bluuebunny/crossref_metadata_2025 huggingface dataset:
Resource Utilization in Primary Cleft Lip Repair
Authors: Owusu James A. , Liu Meixia , Sidman James D. , Scott Andrew R.
Published: February 2015

Objective

1) To estimate the current incidence of cleft lip in the United States and whether any regional variations exist. 2) To determine national variations in resource utilization in the primary repair of cleft lip and identify patient and institutional factors associated with increased resource use.

Method

Retrospective analysis of a national, pediatric database (2009 Kids Inpatient Database (KID)). Patients aged 1 year and below were selected using diagnoses codes for cleft lip and procedure codes for lip repair. A number of demographic variables were analyzed and hospital charges were considered as a measure of resource utilization.

Results

There were 1318 patients identified. Overall incidence nationwide was 0.09% with male to female ratio of 1.8:1. Regional incidence varied from 0.07% (Northeast) to 0.10% (West). The mean age at surgery was 4.2 months. The average length of stay was 1.4 days, with minimal regional variation. The average total charge nationwide was $20,147, ranging from $14,635 (South) to $23,663 (West). Average charge in a teaching institution was $9764 higher than for nonteaching institutions. The strongest predictor of charge was length of stay, increasing by $8102 for every additional hospital day (P <. 01).

Conclusion

Regional variations exist in resource utilization for primary cleft lip repair. Resource use is higher in the West and among teaching institutions. These results show that whiles length of stay is a key determinant of charge; other factors also play a role.
Rhabdomyosarcoma of Head and Neck in Children
Authors: Reilly Brian K. , Pena Maria T. , Kim Aerang , Choi Sukgi S.
Published: February 2015

Objective

Review the clinical presentation, histological subtypes, staging, treatment modalities, and survival rates for non‐orbital pediatric head and neck rhabdomyosarcoma (RMS).

Method

A retrospective chart review of patients treated from 1996 to 2011 for nonorbital primary head and neck RMS at a pediatric tertiary care center. Baseline demographics, clinical presentation, staging, histology, treatment modalities, and survival outcome were analyzed.

Results

Sixteen patients (7 M) were diagnosed with primary head and neck RMS, median age of 6.9 years (range, <1‐19 years). The majority of tumors were of parameningeal location (11/16). Fifty‐six percent (9/16) were metastatic at presentation (stage at diagnosis: 1, n = 1; 2, n = 2; 3, n = 4; 4, n = 9). Nine had skull base erosion and/or cranial nerve deficits. Ten patients had embryonal and sihad alveolar histology. Upfront resection gross resection was feasible in 4 patients (3 of which were non‐parameningeal), all with positive margins. All patients received chemotherapy combined with radiotherapy. Second look surgery was performed in 2 patients.

Conclusion

Most patients presented with advanced disease in our series. Majority were parameningeal, thus limiting the role to biopsy only. Primary excision for non‐paramenigeal RMS is ideal. The role of second look surgery after chemotherapy and radiation is still unknown; however, it was successful in 2 patients in our small review.
The National Tonsil Surgery Register in Sweden
Authors: Stalfors Joacim , Ericsson Elisabeth , Hemlin Claes , Hultcrantz Elisabeth , Roos Kristian , Sunnergren Ola , Hessen‐Söderman Lotta
Published: February 2015

Objective

The purpose of the National Tonsil Surgery Register is to compile outcome data with regard to tonsil surgery for description of the activities of respectively clinic, clinical improvement programs and research. The aim of this paper is to describe age, gender, indications with respect to surgical methods and techniques.

Method

All patients registered in the registry between March 2009 to January 2012 were analyzed with respect to demographics, indication for surgery, surgical method and surgical techniques. A total of 24,084 patients were registered, representing 62% completeness and 86 % coverage.

Results

The most common indication for tonsillar surgery was Z upper airway obstruction registered for 59% of the patients (median age, 5 years, 56% boys). The indicated infection‐ related symptoms were registered for 38% of the patients (median age, 19 years, 61% girls). The most commonly used surgical procedure for patients with obstruction were tonsillotomy + adenoidectomy (TT+A, 46%), tonsillectomy + adenoidectomy (TE+A, 23%), and tonsillectomy (TE, 20%). TE dominated for patients operated for infection‐related symptoms (89%). Regardless of indication TE and TE+A procedures were performed with cold steel (94%) while TT and TT+A was performed with radiofrequency techniques (97%).

Conclusion

In Sweden, tonsil surgery for obstructive symptoms are typically performed in preschool age with TT/TT+A and radiofrequency and affects more boys than girls. Tonsil surgery for infection‐related indications is typically performed in the late teens with TE using cold steel, and girls are affected more often.
Clinical Management of Invasive Fungal Sinisitis
Authors: Takahashi Hirotaka
Published: February 2015

Objective

Invasive fungal sinusitis (IFS) has increased in recent years with the use of steroids and onset of diabetes mellitus. The most frequently observed fungal sinusitis infections are typically associated with Aspergillus. Although most cases of fungal sinusitis are noninvasive, the infection occasionally develops into an invasive type, particularly in immunocompromised patients.

Method

Because of its progressive nature, IFS is a potentially fatal disease with a relatively high overall mortality rate. Once manifested, the fungus frequently involves the orbit of the eye and intracranial area. Although optimum treatment methodologies are still controversial, early diagnosis and treatment of the disease is generally accepted as essential to achieving a positive patient outcome. Several recent reports have claimed successful management of IFS by systemic administration of new anti‐fungal agents such as voriconazole, or combination therapy using debridement and anti‐fungal agents.

Results

Here, we report on the clinical features and outcomes of 4 patients with IFS involving the cavernous sinus and orbit. Prognostic factors facilitating an early diagnosis are described, and the usefulness of combination therapy involving systemic administration of anti fungal agents and surgical intervention is discussed. Strategic treatment employing both surgery and systemic administration of antifungal agents was performed in all patients. One patient with invasion into the cavernous sinus died of brain infarction. The remaining three patients are still alive.

Conclusion

Observations of patients in the present case study suggest that early diagnosis and strategic treatment may contribute to improvement in the prognosis of IFS.
Effects of a TNF‐α Antagonist on Rhinosinusitis Model
Authors: Yeo Sang‐Won , Bae Seong‐Cheon , Kim Dong‐Hyun , Jeon Eun‐Ju , Park Shi‐Nae , Park Kyoung‐Ho
Published: February 2015

Objective

Tumor necrosis factor (TNF) is an important mediator of inflammation and is produced by macrophages in response to stimuli such as bacterial lipopolysaccharide (LPS) and viruses. This study examined the effects of a TNF‐α antagonist on the LPS‐induced inflammatory response in the nasal cavity and sinus of rats.

Method

Experimental groups received an instillation of lipopolysaccharide (LPS) plus an intramuscular injection of amoxicillin/clavulanate (antibiotic group), an instillation of sTNFRI (sTNFRI group), an instillation of sTNFRI and an injection of amoxicillin/clavulanate (sTNFRI/antibiotic group), or no additional treatment (LPS group). Histopathological changes were determined using hematoxylin‐eosin and periodic acid‐Schiff (PAS) staining. Leakage of exudate was determined using fluorescence microscopy. Vascular permeability was measured using the Evans blue dye technique. Expression of MUC5AC was measured using reverse transcriptase PCR.

Results

The sTNFRI, antibiotic, and sTNFRI/antibiotic groups had significantly less capillary permeability, mucosal edema, PAS staining, and expression of MUC5AC than the LPS group. There were no differences in capillary permeability, mucosal edema, PAS staining, and MUC5AC expression between the sTNFRI and sTNFRI/antibiotic groups. The antibiotic group had PAS staining similar to that of the sTNFRI and sTNFRI/antibiotic groups but had a greater increase in capillary permeability, mucosal edema, and MUC5AC expression.

Conclusion

Intranasal administration of sTNFRI reduces inflammatory activity, including elevated microvascular permeability and tissue edema, and mucus hypersecretion, including production of mucosubstance and expression of MUC5AC, in LPS‐induced rhinosinusitis in rats. Results demonstrate that intranasal administration of sTNFRI reduces inflammatory activity and mucus hypersecretion in LPS‐induced rhinosinusitis in rats.
Impact of a Yearly Head and Neck Surgery Trip to Rural Kenya
Authors: Pearce Elizabeth C. , Mainthia Rajshri , Netterville James L. , Rohde Sarah L.
Published: February 2015

Objective

Surgical specialty trips to third world countries have been both praised and criticized for contributions to low‐resource regions. Our objective was to learn the impact of a yearly head and neck surgery trip through initial analysis of 2 years of patient data.

Method

Review of a prospectively maintained data repository cataloging surgical patients treated on a yearly head and neck surgical trip to Malindi, Kenya, during 2010 to 2011. Basic demographics, distance traveled for care, access to physicians, preoperative diagnosis, surgical procedure(s), and pathology results were recorded for each patient.

Results

In 2 years, 222 surgeries were performed. Age of patients ranged between 6 months and 85 years, and patient sex was evenly split. Half of the patients came from outside the town of Malindi, and a third traveled over 100 km for care. A total of 5.7% were known to be HIV positive. The majority reported access to a local physician, and two‐thirds were seen by one for their chief complaint, yet very few patients were offered prior surgical treatment. The most common surgeries performed were adenotonsillectomy, hemithyroidectomy, and biopsy/keloid/lipoma excision. A wide variety of cases were performed, and there were no immediate surgical complications.

Conclusion

Annual surgical specialty trips to rural, resource‐limited regions are worthwhile and offer procedures not otherwise available. It is important to collect patient, surgical, and pathology data on such trips. By continuing to collect valuable data, surgeons can determine the best procedures to teach local physicians and provide needed resources.
Endoscopic Scoring after Endoscopic Sinus Surgery
Authors: Hinohira Yasuyuki , Tsuzuki Kenzo , Suzaki Harumi , Sakagami Masafumi
Published: February 2015

Objective

1) Propose a simple endoscopic scoring after endoscopic sinus surgery (ESS). 2) Show the usefulness of the scoring in the postoperative evaluation.

Method

Eight‐six patients with chronic sinusitis who underwent ESS were enrolled. The patients consisted of 65 men and 21 women, and the mean age was 52.7 years. Fourteen patients with bronchial asthma were included. The postoperative endoscopic scoring (E score) was performed at 1 year after surgery in all patients.

Results

E score was assessed in a similar manner as Lund‐Mackay CT score. The physical findings of each sinus via the opening were scored; 2 points when the opening was closed, 1 point when the sinus was diseased, 0 point when normal. E score is expressed as a percentage of the maximum score possible. E scores in the patients showed a statistical correlation with the postoperative CT scores (P <. 001). The mean E score showed 22.5%, and was close to the postoperative CT score (20.5%). The mean E score in patients without asthma showed statistically better outcomes than with asthma.

Conclusion

A simple endoscopic scoring after ESS has been required although several evaluation methods were advocated. E score is a simple and useful postoperative evaluation method as same as Lund‐Mackay CT score in patients after ESS.
Evaluation of Nasal Patency with 4‐Phase Rhinomanometry
Authors: Lee Heung‐Man , Hong Sung M. , Choi Hyuk , Cho Jung S. , Lee Hye R. , Kang Ju H. , Um Ji Y.
Published: February 2015

Objective

Objective assessment of nasal patency in patients with nasal septal deviation should be required to determine the severity of the symptoms. The purpose of this study was to compare results of nasal sound spectral analysis (NSSA) with results of 4‐phase rhinomanometry.

Method

NSSA and 4‐phase rhinomanometry were performed on 53 patients with nasal septal deviation and 55 healthy subjects. Cutoffs for NSSA and 4‐phase rhinomanometry were defined by receiver operating characteristic analysis.

Results

A significant difference was observed in either NSSA values or 4‐phase rhinomanometry values between the nasal deviated patients and the control group (P <. 001). A correlation was observed in patients between NSSA results of nasal intensity (dB) and its frequency (Hz) at a frequency range of 2 to 4 kHz and 4‐phase results of effective resistance and verteresistance. No significant differences in terms of sensitivity of NSSA and 4‐phase rhinomanometry (79.3% versus 75.5%), specificity (80.0% versus 85.5%) and diagnostic accuracy (79.6% versus 80.6%) were found.

Conclusion

Use of NSSA and the 4‐phase rhinomanometry both for assessment of patients with nasal septal deviation provides objective information to aid in clinical decision making.
Frontal Sinus Cholesteatoma
Authors: Rangel Leonardo G. , Fleming Flavia P. , Augé Luciana B. , Chaves Eliza B. , Almeida Guilherme C. D.
Published: February 2015

Objective

To describe a case of frontal sinus cholesteatoma and review the characteristics of this pathology.

Method

Case report: 32‐year‐old white man. First symptoms: frontal pressure, proptosis of left eye with downward displacement (no visual symptoms or eye movement impairment). ENT examination and nasal endoscopy were normal. CT of paranasal sinuses: large mass in the left frontal sinus, with destruction of orbital and cranial blades.

Results

An endoscopic approach of the frontal sinus was attempted with no success. Nothing could be extracted from the left frontal sinus. Therefore an open approach was attempted, an external approach, using a Lynch incision. By this method we were able to clear out the medial and lateral parts of the left frontal sinus, taking out enough material to be examined by the pathologist. What came out was a cheese‐like debris with a pearly aspect. The final histopathological analysis revealed that the mass was a cholesteatoma of the frontal sinus.

Conclusion

Cholesteatoma is a common pathology of the middle ear. There are few cases reported in the paranasal sinuses. The cholesteatoma is a benign tumor that can become locally aggressive when it promotes erosion of the bone by pressure and also by the production of proteolytic substances, invading the surrounding structures.
Olfactory Disorders in HIV Positive Patients
Authors: Amali Amin , Sazgar Amir Arvin , Langeroudi Maziar Motiee , Saedi Babak
Published: February 2015

Objective

Chemosensory disorder in HIV‐infected patients can lead to lack of intake and subsequently malnutrition, weight loss, and wasting. In this study we aimed to evaluate the prevalence and probable associated factors of olfactory disorder in HIV‐positive patients.

Method

This case‐control study was conducted in Tehran, Imam Khomeini Hospital on 70 HIV‐positive patients and 70 control subjects in 2011. Variables of age, gender, route of transmission, duration of infection, last CD4 count, opportunistic infection, drug history, HCV concurrent infection, patient’s self‐evaluation of his own olfactory function, and threshold test were extracted and evaluated.

Results

Male to female ratio in case and control groups was 0.89 and 1.69, respectively. Age was 43 ± 15 years and 35 ± 7 years in case and control groups, respectively. Case groups showed a significant lower result in threshold test scores, considering smoking cofounder effect. Independent variables of gender, antiretroviral therapy, and duration of infection have significant effect on threshold test scores.

Conclusion

Olfactory threshold test disorders are common in HIV‐positive patients. Age, gender, and smoking are probably effective on threshold test scores. CD4 count most likely does not have effect on threshold test. Recommendation on the effect of antiretroviral‐therapy, duration of infection, route of transmission, opportunistic infection and HCV co‐infection needs further investigations.
Incidence of Trismus in Head and Neck Cancer
Authors: Finizia Caterina A.
Published: February 2015

Objective

To investigate the incidence of trismus and to analyze the impact on health‐related quality of life (HRQL) in patients with trismus undergoing treatment for head and neck (H&N) cancer.

Method

This prospective study assesses the incidence of trismus (≤35 mm) and HRQL in H&N cancer patients during 2007 in a university hospital setting. Maximum interincisal opening was measured in 127 patients during the study year, and the EORTC HRQL questionnaires and Gothenburg Trismus Questionnaire (GTQ) were used.

Results

In the present study the incidence of trismus was 9% pre‐treatment, and the highest incidence (38%) was found 6 months posttreatment. Patients with tumors of the tonsils were the most prone to develop trismus. The trismus patients reported negatively affected HRQL in terms of ability to work and affected social and family life than those without trismus. Furthermore, all patients with H&N malignancies had severe problems with deteriorated HRQL parameters, especially at 3 months posttreatment.

Conclusion

The incidence of trismus in patients with H&N cancer is non‐negligible. Trismus severely impairs HRQL and daily life activities in H&N cancer patients.
Systematic Review to Improve FESS Outcomes in Cystic Fibrosis Patients
Authors: Crockett David , Meier Jeremy D.
Published: February 2015

Objective

1) Review the literature for intraoperative techniques and postoperative practices after functional endoscopy sinus surgery (FESS) that may improve outcomes in patients with cystic fibrosis (CF).

Method

A systematic review of the literature was performed. PubMed was searched from 1970‐2011 using the terms “sinus surgery” and “cystic fibrosis” with papers limited to English. Abstracts were reviewed to identify relevant original and review manuscripts. Bibliographies of review articles were examined to identify additional manuscripts.

Results

The initial PubMed search identified 183 articles. After reviewing the abstracts, selected studies were examined in detail and the bibliographies of review articles checked to identify any additional articles. Intraoperative techniques included medial maxillectomy, image guidance, and intraoperative antibiotic irrigation. Postoperative management included nasal saline irrigation, dornase alfa inhalation, and serial antibiotic lavage. Most studies were limited to case reviews with relatively small numbers of patients. Very few randomized controlled studies were identified.

Conclusion

Despite the prevalence of recurrent sinonasal disease after FESS in CF patients, sparse Level I data exists to support perioperative techniques that improve outcomes in this population. Most recommendations are based on small case series. Multicenter studies to evaluate perioperative strategies that improve FESS outcomes in CF patients are warranted.
Irrigation Device for Duct Dilatation during Sialoendoscopy
Authors: Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Greco Antonio , Fusconi Massimo , Pagliuca Giulio
Published: February 2015

Objective

During sialendoscopic procedures a constant irrigation of saline is required to achieve an effective dilatation of the ducts. The aim of this study is to evaluate the efficacy and safety of a technique to dilate the duct using a cost‐effective device that allows a continuous irrigation at a constant pressure.

Method

In this prospective study 18 consecutive patients with submandibular or parotid sialadenitis were included. In Group A, 9 patients underwent dilatation of the duct using a balloon inflation device, while in Group B dilatations were performed using a manual irrigation. After each procedure, the surgical team expressed an overall evaluation.

Results

Sialoliths, strictures, and mucous plugs were visualized and managed in all patients. Any kind of complication was recorded. The technique of irrigation adopted in Group A obtained a subjective assessment higher than that used in Group B.

Conclusion

This irrigation device allows a simple, safe, and cost‐effective dilation ensuring good visualization of the salivary duct lumen during sialoendoscopy.
The Role of SEB on the Differentiation of T Cells in CRS
Authors: Kim Yong Min , Yoon Young‐Hoon
Published: February 2015

Objective

Recent studies indicate that there is a subset of CD4+CD25+FoxP3+ T cells (Treg cells) that express interleukin (IL)‐17 and the cells might be new proinflammatory cells because of the expression of IL‐17. The aim of this study was to investigate the role of SEB on the differentiation of regulatory T cells to cells that express retinoic acid related orphan receptor gamma (RORγ) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP).

Method

Immunohistochemical stains for SEB, FOXP3, and RORC were conducted in the tissues from 13 control subjects and 20 patients with nasal polyposis. PBMCs were separated from the patients and control subjects and incubated with SEB (1 µL/mL) for 24 hours and 48 hours, and the percentage of the various T cell subsets and cytokine profiles by using flow cytometry.

Results

The cells that express both SEB and FOXP3 or RORC and FOXP3 were higher in nasal polyps, especially eosinophilic polyps compared with control mucosa. CD4+CD25+FOXP3+ T cells, CD4+CD25+FOXP3+RORγt+ T cells, and CD4+CD25+FOXP3+RORγt‐ T cells are significantly increased (p <. 05) in NP patients compared with control subjects.

Conclusion

This result indicated that SEB may be involved in differentiation of regulatory T cell to RORγ+Treg cells and these cells might be involved in tissue inflammation in CRS with nasal polyposis patients.
Key Role for Otolaryngology in a Hereditary Hemorrhagic Telangectasia Center of Excellence
Authors: Thompson Christopher F. , Kim Brandon , Suh Jeffrey D. , Duckwiler Gary , McWilliams Justin , Wang Marilene B.
Published: February 2015

Objective

1) Learn about the initial experiences of a Hereditary Hemorrhagic Telangectasia (HHT) Center of Excellence. 2) Understand which HHT patients require otolaryngologic evaluation and interventions, and review other common clinical manifestations of the disease.

Method

We performed a retrospective review of all patients from the Southwestern United States referred to our HHT Center of Excellence from its inception in May 2010 through February 2012. Clinical presentation, radiographic imaging, genetic testing, otolaryngologic treatments, and other operative interventions were analyzed.

Results

In 2010 a dedicated center was started at our tertiary medical center to manage patients with HHT, an autosomal dominant disease with a prevalence of 1:5000. Of the 159 patients referred, 86 have HHT based on genetic testing or Curacao clinical criteria. Seventy‐three do not have HHT or are undergoing further workup. Fourteen patients have sought otolaryngologic evaluation for relentless epistaxis or oral bleeding, with 50% of these requiring KTP laser ablation for symptomatic nasal and oral telangectasias. Additionally, 21 patients have required embolization, neurosurgical clipping, or radiation for enlarging or symptomatic arteriovenous malformations in the lung, brain, and abdomen.

Conclusion

An HHT Center of Excellence is important in providing comprehensive care for patients with this rare disease with significant clinical sequelae. Otolaryngologists are critical members of this multidisciplinary team performing interventions in the clinic and operating room to improve quality of life for these patients.
p53 Mutation in HPV Positive Oral Squamous Cell Carcinoma
Authors: Ali Adnan M. , Awan Sohail M. , Pervez Shahid
Published: February 2015

Objective

1) To determine whether p53 protein overexpression and human papillomavirus (HPV) infection coexist in a high‐ risk Pakistani population. 2) Learn the correlation with smoking, chewing habits, and histological variables such as grade and stage of tumor in these patients.

Method

This study is based on samples retrospectively collected from patients with oral squamous cell carcinoma (OSCC) who were diagnosed and treated during the period of January 2009 to December 2010. Ninety‐five known HPV‐infected OSCC were used as the research material. TP53 protein overexpression was investigated by means of immunohistochemistry.

Results

Patient ages ranged from 20 to 78 years with a median of 50 years. Sixty‐two patients (65%) were men, and 33 (35%) were women. As expected the majority of the patients exhibited a significant history of smoking and chewing tobacco in different combinations and betel‐quid consumption. Out of 95 patients, 19 patients presented with stage I disease; 27 patients with stage II, 29 patients with stage III, and 20 with stage IV disease according to AJCC staging. Out of 95 HPV positive oral squamous cell carcinomas, 50 (53%) were p53 positive and 45 (47%) were p53 negative.

Conclusion

This work confirms some previous studies that HPV infection and p53 mutation coexisted in the oral squamous cell carcinoma. However, p53 overexpression was not significantly associated with HPV infection. Nevertheless, further studies with large numbers of cases and detection on premalignant lesions are needed to validate these findings.
Percutaneous vs Open Tracheostomy for Critical Care Patients
Authors: Naseri Iman
Published: February 2015

Objective

1) Evaluate the indications for performing a tracheostomy across the spectrum of all trauma and pulmonary critical care patients. 2) Understand the existing contraindications used in the decision against performing a percutaneous dilatational tracheostomy. 3) Examine outcomes among the 2 modes of tracheotomy procedures.

Method

A retrospective review identifying all patients who underwent open surgical or percutaneous dilatational tracheostomy procedure spanning 3 years (from 2008) within a tertiary hospital. Clinical and demographic data were used to compare the 2 groups of patients with respect to average age, hospital stay, related ER visits, and other complications.

Results

A total of 1333 tracheostomies were performed on 1302 patients. This included 452 (34%) open surgical versus 881 (66%) percutaneous dilatational techniques. There was no significant difference in age between the 2 groups (53 years). The average length of hospital stay was 21 days, indifferent among the 2 groups. The majority of the total tracheostomies were performed by the surgical services, in comparison to the pulmonary critical care service, 1080 (81%) versus 253 (19%), respectively. Approximately 26% of all discharged patients had a related ER visit (respiratory or tracheostomy‐related) within a year.

Conclusion

A majority of tracheostomies at our tertiary care trauma hospital are performed via the percutaneous technique. Both groups have similar short‐term safety and complication rates. Our surprisingly high ER return rate suggests possible deficiency in pre‐discharge teaching and care arrangements. Prospective studies are needed to determine long‐term complications.
A Personalized Medicine Approach to Treat Malignant Proliferating Trichilemmal Tumors
Authors: Sewell Andrew , Ogbeide Evbu , Issaeva Nataila , Lovly Christine , Boyd Alan , Gilbert Jill , Yarbrough Wendell G.
Published: February 2015

Objective

Proliferating trichilemmal tumors (PTT) are rare skin neoplasms arising from the hair root sheath. Although benign, PTT can be recurrent and locally destructive, rarely undergoing malignant transformation into malignant PTT (MPTT), with potential for distant metastases. Current treatments for MPTT are largely anecdotal and poorly validated.

Method

We report a patient who presented with multiple recurrences and distal metastases of MPTT. SNaPShot analysis utilizing multiple PCR was performed on both mediastinal nodes and MPTT neck mass in order to detect cancer‐related mutations. Cell culture and biochemical assays were performed to correlate with clinical response to targeted therapy.

Results

A PIK3CA activating mutation (H1047R) was found in a distant metastasis and local MPTT tissue. Specific activating PIK3CA mutations have been found in many human epithelial tumors, including head and neck squamous cell carcinoma and lung cancer. The reported patient enrolled in a Phase IA trial using BYL719, a selective PI3Kα tyrosine kinase inhibitor. Primary cells derived from the patient tumor were very sensitive to multiple agents targeting the PI3K pathway (eg, PI3K, PI3K/mTOR, and AKT). Five additional patients with PTT from our institution had SNaPShot performed on formalin‐fixed, paraffin‐embedded tissue.

Conclusion

There are no suggested treatment guidelines for patients with rare tumors like MPTT. They receive a variety of chemotherapeutic agents based on limited clinical data. We suggest that rare tumors be screened for common oncogenic mutations. This will allow clinicians to personalize medical treatment based on identified dysregulated molecular pathways.
An Exploration of Factors Predicting Malnutrition in Head and Neck Cancer
Authors: Hammerlid Eva B. , Silander Ewa
Published: February 2015

Objective

Malnutrition is common among head and neck cancer patients and it impacts survival and quality of life. This study aims to identify predictors of malnutrition at time of diagnosis in order to enable early nutritional support and prevent malnutrition in patients at risk.

Method

A total of 134 patients with advanced oral and pharyngeal cancer were included in the study. Weight, body mass index (BMI), fat‐free mass (FFM), dysphagia, and quality of life were measured at diagnosis and after 6 months. Two definitions for malnutrition were applied: >10% weight loss and BMI <20 after 6 months.

Results

Six months after diagnosis, 66% of the patients were malnourished, applying >10% weightloss definition and 26% applying BMI <20. In multivariate analysis, chemotherapy and high BMI at diagnosis were the strongest predictors of malnutrition, using 10% weight loss definition and low BMI followed by low FFM and dysphagia were the strongest predictors using BMI <20.

Conclusion

Inconsistent predictors were found depending on the definition used for defining malnutrition. Unintended weight loss of more than 10% seems to be the most reasonable definition for malnutrition since this also correlated to a significant loss of FFM, consequently pointing out treatment with chemoradiotherapy as the strongest predictor for malnutrition.
bFGF Redox Signaling in Hypopharyngeal Cancer
Authors: Fennessy Brendan G. , Woolley John F. , Cotter Thomas G.
Published: February 2015

Objective

Examine the role of basic fibroblast growth factor (bFGF) in the generation of reactive oxygen species (ROS) in FaDu pharyngeal carcinoma cell lines. Evaluate the consequences of disrupting bFGF mediated signaling in tumor cells.

Method

Basic science study of hypopharyngeal carcinoma from 2010 to 2012. The study subjects were FaDu cell lines. Setting: In vitro. Interventions: Disrupting bFGF signaling. Outcomes Measured: ROS generation, apoptosis.

Results

bFGF and fibroblast growth factor receptor are co‐expressed in FaDu squamous cell carcinoma cells. ROS generation in FaDu cells takes place in response to bFGF stimulation, and is inhibited with a FGF receptor inhibitor, in a NADPH‐oxidase dependent and cyclooxygenase‐independent manner. Disrupting bFGF‐FGFR signaling results in an early strong apoptotic stimulus involving caspase‐3, ‐9, and poly ADP ribose polymerase.

Conclusion

bFGF‐mediated signaling in hypopharyngeal cancer has an important role in cell survival and proliferation.
Bilateral Water‐Clear Cell Double Parathyroid Adenomas
Authors: Lawton Brian , Nathan Cherie‐Ann O. , Chaudhery Shubnum
Published: February 2015

Objective

1) Describe the pathologic findings of water‐clear cell hyperplasia and adenomas. 2) Understand the clinical presentation of a patient with primary hyperparathyroidism caused by double water‐clear cell parathyroid adenomas.

Method

A 66‐year‐old white woman was referred to our clinic with hypercalcemia, osteoporosis, and hyperparathyroidism. Sestamibi scan was nonlocalizing and thyroid ultrasound revealed bilateral thyroid nodules. She underwent total thyroidectomy and bilateral superior parathyroidectomy. The inferior parathyroid glands appeared grossly normal and were left intact.

Results

Intraoperative PTH dropped from 209 to 39.5 and postoperative calciums returned to the normal range. Pathology revealed bilateral superior parathyroid adenomas with the right superior gland weighing 2.14 g and the left weighing 1.27 g. Both glands were consistent with water‐clear cell hyperplasia. The thyroid gland, of which FNA had returned preoperatively as atypia, revealed multinodular goiter.

Conclusion

WCC hyperplasia is a rare cause of primary hyperparathyroidism. To our knowledge only one other case has been reported that revealed bilateral water‐clear cell parathyroid adenomas. Unlike primary chief cell hyperplasia, WCC hyperplasia is not associated with MEN syndromes, and the incidence has decreased significantly over the past 25 years.
Cancer Knowledge and Screening among American Indians
Authors: Dwojak Sunshine M. , Emerick Kevin S. , Guadagnolo Beverly A. , Sargent Michele , Deschler Daniel G. , Petereit Daniel G.
Published: February 2015

Objective

To establish the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians (AI) in South Dakota, and to determine if a community‐based head and neck (H&N) cancer screening is an effective method to detect positive findings in this population.

Method

The European Head and Neck Society’s “About Face” survey was augmented with questions on demographics and human papilloma virus (HPV). Surveys were administered at 2 community events, and participants could choose to take part in a H&N cancer screening. Knowledge scores were created for correct responses to H&N cancer questions.

Results

A total of 223 people completed the survey, and 126 participated in the screening: 92% were American Indian, and 32% had pre‐existing knowledge of H&N cancer. Mean knowledge scores were 17 (61%) out of 28. Factors that predicted significantly higher H&N cancer knowledge were having or knowing someone with cancer (P =. 002), race (P =. 02), and education (P =. 002). Fifty‐nine percent of participants had previous awareness of HPV, but only 36% believed that it was associated with H&N cancer. Ten (8%) people had positive findings on examination. The only significant predictor of a positive finding was smoking history, with all 10 findings being current or past smokers (P =. 02).

Conclusion

There are gaps in AI knowledge of H&N cancer risk factors and early symptoms, particularly regarding the role of HPV. These results highlight the need for further public education. Community‐based H&N cancer screening in the AI community is an effective means to identify early findings in smokers.
Clinical Thermal Effects of Flexible Fiber CO2 Laser
Authors: Mendelsohn Abie , Remacle Marc J. , Lawson Georges , Bachy Vincent , Weynand Birgit
Published: February 2015

Objective

To date no clinical investigations have reported on the coagulation effects of flexible fiber CO2 laser delivery to head and neck tissue, the results of which have a direct impact for the progression of transoral laser microsurgery. The objective of the present study was to investigate the histopathologic thermal effects of a flexible fiber CO2 laser delivery system.

Method

A prospective histopathologic analysis of 15 consecutive transoral laser microsurgery specimens using the same CO2 fiber system were subjected to dedicated histopathologic analyses. Repeated coagulation depth measurements of 2 independent clinical pathologists were averaged. Specimens were stratified into lymphoid or epitheloid groups for further comparison.

Results

The mean coagulation depth across all specimens was 81.53 um (SD, 38.73; range, 15.00‐360.34). Although the mean coagulation depth in lymphoid tissues (mean, 75.38 um; SD, 15.91) was elevated over the mean depth of epitheloid tissues (mean, 90.74 um; SD, 31.21), there was no significant difference (P =. 11).

Conclusion

With an average coagulation depth of 81.53 um the flexible fiber thermal effect compares favorably to tissue effect of line‐of‐sight lasers. Epitheloid and lymphoid tissues displayed equivalent coagulative effects. To our knowledge, this is the first clinical description of flexible CO2 laser delivery thermal effects of tissues of the head and neck.
CLN Metastasis with Papillary Thyroid Cancer in the Isthmus
Authors: Lee Jin‐Choon , Lee Byung‐Joo , Wang Soo‐Geun , Lim Yun‐Sung , Lee Yoon‐Se
Published: February 2015

Objective

To investigate the patterns and predictive factors of central lymph node metastasis in patients with papillary thyroid cancer located in the isthmus.

Method

Retrospective chart review. We evaluated 447 cases with solitary nodule out of 1257 patients with papillary thyroid cancer who underwent total thyroidectomy with bilateral central lymph node compartment dissection. The patients were analyzed in 2 groups: group I, patients with cancer located in the isthmus (n = 35) and group II, patients with cancer in other regions (n = 412). We evaluated the clinicopathological characteristics and predictive factors and compared the 2 groups.

Results

The frequency of central lymph node(CLN) involvement was 52.1% (233 cases) in the patients with single nodule of papillary thyroid cancer. The frequency of papillary thyroid cancer located in the isthmus was 7.8% (35 cases). Mean age at diagnosis in group I and II was 45.3 years and 46.2 years, respectively (P =. 892). Size, sex, extrathyroidal extension, and ultrasound findings (eg, marked hypoechoic, taller than wide) showed no significant difference between the 2 groups. CLN metastasis in group I and group II was 62.5% and 56.5%, respectively (P =. 228). Bilateral CLN metastasis was 18.8% in group I and 11.5% in the group II (P =. 067).

Conclusion

Papillary thyroid cancer located in the isthmus showed a tendency to involve bilateral CLN. In conclusion, it is recommended that bilateral central compartment neck dissection is needed as an appropriate surgical option for papillary thyroid cancer with single nodule located in the isthmus.
Comparative Study of Robotic and Endoscopic Submandibular Gland Resection
Authors: Koh Yoon Woo , Lee Hyoung Shin , Kim Won Shik , Hong HyunJun , Lee So‐Yoon , Chung Hyun Pil , Choi Eun Chang
Published: February 2015

Objective

Compare the short‐term clinicopathologic results of robot‐assisted submandibular gland (SMG) resection and endoscopic SMG resection via the retroauricular approach.

Study Design

Prospective review of submandibular gland tumor or chronic dialadenitis conducted for 1 year in a tertiary hospital.

Subjects Studied

Patients who underwent robotic or endoscopic submandibular gland resection via retroauricular approach. Clinical factors were compared using Mann‐Whitney test.

Results

The operation was successful in all patients of 2 groups without any significant intraoperative complications or conversion to open surgery. The operating time in the endo group was longer than the robot group (P =. 034). Total amount (P = 1.000) and duration (P =. 801) of drain between the 2 groups showed no significant difference. The mean duration of hospital stay was also comparable between the groups (P = 1.000). No significant difference was observed in the overall perioperative complications between the 2 groups. Patients of both groups showed excellent cosmetic satisfaction and showed no significant difference (P =. 891).

Conclusion

Robotic and endoscopic SMG resection were both feasible with acceptable perioperative outcomes and excellent cosmetic results. Robot assisted resection showed benefit in shorter operating time.
Diagnosis of Nonrecurrent Laryngeal Nerve by CT Angiography
Authors: Kim JiHoon , Choi Hong‐Shik , Kim Si‐Hong
Published: February 2015

Objective

Nonrecurrent laryngeal nerve (NRLN) is found in 0.5% to 1.0% of the entire population. NRLN mostly develops on the right an anomaly of the subclavian artery. Through 3 cases, we report a simple method to diagnose an anomaly of the right subclavian artery with NRLN.

Method

Case 1. A 52‐year‐old woman was admitted with a thyroid mass. After a neck CT and fine‐needle aspiration biopsy, she had an operation from thyroid papillary carcinoma. Intraopera‐tively, we found NRLN and preserved it. Case 2. A 33‐year‐old woman visited us with a cervical mass. She was diagnosed with thyroid follicular carcinoma. Intraoperatively, we found NRLN cut. Case 3. A 68‐year‐old woman complained of a recurring thyroid mass. Preoperatively, we predicted NRLN through CT angiography. Intraoperatively, we identified the right NRLN.

Results

In case 3, NRNL was expected through neck CT angiography. Intraoperatively we could find NRLN more easily than case 1 and 2.

Conclusion

If we can predict NRLN preoperatively, it will be possible to preserve NRLN easily. We can differentiate arteria lusoria from normal findings more precisely with neck CT angiography as compared with neck CT. We diagnosed NRLN preoperatively with neck CT angiography, and this was helpful for us to preserve RLN intraoperatively. We report the case that we identified and preserved NRLN more easily by predicting NRLN with neck CT angiography.
Survival following TORS for Oropharyngeal SCC
Authors: Kakarala Kiran , Durmus Kasim , Agrawal Amit , Carrau Ricardo L. , Old Matthew O. , Teknos Theodoros N. , Ozer Enver
Published: February 2015

Objective

Report patient characteristics and oncologic results of transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).

Method

Retrospective review of 52 patients who underwent TORS with neck dissection and postoperative adjuvant treatment as indicated for OPSCC within a prospective single‐arm cohort study at an academic medical center. Tumor stage, human papillomavirus (HPV) status, pathology (margin status, nodal status, extracapsular spread), and survival data were collected.

Results

Forty‐two patients had HPV testing with 36 patients being HPV positive (85.7%). Most patients presented with advanced stage disease: 40 patients (76.9%) stage IV and 6 patients (11.5%) stage III. Mean length of follow‐up was 21 months. Overall survival at 1 and 2 years was 97.9% and 72.7%, respectively, and disease‐specific survival at 1 and 2 years was 100% and 84.2%, respectively. There were 2 local recurrences (3.8%), 3 regional recurrences (5.8%), and 2 distant recurrences (3.8%). Subset survival analysis based on HPV status is presented along with predictors of survival in multivariate analysis.

Conclusion

Oncologic outcomes are promising for patients with advanced OPSCC treated with TORS and postoperative adjuvant therapy as indicated. Further prospective study stratified by HPV status is needed to determine the role of TORS in the management of these patients.
Bone Morphogenic Protein (rhBMP‐2) Repair of Alveolar Clefts
Authors: Wudel Justin M. , Valdez Sondra , Perkins Jonathan N. , Blanchard Ashley , Allen Gregory C.
Published: February 2015

Objective

An alternative to autogenous bone grafting for maxillary alveolar cleft repair is the application of recombinant human bone morphogenic protein in a collagen sponge matrix. Our aim was to quantify bone growth, examine parental satisfaction following the procedure, and evaluate dental/orthodontic outcomes for patients who underwent rhBMP‐2 alveolar cleft repair.

Method

A retrospective review was performed on all patients who underwent alveolar cleft repair at a tertiary children’s hospital from 2007‐2010. Satisfaction questionnaires were completed by parents, dentists, and orthodontists. Degree of bone fill was determined by independent grading of postoperative Panorefilms.

Results

Thirty‐two of the 42 patient cohort had postoperative Panorefilms. Independent grading demonstrated 36.7% had >75% of the alveolar cleft filled, 47.8% had 50%‐75% filled, and 17.3% had <50% filled. Mean length of follow‐up was 24.4 months. One minor complication of bony overgrowth into the nasal cavity was reported. Parent and patient satisfaction regarding surgical outcome was 93.3% and 83.3% respectively. Of dentist respondents, 77.8% reported that the bone quality and alveolar ridge mucosal repair allowed for dental treatment. Of orthodontist respondents, 87.5% reported the graft enabled treatment, and 68.7% felt the graft prevented tooth root exposure and resorption.

Conclusion

Alveolar cleft repair using rhBMP‐2 provides adequate bone growth to support dental and orthodontic treatment with minimal complications, while alleviating the need for autogenous bone grafting and its morbidity. In addition, the majority of patients and parents are highly satisfied with the surgical outcome.
Extraesophageal Reflux: Throat and Gastrointestinal Patients
Authors: Powell Jason , Nikkar Ali , Doyle Jill , Wilson Janet A.
Published: February 2015

Objective

Diagnosis and management of EER remains controversial. We have validated a reliable Comprehensive Reflux Symptom Scale (CReSS) incorporating 34 possible symptoms of EER and gastroesophageal reflux disease (GERD). We aimed to compare CReSS in healthy volunteers, throat clinic attenders, and a heterogeneous group referred for upper gastrointestinal (GI) endoscopy.

Method

The CReSS was administered to 532 participants: 103 healthy volunteers, mean age 55 years, 39% male, 15% smokers; 175 throat clinic attenders, mean age 56 years, 37% male, 11% smokers; and 254 attenders for GI endoscopy, mean age 58 years, 41% male, 14% smokers. Regular recent antacid use was recorded.

Results

The mean CReSS total was 6.5 (SD 8.14) in volunteers, significantly lower (P <. 001) than in throat 32.19 (SD 22.37) or GI patients 39.67 (SD 26.14). CReSS totals were independent of age. All items were endorsed by at least 17% of throat patients, 30% of GI patients. The top symptoms in throat patients were throat clearing, hoarseness, globus, and mucus (62%‐82% endorsement); 48 were on regular antireflux medication, and more of this subgroup had heartburn (75%), than of those who were not (38%). Eighty‐six percent of the 148 GI patients on antireflux therapy also experienced heartburn, but only 56% of the remainder.

Conclusion

EER and GERD symptoms are incompletely understood and imperfectly responsive to antireflux therapy. The broad endorsement of all CReSS items by both patient groups supports recent evidence for an EER‐GERD disease continuum. Back pain emerges as an under‐recognized reflux symptom. Over‐restrictive questionnaires reinforce speculative concepts of reflux disease.