waleed H. , Jalisi Scharukh
Published: September 2014

Objectives:

The authors of the RTOG 91‐11 study recently presented long‐term outcomes for 3 nonsurgical treatment strategies to preserve the larynx in patients with locally advanced laryngeal cancer. They concluded that concomitant chemotherapy and radiation is optimal for laryngeal preservation; however, 16% of the patients still required total laryngectomies (TL). Additionally, the incidence of pharyngocutaneous fistulas was 30% within this cohort receiving total laryngectomy. We therefore conducted a single center retrospective study of 47 patients treated with total laryngectomy at a tertiary care center from July 2004 to May 2013 to assess the percentage of patients that develop pharyngocutaneous fistula. We propose that the rate of pharyngocutaneous fistula in patients that receive TL will be lower using the technique of flap augmentation compared with the patients that receive TL using the technique of primary closure.

Methods:

Thirty‐two patients received primary closure for TL with a pharyngocutaneous rate of 9.4% (n = 3), and 14 patients received flap augmentation for TL with a pharyngocutaneous rate of 7.1% (n = 1). We also assessed stage of laryngeal cancer; whether the patient received cheomotherapy, radiation therapy, or concomitant radiation and chemotherapy; the muscle used for flap closure; recipient artery and vein; thyroid‐stimulating hormone, hemoglobin, intact parathyroid hormone, and albumin preoperative and postoperative values, when available.

Results/Conclusions:

The rate of pharyngocutaneous fistula was comparable between the primary closure group and the flap closure group (P = 1). However, because of the low rate of pharyngocutaneous fistulas, it would be necessary to analyze a larger cohort to determine significance and possible confounding factors.
A Method to Quantify the Confounding Effect of the Nasal Cycle on Nasal Airway Obstruction
Authors: Patel Ruchin , Garcia Guilherme J. M. , Frank‐Ito Dennis O. , Kimbell Julia S. , Rhee John S.
Published: September 2014

Objectives:

(1) Develop a methodology to eliminate the confounding effect of the nasal cycle when comparing pre‐ and postsurgery nasal resistance measurements. (2) Illustrate this methodology by reporting nasal resistances derived from computational fluid dynamics (CFD) simulations in a test subject using computational models that span the full range of mucosal engorgement associated with the nasal cycle.

Methods:

A cohort of 40 nasal airway obstruction patients was reviewed to select the one patient with the greatest reciprocal change in turbinate engorgement between pre‐ and postsurgery computed tomography (CT) scans. Ten 3‐dimensional anatomically accurate nasal cycling CFD models were created based on the pre‐ and postoperative CT scans. The thickness of the inferior turbinate, middle turbinate, and septal swell body was systematically increased/decreased by adding/removing layers of pixels around these structures using medical imaging software.

Results:

After surgery (septoplasty), without adjusting for the nasal cycle, nasal resistance decreased by 17% on the left side and by 69% on the right side, and total resistance decreased by 53%. However, after adjusting for cycling, the unilateral nasal resistance decreased by 50% and 43% on the left and right sides respectively, while bilateral resistance decreased by 47%.

Conclusions:

By simulating the nasal cycle using computational models, changes in nasal resistance due to surgery can be distinguished from physiological changes due to the nasal cycle. This ability can lead to more precise objective comparisons of pre‐ and postsurgery nasal resistance measurements and potentially more accurate virtual presurgery planning.
Thyroid Cancer and Hyperthyroidism
Authors: Sharma Sunil D. , Kumar Gaurav , Kaddour Hesham
Published: September 2014

Objectives:

(1) Present a case series of patients with hyperthyroidism and thyroid cancer. (2) Look at the clinical characteristics and outcomes of these patients to determine which patients require further investigation.

Methods:

Retrospective review of case notes of all patients with a histopathological diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism treated at a thyroid cancer center between January 2006 and October 2013.

Results:

During the study period, 66 patients were diagnosed with thyroid cancer. Eight patients had biochemical evidence of hyperthyroidism (12.1%). The mean age of these patients was 56.1 years (range, 29‐87 years). All patients were female. Of these patients, 3 patients were diagnosed with Graves’ disease, 1 patient with toxic multinodular goiter, and 4 patients with an autonomously functioning toxic nodule (AFTN). Five patients had suspicious features on their preoperative ultrasound. All patients were diagnosed with papillary thyroid carcinoma. The mean size of the tumor in patients with an AFTN was significantly larger than those with Graves’ disease (38.1 ± 7.9 vs 4.6 ± 1.3 mm, P =. 001). All 3 patients with Graves’ disease had papillary microcarcinoma, while those patients with AFTN had a poorer prognosis, with 2 patients with extracapsular invasion and lymph node metastases, and 1 patient dying from disease.

Conclusions:

The incidence of hyperthyroidism in thyroid cancer patients is high. In contrast to previous literature, patients with AFTN seem to have more aggressive disease with poorer outcomes when compared to patients with Graves’ disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.