bluuebunny/crossref_metadata_2025 huggingface dataset:
Pyriform Sinus Mucosa Stabilization for Prevention of Postoperative Airway Obstruction in Arytenoid Adduction
Authors: Maragos Nicolas E.
Published: October 2014

Objectives:

The Isshiki arytenoid adduction procedure directly closes the open posterior glottis. Postoperative airway obstruction that necessitates emergent tracheotomy is an important complication in arytenoid adduction patients when the standard posterior thyroplasty window is used to approach the posterolateral larynx. Immediate postoperative fiberoptic laryngoscopy shows ipsilateral edema and/or hematoma of the arytenoid and supraglottic mucosa, with occasional obstructing inspiratory collapse. In this study, I sought to modify the posterior window approach during arytenoid adduction surgery, and thereby decrease the incidence of immediate postoperative airway obstruction.

Methods:

I performed a retrospective chart review of 246 arytenoid adduction patients, looking for immediate postoperative airway compromise.

Results:

There were no episodes of postoperative airway obstruction that necessitated tracheotomy in the first 30 patients in whom I approached the posterolateral larynx using the classic Isshiki techniques. Nine of the succeeding 132 adduction patients required emergent tracheotomy when the standard posterior window technique was used instead of a classic Isshiki approach (6.8%). In the most recent 84 patients, I used one tacking suture to stabilize the elevated pyriform sinus mucosa to the upper margin of the posterior window cartilage at closure. Four of the 84 patients had audible postoperative airway turbulence that abated with medical treatment, and 1 patient required an emergent tracheotomy (1.2%; p = .0495).

Conclusions:

Suture stabilization of the pyriform sinus mucosa is effective and is recommended for prevention of posterior glottic airway obstruction after arytenoid adduction when the posterior window technique is used.
Quantitative and Comparative Studies of the Vocal Fold Extracellular Matrix II: Collagen
Authors: Hahn Mariah S. , Kobler James B. , Zeitels Steven M. , Langer Robert
Published: October 2014

Objectives:

This study examines the collagen content and turnover in the midmembranous vocal fold laminae propriae (LPs) of humans, dogs, pigs, and ferrets.

Methods:

The LP collagen levels were assessed by quantifying tissue hydroxyproline. Quantitative histology allowed evaluation of the collagen content in specific LP regions. Several collagen types and Two markers of collagen turnover were examined immunohistochemically.

Results:

Collagen made up 43.4% ± 2.6% of human LP total protein (TP), with men having approximately 30% higher collagen content than women (p > .024). The collagen levels in pigs (52.6% ± 1.9% of TP) and ferrets (29.8% ± 3.7% of TP), but not that in dogs (45.3% ± 1.2% of TP), varied significantly from that in humans (pigs, p > .016; ferrets, p > .011). Quantitative histology indicated marked interspecies differences in total collagen distribution. Collagen types I, III, and IV were detected in the LP, and spatially complex staining patterns were observed for the Two markers of collagen turnover studied.

Conclusions:

The collagen content of the human LP is approximately 60% to 70% of that of human dermis. Although canine LP collagen levels are most similar to those of humans, quantitative histology indicates that the collagen distribution of the human LP is best matched by the porcine LP. Collagen types I and III seem to be the dominant LP collagens. Spatial variations in collagen turnover appear to exist that may contribute to normal LP physiology.
Predictors of Laryngeal Complications in Patients Implanted with the Cyberonics Vagal Nerve Stimulator
Authors: Shaw Gary Y. , Sechtem Philip , Searl Jeff , Dowdy Emily S.
Published: October 2014

Objectives:

Since its approval by the US Food and Drug Administration in 1997 for management of medically refractory seizures, more than 35,000 patients have been implanted with the Cyberonics vagal nerve stimulator. Preliminary reports described transient vocal changes in the majority of subjects, which were thought to be short-term. However, these reports were for the most part based upon perceptual evaluations by the subjects themselves. Later reports described possibly more permanent recurrent laryngeal nerve injury and recommended measuring the nerve diameter to use the safest spiral cuff electrode. To date, no study has systematically evaluated vocal fold mobility in subjects before and after implantation. The objectives of this study were to determine the true incidence of both short- and long-term recurrent laryngeal nerve injuries and determine whether there are any potential indicators to predict in which patients long-term nerve deficits may develop.

Methods:

Thirteen subjects underwent preimplantation laryngeal electromyography, videolaryngoscopy, measurement of the maximum phonation time, Voice Handicap Index determination, and Consensus Auditory-Perceptual Evaluation of Voice. Two weeks after implantation, all subjects underwent videolaryngoscopy. Three months after implantation and activation of the device, all subjects were reevaluated.

Results:

Six of the 13 subjects had significant vocal fold mobility abnormalities at 2 weeks. Significant electromyographic abnormalities were detected before implantation in 5 subjects. All 5 of these subjects, at 3 months after implantation, had prolonged left vocal fold paresis.

Conclusions:

The authors conclude that perioperative vocal fold paresis occurs in approximately 50% of subjects. Further, laryngeal electromyography performed before implantation of the vagal nerve stimulator is a statistically significant predictor (p > .05) of which patients may be at risk for extended vocal fold abnormalities. Possible explanations for this phenomenon are offered. Surgical modifications to limit vagal nerve injury are offered.
Bacterial Interference of Penicillin-Sensitive and -Resistant Streptococcus Pneumoniae by Streptococcus Oralis in an Adenoid Organ Culture: Implications for the Treatment of Recurrent Upper Respiratory Tract Infections in Children and Adults
Authors: Bernstein Joel M. , Hasse Elaine , Scannapieco Frank , Dryja Diane , Wolf Judy , Briles David , King Janice , Wilding Gregory E.
Published: October 2014

Objectives:

The role of the viridans group of streptococci ( Streptococcus oralis) in the prevention of colonization with Streptococcus pneumoniae was investigated in an adenoid organ culture system.

Methods:

The adenoids from 10 patients who were undergoing adenoidectomy for either hypertrophy or recurrent otitis media were used.

Results:

Streptococcus oralis Parker and S oralis Booth (two organisms isolated from the nasopharynges of patients undergoing adenoidectomy only and patients undergoing adenoidectomy and bilateral tympanostomy with tubes, respectively) uniformly inhibited both penicillin-sensitive and penicillin-resistant S pneumoniae. Although both strains of S oralis inhibited the growth of both S pneumoniae strains, strain Parker provided more complete inhibition than did strain Booth.

Conclusions:

The results indicate that some strains of S oralis may inhibit the growth of the most serious pathogens in the nasopharynx. It is therefore possible that colonization of inhibitory strains of viridans streptococci may be used in the nasopharynx as a relatively safe and inexpensive approach to prevention of recurrent otitis media in some children and of recurrent suppurative sinusitis in both children and adults.
One-off Streptococcal Serologic Testing in Young Children with Recurrent Tonsillitis
Authors: Borschmann Michael E. , Berkowitz Robert G.
Published: October 2014

Objectives:

Recurrent acute tonsillitis in children under 4 years of age is usually viral, making antibiotic therapy inappropriate and the indication for tonsillectomy uncertain. Identifying those young children with bacterial infections is therefore important. The purpose of this study was to determine whether one-off streptococcal serologic testing is a useful tool in assessing recurrent acute tonsillitis in young children.

Methods:

We performed a retrospective study of 45 children (35 male and 10 female) under the age of 4 years who were found by a staff otolaryngologist to have recurrent acute tonsillitis over a 5-year period and had one-off serologic testing for anti–streptolysin O titers and anti–deoxyribonuclease B levels. Data were collected by chart review.

Results:

Three children (6.7%) had clearly positive titers for either one or both streptococcal antibodies. Children with negative serologic results were significantly less likely to have shown a significant response to antibiotic therapy for their acute episodes (26% versus 100%; p = .026). Nine children (20%) eventually underwent tonsillectomy, all of whom had negative serologic results.

Conclusions:

Anti–streptolysin O and anti–deoxyribonuclease B levels may aid clinical evaluation of recurrent acute tonsillitis in young children in differentiating between those cases due to group A β-hemolytic Streptococcus and those that are viral in origin.
Role of the Island Deltopectoral Flap in Contemporary Head and Neck Reconstruction
Authors: Mortensen Melissa , Genden Eric M.
Published: October 2014

Objectives:

The deltopectoral flap (DP) was originally described 40 years ago for head and neck reconstruction. Since that time, use of pedicled myocutaneous flaps and free tissue transfer has supplanted the DP flap as a first-line reconstructive tool. The island DP flap, a variation of the DP flap wherein the skin bridge is de-epithelialized, provides a source of thin and pliable tissue that can be useful for select head and neck reconstruction. The purpose of this review is to assess the utility of the island DP flap in contemporary head and neck reconstruction.

Methods:

A retrospective review of 16 consecutive cases utilizing the island DP flap was performed. Indications, complications, and outcome were reviewed in an effort to determine the role of the island DP in contemporary head and neck reconstruction.

Results:

Sixteen island DP flap procedures were successfully performed in 16 patients for a variety of reconstructions, including esophageal, laryngeal, cutaneous, and pharyngeal defects. The donor skin paddles averaged 22.4 cm2 (range, 14 to 40.8 cm2). There were no recipient site complications; however, there was 1 donor site hematoma that was managed with drainage. In all 16 cases, the island DP flap provided an appropriate source of donor tissue for reconstruction of limited defects of the pharynx, esophagus, and skin of the neck.

Conclusions:

The island DP flap is a reliable donor site that provides an excellent source of thin and pliable tissue for limited defects of the head and neck.
Halofuginone Prevents Subglottic Stenosis in a Canine Model
Authors: Eliashar Ron , Ochana Meir , Maly Bella , Pines Mark , Sichel Jean-Yves , Nagler Arnon
Published: October 2014

Objectives:

Halofuginone is a low-molecular weight quinazolinone alkaloid coccidiostat that inhibits collagen type I synthesis, extracellular matrix deposition, and angiogenesis. This study was conducted to assess its potential in preventing subglottic stenosis (SGS).

Methods:

We induced SGS in 10 dogs randomly divided into 2 groups. Each group received treatment between 3 days before and 21 days after the induction of SGS. One group received oral halofuginone 40 μg/kg, and the other was given placebo. The area of the subglottic lumen was measured at baseline and 3 months later. In addition, human tracheal fibroblasts were cultured. The inhibitory effect of halofuginone was compared to the effect of mitomycin.

Results:

All dogs survived throughout the study with no side effects. Three months after the operation, no halofuginone-treated dog had SGS, in contrast to a 66% to 80% stenosis rate (mean, 72%) in controls (p > .008). Thick fibrotic tissue was found in the placebo-treated larynges, whereas an almost normal architecture was observed in halofuginone-treated larynges. Halofuginone inhibited the growth of human tracheal fibroblasts by 75%, in comparison with 60% inhibition by mitomycin (no statistically significant difference).

Conclusions:

This preliminary study shows that halofuginone is effective in preventing SGS caused by an acute injury. Halofuginone has a potential therapeutic role in preventing SGS in humans.
Nonsurgical Management of Pediatric Tracheal Perforation
Authors: Kelley Richard , Reynders Amy , Seidberg Neal
Published: October 2014

Tracheal perforation is a rare complication of intubation. In the pediatric population, the rates of morbidity and mortality are high if diagnosis and management are delayed. Recommendations for treatment in these patients are based on the several reports of this injury in the adult and neonate populations. Surgical repair is generally favored over conservative care in the majority of cases. We describe the case of a 10-year-old girl who presented with subcutaneous emphysema after intubation in the emergency department. The patient had a 3-cm injury to the distal trachea. Nonsurgical management resulted in a normal-appearing trachea and a healed perforation site as confirmed by repeat tracheobronchoscopy 4 months after the initial injury. In clinically stable pediatric patients, nonsurgical management of tracheal perforations should be considered.
Early Oral Feeds in Laryngectomized Patients
Authors: Prasad Kishore Chandra , Sreedharan Suja , Dannana Naveen Kumar , Prasad Sampath Chandra , Chandra Satish
Published: October 2014

Objectives:

It is a common practice to start oral feeding after 7 to 10 days in patients who have undergone laryngeal surgeries. It was our observation that when oral feeds were initiated earlier than this period, there was no increase in the incidence of pharyngocutaneous fistulas. This prospective study is about our experience in initiating early oral feeds in the postoperative period (on the 2nd day) in laryngectomized patients.

Methods:

Seventy-eight patients underwent laryngectomy with or without partial pharyngectomy over a period of 38 months between October 2001 and December 2004. The oral feeds were initiated on the 2nd postoperative day in 40 patients. Thirty-eight patients served as controls in whom feeds were initiated after the 10th postoperative day.

Results:

Only 1 patient in the study group and 2 patients in the control group developed pharyngocutaneous fistulas. Most patients in the control group wished to avoid nasogastric intubation in the recovery period because of discomfort, gastric symptoms, and the need to taste food.

Conclusions:

With this study we can assume that in a select group of patients, it is possible to initiate oral feeding much earlier in the postoperative period than was formerly thought.
Collagen Subtypes in Human Vocal Folds
Authors: Tateya Tomoko , Tateya Ichiro , Bless Diane M.
Published: October 2014

Objectives:

The collagen subtypes in human vocal folds are of particular interest, because each collagen subtype has different features that make it uniquely suited for performing specific tissue tasks and each collagen subtype can affect the tissue properties of the vocal fold lamina propria.

Methods:

Human vocal folds from 5 autopsy cases (less than 65 years old) were examined by immunohistochemistry for collagen types I, III, IV, and V and elastin.

Results:

Collagen type III was distributed throughout the whole lamina propria. Type I was found just beneath the basal membrane, in the deep layer of the lamina propria and in the anterior and posterior maculae flavae. Types IV and V were present in the epithelial and endothelial basal membrane. Three-dimensional images from thick specimens reconstructed with confocal microscopy showed 2 distinct patterns: type III fibers were wavy, collagenous fibers, as previously observed in the vocal folds, and type I fibers were thinner than type III fibers. These results suggest that type III fibers help maintain the lamina propria structure and that type I fibers provide the tensile strength required around the basal membrane and vocal ligament to maintain the vocal fold shape while withstanding vibratory forces.
Laryngotracheal Stenosis Repair Using Cartilage-Derived Morphogenic Proteins: A Pilot Study
Authors: Tran LenhAnh P. , Zalzal George H.
Published: October 2014

Objectives:

This pilot study evaluated the role of cartilage-derived morphogenic proteins (CDMPs) as promoters of cartilage growth and differentiation and as a possible alternative to autologous cartilage grafts in laryngotracheal reconstruction.

Methods:

In phase 1, 6 New Zealand rabbits underwent subperichondrial injection of CDMP-1, CDMP-2, or CDMP-3 in the right thyroid ala and normal saline solution in the left thyroid ala as controls. In phase 2, 14 rabbits underwent anterior cricoid split and interposition of a fibrillar collagen sponge saturated with normal saline solution, CDMP-2, or CDMP-3.

Results:

In both phases, saline solution failed to induce new cartilage or bone growth. Small foci of cartilage and/or bone formation were observed within the thyroid subperichondria of those rabbits injected with CDMP-2 or CDMP-3. In phase 2, a few small foci of new cartilage and/or bone formation were observed at the edges of the cricoid split with CDMP-2 and CDMP-3.

Conclusions:

A different carrier of CDMP, a change in dosage, or a combination of CDMPs might yield more significant neochondrification. The role of CDMPs as promoters of cartilage and differentiation could not be disqualified in this study and should be further investigated.
Spontaneous Cerebrospinal Fluid Leaks: A Variant of Benign Intracranial Hypertension
Authors: Schlosser Rodney J. , Woodworth Bradford A. , Wilensky Eileen Maloney , Grady M. Sean , Bolger William E.
Published: October 2014

Objectives:

Previous reports indicate that elevated intracranial pressure (ICP) may cause spontaneous cerebrospinal fluid (CSF) leaks. In this study we examined the clinical diagnosis of benign intracranial hypertension (BIH) in this population using the modified Dandy criteria.

Methods:

We performed a retrospective review of clinical data and measurements of ICPs after surgical repair.

Results:

Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. In 11 patients with CSF pressure measurements, strict adherence to the modified Dandy criteria definitively confirmed a diagnosis of BIH in 8 patients (72%) and a likely diagnosis in the 3 remaining patients. The mean ICP was 31.1 cm H2O (range, 17.3 to 52 cm H2O), and 81% of the patients were obese middle-aged women. Clinically, all patients had signs and/or symptoms of elevated ICP, such as headache (91%), pulsatile tinnitus (45%), hypertension (45%), balance problems (27%), and visual complaints (18%). Surgical repair was 100% successful in leak cessation over a mean follow-up of 14.1 months.

Conclusions:

Most patients with spontaneous CSF leaks fulfill the modified Dandy criteria; thus, this disorder appears to be a variant of BIH. Further investigation is needed to determine the exact cause of elevated CSF pressures in this group and whether medical or surgical treatments to correct the intracranial hypertension are warranted.
Airway Manifestations of Pediatric Eosinophilic Esophagitis: A Clinical and Histopathologic Report of an Emerging Association
Authors: Dauer Eileen H. , Ponikau Jens U. , Smyrk Thomas C. , Murray Joseph A. , Thompson Dana M.
Published: October 2014

Objectives:

Pediatric eosinophilic esophagitis (EE) typically presents with dysphagia, vomiting, dyspepsia, or food impaction. The purpose of this study was to highlight the emerging association of pediatric EE and airway disease. An additional goal of this study was to describe the unique histopathologic findings found in EE and specifically explore the potential role of the cytotoxic protein called eosinophil major basic protein (MBP) in the pathophysiology of the disease.

Methods:

A retrospective review of 3 children with EE and airway symptoms included symptom presentation, aerodigestive tract endoscopic findings, ambulatory 24-hour dual pH-metry, allergy tests, treatment modalities, and treatment response. Esophageal tissue obtained from biopsies of each patient was evaluated by hematoxylin and eosin to determine the number of eosinophils per high-power field, by immunofluorescent anti-MBP staining to determine the presence of MBP, and by standard light and transmission electron microscopy to evaluate eosinophil migration patterns.

Results:

All patients had airway inflammation that included nonspecific laryngeal edema and grade I or II subglottic stenosis. Allergy testing was positive in the 2 patients who were tested. All patients had symptoms refractory to standard reflux therapy. Ambulatory pH-metry findings were normal in 2 patients and abnormal in 1 patient despite maximum treatment. Two patients had visual abnormalities seen during esophageal examination. The number of eosinophils ranged from 20 to 45 per high-power field. Intracellular and extracellular MBP deposition was found in all esophageal biopsy specimens. All patients were treated with swallowed fluticasone, and 2 had symptom relapses that required repeat treatment.

Conclusions:

The spectrum of pediatric EE can include upper airway disease. Intracellular and extracellular MBP deposition is present in EE, which potentially releases cytotoxic mediators that explain the esophageal and airway clinical symptoms seen in those with the disease. Eosinophilic esophagitis should be considered in patients with a history of atopic diseases and unexplained upper airway findings refractory to reflux treatment. Treatment with swallowed fluticasone is successful; however, relapses are common and require repeat treatment and close follow-up.
Temperature-Dependent Auditory Neuropathy: Is it an Acoustic Uhthoff-like Phenomenon?; A Case Report
Authors: Cianfrone Giancarlo , Turchetta Rosaria , Mazzei Filippo , Bartolo Michelangelo , Parisi Leoluca
Published: October 2014

Objectives:

We describe the case of a young girl in whom transient deafness occurred when her core body temperature rose.

Methods:

The patient was referred for a series of audiological and neurologic evaluations performed over time in both afebrile and febrile states, as well as after a stress test (with a treadmill) in which the body temperature rise simulated the febrile state.

Results:

The patient was found to have a temporary bilateral hearing loss, but had normal distortion product otoacoustic emissions. Moreover, auditory brain stem responses revealed the absence of neural synchrony when her core body temperature increased.

Conclusions:

These results are consistent with a temperature-dependent auditory neuropathy, a rare condition in which patients show normal outer hair cell function and abnormal neural function of the eighth cranial nerve. The symptom is reminiscent of Uhthoff's phenomenon, which is described as transient visual loss and is usually observed in multiple sclerosis. This case of temperature-dependent auditory neuropathy is noteworthy because it sheds light on a disorder of which there have been few reports in the literature. We discuss its similarity to Uhthoff's phenomenon.
Pulsed Angiolytic Laser Treatment of Ectasias and Varices in Singers
Authors: Zeitels Steven M. , Akst Lee M. , Burns James A. , Hillman Robert E. , Broadhurst Matthew S. , Anderson R. Rox
Published: October 2014

Objectives:

Varices and ectasias in singers are typically the result of phonotraumatic shearing stresses and/or collision forces on the microcirculation within the superficial lamina propria. These lesions can be debilitating in performing vocalists because of the effect of recurrent hemorrhage and/or as a contributing factor to the morbidity of other mass lesions such as polyps, nodules, and cysts. Phonomicrosurgical treatment of performers is understandably approached with great trepidation, as the vocal liability of surgically disturbing the superficial lamina propria and epithelium must be balanced with the inherent detrimental vocal effect(s) of the lesion(s). Pulsed angiolytic lasers that emit radiation at high absorbance peaks of oxyhemoglobin were examined to determine whether they were an efficacious treatment approach for ectasias and varices based on these lasers' mechanisms of action and prior experience in phonomicrosurgery.

Methods:

A prospective trial was done in 39 patients (40 procedures in 54 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 25 cases) and a 532-nm pulsed KTP laser (15 cases) in a noncontact mode to treat 65 varices and 43 ectasias. Twenty-nine of 39 patients had varices and ectasias associated with other phonotraumatic mass lesions that required resection.

Results:

All patients have resumed full vocal activities, and no patient has had a subsequent hemorrhage or vocal deterioration.

Conclusions:

Both the 585-nm PDL and the 532-nm pulsed KTP laser were found to be efficacious and relatively safe treatment modalities for vascular abnormalities of the vocal folds in singers. Noncontact selective photoangiolysis of the aberrant vessels prevented future bleeding without substantial photothermal trauma to the overlying epithelium and surrounding delicate superficial lamina propria, thereby allowing for optimal postoperative mucosal pliability and glottal sound production. However, the pulsed KTP laser was substantially easier to use because of its enhanced hemostasis due to its longer pulse width. Vessel wall rupture was commonplace during use of the 585-nm PDL, but rarely occurred during photoangiolysis with the 532-nm pulsed KTP laser.
Subglottic Wound Healing in a New Rabbit Model of Acquired Subglottic Stenosis
Authors: Roh Jong-Lyel , Lee Yong-Won , Park Hee Tae
Published: October 2014

Objectives:

It is difficult to develop models of subglottic stenosis in small animals that ensure reliable stenosis. We therefore sought to establish a new animal model of subglottic stenosis in rabbits and observe subglottic wound healing.

Methods:

Using a diode laser under endoscopic visualization after anterior tracheal incision, we induced full-thickness injury to the subglottis in 60 rabbits: 20 on the anterior 120°, 20 on the posterior 120°, and 20 circumferentially. The animals were painlessly sacrificed 2 or 4 weeks later, and their gross and histologic findings were compared with those of each other and with those of 16 age-matched nonwounded controls.

Results:

Of the 60 animals, 22 died, primarily of acute airway obstruction and mostly in the circumferential group. All of the injured rabbits showed subglottic stenosis compared with controls, ranging from 12% to 56% reduction in cross-sectional area in the 120° injured groups and from 32% to 82% reduction in the 360° injured group. The significant narrowing of the subglottic lumina resulted in substantial early mortality in the circumferential group. Histologic examination showed mucosal ulceration, inflammation, and formation of granulation tissues during the acute phase after wounding, and collapse of the injured cartilage and submucosal thickening and fibrosis at later times.

Conclusions:

Subglottic healing and stenosis depend on the extent of cartilaginous injury. This model may be useful for developing methods to treat subglottic stenosis.
Peripheral Facial Nerve Regeneration Using Collagen Conduit Entubulation in a Cat Model
Authors: Dresner Harley S. , King Timothy A. , Clark H. Brent , Juhn Steven K. , Levine Samuel C.
Published: October 2014

Objectives:

Facial nerve (FN) injuries are functionally, psychologically, and financially debilitating. Facial nerve autograft repairs produce significant donor nerve morbidity and functional results that rarely exceed House-Brackmann (HB) grade III over VI. In this study we sought to enhance FN regeneration via collagen conduit entubulation.

Methods:

Five control cats underwent right (“cut-side”) FN transection and immediate microsurgical anastomosis repair. Five experimental cats underwent identical repairs plus collagen conduit entubulation of each anastomosis.

Results:

Postoperative behavioral observations revealed gradual FN functional recovery in all cats, who attained adapted HB grades of II to III over VI after 6 weeks. Electromyographic latencies and amplitudes from the bilateral orbicularis oculi and orbicularis oris muscles indicated restoration of FN continuity in all 10 cats. In comparison with FN repairs without conduits, repairs with conduits significantly enhanced recovery of amplitude in cut-side orbicularis oculi muscles (p = .037) and latency in cut-side orbicularis oris muscles (p = .048). In comparison with intact left (“uncut-side”) FN latencies and amplitudes, more statistically significant differences in cut-side FN function were observed in repairs without conduits than in repairs with conduits. Conduits therefore facilitated a more complete return of electrophysiological function. Histologic analyses confirmed FN continuity and revealed more organized FN regenerative architecture in conduit-implanted repairs.

Conclusions:

The overall results support enhanced FN regeneration with collagen conduit entubulation.
Effect of Mitomycin C on the Size of Antrostomy after Endoscopic Sinus Surgery
Authors: Kim Seon-Tae , Gang Il-Gyu , Cha Heung-Eog , Ha Jong-Su , Chung Yoo-Sam
Published: October 2014

Objectives:

Mitomycin C (MMC) is an antibiotic-antineoplastic agent that decreases fibroblast proliferation and scar formation. We aimed to evaluate the effect of MMC on the size of antrostomy and the mucociliary clearance rate.

Methods:

We selected 20 patients with chronic sinusitis on both sides. After middle meatal antrostomy, we selected one side, and a piece of Merocel soaked with 1.5 mL of MMC (0.4 mg/mL) was applied for 5 minutes. On the other side, normal saline solution was applied for a control. The size of the antrostomy was measured serially after surgery with a ruler. Mucociliary clearance was assessed by the saccharin test.

Results:

The effect of MMC in maintaining the size of the antrostomy was only significant during the first month. The relative size (the ratio of the remaining antrostomy area compared to the area in the immediate postoperative period) in the first month was significantly greater on the MMC-treated side than on the control side. The results of the saccharin test were not different between the two sides.

Conclusions:

Topical MMC application may have a short-term effect in maintaining the patency of the antrostomy site. However, it does not seem to improve the relative size over an extended period of time.
Metastasis of Prostatic Adenocarcinoma to the Sphenoid Sinus
Authors: Lavasani Leela , Zapanta Philip E. , Tanna Neil , Sadeghi Nader
Published: October 2014

The presentation, diagnosis, and management of prostatic adenocarcinoma metastatic to the sphenoid sinus are reviewed. We present a case report with a review of the literature. A 67-year-old man with a history of prostatic adenocarcinoma presented with gradual left visual loss. Magnetic resonance imaging revealed a lesion of the left orbital apex with extension into the ipsilateral sphenoid sinus. Operative biopsy of the lesion was significant for adenocarcinoma of the prostate. When an otolaryngologist encounters a mass in the sphenoid sinus, he or she needs to consider a diverse differential diagnosis. In evaluating possible causes, a history of malignancies should be elicited. Furthermore, the pathophysiology and potential routes of metastatic disease should be assessed for these primary neoplasms. Having a high level of suspicion for metastatic disease from specific primary sites will help guide the pathological evaluation. As in this clinical scenario of a patient with a history of prostatic adenocarcinoma, appropriate analysis would entail sending specimens for immunohistochemical staining, such as prostate-specific antigen and prostate-specific acid phosphatase. Correct diagnosis is crucial, as these patients may achieve remission and prolonged survival with irradiation and/or hormonal therapy.
Comparison of a Flexible Laryngoscope with Calibrated Sizing Function to Intraoperative Measurements
Authors: Kobler James B. , Rosen David I. , Burns James A. , Akst Lee M. , Broadhurst Matthew S. , Zeitels Steven M. , Hillman Robert E.
Published: October 2014

Objectives:

The objectives were to assess the clinical performance and accuracy of a prototype fiberoptic transnasal laryngeal endoscope with an auxiliary optical system that allows images to be spatially calibrated.

Methods:

A novel fiberoptic endoscope was developed that projects green laser beams across the field of view from a separate optical channel. According to the location of the spots in the field of view, the images can be calibrated with a software routine. To assess its performance, we compared measurements of 14 lesions imaged with the calibrated endoscope and during microlaryngoscopy, where a calibration instrument was placed next to the lesions. Four clinicians measured lesion length, width, and area from the collected images.

Results:

The calibrated endoscope performed as well as current flexible fiberoptic laryngoscopes in terms of image quality and patient comfort. For lesions with well-defined borders, the error ranged from 14% to 23% for length, from 20% to 30% for width, and from 33% to 50% for area across observers. Factors contributing to larger errors in some subjects were identified.

Conclusions:

The calibrated endoscope is capable of providing useful sizing information for laryngeal structures, and these measures correspond quite well to more direct measurements in the operating room. Objective sizing of laryngeal lesions is complicated by subjective judgments of lesion boundaries, which can be indistinct in many cases.
Fine Needle Aspiration of the Vocal Fold Lamina Propria in an Animal Model
Authors: Cobell Will , Duflo Suzy M. , Magrufov Akhmar , Thibeault Susan L.
Published: October 2014

Objectives:

The development of a minimally invasive fine needle aspiration (FNA) technique for vocal fold (VF) biopsy would have far-reaching implications and applicability in laryngology. The objective of this study was to determine whether FNA of the VF lamina propria is feasible and whether it causes injury to the VF.

Methods:

Unilateral VF FNA was performed with a 26-gauge needle on 20 rabbits. The FNA cell collection of the lamina propria was confirmed by cytology. Four weeks after the FNA, the rabbits were painlessly sacrificed and the larynges were harvested. Histologic analysis of the VF lamina propria included Masson's trichrome and elastin-van Gieson stains. The linear viscoelastic shear properties, elastic modulus, and viscous modulus of the tissue were measured.

Results:

Compared to the contralateral normal VFs, those VFs that underwent FNA demonstrated no significant differences in levels of collagen (p = .17) and elastin (p = .94). Rheologically, the elastic shear modulus and viscous modulus did not significantly differ between the normal and FNA VFs (p = .9380 and p = .9359, respectively).

Conclusions:

Fine needle aspiration of the VF lamina propria is feasible without injury and offers a potentially promising, less invasive alternative to be developed for future diagnostic and therapeutic management of VF lesions.
Pedicled Fat Flap Reconstruction of the Atrophic or “Empty” Paraglottic Space following Resection of Teflon Granuloma or Oversized Implant
Authors: Conoyer J. Matthew , Netterville James L. , Chen Anton , Vos Jeremy D.
Published: October 2014

Objectives:

Loss of functional and supporting architecture in the paraglottic space (PGS) necessitates augmentation to restore phonation and prevent aspiration. Our previous PGS reconstructions using an inferiorly based sternohyoid muscle flap have shown a propensity to fibrose over time, tethering the vocal fold inferolaterally. Poor voice outcomes have led us to explore other reconstructive options such as the laterally based vascularized fat flap described below. Our objectives in the present study were 1) to discuss phonosurgical options for reestablishing PGS volume after removal of an oversized implant or after definitive resection of Teflon granuloma; and 2) to understand the surgical technique, indications, and functional prognosis of the laterally based fat flap used for augmenting the “empty” PGS.

Methods:

Fourteen cases of PGS reconstruction with a laterally based subplatysmal fat flap were retrospectively investigated for indications, functional outcome, and the need for subsequent phonosurgical procedures. Preoperative and postoperative voice and videostroboscopic findings were analyzed.

Results:

Fat flap augmentation helped achieve subjective vocal improvement in patients with an empty PGS. A subset of our patients demonstrated fat flap atrophy within 12 months, prompting revision laryngoplasty. Viable flaps were encountered in each revision, facilitating future medialization attempts.

Conclusions:

Fat flap reconstruction of the PGS is a versatile, beneficial adjunct for revision medialization in select cases.
Recurrent Thyroglossal Duct Cysts: A 23-Year Experience and a New Method for Management
Authors: Perkins Jonathan A. , Inglis Andrew F. , Sie Kathleen C. Y. , Manning Scott C.
Published: October 2014

Objectives:

We present an experience in the management of primary and recurrent thyroglossal duct cysts (TGDCs) and describe a novel method for recurrent TGDC removal.

Methods:

We performed a retrospective review of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003. The surgical techniques for primary and recurrent TGDCs and the factors associated with TGDC recurrence were evaluated and analyzed.

Results:

During the study period, 231 patients underwent 296 TGDC surgeries. Thirty-four of the 231 patients (15%) underwent a total of 88 procedures for recurrent TGDCs. Successful procedures used for secondary TGDC management included central neck dissection with directed base of tongue (BOT) excision in 6 of 9 patients (67%), secondary Sistrunk operation with limited BOT resection in 12 of 27 patients (44%), revision Sistrunk operation with BOT dissection in 7 of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8 of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC incision and drainage and then underwent a total of 21 procedures, excluding the incision and drainage. The factors associated with TGDC recurrence were inaccurate initial diagnosis (17 of 34 or 50%), infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or 15%), and lack of BOT musculature removal (7 of 34 or 20%). The level of surgeon training affected the surgical outcome.

Conclusions:

Successful TGDC treatment requires consideration of factors associated with recurrence. Recurrent TGDCs can be treated by several methods, including suture-guided transhyoid pharyngotomy.
Biomechanical Model for Muscular Dysfunction of the Human Pharynx Using Finite Element Analysis
Authors: Kim Sung Min , McCulloch Timothy M. , Bae Hasuk , Kim Sung Jae
Published: October 2014

Objectives:

The oropharynx functions to transport food from the oral cavity to the esophagus, as well as to maintain an air passage from the nose to the lungs. By combining data from prior material property experimentation, a 3-dimensional finite element method reconstruction of the pharynx, and the utilization of a optimization process based on an inverse dynamic approach, we can estimate the pressures and associated consecutive pressure gradients created internally when the pharynx functions during swallowing.

Methods:

In this study, pharyngeal muscular dysfunction was modeled under 3 scenarios of increasing tissue stiffness. This was done by modifications in the stress-strain relationship material property within the finite element method nodes. This mechanical property was used as a surrogate for clinical changes in muscle function complicating neuromuscular disorders, such as stroke and amyotrophic lateral sclerosis. The pharyngeal tissue and deformation of the cross-sectional area of the pharynx were analyzed while increasing the mechanical stiffness by 25%, 50%, and 75%.

Results:

Increases in stiffness resulted in modified pressure-area curves predicting diminished movement, primarily in stiffened regions.

Conclusions:

These simulation results may act as a clinical index illustrating the association between tissue dysfunction and pharyngeal pressure and movement dysfunction. This type of modeling has the potential to act as an investigational tool, as well as a predictive tool, regarding disease progression, cancer treatment, and perhaps even the effects of aging on swallowing function.
Thyroidectomy for Graves' Disease: A Case-Control Study
Authors: Scharf Joshua L. , Ahmad Sidrah M. , Gaughan John P. , Soliman Ahmed M.S.
Published: October 2014

Objectives:

The most common treatment for Graves' disease in the United States is radioactive iodine. Surgery is performed rarely. The surgery for Graves' disease is usually considered technically difficult. Our goal was to assess the differences in outcomes in patients with Graves' disease who underwent thyroidectomy and in patients without Graves' disease who underwent the same procedures.

Methods:

A retrospective chart review was performed of patients who underwent surgery for Graves' disease between 1997 and 2005. A control group of age-matched and thyroid size-matched patients who underwent thyroidectomy for a diagnosis other than Graves' disease was identified. The groups were statistically compared with respect to length of hospital stay, operative time, and estimated blood loss. Comparison with the published literature was also performed.

Results:

Eleven patients underwent thyroidectomy for a diagnosis of Graves' disease. The operative time, estimated blood loss, and length of hospitalization did not differ significantly from those of the control patients. Three of the 4 complications that occurred, however, were in the 3 patients with persistent hyperthyroidism despite medical therapy at the time of surgery.

Conclusions:

Thyroidectomy may be performed relatively safely for selected euthyroid patients with Graves' disease. In those with persistent hyperthyroidism at surgery, there were more complications.
Immediate Inflammatory Response and Scar Formation in Wounded Vocal Folds
Authors: Lim Xinhong , Tateya Ichiro , Tateya Tomoko , Muñoz-Del-Río Alejandro , Bless Diane M.
Published: October 2014

Objectives:

Vocal fold scarring is the major cause of voice disorders after voice surgery or laryngeal trauma. The role of inflammatory factors in vocal fold wound healing and fibrosis has not been adequately investigated. Scarless wound healing has been associated with decreased inflammatory responses. To understand scar formation and develop reliable treatments, it is necessary to control extracellular matrix production and inflammation. Thus, we examined the inflammation profile and extracellular matrix production in wounded vocal folds in the acute phase of wound healing.

Methods:

Vocal fold stripping was performed on 30 Sprague-Dawley rats. Vocal fold tissue was collected at 5 time points (4, 8, 16, 24, and 72 hours). We examined the in vivo messenger RNA expression profile of inflammatory factors interleukin 1β, interferon γ, tumor necrosis factor a, nuclear factor Kβ, transforming growth factor β, and cyclooxygenase 2, as well as hyaluronic acid synthases 1 and 2, procollagen subtypes I and III, and elastin synthase in scarred vocal folds after injury, compared to normal vocal folds, using real-time reverse transcription-polymerase chain reaction.

Results:

The inflammatory factors showed a time-dependent sequence of expression peaks, starting with interleukin 1β, nuclear factor Kβ, tumor necrosis factor a (4 and 8 hours), and transforming growth factor β (72 hours). Interferon y decreased at 24 hours. Correspondingly, hyaluronic acid synthase 1 expression peaked first (4 and 8 hours), whereas hyaluronic acid synthase 2 expression peaked at 16 hours and again at 72 hours. Procollagen I expression peaked at 72 hours, whereas procollagen III decreased from 8 to 16 hours but peaked at 72 hours. Cyclooxygenase 2 expression was elevated, whereas elastin expression remained constant.

Conclusions:

The results show a clear profile of vocal fold inflammation with corresponding changes in extracellular matrix production.
Is Laryngopharyngeal Reflux Related to Functional Dysphonia?
Authors: Karkos Petros D. , Yates Philip D. , Carding Paul N. , Wilson Janet A.
Published: October 2014

Objectives:

Laryngopharyngeal reflux (LPR) may be a contributing factor in chronic hoarseness. The association of LPR with functional dysphonia (FD), the most common voice clinic diagnosis, is unknown. We attempted to determine whether patients with FD have a higher rate of laryngeal exposure to acidic stomach contents than do healthy volunteers.

Methods:

We recruited through the voice clinic 23 patients who had had persistent dysphonia for 3 months. Pregnancy, major structural laryngeal abnormality, and vocal fold paralysis were exclusion criteria. Eight healthy volunteers were recruited. The subjects gave informed consent to enter the study, which had the approval of our hospital ethics committee. The patients and control subjects underwent 24-hour dual-probe pH-metry.

Results:

Twenty-two patients and 6 control subjects completed the study. Overall, there seemed to be no statistical differences between patients and controls on all but 2 channel 1 pH-metry parameters. These were the longest reflux episode (seconds) in a supine position, and the fraction of time the pH was less than 4 in a supine position. Both of these time periods were longer in patients than in the controls (p <05).

Conclusions:

Our study demonstrated an association between LPR and FD for 2 pH parameters. Larger studies are required to assess the potential relationship between nonorganic dysphonias and reflux. Furthermore, the presence of a multifactorial causation of FD, including “medical” and psychological causes, should be addressed in future studies.
Videofluoroscopic Findings in Dysphagic Patients with Cricopharyngeal Dysfunction: Before and after Open Cricopharyngeal Myotomy
Authors: Muñoz Amanda A. , Shapiro Jo , Cuddy Lorraine Downey , Misono Stephanie , Bhattacharyya Neil
Published: October 2014

Objectives:

Functional outcomes after open cricopharyngeal myotomy (CPM) for Zenker's diverticulum (ZD) and cricopharyngeal dysfunction without diverticulum (CPD) have not been uniformly measured by videofluorographic swallow study (VFSS). Here we characterize preoperative VFSS findings in these groups and evaluate the effect of CPM on swallowing via postoperative VFSS.

Methods:

We performed a retrospective review of paired preoperative and postoperative VFSS results from 50 patients (36 with ZD and 14 with CPD) over 6 years. Semiquantitative scales were used to assess 1) degree of stasis in the pharyngeal recesses; 2) degree of narrowing at the pharyngoesophageal sphincter (PES); 3) aspiration; and 4) diverticular size. Findings were compared between the groups and across subjects.

Results:

Pharyngeal stasis was more severe in subjects with CPD than in subjects with ZD, both before and after CPM (p = .02 and p = .0002, respectively). The CPM improved PES narrowing in both groups (p = .03; p = .06) and reduced diverticular size in the ZD group (p < .001), but it did not significantly reduce the stasis severity or the proportion of patients with aspiration.

Conclusions:

According to VFSS, CPM opens up the PES and decreases diverticular size. More severe stasis in CPD suggests that diffuse pharyngeal weakness may play a role in this disease, and may partially explain the variable post-CPM outcomes that have been observed in CPD.