bluuebunny/crossref_metadata_2025 huggingface dataset:
Ask the Experts: An Endoscopic Potpourri
Authors: Kennedy David W. , Ferguson Berrylin J. , Palmer James N. , Hwang Peter H. , Stankiewicz James A. , Zinreich S. James
Published: September 2014

Program Description:

Rhinologic diagnostic and treatment problems commonly create dilemmas in practice. This miniseminar provides for interactive discussion of the management options and the decision rationale involved in difficult sinus diagnostic and treatment situations. A case presentation format is used with case presentations from each of the panelists emphasizing questions with regard to differential diagnosis, evaluation, imaging, and treatment. Cases are representative of those encountered by either a general otolaryngologist or a subspecialty rhinologist but have critical decision points for discussion. The session focuses on the decision‐making process, frontal sinus disease, revision surgery, and fungal sinusitis, as well as common tumors.

Educational Objectives:

(1) Review the surgical decision‐making process in chronic sinus disease. (2) Implement different imaging modalities and improved quality of interpretation for both computed tomography and magnetic resonance images. (3) Improve the management of difficult‐to‐treat chronic rhinosinusitis.
Difficult Nasal Polyposis: Evolving Treatments and Remedies
Authors: Woodworth Bradford A. , Palmer James N. , Reh Douglas D. , Gosepath Jan
Published: September 2014

Program Description:

Chronic sinusitis with nasal polyposis has a detrimental impact on quality of life and may exacerbate coexisting conditions such as asthma. This miniseminar will outline the latest theories on disease pathogenesis as well as promote rational medical and surgical strategies for severe nasal polyposis management. Treatments designed to decrease reliance on systemic steroids including surgical methods and complementary medical therapeutics such as topical steroid irrigations, macrolides, and anti‐leukotrienes will be discussed. A panel of international experts will provide the latest innovations in medical and surgical treatments through a case‐based approach of difficult patients and strategies for success illustrating these advancements.

Educational Objectives:

(1) Describe current theories on the pathogenesis of nasal polyposis. (2) Recognize the newest medical and surgical treatments for difficult nasal polyposis, including cystic fibrosis. (3) Initiate additional therapeutic measures to appropriately care for patients with severe nasal polyposis.
Evidence‐Based Approach to Topical Therapy for Chronic Rhinosinusitis: Snake Oil or Cure?
Authors: Davis Greg E. , Palmer James N. , Woodworth Bradford A. , Wormald Peter J.
Published: September 2014

Program Description:

Some of the most exciting new research in the field of chronic rhinosinusitis (CRS) relates to topical therapies. These therapies include topical steroids, antibiotics, antifungals, surfactant, and complementary and alternative treatments such as manuka honey and bacteriophage. New research now supports the clinical use of these therapies. However, some topical therapies proposed for treatment of CRS and related disorders should be used with caution due to lack of efficacy and even toxicity. The purpose of this miniseminar is to provide a summary and case studies of the best evidence available to help clinicians treat patients with CRS using topical therapies.

Educational Objectives:

(1) Analyze up‐to‐date evidence‐based research for topical therapy management of CRS including topical steroid, antibiotic, antifungal, surfactant, and other alternative remedies. (2) Apply evidence‐based clinical research in this field to directly improve the therapies available for patients with CRS.
Nonallergic Rhinitis: Diagnosis and Management
Authors: Krouse John H. , Joe Stephanie , Luong Amber U. , Reisacher William R. , Toskala Elina M.
Published: September 2014

Program Description:

Patients with nonallergic rhinitis (NAR) are commonly seen in an otolaryngologist's practice. These patients may have no allergic triggers, may be negative to routine allergy testing, and are therefore diagnosed with NAR. Recent workgroups both in the United States and internationally have attempted to better classify the pathophysiology and phenotype of patients with NAR, with the goal of facilitating more accurate diagnosis and improved treatment. This panel will review, through brief didactic discussions and case presentations, recent knowledge and current understanding of NAR and will highlight methods to improve the management of these frequently challenging patients.

Educational Objectives:

(1) Discuss the various pathophysiologies and presentations that are grouped under the diagnostic category of nonallergic rhinitis. (2) Review important elements of the diagnostic workup in evaluating the patient with nonallergic rhinitis. (3) Implement treatment strategies for patients diagnosed with nonallergic rhinitis.
Office‐Based Surgical Procedures in Rhinology
Authors: Lee Jivianne T. , Han Joseph , Hwang Peter H. , Stringer Scott P.
Published: September 2014

Program Description:

With continual advances in endoscopic instrumentation and technology, a burgeoning number of rhinologic procedures can now be effectively performed in the office environment. Such interventions have provided therapeutic alternatives in the management of primary and recalcitrant sinonasal disease. The purpose of this miniseminar is to describe the principles and techniques involved in successful implementation of rhinologic surgery in the clinic setting. Both fundamental (turbinate surgery, polypectomy) and advanced sinus procedures (frontal sinusotomy, revision surgery) will be discussed. Appropriate setup, anesthesia, and patient selection will be described. This miniseminar will be conducted by academic leading rhinologists using a multimedia, interactive, case‐based format.

Educational Objectives:

(1) Discuss current office‐based, rhinologic surgical procedures and their role in the management of sinonasal disease. (2) Describe appropriate patient selection, preparation, and optimal anesthetic and surgical techniques for rhinologic clinic procedures. (3) Assess recent technologic innovations and understand their proper application in rhinologic office‐based surgical procedures.
Hypoglossal Nerve Stimulation Therapy for Obstructive Sleep Apnea
Authors: Soose Ryan J. , Woodson B. Tucker , Kezirian Eric J. , Jacobowitz Ofer , Gillespie M. Boyd
Published: September 2014

Program Description:

Obstructive sleep apnea (OSA) significantly affects sleep, daytime function, quality of life, public safety, and cardiovascular risk. Although positive pressure remains the primary treatment, suboptimal adherence rates necessitate alternative treatment strategies. Hypoglossal nerve stimulation is a new and emerging treatment option with published prospective clinical trial data. Sleep‐boarded otolaryngologists will review the physiology and basic science of upper airway stimulation, demonstrate the current technology and surgical procedure, present safety and efficacy data from recent multicenter clinical trials, and discuss patient selection and cost‐effectiveness. A panel will explore future directions and the advantages/disadvantages of this technology as it compares to other sleep apnea treatment options.

Educational Objectives:

(1) Examine the pathophysiology of OSA with a particular focus on the neuromuscular control mechanisms. (2) Interpret the basic science and feasibility studies on hypoglossal nerve stimulation and describe the current technology and surgical procedure. (3) Report the safety, efficacy, and cost‐effectiveness data from published prospective multicenter clinical trials.
Procedure Selection with Drug‐Induced Sleep Endoscopy
Authors: Friedman Norman R. , Kezirian Eric J. , de Vries Nico , Soose Ryan J. , Weaver Edward M.
Published: September 2014

Program Description:

Drug‐induced sleep endoscopy (DISE) is a novel technique to identify sites of anatomic obstruction that may be amenable to surgery. Although the technical aspect of the procedure is straight forward, the interpretation and management is not. The science of DISE is rapidly expanding, but there are still many gaps. This miniseminar will present a variety of DISE videos. After audience polling, an expert panel will provide their interpretation and management. Both the art and science behind the decision process will be discussed.

Educational Objectives:

(1) Evaluate a DISE video and classify the obstruction. (2) Formulate a management plan for a variety of anatomic sites of obstruction. (3) Predict the best OSA surgical candidates.
Acute and Delayed Management of Maxillofacial Trauma
Authors: Kellman Robert M. , Jordan James R. , Strong Bradley , Brickman Todd M. , Tatum Sherard A.
Published: September 2014

Program Description:

Otolaryngologists are frequently faced with the challenges of managing patients who have sustained significant injuries due to maxillofacial trauma. Often, these are associated with injuries to other organ systems that may preclude timely attention to the maxillofacial injuries. Sometimes, patients present for medical care after some delay. It is important for surgeons to be able to decide when it is reasonable to delay intervention and when delay is mandatory, as well as have an understanding of how surgical intervention may change as a result of such delays. This miniseminar will address these issues.

Educational Objectives:

(1) Explain the indications for delayed management of maxillofacial injuries. (2) Recognize typical contraindications to early intervention for the management of maxillofacial injuries. (3) Use techniques for delayed intervention and management of maxillofacial injuries and how they differ from acute interventions.
Bridging the Generation Gap: The Reality of EMR Implementation
Authors: Garcia‐Rodriguez Laura R. , Singer Michael C. , Ko Alvin B.
Published: September 2014

Objectives:

Assess the attitude of academic otolaryngology faculty members toward a new electronic medical record (EMR) and determine the impact of implementation on their perspectives.

Methods:

A longitudinal survey study was conducted from December 2013 to June 2013 at an academic medical center. All otolaryngology and audiology faculty members were serially administered an online, 10‐question survey assessing their attitudes toward implementation of a new EMR system. These surveys were completed 3 months prior and 1 and 3 months after implementation. Basic demographic information was also collected.

Results:

Thirty faculty members completed all 3 surveys. Compared with respondents over 40 years old, those under 40 years reported being more comfortable with computers (P =. 035). Prior to implementation, respondents under 40 years were statistically more likely to believe that the new EMR documentation would be both more efficient (P =. 018) and higher quality (P =. 030). However, by the end of the study the attitudes of the groups had converged; those under 40 years were less positive about the efficiency and quality of documentation in the new system and those over 40 years had become more enthusiastic about these aspects of EMR documentation.

Conclusions:

Younger faculty members appear to be more comfortable with the use of computers. This possibly led them to be more optimistic about the potential benefits of the EMR system. However, implementation appeared to alter both age cohorts’ perspectives, with younger faculty becoming less positive and older faculty becoming more enthusiastic about the EMR's impact.
Development of National Guidelines for Office‐Based Otolaryngology Procedures
Authors: Singh Praby , Krespi Yosef P.
Published: September 2014

Objectives:

(1) Describe the various basic recommended guidelines to safely perform office‐based procedures in otolaryngology (levels of anesthesia, staff training, pre/post procedure care, critical equipment and supplies, and hospital transfer). (2) Discuss state‐specific guidelines for office‐based procedures. (3) Describe the basic equipment and room setup to ensure safe, efficient, and successful office‐based procedures for anesthesia without sedation. (4) Develop a national standard for office‐based procedures in otolaryngology that will act as a guideline for the office‐based surgeon.

Methods:

Office‐based procedures will continue to gain significant popularity in otolaryngology as more surgeons take advantage of this safe and effective alternative to procedures based in the operating room. This paper involved examining the various existing guidelines for office‐based procedures, including necessary equipment, staff training, anesthesia protocols, and documentation. The various state guidelines on office‐based procedures were reviewed on an individual basis to produce a set of guidelines that any otolaryngologist can use to develop an office‐based procedure practice.

Results:

A guideline has been developed covering all critical aspects necessary to perform safe, effective, and successful office‐based procedures, focusing on anesthesia without sedation, for the otolaryngology surgeon. This guideline will help outline the necessary steps for the creation of an office‐based procedure practice for otolaryngologists across the country.

Conclusions:

Office‐based otolaryngology procedures are quickly increasing in popularity and frequency. National guidelines are necessary to ensure these procedures continue to be successful, safe, and patient focused.
Evidence‐Based Soft‐Tissue Reconstruction: Incorporating Lessons Learned from Social Perception
Authors: Dey Jacob K. , Ishii Masaru , Boahene Kofi D. O. , Byrne Patrick J. , Ishii Lisa E.
Published: September 2014

Objectives:

Measure the impact of facial lesion reconstruction on observer‐graded attractiveness and measures of negative facial perception.

Methods:

One hundred twenty casual observers viewed images of faces with lesions of varying sizes and locations before and after reconstruction as well as normal comparison faces. Observers rated attractiveness, lesion severity, and how disfiguring, bothersome, and important to repair they considered each face.

Results:

Facial lesions decreased attractiveness –2.26 [–2.45, –2.08] on a 10‐point scale. Mixed effects linear regression modeling showed this attractiveness penalty varied with lesion size and location, with large and central lesions generating the greatest penalty. Reconstructive surgery increased attractiveness 1.33 [1.18, 1.47], an improvement that also varied with size and location, restoring some lesion categories to near normal ranges of attractiveness. Iterated principal factor analysis indicated the disfiguring, important to repair, bothersome, and severity variables were highly correlated and measured a common domain; thus they were combined to create the DIBS factor score, representing negative facial perception. The DIBS regression showed lesion faces have a 1.5 standard deviation increase in negative perception [DIBS: 1.69 (1.61,1.77)], which decreased by a similar magnitude after surgery [DIBS: –1.44 (–1.49, –1.38)]. These findings also varied with lesion size and location.

Conclusions:

Surgical reconstruction of facial lesions increased attractiveness and decreased negative social facial perception, an impact that varied with lesion size and location. This new social perception evidence, when combined with patient and expert perception data, will inform our evidence‐based soft tissue reconstructive algorithm.
Olfactory Neuroblastoma: Fate of the Neck—A Long‐term Multicenter Retrospective Study
Authors: Nalavenkata Sunny B. , Adappa Nithin D. , Schlosser Rodney J. , Wang Eric W. , Woodworth Bradford A. , Smee Robert , Harvey Richard J.
Published: September 2014

Objectives:

Determine the incidence and factors influencing neck disease, at presentation and delayed, in patients with olfactory neuroblastoma.

Methods:

Patients with a histological diagnosis of olfactory neuroblastoma that were treated across 6 tertiary hospitals were included. Treatment modalities to primary site and neck included radiotherapy, surgery, and combinations. The status of cervical lymph node metastases at presentation and at last follow‐up was defined. Disease‐free survival (DFS) was calculated as time taken for patients to develop delayed neck disease following primary treatment of olfactory neuroblastoma. Pearson correlation, regression analysis, and Kaplan Meier plots were performed to identify risk factors for developing cervical neck metastases.

Results:

A total of 113 patients (46 females, 49.7 ± 13.2 years) with median follow‐up of 41.5 months (interquartile range, 58.2 months) were identified. Of the patients, 7.1% presented with primary neck disease while 8.8% of patients presented with delayed neck disease. Neck disease, both primary and delayed, was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ2 2 5.66, P =. 13). Histologic grade was higher in patients with primary neck disease (χ2 2 16.22, P =. 001). Positive surgical margins were associated with a higher risk of delayed neck disease compared with clear surgical margin (17.9% vs 5%, P =. 034). Five‐ and 10‐year disease‐free survival for regional neck disease was 92.4% (SE: 2.8%) and 79.6% (SE: 9.0%), respectively.

Conclusions:

Neck metastasis is an important clinical consideration for olfactory neuroblastoma both at presentation and in surveillance. Primary treatment of the neck could be considered in select patients.
Oral Cancer's Early Diagnosis: The Contribution of Contact Endoscopy
Authors: Santos Alberto , Galrito Marta , Barona Teresa M. , Fonseca Isabel , Papoila Ana Luísa , Salvado Francisco , Macor Carlos
Published: September 2014

Objectives:

Oral cancer has high incidence and prevalence rates. Despite the fact that the oral cavity might be easily observed, the diagnosis of oral cancer is usually done later than expected. Early diagnosis is the main oral cancer challenge to decrease morbidity and mortality. Contact endoscopy allows the assessment in vivo and in situ of epithelial cells, glandular ostia, and microvascular network (60X, 150X). The authors describe the contribution of contact endoscopy in performing real time histological diagnosis and guide biopsies in an office setting.

Methods:

The authors carried out a prospective double blind study (July 2012 ‐ February 2014) where diagnosis was made by contact endoscopy and histology (gold‐standard) in a population of 122 patients with oral lesions persisting without involution for 3 weeks, considering a clinical classification: benign (n = 26), premalignant (n = 83), and malignant (n = 13). Sensitivity, specificity, negative and positive predictive values, and likelihood ratios were calculated.

Results:

Sensitivity and specificity were superior to 95%. By the identification of the cellular and vascular heterogeneous patterns characteristic of a malignant lesion, contact endoscopy allowed the definition of real cellular margins and the detection of suspicious areas without macroscopic disease.

Conclusions:

In our study, contact endoscopy allowed in an office setting a precise diagnosis with similar effectiveness of histology. This noninvasive technique was revealed to be an important guide for biopsies, an easy way to define real safety surgical margins, and a good way to improve follow‐up efficiency. The authors concluded that contact endoscopy has good potential to improve oral cancer's early diagnosis.
Outcomes and Oncologic Considerations for Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy
Authors: Giese Rachel A. , Vural Emre A. , Moreno Mauricio A.
Published: September 2014

Objectives:

Most patients treated with organ‐preservation schemas for laryngeal cancer have no nodal disease at the time of recurrence. The oncologic benefit of an elective neck dissection (END) in a patient with clinically N0 neck at the time of salvage laryngectomy (SL) is still controversial. We sought to determine the oncologic outcomes for END and identify predictors for pN(+) status.

Methods:

Retrospective chart review of 180 patients who underwent laryngectomy between 2004 and 2013 was performed. Fifty‐eight patients met inclusion criteria and the cohort was divided into 2 groups depending upon the END status. Demographics, pathology, and oncologic outcomes were compared.

Results:

The study was comprised of 46 (79.3%) males and 12 (20.7%) females with a mean age of 60.5 years (range, 24‐88 years; SD = 10 years). Nineteen patients (32.8%) were managed conservatively while 39 (67.2%) had END, uni‐ or bilateral. Out of a total of 71 ENDs, 5 necks in 4 patients had positive nodal disease. The only statistically significant predictor for pN(+) status was T‐stage (P =. 017). Contrary to other reports, tumor location (glottis vs. supraglottic) was not a factor. The 5‐year disease‐free survival was 53.8%, and it was significantly lower for patients who underwent an END (P =. 032).

Conclusions:

We found that 7% of the dissected necks had positive disease, and the only predictor for pN(+) status was tumor T‐stage. END did not improve locoregional control or survival compared to observation. Our findings suggest END is warranted in patients presenting with locally advanced recurrences, while observation might be preferable in other instances.
Outpatient Thyroid Surgery: Safety of an Optimized Protocol in More than 1000 Patients
Authors: Segel Jamie M. , Duke William S. , White Jennifer R. , Terris David J.
Published: September 2014

Objectives:

(1) Understand the principles for safe outpatient thyroid surgery. (2) Review the outcomes of outpatient thyroid surgery in a large patient cohort.

Methods:

A protocol for outpatient thyroidectomy was conceived and refined over 3 years. A prospective analysis of all thyroidectomies accomplished by a single surgeon using this protocol from May 2008 to November 2013 was then undertaken. Patient demographics, surgical and pathological data, admission status, and complication and readmission rates were recorded.

Results:

A total of 1311 thyroidectomy procedures were performed during the study period, of which 1018 (77.7 %) were conducted on an outpatient basis. The readmission rate for outpatients was 0.8%, with only 1 readmission in the last 200 procedures. Inpatients were readmitted more often than outpatients (3.9% vs 0.8%, P <. 01). Outpatient management increased steadily throughout the study period (from 59.2% to 92.8%, P <. 01), despite a larger mean nodule size and a higher rate of malignancy over time. There were no changes in the complication rate across the study timeframe except for the incidence of hypocalcemia, which decreased over time (P <. 01).

Conclusions:

Outpatient thyroid surgery is safe in appropriately selected patients using an optimized and systematic protocol.
Postoperative Use of Vasopressors in Head and Neck Microvascular Reconstruction
Authors: Roche Ansley M. , Sterling Michael , El‐Deiry Mark W. , Wadsworth J. Trad
Published: September 2014

Objectives:

Microvascular free tissue reconstruction is overall successful in the treatment of patients with disfiguring wounds resulting from ablative cancer resection, trauma, and osteo(radio)necrosis. Flap failure can be devastating for patients and health care providers. The use of sympathomimetic drugs (vasopressors) in microvascular surgery is controversial; however, current research fails to demonstrate adverse outcomes when intraoperative vasopressors are used. Conversely, intraoperative fluid administration greater than 7 L has been associated with major postoperative complications. The aims of the study were: (1) determine the efficacy of postoperative vasopressor use in free flap patients; (2) compare length of hospital stay in patients who receive vasopressors postoperatively and those who do not.

Methods:

In this retrospective pilot study, we investigated the use of a postoperative hypotension treatment protocol at our institution, implemented in June 2013. Thirty‐nine patients underwent free flap reconstruction of the head and neck secondary to malignancy. Outcome measures included flap viability and length of hospital stay.

Results:

Analysis of this ongoing study reveals that 23% of patients received peripherally‐active vasopressors within the first 3 postoperative days. There were no flap failures in either group. We found no statistically significant difference in the rate of surgical reexploration in patients who received vasopressors postoperatively compared to patients who did not (Fisher's exact test, P value. 12).

Conclusions:

The length of hospital stay is not statistically significantly different when vasopressors are used postoperatively. The implementation of a formalized hypotension treatment protocol in the postoperative setting does not adversely affect the outcome of free flap survival or length of hospital stay.
Predictive Value of Intraoperative Parathyroid Hormone for Hypocalcemia following Total Thyroidectomy
Authors: Kim David S. H. , Barber Annabel E. , Wang Robert C.
Published: September 2014

Objectives:

Investigate whether intraoperative parathyroid hormone (PTH) can predict postoperative hypocalcemia following total thyroidectomy.

Methods:

Cohort study with chart review of total or completion thyroidectomy patients in academic and private settings from May 2013 to February 2014. A total of 42 patients who underwent total thyroidectomy with or without central node dissection were enrolled prospectively. PTH were measured at 2 time points: preincision after induction of general anesthesia and postexcision 20 to 30 minutes following total thyroidectomy. Serum calcium was measured at midnight after surgery (6 hours) and the next morning at 6 am (12 hours). Changes in intraoperative PTH were correlated with post‐thyroidectomy serum calcium.

Results:

Preincision PTH did not show any correlation with 6‐hour calcium. Postexcision PTH values stratified in an interval of 50 were not associated with significantly different calcium levels (PTH 50‐99.9, Ca 8.2; 100‐149.9, 8.4; 150‐199.9, 8.2). Patients with PTH less than 50 had a decreased mean calcium at 7.7; however the reduction was not statistically significant (P =. 143). The reduction from preincision to postexcision PTH between 75% and 99.9% was associated with hypocalcemia (mean Ca 7.5; P =. 041). However, a reduction less than 75% did not yield significant decreases in calcium (percentage reduction 0% to 24.9%, Ca 8.2; 25% to 49.9%, 8.2; 50% to 74.9%, 8.2).

Conclusions:

Preincision PTH is not a reliable predictor of postoperative hypocalcemia. A decrease of 75% or more in PTH following total thyroidectomy is more likely to result in postoperative hypocalcemia.
Primary Surgical Excision of Venous Malformations of the Head and Neck: Subsequent Management and Outcomes
Authors: Rosenberg Tara L. , Klug Theodore D. , Tullos Amanda B. , Richter Gresham T.
Published: September 2014

Objectives:

(1) Discuss primary surgical excision of head and neck venous malformations (VMs) and possible need for subsequent therapy. (2) Describe outcomes of primary surgical excision of VMs of the head and neck.

Methods:

We conducted a retrospective chart review of 45 patients (23 females and 22 males) treated with primary surgical excision of head and neck VMs who presented between 2001 and 2012 to a tertiary pediatric academic institution with a multi‐disciplinary vascular anomalies center.

Results:

Mean age at presentation was 10.2 years, with a higher average age for female patients (11.7 years) than male patients (8.6 years). The most common anatomical subsites were the face/cheek (22.2%), neck (17.8%), and lower lip (11.1%). A majority of patients (73.3%) experienced significant improvement after the initial excision, though 42.2% of patients ultimately required subsequent treatments (either repeat excision, laser therapy, or sclerotherapy) to obtain overall disease control. The majority of patients (57.8%) required only the initial surgical excision for adequate treatment. Few patients experienced postoperative complications. The most common patient complaint was transient postoperative edema. The main outcome measures included need for subsequent treatments after excision, overall improvement (significantly decreased size or resolution of VM and decreased pain) postoperatively, and postoperative complication rate/patient complaints.

Conclusions:

Venous malformations of the head and neck are uncommon. However, when appropriately selected for surgical excision, most do not require subsequent treatment for disease control. We present a series of 45 patients who were treated with primary surgical excision, 57.8% of whom required no further treatment.
Facial Reanimation Technique for Facial Nerve Paralysis following Cancer Resection
Authors: Kejner Alexandra E. , Rosenthal Eben L.
Published: September 2014

Objectives:

Analyze outcomes after static sling suspension and orthodromic temporalis tendon transfer reanimation for facial nerve paralysis after definitive cancer resection with flap reconstruction.

Methods:

Prospectively collected case series in which patient data were collected prospectively from 2004 to 2013 for patients undergoing reconstruction and facial reanimation after resection of malignancy which involved facial nerve sacrifice. Thirty patients were selected for 2 cohorts: static sling suspension (n = 18) and orthodromic temporalis tendon transfer (n = 12). Revision rates, length of stay, complications, time to follow‐up, and postoperative symmetry were compared between the 2 groups.

Results:

Of the 30 patients, 18 underwent static suspension and 12 underwent temporalis tendon transfer. In the static sling group, 6 patients (33%) were advised to undergo revision compared with 2 in the temporalis tendon group (17%; P =. 31). Only 4 patients underwent revision, 3 from the static group and 1 from the temporalis transfer group. Suture size, average number of sutures used to suspend the face, timing of procedure, radiation history, and flap reconstruction played no significant role between patients requiring revision surgery and those that did not. Of the patients requiring revision in the static sling group, 33% had undergone preoperative radiotherapy compared with 0% in the temporalis tendon transfer group (P =. 35). The remaining patients either underwent adjuvant therapy or were observed.

Conclusions:

There was no significant difference between the reconstruction methods. Static sling was performed more commonly at time of flap reconstruction.
The Role of Modifiable Risk Factors in the Development of Thyroid Cancer
Authors: Stansifer Kyle J. , Guynan John F. , Smith Russell B.
Published: September 2014

Objectives:

Evaluate the role of modifiable patient risk factors including tobacco use, secondhand smoke exposure, alcohol consumption, and body mass index (BMI) in the development of thyroid cancer.

Methods:

Retrospective study comparing Midwest thyroid cancer patients from our multicenter Thyroid Tumor and Cancer Registry and Midwest controls without personal history of cancer. Descriptive statistics were created from detailed questionnaires, thyroid cancer type, and odds ratios were reported for significant associations.

Results:

There were 469 cancer patients and 425 controls. The thyroid cancer group included 406 papillary, 47 follicular, 13 medullary, and 3 anaplastic cancers. Comparing all cancer patients with controls, there was no association between smoking and thyroid cancer (P =. 18). Living or working with smokers was associated with increased cancer risk (odds ratio [OR] = 1.36, 95% confidence interval [CI] 1.04‐1.77). Compared with never drinking, current drinking was associated with reduced cancer risk (OR = 0.48, 95% CI 0.31‐0.75) as was consuming 1 to 2 drinks daily compared with drinking <1 drink daily (OR = 0.55, 95% CI 0.36‐0.85). Consuming >2 drinks daily was not associated with cancer risk (P = 0.26, 95% CI 0.47‐1.22). There was no association between BMI and papillary cancer, except in patients older than 45 years with a BMI >30 (OR = 1.87, 95% 1.20‐2.92).

Conclusions:

Our data suggest that secondhand smoke exposure is a risk factor for developing thyroid cancer and mild alcohol consumption is associated with reduced risk of developing thyroid cancer. BMI over 30 may be associated with thyroid cancer development for individuals over 45 years old.
Safety and Efficacy of Primary Tracheoesophageal Puncture and Prosthesis Fit
Authors: Momin Suhael , Llanes Daniel U. , Kmiecik Joann , Burkey Brian B.
Published: September 2014

Objectives:

Compare the safety and efficacy of primary tracheoesophageal puncture (TEP) and prosthesis fit with traditional methods, such as secondary TEP or primary TEP with catheter stenting (secondary fit).

Methods:

Retrospective cohort study of patients who underwent total laryngectomy with TEP between 2009 and 2013. Voice outcome was assessed as voice production at the first postoperative appointment and TEP usage at 6 months and 1 year following puncture. Perioperative emergency department visits, pharyngocutaneous fistula (PCF), and stomal breakdown were analyzed.

Results:

Ninety patients were included. Seventy‐three had primary TEPs, of which 32 were catheter stented and 41 were fitted primarily. The remainder (17) had secondary TEPs, of which 8 were primarily fit. Patients with primary fittings were less likely to come to the emergency department postoperatively (14% vs 39%, P <. 01). PCF rate (9.3% vs 9.7%, P =. 95) and stomal breakdown rate (12.2% vs 9.3%, P =. 7) were similar between primary vs secondary fit. There was no difference in PCF or stomal breakdown rates between primary and secondary punctures. Among patients with primary punctures, primary fit patients trended toward higher initial voice success compared with secondary fit patients (87% vs 78%, P =. 3). At 6 months and 12 months after surgery, primary fit patients also tended toward higher rates of TEP usage (6 m: 83% vs 61%, P =. 1; 12 m: 92% vs 73%, P =. 17).

Conclusions:

Primary TEP with primary fit represents a safe and effective approach to vocal rehabilitation following total laryngectomy.
Surgical Management of Olfactory Neuroblastoma: Outcomes and Patterns of Failure
Authors: Petruzzelli Guy J. , Origitano Thomas C. , Byrne Richard
Published: September 2014

Objectives:

(1) Analyze survival, complications, and impact of transnasal endoscopic cranial base surgery. (2) Describe time course and patterns of local, regional, and distant failure patients with olfactory neuroblastoma (ONB) of the nasal cavity, ethmoid sinus, and/or anterior skull base.

Methods:

Review of prospectively collected clinical data of patients treated by a single head and neck surgeon at 2 academic medical centers over 16 years.

Results:

Thirty‐seven patients were diagnosed with ONB confirmed by immunohistochemistry between 1996 to 2010, and 31 are available for review. There were 10 women and 21 men with a mean age of 50.9 years. Patients were treated with primary resection and no additional therapy (4), radiation therapy (24), or chemotherapy enhanced radiation therapy (3). Primary resections included open medial maxillectomy without craniotomy (n = 2), endoscopic anterior craniofacial resection (CFR) (n = 9), and open CFR (n = 20). Mean and median overall survivals were 95.95 and 80.62 months, respectively (range, 6.53 to 242 months). Operative complications were only observed in patients undergoing open CFR. Recurrences were either limited to the neck (3/11), the neck and a distant site (3/11), or distant sites alone (5/11). Time interval to the development of recurrence ranged from 3 to 186 months, and only patients with isolated recurrences could be salvaged. Intradural tumor extension correlated with recurrence but not necessarily early death.

Conclusions:

Margin negative resection of ONB should remain the goal of primary treatment. Long‐term follow‐up is necessary to identify patients with isolated recurrences who would benefit from aggressive salvage therapy.
Survival with Spindle Cell Carcinoma Compared to Conventional Squamous Cell Carcinoma
Authors: Bice Tristan C. , Merkley Mark A. , van der Sloot Paul G. , Newlands Shawn D. , Miller Matthew C.
Published: September 2014

Objectives:

(1) Compare survival of patients with spindle cell carcinoma variant (SpCC) to survival of patients with conventional squamous cell carcinoma (SCC). (2) Describe the impact of patient demographics and tumor characteristics on survival with SpCC.

Methods:

A retrospective cohort study was conducted with 18,416 cases entered into the Surveillance, Epidemiology, and End Results Program database between 2004 and 2009. Variables including age, sex, race, tumor grade, size, stage group, TNM stage, and treatment modality of 18,298 SCC patients and 118 SpCC patients were extracted and combined into oral cavity, oropharynx, and larynx sites. Characteristics and survival of SpCC and SCC patients were compared in total and at each site. The effect of variables on survival with SpCC was assessed.

Results:

In total, SpCC patients experienced worse survival than conventional SCC patients (P <. 05). Overall, SpCC patient mortality was worse than SCC patients within the first 3 years (P <. 05) but was not different at 5 or 10 years. Of the 3 sites, survival was only significantly worse for SpCC patients within the oropharynx site (P <. 05). Survival of SpCC patients was worse with higher stage group and TNM stage (both P <. 05), but did not differ by sex, race, or tumor grade.

Conclusions:

SpCC carries a worse prognosis than conventional SCC when located in the oropharynx. Survival with SpCC was associated with stage group and TNM stage, but was unaffected by sex, race, or grade.
A Swallow Preservation Protocol Improves Function for Veterans Receiving Chemoradiation for Head and Neck Cancer
Authors: Peng Kevin A. , Wu Edward C. , Unger Lindsay , Lorentz William , Wang Marilene B. , Long Jennifer L.
Published: September 2014

Objectives:

Determine the efficacy of a swallowing preservation protocol on maintaining swallow function in patients undergoing chemoradiation (CRT) for head and neck squamous cell carcinoma (HNSCC).

Methods:

Retrospective case‐control study of patients treated with CRT for HNSCC between July 2011 and December 2013 at a Veterans Affairs medical center. The study group comprised patients participating in a swallowing preservation protocol, including swallowing exercises and biweekly follow‐up, during CRT. The control group received no swallowing intervention during CRT. A previously described functional outcomes of swallowing scale (FOSS; 0 = no symptoms and 5 = nonoral feeding for all nutrition) was used to quantify dysphagia prior to, at the completion of, and 2 months following the completion of CRT.

Results:

Forty‐eight (all male; mean age, 67 years) and 85 patients (all male; mean age, 61 years) were included in the swallowing preservation and control groups, respectively. In the swallowing preservation group, mean pre‐ and posttreatment FOSS scores were 2.2 and 1.9, respectively, while the corresponding scores in the control group were 0.92 and 1.0. This approached statistical significance (Fisher's exact test, P =. 2).

Conclusions:

Patients enrolled in a swallow preservation protocol had overall poorer swallowing function at the initiation of CRT, but compared to the control group, a higher fraction of patients in the swallowing preservation protocol maintained or improved their swallow at posttreatment follow‐up. This confirms the importance of early evaluation and intervention for dysphagia prior to and during CRT.
Free Flap Reconstruction Experience and Outcomes in a Low‐Volume Setting over 20 Years
Authors: Klosterman Tristan , Siu Eric , Morris Lisa , Tatum Sherard A.
Published: September 2014

Objectives:

(1) Recognize the potential efficacy of free flap reconstruction performed at a low volume program. (2) Understand how reconstructive microvascular outcomes and success change over 20 years.

Methods:

A retrospective chart review was performed at a tertiary care academic program on all free tissue flaps from the primary reconstructive surgeon over 20 years (1993‐2013). A total of 135 procedures were obtained from operative notes, billing codes, and chart databases. Outcome variables included overall procedure success, need for surgical revision, and complications. Patients stayed in general surgical intensive care and hospital floor units.

Results:

Free tissue flaps were successful in 91% of all cases. In the past 13 years, 70 flaps were performed with 3 failures (96% success rate). Take‐back rate was 14% of total cases with a flap recovery rate of 50%. Postoperative failure occurred after 72 hours in 70% of cases. Nearly 60% of patients experienced a complication of any type or severity. Twenty percent of successful flaps had a complication, with half due to partial dehiscence. Systemic complications affected 20% of all cases. The average hospital stay for noncomplicated patients was 13 days. There was 1 postoperative mortality. Fibula and radial forearm were the most common flaps, at 44% and 26%, respectively.

Conclusions:

Free flap reconstruction of the head and neck can be performed with acceptable outcomes even in low volume settings.
Diagnostic Yield of Computed Tomography in Evaluation of Vocal Fold Paresis: Is It Worth It?
Authors: Paddle Paul M. , Mansor Masaany , Song Phillip , Franco Ramon A.
Published: September 2014

Objectives:

(1) Determine the diagnostic yield of contrast‐enhanced computed tomography (CT) in the evaluation of patients with idiopathic unilateral vocal fold paresis. (2) Determine the proportion of CTs yielding nondiagnostic incidental findings requiring further patient management.

Methods:

Retrospective cohort. Precision‐based power calculations were performed. All patients of the 2 senior authors who underwent contrast‐enhanced CT for a clinical diagnosis of vocal fold paresis from January 2004 to January 2014 were included. Demographic, history, examination, and investigation data were extracted from outpatient records and CT reports were reviewed. Patients were excluded if there was insufficient history or examination information, if there was a known neurological diagnosis, or if there was vocal fold immobility or bilateral involvement. A diagnostic CT was defined as depicting a pathological lesion along the course of the ipsilateral recurrent or superior laryngeal nerves. Incidental CT findings were defined as those unrelated to paresis and requiring further intervention.

Results:

A total of 128 patients were included in the study. Three out of 128 patients had a diagnostic CT equating to a diagnostic yield of 2.3% (0.49‐6.7 95% confidence interval [CI]). Thirty‐nine out of 128 patients, or 30.5% (22.6‐39.2 95% CI) had an incidental CT finding requiring further management.

Conclusions:

Contrast‐enhanced CT has a low yield of 2.3% in the initial evaluation of idiopathic vocal fold paresis. Conversely, CT has a high, 30.5% yield of incidental cervico‐thoracic lesions. This would suggest that the routine use of CT in the evaluation of idiopathic vocal fold paresis is not warranted.
Dysphonia and Cystic Fibrosis
Authors: Willis John , Misono Stephanie , Michael Deirdre D.
Published: September 2014

Objectives:

Because cystic fibrosis transmembrane conductance regulator (CFTR) chloride channels are found in human vocal fold epithelium, we aimed to (1) assess the prevalence and severity of dysphonia in patients with cystic fibrosis (CF) and (2) compare these with control patient populations.

Methods:

Voice samples and the Voice Handicap Index‐10 (VHI‐10) were collected from patients with cystic fibrosis and control patients with and without chronic sinusitis. Voice samples underwent consensus auditory‐perceptual evaluation of voice (CAPE‐V) assessment by blinded speech‐language pathologists. Sinus‐related symptoms were assessed using the SinoNasal Outcome Test (SNOT‐20). Statistical analysis was performed using unpaired t‐tests and one‐way analysis of variance (ANOVA).

Results:

Thirty‐seven patients participated, including 17 with CF, 10 with chronic sinusitis, and 10 healthy controls. Prevalence of dysphonia by VHI‐10 criteria was 41% in CF, 20% in chronic sinusitis, and 0% in healthy controls. CF patients had worse VHI‐10 scores than healthy controls (P =. 001). There was no significant difference in VHI‐10 or SNOT‐20 between CF and chronic sinusitis patients, but on CAPE‐V assessment, patients with CF had greater overall severity of dysphonia and strain compared with control patients with and without chronic sinusitis (P <. 001) and (P =. 022).

Conclusions:

Auditory‐perceptual evaluation demonstrated greater severity of dysphonia in patients with cystic fibrosis than in controls. This may identify an area of clinical need as well as an opportunity for improved understanding of the role of CFTR in human voice.
Free Flap Reconstruction Outcomes among Elderly Patients
Authors: Goldman Richard A. , Luginbuhl Adam , Curry Joseph , Cognetti David M. , Krein Howard D. , Heffelfinger Ryan
Published: September 2014

Objectives:

Review a single institution's experience with free flap reconstruction of the head and neck in patients 80 years of age and older.

Methods:

A retrospective chart review was conducted of patients undergoing free tissue transfer for head and neck reconstruction in patients 80 years of age and older between 2008 and 2013 at a single academic tertiary care hospital. Main outcomes studied were free flap success rate, postoperative complications, discharge disposition, and length of hospital stay. Independent variables included age, type of reconstruction, and comorbid disease. Patients were stratified into high and low comorbidity groups using the Charlson Comorbidity Index, and associations with outcomes were analyzed.

Results:

A total of 65 patients 80 years of age or older were included in the review. There were 2 free flap failures with a success rate of 97%. Nine patients were 90 years of age or older. The average length of stay was 11 days. There were 11 (17%) flap‐related complications and 18 (28%) medical complications. There was no difference in medical or flap‐related complications between high and low comorbidity groups (P =. 97 and P =. 18, respectively). Patients who experienced flap‐ related complications were more likely to also experience medical complications (P =. 002).

Conclusions:

Free flap reconstruction in the head and neck remains a viable option in patients of advanced age. In our experience a comparable success rate with those reported in the literature among all patients has been achieved and the level of comorbid disease has not appeared to adversely affect outcomes.