bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Skills of Applicants to Residency in Otolaryngology
Authors: Sebelik Merry E. , Challis Mitchell J. , Lewoczko Ken , Stocks Rose Mary S.
Published: February 2015

Objective

1) Measure baseline competence in the performance of a basic surgical task by 4th‐year medical students applying to otolaryngology residency. 2) Determine whether information available in the standardized otolaryngology residency application correlates with competence in performance of the basic surgical task.

Method

Applicants to residency in otolaryngology with the University of Tennessee Health Science Center in 2010 and 2011 constituted the study population. During the interview, the applicant was asked to close a simulated incision with sutures. A blinded observer recorded a 15‐point Objective Surgical Assessment of Technical Skill score.

Results

The OSATS score provided a measure of the suturing skills of individuals applying to residency training in otolaryngology. The OSATS score was incorporated into the calculation of an overall OSCE (Objective Structured Clinical Examination) score modified to focus on surgical skill performance and a professionalism measure. Initial data analysis produced a correlation value (R value) between the OSCE score and data points gleaned from the standardized application (USMLE step I score, prior employment‐related surgical experience, hobbies, musical background, athletic background, research experience that includes performance of surgical procedures).

Conclusion

In contrast to other high‐skill professions such as the airline industry, surgical educators have not universally developed a practice of testing prospective trainees for aptitudes that can be deemed critical to surgical competence. This study represents a methodology for assessment of a simple surgical skill to which all applicants to otolaryngology training should have been exposed. It also determines correlation with applicant data commonly used in selection, such as USMLE score.
The Role of Dexmedetomidine in Awake Tracheotomies
Authors: Seibert Jared R. , Roofe Scott B.
Published: February 2015

Objective

Understand the different types of sedation and anesthesia (to include dexmedetomidine) used during awake tracheotomies along with side effects. Demonstrate how dexmedetomidine has been safely used at our institution to provide analgesia and sedation without compromising respiratory drive during awake tracheotomies.

Method

We performed a retrospective chart review of awake tracheotomies at our institution between 2008 and 2011. We reviewed operative reports, anesthesia records, and postoperative follow‐up notes. Patients were divided into groups based on indication for tracheotomy and if dexmedetomidine was used during the procedure. We reviewed complications and performed a cost analysis.

Results

Sixteen awake tracheotomies were performed at our institution during the observed time period: 9 related to malignancy, 5 due to impending airway obstruction, 1 due to infection, and 1 due to trauma. Dexmedetomidine was used in 6 cases. Ages of patients ranged from 22 to 76 years, with an average age of 53.6 years. No intraoperative complications were reported; however, one of the tracheotomies was performed after a failed planned fiberoptic intubation. Two patients eventually succumbed to their illness postoperatively. A cost analysis was performed demonstrating the variability of medication costs.

Conclusion

Anesthesia providers at our institution have safely used dexmedetomidine during awake tracheotomies. No complications occurred during these procedures. Although dexmedetomidine is more expensive than other agents, it avoids the respiratory depression of other commonly used anesthetics/analgesics. Further research regarding the use of this medication during awake tracheotomies is needed.
Ultrasound Assessment after Submandibular Sialolithotomy
Authors: Joshi Arjun S. , Sood Amit J.
Published: February 2015

Objective

1) To demonstrate the utility of ultrasound in the assessment of residual submandibular stones after endoscopic‐assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for detection of sialolithiasis of the submandibular glands.

Method

From August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic‐assisted or purely open sialolithotomy in a tertiary‐level clinic setting. Pre‐ and immediate postoperative ultrasound was performed. Outcomes included presence of residual stones/fragments and proximal ductal dilatation.

Results

Twenty‐two patients with symptomatic submandibular sialolithiasis refractory to sialendoscopic extraction underwent either endoscopic‐assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound immediately after sialolithotomy. Those patients underwent mandatory exploration at the time of the procedure, and 3 of 3 (100%) were demonstrated to have residual sialoliths/ fragments, which were successfully removed. Thirteen of 22 (59%) demonstrated proximal ductal dilatation after stone removal. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow‐up ranging from 6 months to 1 year.

Conclusion

After cases of endoscopic‐assisted or open submandibular sialolithotomy, there is no widely used method to assess for residual stones. As a first, we propose that ultrasound is reliable not only for the presence of stones prior to treatment but also for the assessment of residual stones after submandibular sialolithotomy.
Ultrasound Localization during Submandibular Sialolithotomy
Authors: Joshi Arjun S. , Sood Amit J.
Published: February 2015

Objective

1) To describe a novel office‐based operative technique that has been demonstrated to be successful in stone localization and retrieval of proximally located submandibular sialoliths. 2) To demonstrate the feasibility of the technique and discuss its indications.

Method

From August 2009 to January 2012, patients with symptomatic submandibular sialolithiasis underwent ultrasound needle localization and open sialolithotomy in a tertiary‐level clinic setting. Outcomes included success of delivery, presence of infection, ductal stenosis, loss of glandular function, or lingual nerve paralysis. Independent variables included size and location of sialoliths.

Results

Sixteen in‐office cases of ultrasound‐guided needle localization and open sialolithotomy were performed for patients who had failed sialendoscopy and stone extraction. Follow‐up ranged from 6 months to 1 year. Sixteen of 16 (100%) were successful. The average size of sialoliths was 6.7 mm (range, 5‐11 mm). Mean procedure time was 24 minutes (range, 18‐42 minutes) from needle localization. There were no complications of infection, ductal stenosis, loss of glandular function, presence of additional sialoliths, or permanent lingual nerve paralysis. No patients had salvage submandibular sialadenectomy.

Conclusion

After failing a purely endoscopic approach, proximally located sialoliths of the submandibular gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound‐guided needle localization is a reliable aid to effective transoral sialolithotomy.
Virtual Interactive Presence: An Operative Feasibility Study
Authors: Phillips James D. , Withrow Kirk
Published: February 2015

Objective

We sought to 1) assess the process required to implement a virtual interactive presence (VIP) system into a standard operating room setting, 2) evaluate the technical performance of the device, and 3) determine the potential utility of the system for guidance of surgical procedures.

Method

A feasibility study was conducted at a teaching hospital in 2011. Patients scheduled to undergo otolaryngology procedures were recruited for VIPAAR system (Birmingham, AL) usage to perform standardized exercises during the case. Setup time and observations regarding performance of the system were recorded. Surveys assessing satisfaction level were completed by the staff.

Results

Following informed consent, the VIP system was implemented in 8 otolaryngology procedures requiring rigid nasal endoscopy (n = 6) or laryngeal microscopy (n = 2). Average setup time was 4.5 minutes at the outset with an additional 2.4 minutes intraoperatively. One hundred percent of OR staff surveyed (n = 24) agreed that the system was safe. Ninety‐two percent disagreed that the system interfered with their duties. Surgeon responses (n = 8) were uniformly positive toward the system’s safety and its usefulness as a teaching tool. Strengths were noted in the system’s clarity of picture and portability. A weakness was identified in the crowding of a smaller OR space.

Conclusion

Otolaryngology requires a highly technical skill set based on learned dexterity. Early intraoperative trials indicate VIP technology is a safe and potentially useful adjunct in providing monitored surgical experience to trainees. Potential barriers exist in smaller OR settings. Limitations of the study are sample size and a single surgeon’s experience.
Dorsal Nasal Mucocele: A Delayed Complication of Rhinoplasty
Authors: Tracy Lauren , Badran Karam
Published: February 2015

Objective

To describe an interesting case of a subcutaneous dorsal nasal mucocele that developed 21 years after primary endonasal rhinoplasty and to list methods by which this delayed complication can be avoided.

Method

A 51‐year‐old man presented with a 2‐year history of a slowly growing asymptomatic mass on the nose which was lateral to midline, cephalic to the lower lateral cartilages, and superficial to the upper lateral cartilage while remaining deep to the subcutaneous tissues.

Results

Fine needle aspiration was performed and was nondiagnostic, as only epithelial cells were identified. Imaging studies indicated a 1‐cm low‐density, difficult‐to‐characterize nodule on the inner aspect of the right nostril. The patient was taken to surgery, and an open rhinoplasty approach was used to access the mass. It was a well‐demarcated, globular, fluid‐containing cystic structure that did not track to the skin or vestibular surface. The differential diagnosis for nasal lesions in this area include inclusion cysts, benign skin adnexal tumors, dermoid cysts, encephaloceles, and minor salivary gland neoplasms. Pathology demonstrated findings consistent with mucocele.

Conclusion

It is likely that the patient had mucosal tissue from the nasal vault trapped subcutaneously during rhinoplasty. Over years, this grew to become cosmetically symptomatic. Prevention of this rare long‐term complication of rhinoplasty requires well‐defined incisions and meticulous attention to wound closure. Treatment herein was via an open rhinoplasty approach.
A Novel Approach to Closure of a Pharyngocutaneous Fistula
Authors: Parker Charles A. , Casper Keith , Thuener Jason
Published: February 2015

Objective

1) Describe a novel approach to the management of a large pharyngocutaneous defect with the vacuum assisted closure (VAC) system. 2) Present photographs demonstrating the application of the VAC system and evolution of the defect. 3) Review other techniques described for the management of pharyngocutaneous fistulas (PCF).

Method

Case report of a patient diagnosed with advanced hypopharyngeal cancer who underwent surgical resection and free flap reconstruction. The postoperative course was complicated by delayed flap failure and development of a PCF. This fistula was managed with the VAC device until the wound healed adequately to proceed with adjuvant radiation.

Results

The patient intially underwent a total laryngopharyngoesophagectomy and reconstruction with an anterior lateral thigh flap. Postoperatively the patient experienced a protracted course of nausea and vomiting, resulting in PCF formation. Because of the location of the PCF near the stoma, the VAC dressing was applied with incorporation of the stoma using a laryngectomy tube with a raised flange and a salivary bypass tube in the pharyngeal defect. The patient was then successfully reconstructed in a delayed fashion after completion of adjuvant radiation with a gastro‐omental free flap. The patient is currently disease free and eating and speaking well.

Conclusion

This case illustrates the successful use of the VAC device in a large pharyngocutaneous defect. This novel approach allowed the use of the VAC device despite the dressing being incorporated into the patient’s stoma.
A Novel Preliminary Step in Orbital Exenteration
Authors: Manickavasagam Jaiganesh , Leeman Hayley , Durham Luke , Yousefpour Afshin
Published: February 2015

Objective

An external approach of orbital exenteration involves retracting the orbital contents within a nonexpandable bony orbit. Orbital pressure would be more raised for patients with orbital tumors where retraction of the orbital contents may be difficult. We describe a simple preliminary step, which may be used to facilitate orbital retraction.

Method

Case reports at a university teaching hospital for nasal tumors with orbital involvement. For the literature research, MEDLINE search from 1950 to Jan 2012.

Results

Prior to orbital exenteration, the cornea of the affected eye is aspirated with a 21‐gauge needle. Approximately 3 to 4 mL of clear fluid can be aspirated. This subsequently causes depression of the bulbar conjunctiva and globe, which reduces the intraocular pressure. This allows orbital contents to be easily retracted and facilitates easy division of the orbital muscles as well as aiding the control of bleeding from the orbital apex, under direct vision. This technique has not previously been reported in the literature. We have used this technique in 18 cases of orbital exenteration for maxillary tumors with orbital involvement.

Conclusion

We have used this technique without any subsequent complications and found it to be extremely useful particularly as it enhances visualization of the orbital apearea. This preliminary step explained above can be an adjunct to all methods of orbital exenteration.
Accuracy of FDG PET and CT Imaging for Nodal Metastasis
Authors: Patell Sapna A. , Mendez Eduardo , Rajendran Joseph , Weiss Noel S.
Published: February 2015

Objective

After radiation treatment, head and neck cancer patients often undergo FDG PET and CT imaging to survey for nodal metastasis. Inconsistencies among these make it difficult to decide if surgery is necessary. Our goal is to determine the accuracy of these modalities using histopathology, both overall and among discrepant results.

Method

We reviewed the records of 486 head and neck squamous cell carcinoma patients who underwent a postradiation FDG PET/CT scan between 2000 and 2011. PET and CT positivity were defined as a standardized uptake value (SUV) of ≥3.0 and a lymph node size of ≥1 cm, respectively.

Results

Of the 64 patients with postradiation PET/CT scans, 16 underwent a neck dissection after imaging. When either PET or CT was positive, all 9 cases of malignancy were identified (sensitivity 100%), and the positive predictive value was 69.2% (9/13). Of the 7 with benign pathology, 3 were negative for both modalities (specificity 42.8%). In this setting, the negative predictive value was 100% (3/3). Eight cases had discrepant results between PET and CT imaging. For these, the positive and negative predictive values with PET imaging alone were 33% and 20%, while with only CT imaging, they were 80% and 66%, respectively.

Conclusion

Corroborating with prior studies, our study observed a high negative predictive value when using the combination of PET/CT in the management of neck disease in postradiated patients. When PET and CT results conflicted, CT imaging had a higher predictive accuracy compared to PET scans.
An Invention on Operative Scar of the Parotid Gland Tumor
Authors: Maeda Hiroyuki , Hasegawa Masahiro , Yamashita Yukashi , Agena Shinya , Kiyuna Asanori , Suzuki Mikio
Published: February 2015

Objective

A parotid gland tumor is an important disease for otolaryngologists to be able to treat through surgical technique in Japan. It is necessary to preserve facial nerves completely and to not make a prominent postoperative incisional scar of the skin, particularly in the case of benign tumors.

Method

We experienced 42 cases of parotid gland tumors in 2011. We tried to diagnose by CT scan, MRI imaging, and fine needle aspiration at preoperation.

Results

Benign tumors made up 37 cases, with the rest malignant tumors. We could identify a benign tumor in almost all cases at preoperation. In case of benign tumor, permanent facial nerve palsy was not found, except the schwwanoma in facial nerve at postoperation. Moreover, when we removed the tumor, the following steps were taken: 1) A skin incision was established with minimum length. 2) Incising the preauricular area, we drew a cutting line on the external auditory canal inside a tragus. 3) The sigmoid curve in the postauricular area was designed as gently as possible. The cervical incision line was drawn along the digastic muscle.

Conclusion

It is clear that during operations for the facial nerves, complete extraction of the tumors and minimum skin incision in the parotid gland tumor yield compatible results.
Biofilms on Patients with Skull Base Osteoradionecrosis
Authors: Tsai Yiih‐Jeng , Chiu Bo‐Han , Hao Sheng‐Po
Published: February 2015

Objective

To study if there are biofilm formations in the nasopharyngeal tissues from NPC patients who were diagnosed as having skull base osteoradionecrosis (ORN).

Method

We conducted a prospective study to evaluate the presence of biofilm formations in NPC patients with and without ORN between 1980 to 2011. The specimens obtained were processed and analyzed with FilmTracer LIVE_DEAD Biofilm Viability Kit and fluorescent microscope. The investigator examining the sample was blinded to the disease state.

Results

Eleven of 15 (73%) NPC with ORN patients demonstrated biofilm formations in their nasopharynbiopsied specimens. Five of them yielded positive cultured results which made the culture rate 45%. Among the culture results, 4 patients showed MRSA infections and 1 patient showed streptococcus viridins. Two patients with MRSA infections had concomitant Escherichia coli and candida infections, respectively. The other 4 NPC with ORN patients without biofilms detected showed negative in culture. In NPC patients without ORN, 1 of the 12 (8%) patients presented the biofilm formation. The culture results were all negative.

Conclusion

Although the role of biofilm in skull base ORN of NPC remains unclear, this article presents further evidence of their existence in this condition. Their presence not only implicate them in the pathogenesis of ORN, but might partly explain its chronicity and its resistance to antibiotic treatment.
Black Thyroid Secondary to Minocycline Use
Authors: Smucker Joanne , Goyal Neerav , Goldenberg David
Published: February 2015

Objective

To present 3 cases of black thyroid syndrome discovered intraoperatively in association with prior and current minocycline use.

Method

This is a case series of 3 cases between 2009 and 2012 at a tertiary care referral center where a darkly pigmented (black) thyroid was identified intraoperatively. Retrospective chart review was performed for each of these cases to review pathology, intraoperative findings, and patient history.

Results

From other studies conducted, black thyroid has been found to be highly associated with the use of the drug minocycline. In reviewing our cases of black thyroid, it was discovered that each patient had taken or was currently taking minocycline. All cases were found incidentally intraoperatively. One case was associated with thyroid carcinoma, while the others did not have pathology consistent with neoplasm. The first case was noted during a total thyroidectomy for papillary thyroid carcinoma, the second case during a parathyroidectomy for primary hyperparathyroidism, and the last case during a partial left thyroidectomy for thyroid goiter.

Conclusion

While other causes of black thyroid have been suggested, the most common cause of black thyroid, minocycline use, held true in the 3 cases presented. There have been recent reports of a linked association with black thyroid and carcinoma which warrants further investigation.
Body Weight for Outcome of Uvulopalatopharyngoplasty
Authors: Chao Chun Chih , Wu Jiunn‐Liang , Chang Yu‐Tuan , Lin Cheng‐Yu
Published: February 2015

Objective

Uvulopalatopharyngoplasty (UPPP) is the commonly performed surgical procedure for the treatment of obstructive sleep apnea syndrome (OSAS). The efficacy of this procedure has not been clearly established. Our aim was to assess long‐term effects of UPPP for OSAS and the impact of body weight for outcome of UPPP.

Method

We report the results of routine pre‐/postoperative OSA‐related assessments in patients undergoing UPPP from January 1, 2003 to June 30, 2011. All participants received overnight polysomnography (PSG) and questionnaires regarding daytime sleepiness, snoring severity, and sleep quality before and after the treatment.

Results

Fifty patients completed the study. Forty‐two (80%) were male subjects. The average age was 30.7 years. The success of UPPP was defined as AHI reduction more than 50% and post‐op AHI <20. The success rate for UPPP was decreased with time (<0.5 year: 81.8%; 0.5‐1 year: 44.4%; 1‐2 years: 33.3%; 2‐3 years: 33.3%; 3‐5 years: 42.9%; >5 years: 40.0%). There were 27 patients with body weight reduction after UPPP. In the group of patients with body weight increase after UPPP, snoring index was increasing (P =. 0080), AHI was increasing (P =. 0512), and ESS was increasing (P =. 0182) with longer follow‐up period.

Conclusion

Sleep apnea could be resolved for most patients in 6 months after UPPP but recurred with longer post‐op period. Body weight change may be an important factor for recurrence. For OSA patients with body weight increase after UPPP, the recurrence rate was higher than patients with body weight reduction.
Boron Neutron Capture Therapy for Squamous Cell Carcinoma of the Skull Base
Authors: Inui Takaki , Haginomori Shin‐Ichi , Ichihara Takahiro , Takamaki Atsuko , Kawata Ryo
Published: February 2015

Objective

1) Describe the first case of inoperative squamous cell carcinoma (SCC) in the skull base recurring after surgery, conventional radiotherapy, and chemotherapy, which was treated using 2‐stage boron neutron capture therapy (BNCT). 2) Determine the effectiveness of BNCT for head and neck cancer.

Method

We present a case of inoperative recurrent SCC in the right temporal bone involving the occipital condyle. The patient underwent BNCT twice in 1 month in 2007 at Research Reactor No. 4 of the Japan Atomic Energy Research Institute to ensure neutron capture in the deep lesion.

Results

An epithermal neutron beam was used as the neutron source. The total estimated radiation dose of the BNCT to the tumor beneath the skin, at the deepest point of the tumor, and in the skin around the right auricle was 41.8, 36.9, and 15.8 Gy‐Eq, respectively. After the BNCT, the tumor became necrotic and shrank immediately and disappeared 6 months after the first BNCT. Radiological studies performed 5 years after the first BNCT showed no evidence of residual or recurrent tumors.

Conclusion

Total resection of SCC deeply invading the skull base is difficult. Surgical complications can leave patients in critical condition. Two‐stage BNCT might be an effective treatment for patients with SCC deep in the skull base.
Caution: Carotid Artery Aneurysm May Disguise as Neck Tumor
Authors: Pacheco Paulette C. , Almodovar Gustavo J.
Published: February 2015

Objective

1) To present a case where a right common carotid aneurysm was clinically undistinguishable from tumor. 2) Stress the importance of contrast‐enhanced imaging in the workup of a neck mass. 3) Review of literature.

Method

A 64‐year‐old male smoker with hypertension presented with hoarseness, dysphagia, and an enlarging right neck mass. Physical examination revealed 6‐cm neck mass, nonfluctuant, nonpulsatile. F/L: Right parapharyngeal mass impinging right hemilarynx, causing partial airway obstruction. Noncontrast computed tomography (CT) scan was suggestive of neoplasia versus abscess formation. Contrast‐enhanced CT revealed an aneurysm of the right carotid bifurcation. PubMed literature was reviewed.

Results

Extracranial carotid aneurysms are rare (1‐4%), with atherosclerosis being the most common etiology. They arise in the internal carotid (67%), bifurcation (32%), and the external carotid artery (1%). Airway obstruction and dysphagia has been reported in very few cases. In our patient this led to the clinical diagnosis of tumor. Contrast‐enhanced imaging is essential in the workup of a neck mass. Management options include interposition bypass grafting, resection with patch angioplasty, or carotid ligation, as well as endovascular interventions with stenting or occlusion.

Conclusion

Large carotid artery aneurysms may resemble a tumor and they must be considered in the differential diagnosis of a neck mass. The importance of contrast‐enhanced imaging before attempting invasive procedures cannot be overemphasized.
Cervicofacial and Cervicothoracic Rotation Flaps: An Update
Authors: Van Deusen Mark B. , Athavale Sanjay , Dang Jennifer , Netterville James L.
Published: February 2015

Objective

1) Understand the indications for use of the cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 2) Learn the surgical technique for constructing cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 3) Describe the varying defects that can be reconstructed with cervicofacial and cervicothoracic advancement flaps.

Method

Retrospective review of medical records at a university‐based head and neck cancer center. Patients were operated on between 2001 and 2012. Patients had varying lesions that were amenable to cervicofacial and/or cervicothroacic advancement flaps. After a thorough description of indications and defect locations, complications and flap viability were evaluated.

Results

Sixty‐nine patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common surgical indication, followed by primary parotid tumors and cervical metastases from aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps. Larger wounds required extension of the incision onto the chest wall. Other reconstructive modalities were used in 38 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 15 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy.

Conclusion

Compound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct compledefects of the face, lateral skull.
Clinical Efficacy of FDG‐PET/CT in Head and Neck Adenoid Cystic Carcinomas
Authors: Smith Tukisa D. , Varvares Mark A.
Published: February 2015

Objective

Positron emission tomography/computed tomography (PET/CT) with fluorine‐18‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG) of salivary malignancies is variable, thus unreliable for staging/surveillance. For adenoid cystic carcinomas (ACC), data is limited regarding FDG uptake. The objective is to characterize PET/CT and its ability to detect primary disease/tumor recurrence in patients with head and neck ACCs (HNACCs).

Method

Ten‐year retrospective study of 25 patients diagnosed with HNACCs. Eleven patients (8 women; age 33‐65 years at time of diagnosis) were referred for whole‐body FDG‐PET/CT. Secondary imaging modalities were also acquired. Fifteen tumor sites (primary and metastatic foci) were evaluated. Histological disease was confirmed by biopsy and surgical pathology.

Results

Of those referred for PET/CT, 81.8% (9/11) had primary disease foci detected and 22.2% (2/9) had distant metastasis. In one patient with metastatic disease, cavernous sinus disease was detected on MRI and not appreciated on PET/CT but was consistent with MRI in detecting disease foci of the nasal dorsum and lung. In one patient with base of the tongue ACC, PET/CT accurately detected cervical lymph nodes suspicious for malignancy not detected on CT scan. On MRI, another patient treated for nasal cavity ACC had what appeared to be disease recurrence, not appreciated on PET/CT and was confirmed as a pyogenic granuloma.

Conclusion

In HNACCs, FDG‐PET/CT is useful for preoperative evaluation of initial/recurrent disease foci and disease staging for treatment strategy; thus it shouldn’t be excluded as a method of patient evaluation.
CRP as an Inflammatory Marker in Oral Rinses
Authors: Pierce Brendan H. G. , Ondrey Frank
Published: February 2015

Objective

1) Learn if CRP stimulates production of IL‐6 in human leukoplakia cells (MSK‐Leuk1). 2) Learn if pioglitazone attenuates CRP stimulation of IL‐6 in leukoplakia cells. 3) Establish an oral rinse CRP reference range in controls that can be used in an ongoing trial of leukoplakia patients treated with pioglitazone.

Method

ELISA will be used to measure IL‐6 release from MSK‐Leuk1 treated with varying concentrations of CRP and pioglitazone. ELISA will be used to measure CRP in oral rinses of control patients. Two‐sided t test and ANOVA are used for analysis of results with significance level of 5%.

Results

When treated with CRP (0.001‐10 ug/mL), MSK‐Leuk1 cells increased IL‐6 release in a dose‐dependent manner (P <. 05). When treated with CRP (0.01‐10 ug/mL) and with pioglitazone (10 uM) MSK‐Leuk1 cells released a statistically significantly decrease in IL‐6 as compared to CRP treatment (P <. 05) Oral rinses were easily collected and CRP was measured by ELISA to establish controls for an ongoing study of pioglitazone treatment of leukoplakia and CRP as an affective inflammatory marker.

Conclusion

CRP is now shown to play an active roll in increasing the inflammatory cascade in leukoplakia cells, and pioglitazone attenuates this stimulation as measured by IL‐6. The next step is to test CRP in already collected oral rinses of leukoplakia patients before and after treatment with pioglitazone.
Dental Health of Patients Receiving Intensity Modulated Radiation Therapy vs Conventional Radiation Therapy
Authors: Duarte Victor M. , Tajima Tracey , Nabili Vishad , Wang Marilene B.
Published: February 2015

Objective

To analyze the dental health of head and neck cancer patients who received comprehensive dental care before and after radiation.

Method

Retrospective study of 282 head and neck cancer patients at a single VA hospital who were treated with radiation between 2000 and 2010 were identified. All patients received conventional radiation therapy (RT) or intensity‐modulated radiation therapy (IMRT).

Results

A complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The treatment plan was formulated to eliminate current and potential dental disease, as well as prepare for future dental rehabilitation. The rates of dental extractions, infections, and caries were analyzed and comparison made between patients treated with IMRT and those treated with conventional RT. The number of posttreatment extractions has been reduced with advent of IMRT, and more so with a complete dental evaluation prior to treatment. The rate of caries was found to be less in patients treated with IMRT.

Conclusion

Head and neck cancer patients who had IMRT had significantly less radiation caries and more salivary flow and less requisite post‐treatment extractions compared to those patients with conventional RT.
Effect of Aging on Tracheoesophageal Speech Rehabilitation
Authors: Lundy Donna , Weed Donald T. , Landera Mario A. , Bremekamp Jocelyn
Published: February 2015

Objective

1) To determine whether tracheoesophageal puncture usage changes as a function of age. 2) To determine whether age is associated with voice deteroriation, need for repuncture, or dependence in stomal care.

Method

Retrospective chart review on individuals following total laryngectomy and tracheoesophageal puncture (TEP) and minimum 1‐year follow‐up data after prosthesis placement. Data reviewed included demographic variables and medical/surgical factors related to laryngectomy. Outcome measures of voice deterioration, TEP use, repuncture, and change in dependent prosthesis management were compared with age.

Results

Sixty‐nine individuals were identified that met criteria; 58 men and 11 women. Mean age was 65 years (range, 43‐88 years). Nine individuals, mean age of 70.0 years, did not use their prosthesis for speech purposes; 2 chose never to use it and the remainder became unable to speak due to further medical issues. Deterioration in speech was further noted in five individuals, mean age of 79.4 years. Seven individuals, mean age of 58.6 years, required a re‐puncture due to extrusion. Six individuals with a mean age of 76.3 years became dependent over time for daily stoma management.

Conclusion

Age was significantly associated with deterioration in alaryngeal voice quality and need for dependence in stoma care for older individuals while repunctures were associated with a younger age. These results support careful selection criteria and counseling when considering a tracheoesophageal puncture in an older aged individual.
Endoscopic Transnasal Craniectomy for Sinonasal Malignancies
Authors: Villaret Andrea Bolzoni , Nicolai Piero , Bottazzoli Marco , Bignami Maurizio , Turri‐Zanoni Mario , Battaglia Paolo
Published: February 2015

Objective

This study reviewed the surgical technique of endoscopic resection with transnasal craniectomy (ERTC), its indications, and morbidity in the management of selected sinonasal malignancies.

Method

From April 1996 to December 2010, 265 patients affected by sinonasal malignant tumors were treated by endoscopic resection at 2 referral university hospitals. From 2004, 126 patients underwent ERTC. Duraplasty was carried out using iliotibial tract and fat tissue. Overall (O), disease‐specific (DS), and recurrence‐free (RF) survival were calculated.

Results

The most frequent histologies were adenocarcinoma (57%) and olfactory neuroblastoma (16%). Eighty‐seven (69%) patients were previously untreated. The overall complication rate was 10.6%. Cerebrospinal fluid leak was observed in 9 (7%) cases. The mean hospitalization time was 10.5 days (range, 5‐32 days). Overall, 75 (60%) patients received adjuvant treatment. After a mean follow‐up of 52.7 months (range, 12‐169 months), 100 (79.3%) patients had no evidence of disease, with 5‐year OS, DSS, and RFS of 82.6%, 85.7%, and 77.9% respectively.

Conclusion

ERTC is a safe procedure with an acceptable complication rate, allowing the ability to perform a wide resection of the dura with a correct assessment of its involvement. Only a few cases of malignancies extending intracranially require combining with an external subfrontal craniotomy.
TNM Staging Does Not Predict Survival in HPV‐Positive OPSCC
Authors: Ward Matthew J. , Mellows Toby , Riley Catherine L. , King Emma V. , Thomas Gareth J.
Published: February 2015

Objective

1) To establish the rates of HPV associated oropharyngeal SCC (OPSCC) in our local population. 2) To establish the effect of HPV on survival from OPSCC. 3) To establish relevance of TNM staging in OPSCC.

Method

We conducted a retrospective chart review of 256 consecutively treated OPSCCs in Southern England between 2000 and 2010. We recorded TNM stage and other potentially prognostic factors including differentiation, margin status, extracapsular spread, and tumor cohesion. HPV status was determined using both p16 immunohistochemistry and HPV in situ hybridization (ISH).

Results

A total of 57.4% of OPSCC were found to be HPV‐positive (p16‐positive, ISH‐positive) and had improved disease specific survival (DSS) (OR 0.290, P <. 001). TNM staging predicted for survival in HPV‐negative patients only (HPV‐ve OR 2.119, P =. 033; HPV+ve OR 2.022, P =. 49). Further analysis showed that although T stage was predictive in both cohorts (HPV‐ve OR 3.579, P =. 006; HPV+ve OR 11.654, P =. 001), N stage only predicted for DSS in HPV‐negative tumors (HPV‐ve OR 1.996, P =. 022; HPV+ve OR 1.437, P =. 623), despite the fact that a higher proportion of HPV‐positive tumors present with advanced nodal disease (N2/N3) (HPV+ve 75.3%, HPV‐ve 50.1%, P <. 001).

Conclusion

HPV‐positive OPSCC frequently presents with advanced nodal disease. However, in contrast to HPV‐negative disease, this does not have a negative effect on disease specific survival. These data show that classical prognostic indicators do not apply to HPV‐positive OPSCC and highlight the essential requirement for determining HPV status in OPSCC patients.
3D Reconstruction to Detect Fish Bones in Foreign Body Models
Authors: Yoo Young Sam , Lee Han Bee , Choi Jung Hwan , Cho Kyung Rai
Published: February 2015

Objective

When fish bones are impacted in pharynx or in esophagus, it’s hard to find them with simple radiography. We designed foreign body models with fish bones and used their computed tomogram data to make 3D reconstructed images. Various modifications of 3D data were tested for foreign body detection.

Method

Bones from 3 species of fishes frequently consumed in Korea were used as foreign body models. Fish bones were sandwiched between plates of fish paste. Computed tomograms taken were converted into 3D images. Multi‐planar reconstruction, volume rendering, and virtual endoscopy were used to determine the characteristics of fish bones.

Results

Shapes of the bones are easily reconstructed for the mandible. Gill cover and spine cannot be reconstructed perfectly. The shape could be figured out in every reconstructed image in volume rendered images after removal of soft tissue data. In measuring size, plane CT are useful in detecting margins. Volume rendered images also were suitable in measuring the size. The location of the foreign bodies could be easily measured if the reference point is given. The axial CT image or 3D images are both useful in calculating distance from the reference point. In view of orientation, 3D images are best of all.

Conclusion

Searching for fish bones and gathering information about them are difficult tasks in esophageal foreign body cases. Fish bone foreign body models and their reconstructed images are useful in getting information about size, shape, location, and orientation. This technique could be applied in finding real fish bone foreign bodies.
Balloon Cricopharyngeoplasty for Cricopharyngeal Achalasia
Authors: Rao‐Merugumala Srinivasa
Published: February 2015

Objective

To evaluate a series of patients with dysphagia who required diagnostic rigid endoscopy including failed flexible endoscopies (had hypopharyngeal cancer). To present a rare case of cricopharyngeal achalasia and to document the diagnostic process followed. Determine the efficacy and the safety of endoscopic balloon cricopharyngeoplasty (EBCP) for cricopharyngeal achalasia.

Method

To evaluate 99 consecutive patients including 5 failed flexible endoscopies (referred from elsewhere) who underwent rigid hypopharyngoscopy ± laryngoscopy for dysphagia ± hoarse voice since 2005, and to present 1 unusual case of cricopharyngeal achalasia and its effective management with EBCP.

Results

Among the 99 patients, the 5 patients had prior flexible endoscopy/gastroscopy showed hypopharyngeal cancer (2 circumferential, 2 pyriform fossae, and 1 with tumor with bilateral cervical and distant metastasis). The false reassurances of these flexible endoscopies lead to the advanced presentations of these tumors. One representative case includes an 80‐year‐old Asian female patient presented with 3‐year history of progressive severe dysphagia, cachexia, and choking on liquids. Cricopharyngeal achalasia was noted on rigid endoscopy and EBCP was performed, which was well tolerated with no postoperative complications with complete relief of dysphagia. The patient was discharged on the same day.

Conclusion

Cricopharyngeal achalasia is a rare and potentially lethal cause of dysphagia, due to aspiration in the elderly. EBCP offers a safe an effective, safe alternative to conventional procedures. Symptomatic relief is immediate and complete with no long‐term recorded recurrence; hence, EBCP is proposed as a simple alternative to laser/open procedures.
Endoscopic Posterior Cricoid Expansion in Children
Authors: Gerber Mark E. , Modi Vikash K. , Ward Robert F. , Gower Verlia , Thomsen James R.
Published: February 2015

Objective

To review our experience with endoscopic posterior cricoid split and costal cartilage graft placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS).

Method

Multi‐institutional retrospective case series of all patients treated with endoscopic posterior cricoid split and costal cartilage graft placement (EPCSCG) by any of the authors. Outcomes measured include: indications, complications, outcome.

Results

Twenty‐six patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years. Overall, there was an excellent success rate with 25/26 either never requiring tracheostomy or achieving decannulation and 24/26 having adequate symptom control. The mean follow‐up was 23.15 months. Sixteen patients had resolution of their symptoms. Fourteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis or vocal fold immobility. Thirteen achieved decannulation and/or had resolution of preoperative symptoms. Three patients had isolated PGS or cricoarytenoid fixation with 2 achieving decannulation without additional procedures and the third decannulated after revision endoscopic division of a congenital anterior glottic web. Nine patients had isolated BVFI. Two of the 9 had failed prior laryngeal surgeries and 4 did not have tracheostomies at the time of their EPCSCG. Of these 9 patients, 7 had resolution of their airway symptoms without additional procedures.

Conclusion

Based on this experience, EPCSCG is worth consideration for the management of select pediatric patients with BVFI, PGS, and SGS.
CT‐Measured Normative Costochondral Growth in Children
Authors: Andreoli Steven M. , Mills Jared C. , Kilpatrick Lauren A. , White David R. , Patel Krishna G.
Published: February 2015

Objective

Careful operative timing is required for children undergoing microtia repair using autologous costochondral grafting. There remains a paucity of data regarding cartilaginous growth of the ribs and synchondrosis routinely harvested during microtia repair. This study employs CT imaging to generate normative costochondral growth curves in children.

Method

A population study was performed at a tertiary pediatric hospital. Chest CTs were reviewed in children ages 3 to 20 years. Demographic information was recorded. CT measurements included: cartilaginous length of ribs 6, 7, and 8 and the height of the synchondrosis between ribs 6 and 7.

Results

A total of 360 studies were reviewed. At age 6: ribs 6, 7, and 8 measure 5.76 ± 0.65, 7.57 ± 0.87, and 6.68 ± 1.06 cm, respectively. In adulthood ribs 6, 7, and 8 measure 8.29 ± 1.00, 11.10 ± 1.19, and 8.95 ± 1.99 cm. The vertical height of the synchondrosis between ribs 6 and 7 at years 6 and 20 are 2.64 ± 0.37 and 3.59 ± 0.52 cm. Synchondrosis height is 85% and 100% of adult auricle width at ages 6 and 8, respectively. Beginning at 3 years, ribs 6, 7, and 8 grow near linearly at 1.71, 2.46, and 1.35 mm, respectively, per year. Mean synchondrosis growth is 1.81 mm annually. Gender‐ and race‐specific growth charts are presented.

Conclusion

Cartilaginous growth of ribs 6 to 8 during childhood is nearly linear. Synchondrosis height approaches adult auricle width at 8 years. Rib size is consistently larger in males and on the left side. These data allow planning for the pediatric otolaryngologist and facial plastic surgeon performing microtia surgery.
Microdebrider in Management of Obstructive Laryngeal Tumors
Authors: Hassan Mohamed H. , Gaafar Alaa , Bahgat Ahmad Y. , Elhady Mona Abd
Published: February 2015

Objective

1) To determine the efficacy of the powered endoscopic microdebrider as a tool in the management of obstructive laryngeal tumors. 2) To compare the histopathological diagnosis between a biopsy taken using the laryngeal forceps and the resected tissue from the microdebrider.

Method

This study is a prospective randomized study. Eighteen patients presented with obstructive laryngeal tumors to the outpatient clinic or emergency room of Alexandria Main University Hospital in 12 months duration starting from November 2010 till November 2011. Tumor debulking was done using laryngeal microdebrider.

Results

All cases presented with moderate to severe stridor, the lesion obstructing more than 50% of the lumen of the larynx. In all cases tracheotomy could be avoided until a definitive therapy was initiated. No significant bleeding was encountered during these procedures. The operating time was directly dependent on the volume of the tumor. Both biopsies (one taken by forceps and the other from tissues resected by microdebrider) gave the same diagnosis except in 1 patient, as there were artifacts in microdebrider collected tissues.

Conclusion

Endoscopic debulking of laryngeal tumors using the microdebrider is a safe, accurate, and reliable method, thus preventing tracheotomy in most cases. The use of microdebrider does not preclude the submission of tissue for histological analysis. These preliminary results are encouraging and worthy of further evaluation and comparison with other techniques.
“Punch” Method for Bone‐Anchored Hearing Aid Placement
Authors: Goldman Richard A. , Shaia Wayne T. , Georgolios Alexandros
Published: February 2015

Objective

Various techniques have been described for bone anchored hearing system placement. Alterations to the initial technique have helped lower complication rates. Additional modifications can continue to improve postoperative results. A safe, streamlined approach for bone anchored hearing system placement to limit these known complication rates will be presented.

Method

A retrospective chart review of 15 consecutive adult patients from an otology/neurotology practice was performed. Patients underwent the “Punch” method for placement using a 4‐mm implant with the longer 9‐mm abutment. The initial incision is performed using a 12‐mm punch biopsy with variations to the standard procedure.

Results

Fifteen of 15 patients had successful placement of the bone anchored device. Ten were Oticon Ponto® systems, and 5 were the Cochlear BAHA® systems. There were no cases of tissue overgrowth, failure of osseointegration, or major postoperative infections. The only complications were minor skin infections that were treated with oral and topical antibiotic. All operative times were recorded and found to be less than 15 minutes. Postoperative follow‐up ranged from 10 to 24 months. All implants were found to be well integrated.

Conclusion

Bone‐anchored hearing system placement with longer abutments may reduce postoperative tissue overgrowth. Using the “Punch” method decreases major postoperative infections, reduces incision length, improves cosmesis, and decreases operative time. Larger studies are needed to determine if the low complication rate demonstrated in this study will continue.