bluuebunny/crossref_metadata_2025 huggingface dataset:
Viability of Crushed and Diced Cartilage Grafts Wrapped in Oxidized Regenerated Cellulose and Esterified Hyaluronic Acid: An Experimental Study
Authors: Kazikdas Kadir Cagdas , Ergur Bekir , Tugyan Kazim , Guneli Ensari , Kaya Durdane , Sahan Murat
Published: February 2009

Objectives: The objective of this study was to investigate the viability of diced/crushed cartilage grafts wrapped in esterified hyaluronic acid (HYAFF) and oxidized regenerated cellulose (Surgicel) with respect to macroscopic and microscopic parameters.

Study Design: Experimental study.

Methods: A total of 10 New Zealand rabbits were acquired for the study. Cartilage grafts were harvested from both ears, with the ventral and dorsal perichondrial layers dissected off. There were six comparison groups in this experimental study: 1) bare, diced cartilage, 2) diced cartilage wrapped in Surgicel, 3) diced cartilage wrapped in HYAFF, 4) bare, crushed cartilage, 5) crushed cartilage wrapped in Surgicel, 6) crushed cartilage wrapped in HYAFF. Six cartilage grafts were inserted into the six subcutaneous pockets of the same animal. All the rabbits were sacrificed at the end of 2 months, the samples were collected, and the total specimen was examined histopathologically. The sections were stained with hematoxylin‐eosin and Masson trichrome stain and examined under light microscopy.

Results: There was a significant difference among the bare, diced cartilage, the Surgicel, and the HYAFF groups with respect to fibrosis, chronic inflammation, cartilage mass, and vascularization. A significant difference was observed among the bare, crushed cartilage, Surgicel, and HYAFF groups with respect to fibrosis, chronic inflammation, and cartilage mass. There was no significant difference among the three groups regarding vascularization.

Conclusions: This study suggests that wrapping cartilage grafts with Surgicel grossly reduces cartilage viability and the regeneration potential of the chondrocytes, leading to fibrosis formation. On the other hand, hyaluronic acid promotes cartilage integrity and survival, thus increasing clinical predictability and avoiding the need for overcorrection.
Minimally Invasive Single‐Stage Multilevel Treatment for Obstructive Sleep Apnea/Hypopnea Syndrome
Authors: Friedman Michael , Lin Hsin‐Ching , Gurpinar Berk , Joseph Ninos J.
Published: February 2009

Objectives: To assess subjective and objective improvement after single‐stage multilevel minimally invasive treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS).

Study Design: A retrospective review of a prospective dataset of patients treated in a tertiary care referral center.

Methods: Charts of 145 patients with mild/moderate OSAHS treated with a single‐stage multilevel minimally invasive technique were reviewed to abstract pre‐ and posttreatment symptoms and polysomnographic data. One hundred twenty‐two patients had minimum follow‐up of 6 (range, 6–23) months and complete data available for analysis. All patients studied had three‐level treatment that included nasal surgery, palatal stiffening by Pillar implant technique, and radiofrequency volume reduction of the tongue base. Primary outcomes included change from baseline in apnea/hypopnea index (AHI). Secondary outcomes included change in Epworth Sleepiness Scale (ESS) and bed‐partner assessed snoring visual analogue scale (VAS, 0–10), pain levels, narcotic use, and complications.

Results: Mean AHI decreased from 23.2 ± 7.6 preoperatively to 14.5 ± 10.2 postoperatively (P < .0001). Classical “cure” was achieved in 54 (47.5%) patients. Mean ESS decreased from 9.7 ± 3.9 preoperatively to 6.9 ± 3.3 postoperatively (P < .0001). Mean snoring VAS decreased from 9.4 ± 0.9 preoperatively to 3.2 ± 2.4 postoperatively (P <. 0001).

Conclusion: Polysomnographic respiratory parameters, ESS, and snoring VAS significantly improved in patients with mild/moderate OSAHS treated with single‐stage multilevel minimally invasive surgery. Multilevel minimally invasive single‐stage surgery is a valid option for selected patients with mild/moderate OSAHS with the understanding that they may require secondary treatment.
Caveolin‐1 Inhibits the Growth of Human Laryngeal Squamous Cell Carcinoma and Down Regulates EGFR‐MAPKs Signaling Pathway
Authors: Gu Donghua , Li Hua , Wang Zhen , Chen Qi , Jiang Jack , Zhu Hongguang
Published: February 2009

Objective: To investigate the effects of caveolin‐1 on the growth of laryngeal squamous cell cancer HEp2 cell line in vitro and in vivo.

Methods: The caveolin‐1 gene was introduced into HEp2 cells and stable over‐expressing caveolin‐1 clones were obtained. In vitro and anchorage‐independent growth rates were measured by methyl thiazolyl tetrazolium (MTT) and colony formation in soft agar assay, respectively. Flow cytometry was used to analyze the cell cycle and apoptosis. Activities of extracellular signal‐regulated kinase 1/2 (Erk1/2) and epidermal growth factor receptor (EGFR) were determined by Western blot analysis, and the interaction between EGFR and caveolin‐1 was determined by coimmunoprecipitation assay. The effect of caveolin‐1 on the tumor growth in vivo was tested by tumorigenicity assay in nude mice.

Results: Stable over‐expressing caveolin‐1 clones, namely HEp2‐CAV1‐2 and HEp2‐CAV1‐3, exhibited a slower rate of growth in vitro and reduced capacity of anchorage‐independent growth. In addition, over‐expression of caveolin‐1 resulted in a cell cycle arrest in the G0/G1 phase and increased the apoptotic cell fraction by 3.86‐fold and 3.71‐fold in HEp2‐CAV1‐2 and HEp2‐CAV1‐3 cells. Compared with the parental HEp2 cells, the phosphorylation of EGFR and Erk1/2 was reduced by 66% and 83% in HEp2‐CAV1‐2 cells and by 58% and 78% in HEp2‐CAV1‐3 cells, respectively; an interaction between EGFR and caveolin‐1 was observed. Moreover, over‐expression of caveolin‐1 in HEp2 cells significantly reduced the probability of tumor formation in vivo.

Conclusion: Caveolin‐1 inhibits the growth of human laryngeal squamous cell carcinoma HEp2 cell line in vitro and in vivo. Downregulation of EGFR‐mitogen‐activated protein kinase signaling pathway may be critical for understanding its mechanism of tumor suppression.
Assessing Penetration and Aspiration: How Do Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing Compare?
Authors: Kelly Annette M. , Drinnan Michael J. , Leslie Paula
Published: February 2009

Objectives/Hypothesis: We aimed to investigate whether the type of dysphagia examination (fiberoptic endoscopic evaluation of swallowing [FEES] or videofluoroscopy) influences the scoring of penetration and aspiration.

Study Design: Prospective, single‐blind study.

Methods: Fifteen dysphagic participants were recruited and underwent one FEES and one videofluoroscopy examination, performed and recorded simultaneously. Fifteen independent raters from 12 centers scored penetration and aspiration from recordings using the Penetration Aspiration Scale. Raters were blind to participant details, the pairing of the FEES and videofluoroscopy recordings, and the other raters' scores. Interrater and intrarater reliability were analyzed using weighted kappa.

Results: The Penetration Aspiration Scale scores were significantly higher for the FEES recordings than for the videofluoroscopy recordings (ANOVA P < .001). The mean difference between the FEES and videofluoroscopy penetration aspiration scores for the same swallows was 1.15 points. Interrater and intrarater reliability ranged from 0.64 to 0.79 (weighted kappa).

Conclusions: Penetration aspiration is perceived to be greater (more severe) from FEES than videofluoroscopy images. The clinical implications are discussed.
The Supraglottic Nerve Supply: An Anatomic Study With Clinical Implications
Authors: Olthoff Arno , Schiel Rolf , Kruse Eberhard
Published: February 2009

Objectives: To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions.

Methods: In 30 normal human hemilarynges, the SLN with its internal (intSLN) and external branch (extSLN) were dissected under microsurgical conditions and marked with acrylic dye. All anatomic structures of the larynges (muscles, cartilages, and ligaments) were dissected in detail.

Results: The intSLN subdivides into three branches. The superior branch (I) runs to the lingual (extralaryngeal) part of the epiglottis and sends small fibers through the epiglottic foramina to the laryngeal surface. The middle branch (II) runs through the aryepiglottic fold into the ventricular fold, and the inferior branch (III) to the piriform sinus and to the postcricoid region, forming various anastomoses (e.g., ansa galeni) with the recurrent laryngeal nerve (RLN). The extSLN runs to the cricothyroid muscle (CT) and sends a branch through the CT along the lower rim of the thyroid cartilage into the larynx and up to the ventricular fold. This ventricular branch is a potential candidate for the innervation of the ventricular muscle (VM).

Conclusions: Our results may contribute to a better understanding of supraglottic actions that provide primary functions of the larynx (such as swallowing, coughing, and breathing). An enhanced knowledge of neurolaryngology also provides a basis for interpreting disorders or paralyzes following surgical treatments (e.g., thyroid surgery, partial laryngectomy) and helps to lower the risks.
Visual‐Motor Integration Skills of Prelingually Deaf Children: Implications for Pediatric Cochlear Implantation
Authors: Horn David L. , Fagan Mary K. , Dillon Caitlin M. , Pisoni David B. , Miyamoto Richard T.
Published: February 2009

Objective: To investigate visual‐motor integration (VI) skills of prelingually deaf (PLD) children before and after cochlear implantation (CI) and investigate correlations with spoken‐language and related processing measures.

Design: Study 1 was a longitudinal study in which VI was tested preimplant. Study 2 was a cross sectional study of school‐age children who used a CI for >2 years.

Method: In study 1, a standardized design‐copying task was administered preimplant, and spoken‐language data were obtained at intervals up to 4 years postimplantation. Analyses were conducted to determine if preimplant VI scores were predictive of various spoken‐language measures. In study 2, standardized design copying and speeded maze tracing tasks were administered along with speech perception, vocabulary, and related processing measures.

Results: Whereas preimplant VI scores for children in study 1 fell within the typical range based on age‐equivalent norms, postimplant VI standard scores in study 2 were low compared to the normative sample. Postimplant VI scores were inversely related to age at implantation. Preimplant VI scores were robustly predictive of most, but not all, spoken‐language outcome scores. Postimplant design copying scores were also correlated with spoken‐language and related processing measures whereas maze‐tracing scores were less robustly related to these measures.

Conclusions: Early auditory and linguistic experience may impact the development of VI skills. VI is a preimplant predictor of later spoken language outcomes. Design copying and speeded maze tracing tasks appear to tap different sets of cognitive resources in PLD children with CIs.
Restoration of Eyelid Closure in Facial Paralysis Using Artificial Muscle: Preliminary Cadaveric Analysis
Authors: Tollefson Travis T. , Senders Craig W.
Published: February 2009

Objectives:Electroactive polymer artificial muscle is an emerging technology that has the potential to be used in rehabilitating facial movement in patients with paralysis. These electroactive polymers act like human muscles by expanding and contracting based on variable voltage input levels. The authors seek to establish a reproducible eyelid blink with artificial muscle. The aim of this proof of concept study is to determine whether eyelid closure can be created with a novel eyelid sling model.

Study Design:A human cadaver study was performed.

Methods:With use of four cadaver heads, an extended upper and lower blepharoplasty incision was used to secure an upper and lower expanded polytetrafluoroethylene implant in the medial orbital wall and tarsal plates. The slings were passed through a hole drilled in the lateral orbital wall or around a titanium screw. Lateral pull on the sling created eyelid closure, and the necessary distance of pull was measured.

Results:The eyelid sling mechanism functioned to achieve complete eyelid closure. Less tension was required for eyelid closure when the sling was placed in both eyelids (3 mm of pull instead of 6 mm).

Conclusions:The application of artificial muscle to a range of problems that affect both patient morbidity and quality of life is promising. Eyelid closure was created in a cadaver model using a novel sling, but future studies will need to address the feasibility of a prototype artificial muscle eyelid device in humans.
Comparison of Pullout Strength of Resorbable Screws and Titanium Screws in Human Cadaveric Laryngeal Cartilage
Authors: Windham B Pearson , Jordan J Randall , Parsell Doug E.
Published: February 2009

Objectives: To compare the pullout strength of titanium screws and resorbable screws from human fresh‐frozen cadaveric laryngeal cartilage. The importance of drill hole diameter, screw diameter, and whether the drill hole was tapped (resorbable screws only) was also determined.

Study Design: Prospective.

Methods: Sixteen cartilage specimens were tested after debridement of connective tissue and perichondrium. Linear pullout strength of screws was measured using a load cell. Titanium and resorbable screw sizes of 1.5 and 2.0 mm were tested using drill hole diameters of 1.1 and 1.5 mm. For the resorbable‐tapped group, screw diameters of 1.5 and 2.0 mm were tapped with 1.5 and 2.0 mm taps, respectively. All tested screws were 6 mm in length.

Results: We found a uniformly constant difference between the three screw types (P < .001). Post hoc analysis indicated a significant difference between the resorbable‐untapped screw and both the resorbable‐tapped screw and the titanium screw. We failed to find a significant difference, however, between the resorbable‐tapped screw and the titanium screw. We also found a significant effect in regard to screw size (P = .0133), with post hoc analysis demonstrating the 1.1/1.5 mm combination to be inferior to the 1.1/2.0 and 1.5/2.0 mm combinations. There was no significant difference between the 1.1/2.0‐ and 1.5/2.0‐mm combinations.

Conclusions: Resorbable screws with untapped drill holes result in higher resistance to linear loads than both titanium screws and resorbable screws with tapped drill holes. The 1.1/2.0‐ and 1.5/2.0‐mm drill/screw combinations are superior to the 1.1/1.5‐mm combination when considering untapped resorbable screws.
AM‐111 Reduces Hearing Loss in a Guinea Pig Model of Acute Labyrinthitis
Authors: Barkdull Gregory C. , Hondarrague Yannick , Meyer Thomas , Harris Jeffrey P. , Keithley Elizabeth M.
Published: February 2009

Objectives/Hypothesis: This study investigated the otoprotective properties of AM‐111, an inhibitor of c‐Jun N‐terminal kinase‐mediated apoptosis and inflammation.

Study Design: A controlled, prospective animal study using a guinea pig model of acute labyrinthitis.

Methods: Acute labyrinthitis was generated by injection of antigen into the scala tympani of sensitized guinea pigs. Treatment groups received 100 μL of AM‐111 at concentrations of 100 μmol/L, 10 μmol/L, and 1 μmol/L in a hyaluronic acid gel formulation delivered over the round window niche within 1 hour of antigen challenge. Cochlear function was monitored over 21 days with serial auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) measurements followed by histologic analysis.

Results: The ABR results on day 21 demonstrated that untreated control ears for acute labyrinthitis had a mean hearing loss (HL) of 68 ± 12 dB. In contrast, ears treated with AM‐111 (100 μmol/L) had a mean HL of 39 ± 31 dB. These two groups were statistically different (one‐way analysis of variance, P = .03). Secondary outcomes, including DPOAE shift, inner hair cell survival, inflammatory cell counts, and spiral ganglion density, were also statistically significant in favor of an otoprotective effect of AM‐111. Lower doses of AM‐111 did not produce a statistically significant reduction in HL over controls.

Conclusion: AM‐111 delivered over the round window membrane in a 100 μL hyaluronic acid formulation at a 100 μmol/L concentration immediately after induction of acute labyrinthitis in the guinea pig cochlea protects hearing, reduces hair cell loss, and reduces the number of inflammatory cells at 21 days after treatment.
Utility of History and Physical Updates for Ambulatory Otolaryngic Surgery
Authors: Lee Scott L. , Taliercio Salvatore , Ata Ashar , Clayton Jessica , Parnes Steven M.
Published: February 2009

Objectives/Hypothesis: Preoperative assessment is intended to identify anesthetic risk and a patient's appropriateness to undergo a proposed surgery. The timing of these assessments varies among institutions. In our ambulatory surgery center, preoperative reassessments were initially performed within 30 days of surgery (group A). Recently, this changed to require reassessments within 7 days of surgery (group B). Now, the policy mandates a preoperative reassessment within 24 hours (group C). We evaluate whether there are differences in surgical cancellations based on these new reassessment intervals.

Study Design: Retrospective operative log and chart review.

Methods: We identified 1,108 cases representative of group A. The rate of surgical cancellations for this group was compared with that of the 3,705 cases in group B and the 1,060 cases in group C. Differences were evaluated with a χ2 test.

Results: Total cancellation rates for groups A, B, and C were 3.0%, 3.3%, and 3.9%, respectively (P = .51). Cancellations secondary to a history and physical examination findings during these preoperative reassessment periods were 0.81%, 0.38%, and 0.66% for groups A, B, and C, respectively (P = .15).

Conclusions: Cancellation rates for patients undergoing ambulatory otolaryngic surgery based on preoperative reassessment intervals of 30 days, 7 days, and 24 hours were similar.
Collagen Fiber and Versican Distribution Within the Lamina Propria of Fetal Vocal Folds
Authors: Buhler Rogerio Borghi , Sennes Luiz U. , Mauad Thais , Melo Erich Christiano M. , Silva Luiz Fernando F. , Saldiva Paulo Hilário N.
Published: February 2009

Objectives: To analyze the presence and distribution of collagen fibers and versican in human vocal fold lamina propria of fetal larynges.

Study Design: Cross sectional analysis of cadaveric vocal folds of human fetuses.

Methods: Seven fetal larynges obtained from 28‐ to 36‐week‐old fetuses were analyzed with the Picrosirius‐polarization method, immunohistochemistry, and image analysis.

Results: Collagen fibers within the lamina propria exhibited a monolaminar distribution pattern and spatial arrangement in “wicker basket.” Versican distribution was larger in the superficial and intermediate layers when compared to the deep layer.

Conclusion: Our findings suggest that collagen and versican distribution and arrangement within the lamina propria in the developing fetus are important for vocalization at birth.
A Rational Approach to the Use of Tracheotomy in Surgery of the Anterior Skull Base
Authors: Ducic Yadranko , Zuzukin Vladimir
Published: February 2009

Objective: To offer an algorithm for airway management in anterior skull base surgery.

Methods: This is a retrospective review of 109 patients undergoing major anterior skull base surgery from a single senior surgeon's experience from September 1997 to May 2006.

Results: We report only one (1%) postoperative mortality in this series and only seven major complications in six patients, including two cases of stroke, one case of cerebrospinal fluid (CSF) leak, and four cases of delayed osteoradionecrosis. No patients in this series developed tension pneumocephalus. The total major complication rate is 6%. Fifty‐one (47%) patients received prophylactic tracheotomy, and 58 (53%) patients did not receive prophylactic tracheotomy. Eighty‐eight (81%) patients received anterior skull base reconstruction with local flaps. Six (5.5%) patients required primary reconstruction with a free flap.

Conclusion: We attribute the very low rate of major complications in this series and, in particular, no cases of tension pneumocephalus and rarity of CSF leaks primarily to prophylactic tracheotomy in selected patients and to a reconstructive strategy that emphasizes use of local vascularized tissue to reconstruct the anterior skull base.
Polydimethylsiloxane in the Human Vocal Fold: Description of Partial Explantation
Authors: Echternach Matthias , Delb Wolfgang , Wagner Mathias , Sittel Christian , Verse Thomas , Richter Bernhard
Published: February 2009

We describe here for the first time a partial explantation of polydimethylsiloxane in a patient 7 years after implantation caused by faulty positioning of the implant. The histopathologic examination demonstrated that the material that displayed green autofluorescence in hematoxylin‐eosin staining was biologically inert and stable. Major inflammatory reaction could not be ascertained.
Patient Compliance to Radiation for Advanced Head and Neck Cancer at a Tertiary Care County Hospital
Authors: Patel Urjeet A. , Thakkar Kunal H. , Holloway Nathaniel
Published: February 2009

Background: Combined chemotherapy and radiotherapy are routinely used to treat advanced‐stage head and neck squamous cell carcinoma (HNSCC). Patient compliance is often difficult given increased toxicities. Medically underserved or uninsured patients may lack the necessary support to complete such treatment.

Objective: To evaluate compliance to radiation therapy for patients with advanced stage HNSCC at an urban tertiary‐care county hospital.

Study Design: Retrospective review.

Methods: Data were extracted from the charts of 136 consecutive patients who had been advised to undergo chemoradiotherapy for newly diagnosed HNSCC from 2004 to 2006. Demographic and tumor‐related information was collected, as was patient compliance with radiation treatment. Total dose, length of treatment, and theoretical “loss of loco‐regional control” was calculated. Benchmark compliance data were obtained from select publications.

Results: Of 136 patients, 55 did not begin treatment or transferred care elsewhere, leaving 81 study patients. Twenty‐eight patients (35%) had unacceptable overall treatment courses. Forty‐eight patients (59%) received less than the effective dose of 65 Gy after accounting for missed treatment days. Fifty‐one patients (63%) had a greater than 10% calculated loss in loco‐regional control. Univariate and multivariate analysis yielded no predictive value for gender, ethnicity, node status, stage, or primary site on compliance.

Conclusion: Compared with other institutions, HNSCC patients in this setting are less likely to complete a prescribed therapeutic regimen. Patient and tumor characteristics measured in this study do not predict compliance. Organ preservation protocols require further evaluation in populations where compliance is suspect. Future research must examine interventions to improve compliance and assessment of its impact on survival.
Effects of Depression on Quality of Life Improvement After Endoscopic Sinus Surgery
Authors: Mace Jess , Michael Yvonne L. , Carlson Nichole E. , Litvack Jamie R. , Smith Timothy L.
Published: February 2009

Objectives/Hypothesis: To determine whether self‐ reported depression predicts lesser postoperative improvement in health‐related quality of life (HRQoL) after endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS).

Study Design: Prospective open cohort.

Methods: An adult (≥18 yr) cohort of 23 patients with depression and 79 patients without depression undergoing ESS were followed for 12 ± 2 months. Patient characteristics and computed tomography scores were examined preoperatively. Endoscopy scores and two HRQoL measures, the Rhinosinusitis Disability Index (RSDI) and Chronic Sinusitis Survey, were analyzed pre‐ and postoperatively. Univariate and multivariate analyses were used to evaluate outcome differences for patients with depression.

Results: There was a significantly higher prevalence of women (P = .002) and longer duration of follow‐up (P = .004) for the depressed subgroup. Depressed patients reported significantly lower pre‐ and postoperative HRQoL scores on all RSDI subscales (P < .05). Without baseline adjustment, depression was not associated with significant differences in postoperative change for disease‐specific HRQoL scores (P > .10) in multivariate analysis.

Conclusions: Depressed patients with CRS present similarly but have worse pre‐ and postoperative HRQoL scores and experience similar disease‐specific QoL improvements from sinus surgery compared with other CRS patients. Sinus surgery is not effective in alleviating the effect of depression on disease‐specific HRQoL, and it is likely that comorbid depression and CRS are operating on independent disease pathways. Additional research and hypothesis testing using continuous, objective measures is warranted.
Cochleovestibular Anomalies in Children With Cholesteatoma
Authors: Propst Evan J. , Blaser Susan , Trimble Keith , James Adrian , Friedberg Jacob , Papsin Blake C.
Published: February 2009

Objective: To describe the cochleovestibular apparatus on computed tomography (CT) imaging in patients with cholesteatoma. We asked whether cochleovestibular anomalies coexist in individuals with cholesteatoma.

Study Design: Randomized, controlled, prospective measurement.

Methods: A database search yielded 145 children with cholesteatoma: 31 met inclusion criteria by not having sensorineural hearing loss, not having an associated syndrome, and having digitally stored temporal bone CT imaging available. Prospective measurement of 31 individuals (62 ears) with unilateral cholesteatoma and 32 normally hearing nonsyndromic controls (64 ears) was performed by a neuroradiologist blinded to the study objective. Twenty‐six temporal bone aspects on axial imaging were evaluated (16 measurement, 10 calculated from measurement).

Results: The cholesteatoma group had a larger endolymphatic fossa and vestibular aqueduct, and there was a trend for the lateral semicircular canal vestibule to be smaller as compared with controls. Subgroup analysis revealed a gradient in prevalence of these findings being most common in the congenital cholesteatoma group, intermediate in the acquired cholesteatoma group, and least common in controls. There were no differences in measurements between ears with cholesteatoma and contralateral disease‐free temporal bones.

Conclusions: Children with cholesteatoma have abnormal vestibular anatomy. The gradient in prevalence of these findings may suggest a relationship between congenital and acquired cholesteatoma. These may include a generalized temporal bone anomaly that predisposes to cholesteatoma formation, or a third variable such as genetic mutation may predispose to both anomalous cochleovestibular formation and cholesteatoma.
Does Tumor Depth Affect Nodal Upstaging in Squamous Cell Carcinoma of the Head and Neck?
Authors: Alkureishi Lee W. T. , Ross Gary L. , Shoaib Taimur , Soutar David S. , Robertson A G. , Sorensen Jens A. , Thomsen Jorn , Krogdahl Annelise , Alvarez Julio , Barbier Luis , Santamaria Joseba , Poli Tito , Sesenna Enrico , Kovács Adorján F. , Grünwald Frank , Barzan Luigi , Sulfaro Sandro , Alberti Franco
Published: February 2009

Purpose: The aim of this study was to determine whether tumor depth affects upstaging of the clinically node‐negative neck, as determined by sentinel lymph node biopsy with full pathologic evaluation of harvested nodes including step‐serial sectioning (SSS) and immunohistochemistry (IHC).

Patients and Methods: One hundred seventy‐two patients with cT1/2 N0 squamous cell carcinoma (SCC) of the oral cavity/oropharynx undergoing primary resection and either sentinel node biopsy (SNB) or SNB‐assisted neck dissection as a staging tool for the cN0 neck. Harvested nodes were examined with hematoxylin‐eosin staining, SSS, and IHC. Patients upstaged by SSS/IHC were denoted pN1mi.

Results: One hundred one of 172 patients were staged pN0, with 71 (41%) patients upstaged. Increasing tumor depth was associated with higher likelihood of upstaging (P < .001). Tumor depth showed a positive correlation with nodal stage according to TNM classification (P < .001). Tumor depth greater than 4 mm appears to be the most appropriate cutoff for risk stratification, although tumors in the oropharynx may require a lower value.

Conclusion: Tumor depth is an important prognostic factor for patients with SCC of the oral cavity or oropharynx. Tumors greater than 4 mm are associated with greater risk of upstaging; however, this optimum cutoff value may vary between primary tumor sites.
Selective Neck Dissection (IIA, III): A Rational Replacement for Complete Functional Neck Dissection in Patients With N0 Supraglottic and Glottic Squamous Carcinoma
Authors: Ferlito Alfio , Silver Carl E. , Rinaldo Alessandra
Published: February 2009

Introduction: The purpose of this paper is to determine the optimal elective treatment of the neck for patients with supraglottic and glottic squamous carcinoma. During the past century, various types of necks dissection have been employed including conventional and modified radical neck dissection (MRND), selective neck dissection (SND) and various modifications of SND.

Materials and Methods: A number of studies were reviewed to compare the results of MRND and SND in regional recurrence and survival of patients with supraglottic and glottic cancers, as well as the distribution of lymph node metastases in these tumors.

Results: Data from seven prospective, multi‐institutional, pathologic, and molecular analyses of neck dissection specimens, obtained from 272 patients with laryngeal squamous carcinoma and clinically negative necks, revealed only four patients (1.4%) with positive lymph nodes at sublevel IIB. Data was also collected from three prospective, multi‐institutional, pathologic and molecular studies of neck dissection specimens which include 175 patients with laryngeal squamous carcinoma (only 2 with subglottic cancer) and clinically negative necks. Only six patients (3.4%) had positive nodes at level IV.

Conclusions: SND of sublevel IIA and level III appears to be adequate for elective surgical treatment of theneck in supraglottic and glottic squamous carcinoma. Dissection of level IV lymph nodes may not be justified forelective neck dissection of stage N0 supraglottic and glottic squamous carcinoma. Bilateral neck dissection incases of supraglottic cancer may be necessary only in patients with centrally or bilaterally located tumors.
A Novel Controlled Local Drug Delivery System for Inner Ear Disease
Authors: Paulson David P. , Abuzeid Waleed , Jiang Hao , Oe Tomoyuki , O'Malley Bert W. , Li Daqing
Published: February 2009

Purpose: Our goal is to develop a novel drug delivery system that can potentially improve clinical outcomes compared to current methods of dosing drugs such as dexamethasone or gentamicin. This system focuses on a single local application to the inner ear via the round window membrane.

Hypothesis: A chitosan‐glycerophosphate (CGP)‐hydrogel based drug delivery system can be engineered to provide local and sustained drug release to the inner ear.

Study Design: In vitro: drug release and (CGP)‐hydrogel matrix degradation were characterized using dexamethasone as a model drug. In vivo: dexamethasone laden CGP‐hydrogel was placed in the round window niche of mice. Perilymph samples were obtained from the oval window and analyzed for dexamethasone. The impact of CGP‐hydrogel on auditory function was evaluated.

Results: In vitro: A CGP‐hydrogel was designed to release 92% of the dexamethasone load over 4 consecutive days with concurrent degradation of the hydrogel matrix. In vivo: After surgical placement of CGP‐hydrogel to the round window niche, we detected elevated levels of dexamethasone in perilymph for 5 days. Auditory function testing revealed a temporary hearing loss in the immediate postoperative period, which resolved by the 10th postoperative day.

Conclusions: We report the development of CGP‐hydrogel, a biodegradable matrix that achieves local, sustained delivery of dexamethasone to the inner ear. There were no significant complications resulting from the surgical procedure or the administration of CGP‐hydrogel to our murine model.
Effect of Radiation Techniques in Treatment of Oropharynx Cancer
Authors: Rusthoven Kyle E. , Raben David , Ballonoff Ari , Kane Madeleine , Song John I. , Chen Changhu
Published: February 2009

Objectives: To compare the toxicity and outcomes of three radiotherapy techniques—three‐dimensional conformal (3D‐RT), accelerated fractionation with concomitant boost (AFxCB), and intensity modulated radiotherapy (IMRT)—in the combined modality treatment of stage III–IV squamous cell carcinoma (SCC) of the oropharynx.

Study Design: Retrospective review.

Methods: Between 1998 and 2007, a total of 87 patients were treated; 23 were treated with 3D‐RT, 32 with AFxCB, and 32 with IMRT. Systemic therapy consisted of platinum‐based chemotherapy in 81 and anti‐epidermal growth factor receptor (anti‐EGFR)‐targeted therapy in 6 cases. Median radiotherapy doses were 70Gy with 3D‐RT, 72Gy with AFxCB, and 69.3Gy with IMRT. Locoregional control, survival outcomes, and feeding tube (PEG) dependence were compared using log‐rank method. The incidence of acute mucositis and skin reaction, and grade ≥2 xerostomia at 6, 12, and 18 months after radiotherapy was compared using Fisher's exact test.

Results: Median follow‐up was 24 months (range 3 to 103 months) for living patients. Two‐year overall survival (OS), disease‐free survival (DFS), and locoregional control (LRC) were 77.3%, 69.5%, and 86.4%, respectively. There was a trend toward improvement in LRC in patients treated with IMRT. Acute grade ≥3 skin and mucosal toxicity were significantly lower with IMRT compared to AFxCB (P < .001). Grade ≥2 xerostomia was significantly reduced with IMRT compared to AFxCB and 3D‐RT (P < .001). There was no difference in the actuarial rate of PEG dependence (P = .96).

Conclusions: Compared to AFxCB and 3D‐RT, IMRT confers an improvement in toxicity and appears to have similar efficacy in patients with SCC of the oropharynx.
Clinical Implications of Anterolateral Thigh Flap Shrinkage
Authors: Ng Raymond W. M. , Chan Jimmy Y. W. , Mok Vivian , Leung Mark S. C. , Yuen Anthony P. W. , Wei William I.
Published: February 2009

Objective: To evaluate anterolateral thigh flap shrinkage after elevation and to develop a predictive model for flap design.

Method: A prospective study was conducted in a university teaching hospital. The skin islands from anterolateral thigh flaps were outlined on a transparent sheet before and after the reconstruction procedure. Dimensions of the stretched flaps were also recorded. These three outlines were scanned and the surface areas computed and compared by tracing and use of AutoCAD. Age, sex, flap dimension, and flap thickness were investigated for association with flap shrinkage.

Results: Forty‐five anterolateral thigh flaps harvested for head and neck soft tissue reconstruction after tumor resection were studied. Flap size ranged from 4 to 14 cm in width and 8 to 22 cm in length; flap area ranged from 30.6 to 151.0 cm2. On average, the flaps shrunk by 25.0% (6.2%–52.6%), a highly significant change (P < .01). Flap width and thickness correlated with the reduction in flap size. The average stretched‐flap area was 10.1% (0.4%–29.4%) less than the preflap area, a significant reduction (P < .01). The difference between stretched‐flap and preflap areas was independent of all variables. We developed a predictive model using a stepwise multiple linear regression method with a coefficient of determination of 0.495.

Conclusions: Anterolateral thigh flaps shrink after harvesting, and flap width and thickness are significant contributing variables. These findings indicate that flap size must take shrinkage into account to ensure sufficient coverage.
Sentinel Node Mapping for Node Positive Oral Cancer: Potential to Predict Multiple Metastasis
Authors: Matsuzuka Takashi , Kano Makoto , Ogawa Hiroshi , Miura Tomohiro , Tada Yasuhiro , Matsui Takamichi , Yokoyma Shuji , Suzuki Yasushi , Suzuki Masahiro , Omori Koichi
Published: February 2009

Objective: The objective of this study is to evaluate lymph node mapping for clinically positive neck metastasis using a sentinel node navigation technique.

Methods: 99mTc‐labeled rhenium sulfide was injected as a radiotracer in 10 patients with squamous cell carcinoma of the tongue. After surgery, lymph nodes were classified into two categories according to the radioactive accumulation: nodes with radioactivity and nodes without radioactivity. The ratio of the metastatic area (RMA) of pathologically metastatic lymph nodes was measured.

Results: In 5 of 10 cases, all of the metastatic nodes had radioactive accumulation. In one case with three metastatic nodes, radioactivity was not detected in one metastatic node, although it was detected in the other two nodes. In the other four cases, there were no radioactivities in any of the metastatic nodes. RMA of lymph nodes in which radioactivity was not detected was higher than that of lymph nodes in which radioactivity was detected. None of the nodes in which radioactivity was detected was fully occupied by metastatic carcinoma cells. In each case, in comparing the clinically positive lymph nodes, RMA of the nodes in which no radioactivity was detected was higher than that of the nodes in which radioactivity was detected.

Conclusion: The principle behind the sentinel node technique is detection of the node that has the most lymph flow from the tumor through injection of the tracer into the circumference of the tumor. When no radioactive accumulation is found in clinically positive metastatic lymph nodes, the possibility of metastasis to other lymph nodes should be highly suspected.
Novel Adenoviral Gene Delivery System Targeted Against Head and Neck Cancer
Authors: Li Daqing , Guang Wei , Abuzeid Waleed M. , Roy Soumitra , Gao Guang‐Ping , Sauk John J. , O'Malley Bert W.
Published: February 2009

Objectives: The clinical applicability of adenovirus‐mediated gene therapy is limited by the lack of tumor‐targeted strategies. Ubiquitous expression of the coxsackie‐adenovirus receptor, the native binding site for adenovirus, broadens viral tropism and increases systemic toxicity. Adenoviruses can be genetically engineered to target tumor‐specific cell surface biomarkers. Here, we present a novel recombinant adenovirus vector (Ad5‐Flag‐LDS) that demonstrated a marked targeting bias against Hsp47, a biomarker for head and neck squamous cell carcinoma (HNSCC).

Methods: Cell surface expression of Hsp47 was determined in six human HNSCC cell lines and in negative and positive control cells. Colocalization of LDS and Hsp47 was assessed by immunocytochemistry in Ad5‐Flag‐LDS‐transfected cells, and subsequent transgene expression was determined. The contribution of the Hsp47 biomarker in mediating targeted gene transfer was evaluated with a blocking assay. Ad5‐Flag‐LDS‐targeting efficacy in a mixed cell population was determined by immunofluorescence.

Results: HNSCC cells had significantly higher Hsp47 biomarker density than control cell lines. After Ad5‐Flag‐LDS transfection, significant colocalization was found between the LDS peptide and Hsp47 biomarker, indicating that viral entry occurred via Hsp47‐LDS binding. This unique tumor‐targeted entry feature significantly enhanced gene transfer relative to an untargeted adenoviral vector. Blockade of Hsp47 biomarkers abrogated transgene expression, indicating that Hsp47 has a dominant role in Ad5‐Flag‐LDS targeting. Ad5‐Flag‐LDS‐targeting selectivity was maintained in a cell mixture, producing greater transgene expression in Hsp47‐expressing cells.

Conclusions: The enhanced targeting achieved with Ad5‐Flag‐LDS highlights a potential strategy for clinically applicable targeted gene therapy against HNSCC or any tumor type expressing Hsp47.
Fabrication of a Neotrachea Using Engineered Cartilage
Authors: Weidenbecher Mark , Tucker Harvey M. , Awadallah Amad , Dennis James E.
Published: February 2009

Objectives: Surgical management of long‐segment tracheal stenosis is an ongoing problem. Many types of tracheal prostheses have been tried but with limited success because of immune rejection, graft ischemia, or restenosis. Tissue engineered cartilage may offer a solution to this problem, although scaffolds, which are currently often used for support, can lead to biocompatibility problems. This study investigated the feasibility of scaffold‐free cartilage to tissue engineer a vascularized neotrachea in rabbits.

Study Design: Animal study.

Methods: Autologous neotracheal constructs were implanted in the abdomen of six New Zealand white rabbits. Auricular chondrocytes were used to engineer scaffold‐free cartilage sheets. A muscle flap raised from the external abdominal oblique muscle and the engineered cartilage were wrapped around a silicone stent to fabricate a vascularized neotrachea in vivo. In two of the six rabbits, a full thickness skin graft was used to create an epithelial lining. The constructs were harvested after either 6 or 10 weeks.

Results: All neotracheal constructs were healthy with well‐vascularized and integrated layers. The implanted engineered cartilage underwent a remodeling process, forming a solid tracheal framework. Constructs harvested after 10 weeks proved to have significantly better mechanical properties than after 6 weeks and were comparable with the rabbit's native trachea.

Conclusion: Scaffold‐free engineered cartilage can successfully fabricate a well‐vascularized, autologous neotrachea with excellent mechanical properties. The results suggest that this approach can be used to reconstruct tracheal defects in rabbits.
Neck Hematoma Caused by Spontaneous Common Carotid Artery Rupture
Authors: Pazardzhikliev Dimitar Dimitrov , Yovchev Ilya Petkov , Zhelev Drago Dragov
Published: February 2009

We present a case of an 83‐year‐old male without previous history who presented with a cervical hematoma, initially misdiagnosed as a neck phlegmona. In the course of the diagnostic workup, the hematoma enlarged, thereby causing respiratory distress because of upper airway compromise. The endotracheal intubation was lifesaving. Later, contrast enhanced computed tomography revealed hematoma in the region of the left common carotid artery. Emergency surgery evacuated the hematoma and repaired a slit‐like defect of the left common carotid 2 cm before bifurcation. The patient was discharged on the seventh postoperative day in good condition. We discuss four aspects of the case, namely, the rarity of the condition and the variety of causes, the diagnostic and treatment strategy, the uncertain reasons for spontaneous ruptures of the carotid, and the operative techniques for hematoma evacuation and definitive hemostasis. The optimal strategy for cases of cervical hematoma is the following: intubation, diagnosis, and surgery.
Increased Nerve Fiber Expression of Sensory Sodium Channels Nav1.7, Nav1.8, and Nav1.9 in Rhinitis
Authors: Keh Siew M. , Facer Paul , Simpson Karen D. , Sandhu Guri , Saleh Hesham A. , Anand Praveen
Published: February 2009

Introduction: Voltage‐gated sodium channels Nav1.7, Nav1.8, and Nav1.9 are involved in nerve action potentials and have been proposed to underlie neuronal hypersensitivity. We have therefore studied their levels in allergic and nonallergic rhinitis.

Materials and Methods: Inferior turbinate biopsies from 50 patients (n = 18 controls, n = 20 allergic, and n = 12 nonallergic rhinitis) were studied by immunohistology using antibodies to Nav1.7, Nav1.8, and Nav1.9, the structural nerve marker (protein gene product [PGP]9.5), nerve growth factor (NGF), mast cells (c‐kit), macrophages (CD68), and T cells (CD3). Sodium channel‐positive nerve fibers were counted per millimeter length of subepithelium, and immunoreactivity for inflammatory cell markers PGP9.5 and NGF were image analyzed.

Results: All three sodium channel‐immunoreactive nerve fiber numbers were significantly increased in allergic (Nav1.7, P = .0004; Nav1.8, P = .028; Nav1.9, P = .02) and nonallergic (Nav1.7, P = .006; Nav1.8, P = .019; Nav1.9, P = .0037) rhinitis. There was a significant increase of subepithelial innervation (PGP9.5, P = .01) and epithelial NGF immunoreactivity (P = .03) in nonallergic rhinitis, comparable with our previous report in allergic rhinitis. Inflammatory cell markers were significantly increased in allergic (mast cells, P = .06; macrophages, P = .044; T cells, P = .007) but not nonallergic rhinitis.

Conclusion: The increased levels of sensory sodium channels in allergic and nonallergic rhinitis may contribute to the hypersensitive state, irrespective of the degree of active inflammation. Selective blockers of these sodium channels, administered topically, may have therapeutic potential in rhinitis.
Image‐Guidance for Endoscopic Sinus Surgery
Authors: Fried Marvin P. , Parikh Sanjay R. , Sadoughi Babak
Published: February 2009

Objectives/Hypothesis: Image‐guided surgery (IGS) is a critical tool. However, its clinical validity remains controversial. A review of indications and a consensus based on literature are presented.

Methods: Literature review.

Results: Traditional indications remain valid. Novel applications have emerged, and the reliability of IGS has been consistently endorsed. Although evidence is based on scattered reports and expert opinions, the use of IGS in approved instances is regarded as the state of the art.

Conclusions: IGS is reliable, and a scientific validation of outcomes would entail unethical strategies. An expanding spectrum of indications is anticipated, although IGS does not replace proper training.
Day Float: An Alternative to the Night Float Coverage System for Residency Programs
Authors: Suryadevara Amar C. , Zandifar Hootan , Guyer Marci , Kellman Robert M.
Published: February 2009

Objectives: The Accreditation Council for Graduate Medical Education (ACGME) has mandated an 80‐hour work week that has resulted in changes to many residency programs. In otolaryngology, most programs have switched to either home call or night float systems. Our department covers all of the maxillofacial trauma and backup airway calls, which has made it difficult to employ a home call system. Instead of a night float coverage system, our program implemented a day float coverage system that allows the residents to participate in a 24‐hour call period. After call and sign‐out, the residents go home; however, their clinical duties are covered by the day float resident.

Study Design: A brief review of the literature pertaining to call coverage systems followed by a description of our day float system. Residents who have participated in either night float, day float, or both systems were then surveyed regarding their experiences or perceptions of both systems.

Methods: A nine‐question survey was handed out to our otolaryngology residents and their responses were recorded.

Results: The averaged responses strongly favored the day float over the night float coverage system regardless of the level of training and the systems in which the residents have participated.

Conclusions: The day float coverage system is favored by residents in our program. It allows for a more attending‐like 24‐hour period of call, continuity of care, attendance at educational activities, and more time with family. In addition, it eliminates a prolonged period devoid of clinical activities.