bluuebunny/crossref_metadata_2025 huggingface dataset:
Otolaryngological Features of ANCA Associated Vasculitis
Authors: Nakamaru Yuji , Fukuda Satoshi
Published: September 2011

Objective

ANCA‐associated vasculitis (AAV) is characterized by systemic necrotizing vasculitis. AAV is composed of proteinase 3 (PR3)‐ANCA and myeloperoxidase (MPO)‐ANCA. Because infections are a trigger of AAV, the upper airway areas are the favorite sites of AAV. In this study, we compare the otolaryngological features of AAV between patients with PR3‐ANCA and patients with MPO‐ANCA.

Method

Retrospective case series study. Thirty‐four patients enrolled in this study. All patients were diagnosed with AAV at Hokkaido University between 2002 and 2009. We evaluated clinical otologic and rhinologic manifestation of AAV and compared the difference between 2 different ANCA positive patients.

Results

The otologic symptoms were divided into 3 types: chronic otitis media (COM), secretory otitis media (SOM), and sensory nerve hearing loss (SNHL). The COM type was more frequently found in patients with PR3‐ANCA (P <. 05).

Conclusion

A large difference was observed in the disease spectrum between patients with PR3‐ANCA and those with MPO‐ANCA. In particular, the discrepancy in the granuloma formation between these 2 ANCAs was thought to be the main reason for these clinical feature differences in the otolaryngological field.
Outcomes of Vagal Nerve Stimulator Implantation by Otolaryngologists
Authors: Perez Angel Javier , Dyckman Damian , Schroeder Ashley A. , Clenney Timothy L.
Published: September 2011

Objective

A vagal nerve stimulator (VNS) is a FDA‐approved device implanted for treatment of intractable epilepsy and major depression in adults and children. Recently, otolaryngologists are becoming more involved in the implantation and care of side effects for these devices.

Method

A retrospective chart review was performed. Our local surgical database was searched for cases of VNS implantation during a period of 40 months. Fourteen cases performed by otolaryngologists were identified. Medical records were then reviewed for outcomes including medication reduction, seizure frequency and duration, device‐related complications, and surgical complications.

Results

Of the 14 cases performed by otolaryngologists over 40 months, 11 (78.6%) cases demonstrated either a decrease in medications required, seizure frequency, or duration. The most common side effect was voice alteration during device initiation. There were no early postsurgical complications.

Conclusion

These data provide support for the qualification of otolaryngologists for performing VNS implantation and monitoring postoperative and laryngeal side effects of the VNS.
P63‐Mediated Cisplatin Resistance with Head and Neck Cancer
Authors: Yamashita Taku , O’Malley Bert , Li Daqing , Miyamoto Shunsuke
Published: September 2011

Objective

1) Understand the molecular pathway of cisplatin‐based chemoresistance with head and neck cancer. 2) Investigate if p63 plays an important role in regulating MRE11/RAD50/NBS1 (MRN) complex that contributes to cisplatin‐based chemoresistance.

Method

Both JHU006 and JHU020 HNSCC cell lines were characterized as either sensitive or resistant to cisplatin. MRN and p63 expression levels were examined. The p63‐mediated MRN regulation was studied by introducing mutant NBS1 and siRNA. Cell growth was evaluated in response to cisplatin treatment and regulation of p63 and MRN.

Results

IC50 to cisplatin for JHU006 and JHU020 was 8.76 and 0.61, respectively, suggesting that JHU006 is a cisplatin‐resistant cell line. Increased expression levels of MRN were found after cisplatin treatment in JHU006 as compared with JHU020. The p63 expression level, which is a positive transcriptional factor for RAD50 and MRE11, was up‐regulated after cisplatin treatment in JHU006 but not in JHU020. The knockdown of p63 resulted in the down‐regulation of MRN, and therefore there were interrupted DNA repair and sensitized resistant tumor cells to cisplatin. The introduction of mutant NBS1 could down‐regulate MRN, but was not effective on the p63 expression.

Conclusion

Our study suggested that p63 may play an important role in regulating cisplatin‐based chemoresistance via MRN. The understanding of the molecular pathway of cisplatin‐based chemoresistance could help us to design an efficient treatment strategy for head and neck cancer.
Rhinoscleroma in an Urban Non‐endemic Setting
Authors: Suchanova Pavlina Paja , Mohyuddin Nadia G. , Eicher Susan A.
Published: September 2011

Objective

1) Increase awareness and understanding of the clinical presentation, diagnosis, and treatment options of respiratory rhinoscleroma among otolaryngologists in nonendemic areas. 2) Review current literature, including our clinical experience, and propose a treatment algorithm for rhinoscleroma cases in a nonendemic setting.

Method

Report 2 cases of nasal and 1 case of laryngeal rhinoscleroma in an urban nonendemic setting in Ben Taub General Hospital in Houston, Texas. All patients presented in the spring of 2010 and were treated medically and/or surgically with an established follow‐up of more than 6 months.

Results

Rhinoscleroma is a chronic, slowly progressive, infectious disease of the respiratory tract that is rare in nonendemic countries. Increased travel from endemic areas is increasing its incidence in a nonendemic setting, and there is a need for an increased awareness of its clinical presentation and treatment options. The condition can easily mimic other pathologies and, if untreated, lead to disfiguring nasal anatomy and laryngeal stenosis. No comprehensive English review exists, as many case reports are published in their respective native languages only.

Conclusion

A treatment algorithm based on available literature review and our clinical experience is proposed with a full review of clinical presentation, diagnosis, and the natural course of the disease, including its histopathology.
Systematic Review of Steroid Prophylaxis for Thyroidectomy
Authors: Mascarinas Christopher A. , Aynehchi Behrad B. , Parmar Perminder S. , Rosenfeld Richard M.
Published: September 2011

Objective

Determine whether systematic review with meta‐analysis supports the use of corticosteroids to reduce postoperative nausea, vomiting, pain, and voice dysfunction after thyroidectomy.

Method

A systematic review of currently available randomized controlled trials in EMBASE and PUBMED databases comparing intravenous perioperative corticosteroids with placebo to prevent postoperative nausea, vomiting, pain, or voice dysfunction was performed by 2 independent reviewers. The quality of studies was evaluated and results synthesized using standard random‐effects meta‐analysis methods.

Results

Eight randomized controlled trials were eligible for review. Dexamethasone reduced the absolute incidence of postoperative nausea at 24h by 18% (95% CI, 2‐8‐27%), P <. 001, and postoperative vomiting at 24h by 27% (95% CI, 13‐40%), P <. 001 in 4 trials with 304 patients. Dexamethasone increased the absolute incidence of complete response (no episodes of nausea or vomiting) to steroids by 30% (95% CI, 7‐52%), P =. 11 in 3 trials with 246 patients. Dexamethasone reduced the absolute VAS score for pain (0‐10 scale) at 24h by 1.32 95% CI (0.49‐2.15), P =. 002 in 3 trials with 232 patients. There was insufficient data to perform meta‐analysis for voice dysfunction.

Conclusion

These results argue strongly for routine use of dexamethasone during thyroidectomy because the intervention is safe and only about 2.5 patients need treatment to prevent one episode of postoperative nausea or vomiting.
The Impact of Salivary Gland Frozen Section on Surgical Outcomes
Authors: Houlton Jeffrey , Turner Kevin , Fernandez Nella , Sun Gordon H. , Zhai Qihui , Patil Yash J.
Published: September 2011

Objective

Determine the accuracy of intraoperative salivary gland frozen section (FS) and to evaluate the effects of misdiagnosis on surgical outcomes and postoperative complications.

Method

Data were retrospectively reviewed for all patients undergoing intraoperative salivary gland FS at a tertiary care center from January 2000 to June 2010. FS was correlated with permanent pathology and categorized as concordant, discordant, or deferred. Patients with discordant/deferred FS were evaluated for appropriateness of surgical intervention and for postoperative complications of inappropriate surgery.

Results

Over 2,000 patients underwent salivary gland surgery in the 10‐year study period. One hundred eighty underwent intra‐operative FS, including 73% (132) concordant, 2% (3) discordant, and 25% (45) deferred (non‐definitive) FS interpretations. One of 3 patients with discordant FS underwent surgery of inappropriate extent resulting in an unnecessary neck dissection and permanent spinal accessory nerve paralysis. 7% (3/45) of patients with deferred/nondefinitive FS underwent suboptimal surgery, resulting in one re‐operation but no other major complications. Overall, 98% (176/180) of patients that underwent salivary gland FS received operations consistent with permanent pathology. Pleomorphic adenoma was the most commonly deferred entity.

Conclusion

Though deferred and discordant salivary gland FS diagnoses may lead to suboptimal surgical intervention and potential postoperative complications, the use of FS correlates with optimal surgical intervention in the vast majority of cases.
Thimble‐Enhanced Fine Needle Aspiration of the Submandibular Triangle
Authors: Cannon C. Ron
Published: September 2011

Objective

1) Learn a method to enhance the yield in diagnosing masses in the submandibular triangle via Fine Needle Aspiration (FNA). 2) Learn how to enhance the technique of FNA using an inexpensive sewing thimble.

Method

In patients with submandibular triangle masses, a thimble is placed over the surgeons index finger and gloved. The index finger is placed intraorally and the contents of the submandibular triangle are displaced inferiorly and laterally. Using the contralateral hand or a “two‐person” technique, the FNA is then completed.

Results

This simple refinement has aided in the successful completion of FNA for masses located in the submandibular triangle.

Conclusion

The use of an inexpensive sewing thimble is a helpful adjunct in the successful completion of FNA in masses located in the submandibular triangle.
Treatment of Thyroglossal Duct Cyst by OK‐432
Authors: Ota Nobuo , Fukase Shigeru
Published: September 2011

Objective

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

Method

We tried this therapy in 15 patients with thyroglossal duct cysts between January 2001 and February 2009. We injected OK‐432 solution into the lesion with a 27 gauge needle to prevent the leak of the agent out of the cyst. We performed this treatment on an outpatient basis without hospitalization.

Results

Disappearance and marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity of the auricle did not occur in any patients. As side effects, local pain at the injection site and fever (37 to 38°C) were observed in a few cases of the patients who had this therapy, but such problems resolved within a few days.

Conclusion

These results may allow us to speculate that intralesional injection therapy with OK‐432 is simple, easy, safe, effective, and useable as a substitute for surgery in the treatment of thyroglossal duct cysts.
Ultra‐low Velocity Penetrating Neck Trauma: Explore/Extract?
Authors: Page Matthew P. , Panfili Zachary E. , Lasiter J. Clint
Published: September 2011

Objective

1) Describe the injury pattern caused by ultra‐low velocity (ULV) foreign body penetration of the neck in the context of self‐mutilation, and 2) Propose a conservative management strategy for removal of such foreign bodies when the likelihood of serious injury is low.

Method

Case series of 8 incidents of self‐inflicted ULV penetrating neck trauma in a single patient who presented to a tertiary care hospital between December 2007 and December 2008. Postoperative morbidity was analyzed according to the presenting signs, symptoms, and radiologic findings and to the extent of surgical intervention.

Results

Ten foreign bodies were removed on 8 separate occasions. Concerning physical signs were present on one occasion (bleeding); symptoms on 3 (dyspnea or odynophagia); and radiologic findings on 6. Seven objects were retrieved by targeted dissection, with a mean operative time of 27.7 ± 8.4 min. Three objects were removed in the context of formal neck exploration, each with an operative time of 65 min. No significant injuries were found after foreign body removal. Minor transient incisional pain was the only morbidity observed, and this did not vary with preoperative injury assessment or extent of surgical intervention.

Conclusion

In our series of ULV penetrating neck trauma, concerning CT findings were more common than signs/symptoms of serious injury. Morbidity from ULV foreign body penetration and from its surgical treatment was low, whether formal exploration or targeted extraction was performed. Imaging tended to overestimate injury but helped with surgical planning.
Closure of Scalp Defects Using External Tissue Expander
Authors: O’Reilly Ashley , Youse Jeremy , Roenigk Randall , Price Daniel L. , Schmitt William R.
Published: September 2011

Objective

1) Present a novel method of closure of large scalp defects with an external tissue expansion device. 2) Review methods of scalp closure.

Method

Patients with large central scalp defects secondary to cutaneous malignancy underwent wound closure with a novel external tissue expansion device. The device applies a constant, measured tension to approximate the wound edges. Data regarding patient clinical factors, defect size, and photographs were collected prospectively.

Results

Four patients had large scalp defects secondary to extirpation of cutaneous malignancies. Two patients with wounds 7.5‐ x 7.5‐cm and 9.5‐ x 5‐cm respectively achieved primary closure after 8 days of expansion. One patient with a 6.5‐ x 7.5‐cm wound had reduction of wound size to 3.5‐ x 2.5‐cm after 14 days. The wound then healed by secondary intention. One patient with a 6‐ x 7‐cm wound achieved closure with the use of bilateral rotation‐advancement flaps after 8 days. This flap ultimately failed and will require free flap reconstruction. There were no other postoperative complications, wound breakdown, or device failures.

Conclusion

External tissue expansion is a safe and alternative technique to close large scalp defects that would otherwise require skin grafting or free flap reconstruction in appropriately selected patients, and can be achieved in a relatively short period of time.
A Novel Transgenic Animal Model for HPV‐Associated Cancer
Authors: Sewell Duane , Dobrosky Christine , Marvel Douglas , Hancock Melyssa , Gendron Kristin B. , Banyard Derek
Published: September 2011

Objective

The incidence of HPV‐associated tumors is rising at a rapid pace. In order to develop novel therapies with high efficacy but low toxicity, it is crucial to have an animal model in which HPV‐associated oral lesions spontaneously develop. Our objective was to develop such a model.

Method

A transgene was created to target expression of E7 to the oral cavity by cloning HPV‐16 E7 downstream of the L2 promoter. Transgenic mice which carry this gene were created on the C57Bl6 background. Then, these mice were backcrossed with a strain of mice heterozygous for p53.

Results

Mice were bred to create the desired genotype, E7 +/+, p53 ‐/‐. Because of the short life span and limited breeding potential of mice with a homozygous p53 deletion, breeding was performed with p53 heterozygous mice. In accordance with Mendelian genetics, we found the majority of offspring were heterozygous for p53, and did not form spontaneous tumors. Of the offspring with homozygous p53 deletions, few lived longer than 25 weeks. However, one mouse lived long enough to develop an HPV‐associated oral tumor. E7 transcript was detected in the tumor by RT‐PCR, and E7 protein was detected via Western blot.

Conclusion

We report the development of a transgenic mouse which spontaneously expressed an HPV‐associated oral tumor. Additional genetic manipulation may be required to enhance the longevity and stability of this mouse strain. This strain has the potential to serve as a platform to investigate novel therapeutic strategies for HPV‐associated tumors.
A Survival Analysis for Primary and Salvage Ablative Surgery with Microvascular Reconstruction for Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Authors: Boeckmann Jacob O. , Spencer Horace , Vural Emre A. , Suen James Y. , Yuen James C.
Published: September 2011

Objective

Provide prognostic data for the physicians and patients when a decision is made for primary or salvage ablative surgery of the upper aerodigestive tract with the aide of microvascular reconstruction.

Method

Retrospective chart review of patients with primary or recurrent upper aerodigestive tract squamous cell carcinoma treated with free flap reconstruction between 1993 and 2009. Prior treatment, recurrence time and site, sex, age, complications, cause of death, stage, and survival rates were analyzed.

Results

A total of 219 patients were identified. Mean age was 59.6 years. A total of 136 patients underwent primary resection with immediate reconstruction, 83 patients underwent salvage treatment. A total of 196 patients had advanced clinical stage oral (n = 129) and oropharyngeal squamous cell carcinomas (n = 51). Median overall survival for all patients was 21.7 months (CI 16.2, 33.1) with median recurrence free survival of 12.6 months (CI 8.8, 16.6). Median overall survival was 31.3 months (CI 18.6, 48.6) for primary resection group and 14.6 months for salvage group (CI 11.4, 21.5). Recurrence free median survival was 16.6 months for the primary resection group and 7.7 months for salvage group (P =. 009).

Conclusion

The surgeon and the patient need to be aware of survival rates, when radical resection with free flap reconstruction offered; especially in salvage setting. This may help the patient and the surgeon in choosing the most suitable treatment modality for any given condition.
Adenoid Cystic Carcinoma: Benefit of Surgery Plus Adjuvant Radiation
Authors: Pearce Elizabeth C. , Yu Chang , Alvarez JoAnn , Netterville James L. , Rhode Sarah L.
Published: September 2011

Objective

Evaluate the role of adjuvant radiation compared with surgical resection alone in treatment of adenoid cystic carcinoma of the head and neck. In addition, given the varied course and presentation of the disease, to analyze the impact of perineural invasion, margin status, and AJCC Tumor stage on survival.

Method

Retrospective review of 92 patients treated for adenoid cystic carcinoma of the head and neck between 1978 and 2010 at a single tertiary care academic center. Kaplan‐Meier survival curves and Cox Proportional Hazards Model were used to evaluate the impact of treatment modality and clinical and pathological parameters on survival.

Results

The oropharynx was the most common site (30.4%). Overall 2‐, 5‐, and 10‐year survival rates were 75%, 51%, and 22%. Mean follow‐up was 75.9 months. All but 3 patients were treated with surgery and 60 out of 92 (65.2%) underwent postoperative radiation. Mean time to recurrence was 45.6 months and occurred in 45 out of 90 patients (50%). Significantly more T3/T4 staged patients underwent surgery plus adjuvant radiation than T1/T2 patients (P <. 045).

Conclusion

Despite being classified with more advanced disease (T3/T4 Stage), patients in the surgery plus radiation group had similar outcomes to patients who received surgery alone. Adjuvant radiation should be considered in all patients with adenoid cystic carcinoma of the head and neck.
An Inexpensive, Reproducible Anatomic Model for Surgical Training of Myringotomy
Authors: Ingram Amy , Malone James P.
Published: September 2011

Objective

Design an inexpensive, reproducible anatomic model to simulate myringotomy and tympanostomy tube placement in the surgical skills laboratory, which would allow residents to familiarize themselves with the microscope, anatomy, and tools used during a typical procedure.

Method

Design an inexpensive, reproducible anatomic model to simulate myringotomy and tympanostomy tube placement in the surgical skills laboratory, which would allow residents to familiarize themselves with the microscope, anatomy, and tools used during a typical procedure.

Results

The model was assembled by sawing the styrofoam head in half and making medial and lateral openings. The medial portion of the simulator ear was removed and the ear placed within the external opening of the head. A T‐pin was molded to represent the malleus and secured at the inner edge of a three cm segment of detached bulb syringe tip. Glad Wrap was draped over the “malleus,” and the entire assembly was then placed within the medial opening of the head to line‐up with the external canal. The “tympanic membrane” is the only disposable portion of the model.

Conclusion

This model is a practical and reproducible anatomic model for simulation training of a myringotomy. It has been used successfully by multiple residents and can be created by utilizing inexpensive materials. We plan to integrate this into a Verification of Proficiencies (VOP) program to assess surgical skills in otolaryngology residents.
Assessment for Staging of Head and Neck Cancers by FLT PET
Authors: Hoshikawa Hiroshi , Kishino Takehito
Published: September 2011

Objective

Investigate the feasibility of using FLT PET to detect head and neck squamous cell cancer (HNSCC) and to compare the diagnostic efficacy with that of FDG PET in evaluation of the nodal and distant metastatic staging.

Method

Patients with histopathologically proven HNSCC underwent FLT PET and FDG PET performed at 60 min after radiotracer injection. The PET images were evaluated qualitatively for regions of focally increased metabolism and for semiquantitative analysis, the maximum standardized uptake value (SUV) was calculated.

Results

For depiction of primary tumors, the sensitivity of both approaches was 100%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for lymph node staging on a per‐patient basis were 71, 95, 94, 72, and 81%, respectively, with FLT PET and 79, 89, 90, 77, and 84%, respectively, with FDG PET. One of 2 distant metastases was detected with FLT and FDG PET. Although FLT PET had no false‐positive result for M staging, FDG PET showed three false‐positive results owing to physiological bowel activity and/or inflammation.

Conclusion

FLT PET was found to have high sensitivity for depiction of primary tumors despite a lower FLT SUV than FDG. FLT PET showed better specificity and positive predictive values for N staging than FDG PET. Further studies are needed to predict and evaluate tumor response to therapy by FLT PET.
Assessment of Autofluorescence for Oral Cancer Screening
Authors: Sweeny Larissa , Clemons Lisa , Dean Nichole , Rosenthal Eben L. , Magnuson J. Scott , Carroll William R.
Published: September 2011

Objective

Although FDA approved for clinical use, the utility of hand‐held tissue reflectance and autofluorescence devices for screening head and neck cancer (HNC) patients is poorly defined. There is no published evidence regarding the efficacy of these devices. We investigated the sensitivity and specificity of these modalities compared with standard examination.

Method

Study design: prospective, cross sectional analysis. Included patients previously treated for HNC (n = 89) and patients being evaluated for a new primary (n = 10) between 2009 to 2010. Patients were screened using white light illumination (standard of care) followed by tissue reflectance and autofluorescence illumination. Results were compared with biopsy results or follow‐up screening.

Results

Violet light had a specificity (Sp) of 67% and a sensitivity (Sn) of 79%, which was comparable with standard of care (white light) examinations (67% Sp and 86% Sn). Amber light had poor specificity (0%) and good sensitivity (83%). The positive and negative predictive values for standard white light examination (15% and 96% respectively) were superior to both violet and amber light. For patients presenting with new lesions (n = 10), tissue reflectance (60% Sp, 83% Sn) and autoflourescence (50% Sp, 75% Sn) were inferior to standard white light examination (100% Sp and Sn).

Conclusion

Standard clinical lighting has a higher sensitivity than tissue reflectance and autoflourescence visualization for detection of disease in new patients or those with a history of HNC. This study does not support the added costs associated with these devices.
Culture of Human Septal Chondrocytes in a Rotary Bioreactor
Authors: Reuther Marsha S. , Briggs Kristen , Schumacher Barbara , Watson Deborah , Masuda Koichi , Sah Robert L.
Published: September 2011

Objective

1) Show that extracellular matrix deposition is possible in 3‐dimensional culture of human septal chondrocytes cultured in a rotary bioreactor as well as in static conditions. 2) Demonstrate that the biomechanical properties of human septal chondrocytes cultured in a bioreactor and static culture amplify with time.

Method

Human septal chondrocytes from 9 donors were expanded in monolayer and seeded in alginate beads. The beads were cultured in a rotary bioreactor for 21 days in media supplemented with growth factors and human serum, using static culture as the control. Biochemical and biomechanical properties of the beads were measured.

Results

Glycosaminoglycan (GAG) accumulation significantly increased during 2 measured time intervals, 0 to 10 days and 10 to 21 days (P <. 01). No significant difference was seen between the static and bioreactor conditions. However, substantial type II collagen production was demonstrated in the beads terminated at day 21 of culture in both conditions. In addition, the biomechanical properties of the beads were enhanced at 21 days in comparison with beads from days 0 and 10.

Conclusion

Human septal chondrocytes cultured in alginate beads exhibit significant matrix deposition and improved biomechanical properties after 21 days. Enhanced matrix deposition during bead culture will expectantly lead to formation of neocartilage that is comparable with native tissue. Matrix production in beads is supported by the use of a rotary bioreactor.
Business Case for Pretreatment Swallowing Exercises
Authors: Focht Kendrea Layne , Simpson Kit , Martin‐Harris Bonnie
Published: September 2011

Objective

Construct a decision analysis model to 1) estimate the incremental cost‐effectiveness ratio (ICER) of pretreatment swallowing exercises to posttreatment swallowing exercises, and 2) propose a clinical decision‐making tool to reduce head and neck cancer treatment‐related morbidity.

Method

A transition state model was constructed to estimate the ICER of pretreatment swallowing exercises in 100 hypothetical patients with HNC treated with chemoradiation. Quality of life estimates were obtained through convenient sampling. Costs were estimated from Medicare reimbursement data. Sensitivity analyses evaluated changes in efficacy, utilities, and costs.

Results

Pretreatment swallowing exercises were less costly and resulted in a greater gain in quality‐adjusted life‐years (QALYs) when compared with posttreatment swallowing exercises. Compared with standard practice of providing posttreatment swallowing exercises, the pretreatment exercise intervention provides a dominant ICER of $142,972 and 15.88 QALYs per 100 patients. Sensitivity analysis adjusting both costs and utilities had minimal impact on these results as the ICER continued to be dominant, which suggests that pretreatment swallowing exercises are more effective and less expensive than posttreatment swallowing exercises.

Conclusion

Pretreatment swallowing exercises offer a clinical benefit in patients treated with chemoradiotherapy for head and neck cancer with significant cost savings relative to current standard of care. Findings from this analysis result in a useful decision‐making tool for clinicians regarding prophylactic swallowing exercises to reduce treatment‐related morbidity.
Central Neck Compartment Metastases in Tall‐Cell Variant of Papillary Thyroid Cancer
Authors: Roman Benjamin R. , Opher Elana , Har‐El Gady , Carew John
Published: September 2011

Objective

Recent American Thyroid Association (ATA) guidelines suggest a role for prophylactic central neck dissection in patients with papillary thyroid cancer (PTC). No studies directly address this subject in patients with the tall‐cell‐variant (TCV) of PTC. We sought to determine the risk of metastasis to the central compartment in patients with TCV.

Method

A retrospective review was performed of all cases of papillary thyroid cancer undergoing primary surgical therapy with central neck dissection (CND) at our institution from 2007‐2010. Charts were reviewed for demographic data, and pathology was reviewed for tumor histology, size, multi‐focality, CND positivity, and extra‐thyroidal extension (ETE).

Results

A total of 63 patients with PTC underwent primary surgical therapy with CND, 10 of whom had TCV. Five of the TCV patients had positive nodes (50%), whereas only 18 of the 53 classical PTC had positive nodes (34%). TCV tumors were significantly larger than PTC tumors (1.8 cm 1.2 cm, P <. 005). In both groups, a larger tumor size correlated with a significantly higher incidence of positive CND (P <. 05 for TCV, and P <. 01 for PTC). In the PTC group, ETE correlated with significantly higher incidence of positive CND (P =. 001). Patients’ age and tumor multi‐focality did not correlate with increased positive CND in either group.

Conclusion

Central compartment metastases occurred in 50% of TCV and 34% of classical PTC. This may be due to the fact that TCV tumors presented with a significantly larger size when metastases were already present. The findings of this study support the ATA recommendation for CND in patients with TCV.
Circulating Tumor Cells in Head and Neck Squamous Cell Carcinoma: Evaluation of a Novel Method
Authors: Baker Jeffrey C. , Ducatman Barbara , Rassekh Christopher H.
Published: September 2011

Objective

The primary objective of this project is to determine if circulating tumor cells (CTCs) are identifiable in peripheral blood from patients with advanced head and neck squamous cell carcinoma using a commercially available semi‐automated technique.

Method

Prior to treatment, adult patients with advanced Head and Neck Squmous Cell Carcinoma had whole peripheral blood drawn and analyzed using the CellSearch Epithelial CTC kit. The target molecules of the system include EpCAM and cytokeratins 8, 18, and 19.

Results

There was a total of 18 patients with additional positive and negative controls. The average age was 65 years and 61% of the population was female. Primary tumor sites were varied with 39% laryngeal, 33% pharyngeal, 22% oral cavity, and 6% cutaneous. The majority of patients, 78%, had stage IV disease at the time of evaluation. The positive control, SCC‐1483, identified over 305 CTCs. There were no CTCs identified in clinical samples.

Conclusion

HNSCC cells are detectable using the CellSeach system, as evidenced by the positive control. Despite testing a population with advanced disease, the system failed to detect a CTC in a clinical sample. Therefore, the system is not a sensitive technique for identifying CTCs in HNSCC.
Clinical Usefulness of Harmonic Scalpel in Free Flap
Authors: Baek Chung‐Hawn , Byun Hayoung , Ki Chung Man , Park JuYeon , Son Young‐lk
Published: September 2011

Objective

Assess the efficacy and safety of ultrasound‐powered shears (Harmonic Scalpel) in free flap elevation for head and neck defects.

Method

From January to August 2010, there were 15 patients enrolled, who underwent reconstructive surgery with free flap in our institution. Donor sites were radial forearm in 10, anterolateral thigh in 5, and fibula in 2. HS was used in harvesting the perforators and the vascular pedicles.

Results

All the free flaps were successfully harvested within 50 to 70 min (from skin incision to pedicle ligation). Bleeding was minimal even without tourniquet application. All vascular pedicle dissections were performed without mechanical or thermal damages, and they were anastomosized to proper, recipient vessels.

Conclusion

Based on our experiences, HS is a safe and efficient instrument in harvesting the free flaps, especially because of no increased risk of thermal damage to vascular pedicle.
Collateral Tissue Destruction with the Harmonic Scalpel vs the Coblator Wand: How Does This Affect Tumor Resection Margins?
Authors: Siva Thiru , Gurr Paul A. , MacKeith Samuel A.
Published: September 2011

Objective

Oncological surgical technological innovation has produced alternative hemostatic dissection techniques. Collateral tissue destruction and impact upon assessment of tumor resection margins from Harmonic and Coblation dissectors remains unknown. This study uses an ex‐vivo animal model to quantify the collateral tissue destruction caused by the harmonic scalpel vs coblator wand dissection.

Method

Incisions through cow tongue were made between defined parallel lines with each dissection technique. The residual tissue width was measured with vernier calipers and subtracted from the width of original tissue. A scalpel blade was used as a control.

Results

The mean width of collateral tissue destruction for each modality was as follows: harmonic cutting 3.0 mm, harmonic coagulating 4.1 mm, coblation cutting 3.5 mm, harmonic cutting under tissue tension 1.2 mm.

Conclusion

This study demonstrates that tissue destruction produced when using the harmonic scalpel and coblation is significant when compared to cold steel dissection. The findings of this study should be borne in mind when using the harmonic scalpel and coblation in oncological surgery and making decisions regarding postoperative adjuvant therapy.
Complication Rates for Radiologically Inserted Gastrostomy in Head and Neck Cancer Inpatients
Authors: Kulendra Kevin , Butler Colin , Sherman Jennifer , Clarke Peter
Published: September 2011

Objective

Identify complications of Radiologically Inserted Gastrostomy (RIG) insertion and factors contributing to complication rates, including the grade of radiologist, forms of treatment, and time from RIG insertion to onset of complications.

Method

A retrospective audit was performed on head and neck cancer inpatients undergoing RIG insertion between 2007 and 2008. A case note review analyzed the type and timing of complications. A change in clinical practice was introduced by delaying RIG suture removal from 3 to 7 days. Complication rates were re‐audited from 2009 to 2010.

Results

A total of 63 RIG insertions were performed on 56 inpatients (13 surgical and 50 oncological). Major and minor complication rates were 7.9% (n = 5) and 63.4% (n = 40), respectively. Minor complications in surgical patients were significantly higher (P =. 02) than oncological cases (92.3% vs 56%). Average time onset for major complications was 2 ±1 days (±SD) and for minor complications was 27 ±35 days. There were no deaths. Tube dislodgement was the most common minor complication, and preliminary data from re‐audit demonstrates improved rates following the change in timing of suture removal.

Conclusion

We report no differences in major complications. High rates of minor complications were noted. This may be due to the tube type or size utilized. Subgroup differences may be accounted for by timings in RIG placement. The rates of tube dislodgement were reduced by leaving stay sutures in for longer.
ENT Service Compliance to United Kingdom Targets for Suspected Cancers
Authors: Chan John , Rashid Mamun
Published: September 2011

Objective

The NHS Cancer Plan sets out a 2‐week maximum wait for out‐patient appointments for suspected cancers. The NHS Improvement Plan sets an 18‐week limit from referral to treatment for noncancer cases. Research on evaluation of adherence to these targets is lacking, and we therefore present data to address this issue.

Method

An audit was performed at a local GP practice over a 4‐month period. EMIS database was used to retrieve correspondence with commissioned ENT services. Date of referral, clinic attendance, type of investigations, and date of first definitive treatment were observed. Standards for the 2‐week and 18‐week target are both 100%.

Results

n = 31.97% (30/31) were compliant with the “2‐week rule.” Only 42% (13/31) were compliant with the 18‐week pathway. Of the cases that breached the 18‐week pathway, 56% (10/18) were pending clinic, 33% (6/18) investigations and 11% (2/18) treatment.

Conclusion

Despite extensive frameworks formulated by the Department of Health for tackling waiting times, our data suggest that the local ENT services are not in compliance with the 2‐week or 18‐week standards. There is need for wider debate and national review.
Adapting Quality Assurance Principles to Open Structure Rhinoplasty
Authors: El‐Guindy Ahmed S.
Published: September 2011

Objective

Evaluate the methodology and outcome of open structure rhinoplasty after adapting Quality Assurance (QA) principles during planning, surgery and follow‐up. Quality assurance broadly means conforming to standards, meeting customer expectations and fulfilling consumer satisfaction.

Method

Retrospective study was conducted on 82 patients who underwent open structure rhinoplasty. Patient expectation was measured by comparing preoperative virtual image with the postoperative real one. Patient satisfaction was measured by validated procedure‐specific Quality‐of‐Life questionnaires. Conforming to standards was evaluated through assessing aesthetic measures and functional parameters.

Results

A total of 91.4% of the surgeries met patient expectations while 93.3% fulfilled patient satisfaction. A total of 85.4% of cases conformed to aesthetic nasal measures while 92.7% to functional clinical parameters.

Conclusion

Adapting QA principles to rhinoplasty allowed standardization of methodology and assessment of results in precise and accurate manner. It enhances education through defining norms, analyzing variants, addressing deviations, and better planning through proper selection of techniques and customized sequencing of steps. It allowed achievement of preoperative goals effectively and efficiently.
Prognostic Factors of Limited T1‐2N0‐1 Oropharyngeal Cancers
Authors: Psychogios Georgios , Waldfahrer Frank , Mantsopoulos Konstantinos , Iro Heinrich , Zenk Johannes , Koch Michael
Published: September 2011

Objective

Nonsurgical therapies, which utilize combinations of chemotherapy and radiotherapy, have become popular treatments for early oropharyngeal carcinomas (OPC). The aim of this study is to analyze the outcome of primary definitive surgical management of patients with limited OPC and assess the influence of various prognostic factors in survival.

Method

A retrospective study was conducted between 1980 and 2007. A total of 266 surgically treated patients were included. The endpoints for the analysis were disease‐specific survival (DSS) and local control (LC), with respect to T‐ and N‐classification, status of margins, tumor depth, and type of treatment. Major complications were documented.

Results

Overall 5‐year DSS was 89.9% and LC 93.3%. The univariate analysis showed a significant difference in DSS between pT1 and pT2 OPC (DSS 94.0% vs 81.2%, P =. 008) and patients with tumor depth greater than 5 mm (DSS 94.5% vs 78.9%, P =. 031). No difference could be found according to N‐stage, marginal status, HPV status, type of treatment, and adjuvant radiotherapy. Multivariate analysis showed that T‐stage (HR = 2.49, 95% CI = 1.243‐4.974, P =. 01) and tumor depth (HR = 2.88, 95% CI = 1.055‐7.865, P =. 039) were independently associated with DSS. Incidence of major complications was 8% and mortality rate 0.7%.

Conclusion

Primary surgical treatment is a very effective therapy against limited OPC independent to the surgical technique used. A low complication and mortality rate was documented. Patients with tumor depth of more than 5 mm have a significant worse survival and should be considered for adjuvant radiotherapy.
Role of Lymphocytic Thyroiditis in Metastasis of Papillary Thyroid Carcinoma
Authors: Paulson Lorien M. , Shindo Maisie L. , Schuff Kathryn
Published: September 2011

Objective

The role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) is unclear. Studies have failed to demonstrate correlation of CLT with lymph node metastases (LNM) in part due to lack of standardized central lymph node dissection (CND). We investigate the incidence of LNM in specimens with CLT.

Method

All OHSU patients who underwent total thyroidectomy with comprehensive ipsilateral CND for PTC between 2005 and 2010 were included. All specimens underwent genomic mutation analysis using a panel of known mutations. Reports were reviewed for tumor type, presence of lymphocytic thyroiditis, extracapsular extension, angiolymphatic invasion, and nodal metastasis.

Results

A total of 139 patients met the selection criteria for this study. The overall rate of chronic lymphocytic infiltrate was 43.8%. The overall rate of central node positivity was 63%. There was a significantly higher proportion of central node positivity in the non‐CLT patients (74% vs 49%, P =. 003). There was also a higher rate of angiolymphatic invasion in the non‐CLT patients (31% vs 15% P <. 05). There was no significant difference in mean age, tumor size, and extracapsular extension. Molecular genotyping did not reveal a significant difference in the types of mutations found in both groups.

Conclusion

Our data indicates a lower incidence of LNM in those with CLT (P =. 003), suggesting a potential protective role in tumor spread. The equal distribution of mutations in tumors with and without CLT argues against mutation‐specific inflammation. Further research is needed to characterize the role of autoimmunity in thyroid cancer.
Selective Neck Dissection in Node Positive Squamous Cell Carcinoma of Head and Neck
Authors: Givi Babak , Linkov Gary , Shah Jatin P. , Wong Richard J. , Kraus Dennis H. , Singh Bhuvanesh , Linkov Gary , Shaha Ashok R.
Published: September 2011

Objective

Optimal type of neck dissection in head and neck squamous cell carcinoma HN(SCC) with clinically positive neck nodes has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients.

Method

HNSCC patients with cervical lymph node metastases who were treated with SND in a single institution from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, prior and adjuvant treatments, locoregional control and survival were recorded. Recurrence in the neck and disease‐specific survival (DSS) were primary and secondary endpoints.

Results

A total of 130 patients underwent SND. A total of 84 (65%) were male. Median age was 62 years (range, 20‐89 years). Most common primary site was oral cavity (64%). Twenty‐one patients (16%) had prior treatments, 107 (82.3%) received adjuvant treatment. Median follow‐up was 21 months. Fifteen patients (11.5%) had recurrence in dissected neck. Five‐year neck recurrence‐free survival (NRFS) was 82.5%. N2C disease patients had shorter NRFS (5‐year: 64%). At the end of study 75 (58%) patients had NED and 32 (25%) had died of disease. Five‐year DSS was 70%. Number of positive nodes, positive surgical margins, and perineural invasion were predictors of shorter DSS.

Conclusion

Selective neck dissection in patients with cervical lymph node metastases from head and neck SCCs is effective in controlling the disease in the neck, when performed in the setting of multi‐modality treatment including post operative radiotherapy.
Sentinel Lymph Node Biopsy for Desmoplastic Melanoma: Not a Given
Authors: Eppsteiner Robert W. , Swick Brian , Milhem Mohammed , Pagedar Nitin A.
Published: September 2011

Objective

1) Determine the frequency of positive sentinel lymph node biopsy (SLNB) and characteristics predictive of positivity in a population of patients with desmoplastic melanoma of the head and neck. 2) Assess the utility of SLNB by determining the survival benefit and negative predictive value (NPV) of SLNB.

Method

Using the Surveillance, Epidemiology, and End Results (SEER) database, 467 patients with cutaneous desmoplastic melanoma of the head and neck were identified between 2003 and 2007 (years with reliable SLNB data). Frequency of nodal positivity, survival, and NPV of SLNB were determined.

Results

A total of 467 cases of desmoplastic melanoma were identified, of which most were locally advanced (mean Breslow depth 3.5 mm, 96% Clark level 4 or deeper). Few had regional lymph node metastases (3.4%) or distant spread (3.2%). A total of 165 patients had SLNB of which 4.8% had positive regional lymph nodes (NPV 98.5%). Breslow depth, ulceration, age, and sex were not predictive of positive SLNB. Patients who had SLNB did not have different disease‐specific survival from those who did not undergo SLNB.

Conclusion

Despite the high accuracy of SLNB, this procedure should be undertaken with caution in patients with cutaneous desmoplastic melanoma of the head and neck, given the low propensity for lymphatic spread (3.4%), possibility of complications, and questionable disease‐specific survival benefit.
Sialendoscopy in the Treatment of over 900 Sialoliths
Authors: Zenk Johannes , Klintworth Nils , Bozzato Alessandro , Iro Heinrich , Koch Michael
Published: September 2011

Objective

Minimally invasive techniques have an increasing relevance for the treatment of sialolithiasis of the parotid and submandibular glands. Sialendoscopy can be used as both a diagnostic and therapeutic tool.

Method

Retrospective data analysis for patients with a sialolithiasis of the parotid and submandibular glands who were treated between 2002 and 2008.

Results

A total of 206 patients were treated because of sialolithiasis of the parotid gland, 98 (48%) by interventional endoscopy alone, and 108 (52%) by combined procedures. Patients with submandibular disease (736) were treated endoscopically alone in 7.5% (55); 92.5% (681) received a combined treatment together with sialendoscopy. The follow‐up showed that 93% of the patients treated with endoscopy alone were free of symptoms. In the combined group 90% and 79% of the patients with sialolithiasis of the submandibular glands and parotid glands respectively were free of symptoms.

Conclusion

Sialendoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis. It can be effectively used therapeutically as a single treatment option, and it improves the combined techniques. As a single treatment it plays a very important role in parotid gland stones.