bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency for the Treatment of Allergic Rhinitis Refractory to Medical Therapy
Authors: Lin Hsin‐Ching , Lin Pei‐Wen , Su Chih‐Ying , Chang Hsueh‐Wen
Published: November 2003

Objectives/Hypothesis The ideal treatment for allergic rhinitis refractory to medical therapy is still lacking. The aim of the study is to evaluate the efficacy of turbinate surgery with radiofrequency for the treatment of allergic rhinitis that is unresponsive to medical therapy.

Study Design A prospective, nonrandomized clinical study.

Methods From February 2000 to April 2002, 108 consecutive patients (45 men and 63 women [mean age, 29.5 y]) with allergic rhinitis refractory to medical therapy who underwent radiofrequency turbinate surgery were enrolled in the study. Postoperative follow‐up ranged from 12 to 26 months. A standard 0‐to‐10 visual analogue scale with an anchor was used to assess the pain and the allergic symptoms, including nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes, preoperatively and postoperatively at the end of weeks 1 and 2 and months 1, 3, 6, and 12 after surgery. Statistical analysis was determined by repeated measures of ANOVA.

Results None of the 108 patients had obvious discomfort other than mild numbness over the premaxillary area (24 of 108 [22.2%]) during operation. Also, no adverse reactions including bleeding, infection, adhesion, or a worsening of allergic symptoms were encountered. One hundred one patients were included in the final statistical analysis. Only nine patients reported no improvement at all after treatment. The response rate of radiofrequency turbinate surgery for allergic rhinitis refractory to medical therapy was 91.1% (92 of 101). At 1 year after the treatment, the degree of nasal obstruction had changed on the visual analogue scale (mean ± SD) from 6.84 ± 2.09 to 2.47 ± 1.60, an improvement of 63.9%. The degree of rhinorrhea had changed from 5.74 ± 2.75 to 2.57 ± 2.31, an improvement of 55.2%. The degree of sneezing had changed from 5.30 ± 2.80 to 2.59 ± 2.13, an improvement of 51.1%. The degree of itchy nose had changed from 3.74 ± 3.16 to 1.82 ± 2.27, an improvement of 51.3%. The degree of itchy eyes had changed from 3.17 ± 3.09 to 1.68 ± 2.38, an improvement of 47.0%. The visual analogue scale scores for nasal obstruction, rhinorrhea, sneezing, itchy nose, and itchy eyes decreased significantly with time, from preoperative scores to scores at 1 year after surgery. Other additional effects and improvements, including headache, lumpy throat, night cough, and tinnitus, were also reported by the patients. Most of the patients stated that they would consider repeating this procedure if necessary and would recommend the new method to their friends with the same problems.

Conclusions The study demonstrates that radiofrequency appears to be an effective and safe tool for treating allergic rhinitis with poor response to medical therapy. In the future, radiofrequency has the potential to be one of the most popular surgical modalities for the treatment of allergic rhinitis refractory to medical therapy.
Preoperative Diagnosis of Allergic Fungal Sinusitis
Authors: Dhiwakar Muthuswamy , Thakar Alok , Bahadur Sudhir , Sarkar Chitra , Banerji Uma , Handa Kumut Kumar , Chhabra Sunil Kumar
Published: November 2003

Objectives/Hypothesis Although the diagnosis of allergic fungal sinusitis is mainly based on characteristic histopathological findings, certain preoperative diagnostic criteria have been proposed. However, their usefulness in differentiating allergic fungal sinusitis from other sinus diseases is unknown. The objective of the study was to identify accurate preoperative diagnostic parameters for allergic fungal sinusitis.

Study Design Prospective, comparative study.

Methods Twenty consecutive cases of allergic fungal sinusitis were evaluated prospectively and compared with 16 cases of ethmoidal polyposis and 5 cases of invasive sinus aspergillosis, with regard to various clinical, radiological, and immunological parameters. All patients were categorized based on histopathological findings.

Results Nasal polyps were seen in all 20 cases of allergic fungal sinusitis, all 16 cases of ethmoidal polyposis, and 2 of 5 cases of invasive sinus aspergillosis. Computed tomography (CT) scan hyper‐attenuation was seen in all 20 cases of allergic fungal sinusitis but also in 2 (13%) cases of ethmoidal polyposis and 2 (40%) cases of invasive sinus aspergillosis. Serum levels of specific anti‐Aspergillus immunoglobulin E were elevated in 14 (70%) cases of allergic fungal sinusitis, 2 (13%) cases of ethmoidal polyposis, and 3 (60%) cases of invasive sinus aspergillosis. The combination of all three (ie, nasal polyps, CT scan hyper‐attenuation, and elevated titers of anti‐Aspergillus immunoglobulin) was not found in any case of ethmoidal polyposis or invasive sinus aspergillosis. This triad demonstrated a sensitivity of 70% and a specificity of 100% for the preoperative diagnosis of allergic fungal sinusitis.

Conclusions Nasal polyps, CT scan, and specific immunoglobulin E titers, when considered in combination, have a high preoperative diagnostic value in allergic fungal sinusitis. However, they should not be considered in isolation because considerable overlap occurs with invasive sinus aspergillosis and ethmoidal polyposis.
Professor Nicolas Taptas (1871–1955): A Pioneer of Post‐Laryngectomy Voice Rehabilitation
Authors: Lascaratos John G. , Trompoukis Constantinos , Segas John V. , Assimakopoulos Dimitrios A.
Published: November 2003

Objective To report on the career of Professor Nicolas Taptas of Constantinople (1871–1955) and his contribution to the development of an artificial larynx.

Study Design Historical review.

Methods The unpublished documents of Taptas's family archives and one of his papers, describing his own original technique for voice rehabilitation after total laryngectomies, were studied.

Results In his texts, Taptas described the application of external laryngeal prostheses in one of his patients who underwent total laryngectomy. Taptas meticulously recorded his own first successful attempt in a woman with cancer of the larynx. He was one of the first scientists who, at the end of the 19th century, devised an external laryngeal prosthesis, which had the advantage of rehabilitating a sufficiently strong whispering voice; by using a prototype valve, he avoided problems of aspiration of liquids and food to the bronchi.

Conclusion Nicolas Taptas's contribution to the development of the artificial larynx was vital because he devised and applied one of the first external laryngeal artificial prostheses with satisfactory functional results.
Intraoperative Parathyroid Hormone Testing: What Have We Learned?
Authors: Proctor Matthew D. , Sofferman Robert A.
Published: November 2003

Objectives/Hypothesis The development of rapid, sensitive assays for measuring the intact parathyroid hormone (iPTH) molecule has the potential to allow the surgeon to determine the success of parathyroid surgery intraoperatively. The purpose of the study was to review our results in the context of currently held beliefs regarding the ability of the intraoperative iPTH to predict resolution of hyperparathyroidism.

Study Design Retrospective review.

Methods The study series is a retrospective review of 107 consecutive parathyroidectomies performed by a single surgeon. Patients with primary, secondary, and tertiary hyperparathyroidism were included.

Results The intraoperative assay allowed an overall success rate of 93.4% across all patient categories. The success rate in patients with primary hyperparathyroidism was 95.7%. Measuring the iPTH level at 10 versus 15 minutes after the removal of tissue did not significantly affect the predictive value of the test. A decrease of 50% in the iPTH level after the resection of hyperfunctioning tissue was prognostic of successful treatment of the hyperparathyroid state. By contrast, a postexcision iPTH level that was within the normal range was not always predictive of cure.

Conclusions The intraoperative iPTH assay is particularly useful in the treatment of primary hyperparathyroidism. The assay eliminates the need for intraoperative frozen‐section analysis in most cases and allows the surgeon to perform limited resections with confidence. This is especially true in complicated parathyroid surgeries, such as revision surgeries or those requiring concomitant thyroid surgery. The assay is also useful in secondary hyperparathyroidism, although it appears that the inability to identify small nonfunctional or hypofunctional supernumerary parathyroid glands means that long‐term normocalcemia may not be assured.
State of Mastication Affects Quality of Life in Patients With Maxillary Sinus Cancer
Authors: Terada Nobuhisa , Numata Tsutomu , Kobayashi Noriko , Gorai Shigeki , Kobayashi Tadashi , Ono Ken‐ichi , Konno Akiyoshi
Published: November 2003

Objectives/Hypothesis The quality of life of head and neck cancer patients after treatment is poor compared with a typical population sample. However, little is known about patients with maxillary sinus cancer. The identification of symptoms that are most troublesome for these patients and the development of strategies to minimize these negative sequelae should be matters of high priority.

Study Design A restrospective study of patients with maxillary sinus cancer who underwent maxillary bone resection.

Methods Thirty patients with maxillary sinus squamous cell carcinoma participated in the study. The relationships among the degree of masticatory ability, the extent of the surgically resected area, and quality of life after combined treatment of maxillary cancer were evaluated.

Results Scores of all physical and mental factors as assessed by the Short Form–36 questionnaire decreased as the masticatory ability of patients worsened. In edentulous cases, the masticatory ability was higher in the reduced operation group than in the extensive operation group.

Conclusion Maintaining adaptability to a denture is essential to preserve quality of life, particularly in patients with anodontia.
Voice, Speech, and Swallowing Outcomes in Laser‐Treated Laryngeal Cancer
Authors: Jepsen Matthew C. , Gurushanthaiah Deepak , Roy Nelson , Smith Marshall E. , Gray Steven D. , Davis R. Kim
Published: November 2003

Objective To describe preliminary voice, speech, and swallowing outcomes in patients treated by endoscopic laser excision of laryngeal cancer with or without adjuvant radiation therapy.

Study Design Retrospective review.

Methods Seventeen surgically treated patients (five T2 glottic and 12 clinically staged T2 supraglottic squamous cell carcinomas) participated in the study. Self‐ratings of voice (Voice Handicap Index) and swallowing (M. D. Anderson Dysphagia Inventory) were completed, as well as independent auditory‐perceptual ratings of voice and speech recordings.

Results Although no significant difference between Voice Handicap Index, M. D. Anderson Dysphagia Inventory, and listener ratings was identified based on tumor site and irradiation status, there was a trend toward poorer outcomes in patients who received adjuvant radiation therapy. Whereas the patients having supraglottic cancer tended to report better voice but poorer swallowing outcomes, the glottic cancer group displayed the opposite pattern. Severity on Voice Handicap Index correlated significantly with listener severity ratings of speech, suggesting that the patients' perception of their voice handicap was similar to the listeners' judgments of their speech severity.

Conclusions The results suggest the following trends: 1) Adjuvant radiation therapy was associated with poorer outcomes for voice, speech, and swallowing and may be associated with more impairment than surgery alone and 2) poorer outcomes on voice and swallowing were observed for the glottic and supraglottic cancer groups, respectively. To bolster these preliminary findings, additional outcomes studies in patients treated with conservation therapy are needed.
Adenocarcinoma Ex‐Pleomorphic Adenoma of the Lacrimal Sac and Nasolacrimal Duct: A Case Report
Authors: Baredes Soly , Ludwin Danielle B. , Troublefield Yolanda L. , Langer Paul D. , Mirani Neena
Published: November 2003

Objectives To present the clinical presentation, workup, surgical approach, and pathological findings of the first case report of a patient with adenocarcinoma ex‐pleomorphic adenoma of the lacrimal sac and nasolacrimal duct.

Study Design Retrospective review of the records of a case of adenocarcinoma ex‐pleomorphic adenoma of the lacrimal sac and nasolacrimal duct.

Methods The clinical presentation, workup, surgical approach, and pathological findings were reviewed.

Results A 51‐year‐old man presented with a 10‐year history of recurrent epiphora of the right eye. At dacryocystorhinostomy a small lesion was visualized within the lumen of the lacrimal sac. A biopsy specimen was consistent with adenocarcinoma. En bloc resection was accomplished using a lateral rhinotomy and medial maxillectomy. The final specimen showed adenocarcinoma ex‐pleomorphic adenoma. The patient was given postoperative radiation therapy. He was free of disease 16 months after treatment.

Conclusions Lacrimal sac tumors should be considered in the differential diagnosis of chronic epiphora. Management of nasolacrimal adenocarcinoma requires complete surgical resection. Radiation treatment in and of itself is not curative but may be useful as adjuvant therapy. Carcinoma ex‐pleomorphic adenoma can develop in the lacrimal sac and nasolacrimal duct.
Postural Cephalometric Analysis and Nasal Resistance in Sleep‐Disordered Breathing
Authors: Virkkula Paula , Hurmerinta Kirsti , Löytönen Markku , Salmi Tapani , Malmberg Henrik , Maasilta Paula
Published: November 2003

Objectives The study was designed to compare upright and supine cephalometric measurements in snorers and to evaluate the effects of mandibular position and nasal resistance on pharyngeal dimensions. Anthropometric, rhinomanometric, and cephalometric measurements were used to investigate predictors of apnea‐hypopnea index.

Study Design Prospective, cross‐sectional.

Methods Forty consecutive habitually snoring men waiting for nasal surgery (mean age, 44 y; mean body mass index, 28 kg/m2) underwent an overnight polysomnographic, anterior rhinomanometric, and cephalometric analysis in upright and supine positions.

Results Nasal resistance correlated positively with minimal pharyngeal airspace at the level of tongue. The opening of jaws after voluntary relaxation of the mandibular position on lying down correlated with decrease in pharyngeal airway measurements at both velopharyngeal and tongue‐base levels. In stepwise multiple regression analysis the overall patient model explained 68% of the variation in apnea‐hypopnea index with body mass index as the largest predictor. In the nonobese patients, the model explained 86% of variation in apnea‐hypopnea index with change in anteroposterior position of the lower jaw in upright and supine measurements and combined nasal resistance after mucosal decongestion as independent determinants. In selected skeletal subtypes the models predicted 83%, 79%, 61%, and 90% of the variation in apnea‐hypopnea index.

Conclusions In the nonobese patients nasal resistance and change in mandibular position on lying down were found to be independent contributing factors to the apnea‐hypopnea index. Further research on supine cephalometry and relaxed mandibular position may improve prediction of sleep‐disordered breathing in snorers.
Intrapharyngeal Distribution of Gastric Acid Refluxate
Authors: Shaker Reza , Bardan Eytan , Gu Chengming , Kern Mark , Torrico Laura , Toohill Robert
Published: November 2003

Objectives/Hypothesis Determination of intrapharyngeal distribution of gastric acid refluxate is needed to better understand the pathogenesis of reflux‐attributed aerodigestive tract disorders. The aims of the study were to determine intrapharyngeal distribution of gastric acid refluxate and to determine whether this distribution can better differentiate patients from control subjects compared with data obtained from a single hypopharyngeal site.

Methods We prospectively studied 10 healthy volunteers, 12 patients with reflux laryngitis, and 15 patients with vasomotor rhinitis using a concurrent dual pharyngeal/dual esophageal pH recording technique. We determined the hypopharyngeal and oropharyngeal pH profile, including number, duration, and distribution of reflux events irrespective of and in correlation with intraesophageal pH profile using four different pH thresholds.

Results Few drops in pharyngeal pH were found to be true reflux events based on their correlation with esophageal pH events. For the pharyngeal pH threshold criterion of a drop to 4.0 or less, 6 of 12 patients with reflux laryngitis, 5 of 15 patients with vasomotor rhinitis, and 2 of 10 normal control subjects exhibited a total of 25 (range, 1–5) distal pharyngeal acid reflux events. Overall, 34% of these events reached the oropharyngeal pH recording site. Between‐group comparison for all levels of pH threshold criteria did not show any significant difference of reflux parameters in the hypopharyngeal or in the oropharyngeal sites among the studied groups.

Conclusions Reflux of gastric acid into the pharynx may extend to the region of the oropharynx in both patients and control subjects. Overall distribution of acid refluxate to the oropharynx is low but as groups is similar between healthy individuals and patients with reflux laryngitis and those with vasomotor rhinitis. Parameters of oropharyngeal acid reflux such as number and duration do not differentiate patients from control subjects.
Expression of Hypoxia Inducible Factor 1 α and Von Hippel Lindau Protein in Human Middle Ear Cholesteatoma
Authors: Adunka Oliver , Gstoettner Wolfgang , Knecht Rainald , Kierner Antonius C.
Published: November 2003

Objective To evaluate the role of hypoxia in cholesteatoma progression.

Study Design Immunohistochemical analysis of paraffin‐embedded human specimens.

Methods Thirteen middle ear cholesteatomas and 10 samples of normal human external ear canal skin were stained immunohistochemically for the presence of hypoxia inducible factor 1 α (HIF 1 α) and Von Hippel Lindau protein. Specimens were then analyzed semiquantitatively.

Results Staining for both antibodies could be detected in all cholesteatomas (perimatrix and matrix), as well as in the samples of normal human ear canal skin. Cholesteatoma specimens showed statistically significant increased staining when compared with normal human skin and mucosa. The age of patients and relapse surgery affected immunohistochemical staining of HIF 1 α and Von Hippel Lindau protein.

Conclusions Elevated staining intensities for HIF 1 α and Von Hippel Lindau protein in cholesteatoma tissue indicated that cholesteatoma may be hypoxic. In addition, our data indicated that relapse cholesteatomas yield a higher degree of hypoxia than ears without surgery.
Cochlear Implantation in Children With Otitis Media
Authors: Fayad Jose N. , Tabaee Abtin , Micheletto Jennifer N. , Parisier Simon C.
Published: November 2003

Objective To describe the outcome of cochlear implantation in a cohort of pediatric patients with a history of otitis media.

Study Design Retrospective chart review and follow‐up phone survey.

Methods The medical records of patients younger than 48 months of age who underwent cochlear implantation were reviewed for demographics, complications, and history of otitis media and bilateral myringotomy and ventilation tubes. A follow‐up phone survey was performed to determine the long‐term natural history of otitis media.

Results The records of 126 profoundly deaf pediatric patients were reviewed. Seventy‐two percent had a history of at least one episode of otitis media, 31% had a history of greater than three episodes, and 2% had a history of chronic serous otitis media. Twenty‐three percent underwent bilateral myringotomy and tubes in the distant past, 6 to 8 weeks before implantation, at the time of implantation, or after implantation. A phone survey was successfully completed for 76 patients with a mean follow‐up period of 46 months. There was a significant decrease in the incidence of otitis media after the cochlear implantation in the majority of patients with a history of otitis media with and without a history of bilateral myringotomy and tubes.

Conclusions Placement of ventilation tubes either before or at the time of cochlear implantation seems to adequately prevent infectious disease–related complications in otitis‐prone children. Therefore, implantation should not be delayed, and subsequent episodes of otitis media can be managed by conventional therapy.
Swallowing Function and Tracheotomy Dependence After Combined‐Modality Treatment Including Free Tissue Transfer for Advanced‐Stage Oropharyngeal Cancer
Authors: Skoner Judith M. , Andersen Peter E. , Cohen James I. , Holland John J. , Hansen Eric , Wax Mark K.
Published: November 2003

Objectives/Hypothesis There are many treatments available for advanced oropharyngeal cancer. Organ‐sparing protocols reserve surgery for salvage and are thought to provide adequate rehabilitation. Surgical resection with free tissue transfer may also provide adequate functional rehabilitation. The objective was to describe swallowing status and time to decannulation in a series of patients treated with combined‐modality therapy that included free flap reconstruction.

Study Design Retrospective chart review.

Methods Patient data were obtained from medical records of 20 patients with stage III or IV oropharyngeal carcinoma, who were consecutively treated with surgical tumor extirpation, free flap reconstruction, and postoperative irradiation at a tertiary academic center from 1985 to 2002. The following variables were identified: patient and tumor characteristics, free flap type, irradiation data, and airway and swallowing status before and after treatment.

Results One patient underwent total laryngopharyngectomy, and the remaining 19 patients underwent tracheotomy at the time of definitive surgery. Free flap reconstructions included 1 ulnar and 15 radial forearm fasciocutaneous flaps and 4 fibula osteocutaneous flaps. Postoperatively, all 19 tracheotomized patients had successful decannulation. Average time to decannulation was 15 days (range, 3–42 d). After surgery and before irradiation, 13 patients initiated oral intake, on average, at 19.5 days (range, 7–28 d); 6 patients required no additional supplementation. By 4 months after surgery, having completed radiation therapy, 10 patients were consuming all nutrition orally; the other 10 patients still required tube‐feed supplementation, although 6 of these patients were also eating by mouth.

Conclusion Combined‐modality treatment that includes free flap reconstruction for advanced‐stage oropharyngeal cancer may provide reasonable functional rehabilitation with respect to postoperative airway and swallowing.
A New Method for Closing Tympanic Membrane Perforations Using Basic Fibroblast Growth Factor
Authors: Hakuba Nobuhiro , Taniguchi Masafumi , Shimizu Yoshitaka , Sugimoto Akira , Shinomori Yusuke , Gyo Kiyofumi
Published: November 2003

Objective To present a new method for closing tympanic membrane perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane as a patch material.

Study Design Closure of tympanic membrane perforations was attempted using bFGF, which is thought to facilitate the growth of fibroblasts and collagen fibers at the margin of the perforation.

Methods Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane infiltrated with 0.2 mL Trafermin (0.1% solution) (bFGF group) or saline (control group) was then placed in the perforation with the silicon layer facing outward. Nine patients were treated with bFGF, and five were treated with saline. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete tympanic membrane closure.

Results The mean perforation size before treatment was 16.5% in the bFGF group and 9.6% in the control group. Closure of the tympanic membrane perforation was achieved in all cases in the bFGF group, whereas it was achieved in only two of five cases in the control group. With bFGF treatment, the tympanic membrane perforations closed completely within 3.7 weeks, and hearing improved by 13.3 dB in the bFGF group.

Conclusion The study demonstrated that bFGF combined with an atelocollagen/silicone bilayer membrane is effective for the conservative treatment of tympanic membrane perforation.
Cochlear Implants: Growing Pains
Authors: Parisier Simon C.
Published: November 2003

Objectives/Hypothesis The objective was to make familiar the problems faced in the application of cochlear implants to the half‐million to a million severe to profoundly deaf individuals who are potential beneficiaries of this technology.

Study Design Observations accumulated during 23 years as Medical Director of the Manhattan Eye Ear Throat Hospital Cochlear Implant Center.

Methods The author reviewed insights gained while directing the Cochlear Implant Center since the early 1980s at Manhattan Eye, Ear and Throat Hospital (New York, NY).

Results The rapid application of cochlear implant technology for patients with severe to profound hearing losses is creating critical problems. It is being hampered by inadequate reimbursement. There is a critical shortage of cochlear implant–trained audiologists, who are an essential keystone in the application of this technology. These audiologists are required to provide lifelong audiological services to patients who have received cochlear implants. At the same time, they must evaluate the exponentially growing number of new candidates.

Conclusion The restoration of hearing with cochlear implants provides an enormous educational and societal benefit. However, the existing health care delivery system limits the application of cochlear implant technology. University audiological training programs must expand their curricula to include cochlear implant–related courses. The existing rehabilitation audiologist delivery system could be applied to provide long‐term, community‐based cochlear implant services.
Advances in Head and Neck Reconstruction
Authors: Urken Mark L.
Published: November 2003

There are numerous advances that have taken place over the last several years in head and neck reconstruction. In this article, the author has outlined three exciting developments. The first is in the area of palatomaxillary reconstruction using free tissue transfer. In select cases, depending on the nature of the defect, soft tissue flaps have been highly successful. However, in more extensive defects, the author chooses to transfer vascularized bone composite flaps to achieve successful dental restoration as well as closure of the palatal defect. Sensory restoration through the use of sensate flaps has been a topic of considerable controversy. The author presents his experience with three patients who underwent a unique reconstruction of the laryngopharynx that has demonstrated conclusively that targeted sensory restoration can be achieved through neural anastomoses. By anastomosing the sensory nerve to the superior laryngeal nerve, there are implicit physiologic implications with respect to the feedback that is achieved and its role in achieving glottic closure during deglutition. Extensive laryngeal reconstruction with subglottic involvement can be a very challenging problem. The author describes a new technique using vascularized tracheal autografts with the thyroid gland as a carrier. This provides the necessary ingredients for transferring a cartilaginous infrastructure within a thin layer of vascularized mucosa to restore the framework and the lining to the laryngotracheal region. Three patients have been restored who had extensive glottic and subglottic stenoses that have since been decannulated and are successfully eating as well as speaking. In addition, the author feels that this is a very promising technique for the management of chondrosarcomas, in which a significant portion of the cricoid arch requires reconstruction.
Mitomycin C for the Treatment of Pharyngoesophageal Stricture After Total Laryngopharyngectomy and Microvascular Free Tissue Reconstruction
Authors: Annino Donald J. , Goguen Laura A.
Published: November 2003

Objectives To assess the role of mitomycin C (MMC) in the management of pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction.

Study Design Five patients since 1998 underwent evaluation and treatment for pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction. The method of reconstruction included four tubed radial forearm free flaps and one jejunal free flap. All patients underwent barium swallow, computed tomography, and endoscopic examination and were proven to be free of recurrent disease.

Methods The patients were taken to the operating room. After dilation, the stenotic segment was exposed, and 1 mL of 0.4 mg/mL mitomycin‐C was applied for 4 minutes using a cotton pledget. The patients were then followed clinically and with barium swallows for a minimum follow‐up period of 18 months.

Results All five patients experienced improved swallowing ability. The need for further dilatations was either eliminated or lessened. All patients were happy with the treatment results. No complications occurred.

Conclusions This small case series suggests that MMC is a safe and effective adjunctive treatment for pharyngoesophageal stricture after total laryngopharyngectomy and free flap reconstruction.
Treatment Outcomes in the Management of Inverted Papilloma: An Analysis of 160 Cases
Authors: Lawson William , Kaufman Matthew R. , Biller Hugh F.
Published: November 2003

Objective The objective of this study is to compare the surgical options for treatment of inverted papilloma to determine the appropriate indications for conservative and aggressive management.

Study Design and Setting A retrospective review of 160 patients with a diagnosis of inverted papilloma treated by the two senior authors (w.l. and h.f.b.) between 1973 and 2001.

Results The study group consisted of 124 male and 36 female patients with an average age of 56 years. The follow‐up period ranged from 10 months to 16 years (mean, 5.2 years). Seventy‐eight patients (49%) had undergone prior surgery. Lateral rhinotomy was performed in 112 patients (70%), with a recurrence rate of 18%. Conservative removal was performed in 41 patients (26%), including 30 (19%) endoscopic approaches, with a recurrence rate of 12%. The remaining patients underwent midfacial degloving, osteoplastic approach, or craniofacial resection. The rate of malignant transformation was 7%.

Conclusion We present the largest personal series of cases of inverted papilloma to date. Our data suggest that conservative approaches, especially endoscopic removal, can be performed on selected lesions with recurrence rates that are comparable to those of more aggressive techniques. Those inverted papillomas that recur after treatment may represent a subset of lesions with an inherent aggressiveness, for which optimal treatment has yet to be determined.
Detection of Helicobacter pylori in Nasal and Maxillary Sinus Specimens From Patients With Chronic Sinusitis
Authors: Morinaka Setsuko , Ichimiya Masato , Nakamura Hiroyuki
Published: November 2003

Objectives In patients with chronic sinusitis, the colonization of nasal and maxillary sinus tissues by Helicobacter pylori (HP) was investigated using polymerase chain reaction, urease test (CLO test), culture, and immunohistochemical analysis.

Study Design A prospective clinical study.

Methods The subjects were 11 patients aged 20 to 72 years with chronic sinusitis who had undergone sinus surgery under local anesthesia. In 7 of 11 patients, the HP status of the stomach was also studied. Nasal and maxillary sinus tissues were studied using polymerase chain reaction, urease test, culture, and immunohistochemical analysis. Helicobacter pylori infection of nasal and maxillary sinus tissues was defined by at least two positive results of different tests.

Results Three (16%) of 19 nasal and maxillary sinus specimens from two patients were shown to be HP‐positive (positive by polymerase chain reaction and immunohistochemical analysis and weakly positive by the CLO test). In one of these two patients, HP infection of the stomach was confirmed. In the other, a positive findings on immunohistochemical analysis suggested HP infection of the stomach. Immunoreactive structures were seen by immunohistochemical analysis in the nasal, maxillary sinus, and gastric specimens of these two patients but were partially degraded.

Conclusion Helicobacter pylori may exist in the nasal and maxillary sinus tissue specimens of some patients with chronic sinusitis with gastric HP infection.
Promoting Healing With Recombinant Human Platelet‐Derived Growth Factor–BB in a Previously Irradiated Problem Wound
Authors: Hom David B. , Manivel J. Carlos
Published: November 2003

Objectives/Hypothesis Persistent, poorly healing wounds are a significant clinical problem in patients who have had previous irradiation. Despite current treatments, refractory nonhealing soft tissue wounds persist. The study described one of the earliest reported uses of recombinant human platelet‐derived growth factor‐BB (rhPDGF) gel to improve the healing of a previously irradiated refractory dermal wound to the neck that had been present for 12 years.

Study Design Case report and literature review.

Methods Review of local healing management of previously irradiated wounds and review of patients chart one year after follow‐up treatment.

Results A 47‐year‐old man had a 12‐year history of a persistent, painful, nonhealing full‐thickness dermal wound on the left side of his neck after radiation therapy and chemotherapy for a T2N2bM0 nasopharyngeal carcinoma. He had been tumor free for 12 years. Despite multiple modalities of therapy over a 1‐year period (including moist hydrogel dressings, topical and oral antibiotics, serial debridement, and hyperbaric oxygen), the wound did not heal. After 6 months of topical rhPDGF gel treatment, sufficient granulation tissue developed within the dermal wound that a split‐thickness skin graft was successfully performed. Symptomatically, the patient's continuous pain at the neck resolved after rhPDGF treatment. Serial histological biopsy specimens before and after rhPDGF treatment confirmed the wound transformation from a chronic state to a short‐term healing state.

Conclusion In previously irradiated tissue, rhPDGF can be useful in helping refractory wounds to heal by inducing further granulation formation. If such treatment is planned, the patient should be informed of the possible theoretical risks of its use when it is in proximity to a previously treated neoplastic site.
Cost‐effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery
Authors: Wilson Leslie , Lin Eddie , Lalwani Anil
Published: November 2003

Objectives: Despite the utility of intraoperative facial nerve monitoring in reducing the risk of iatrogenic facial nerve injury during neurotologic surgery, its routine use during primary or revision surgery remains controversial. One of the major barriers to its acceptance is cost. This study evaluates the cost‐effectiveness of intraoperative facial nerve monitoring during middle ear or mastoid surgery. Research Design/Methods: A simple decision analytic cost‐effectiveness model and a societal approach were used to evaluate three cohorts of individuals who received (1) intraoperative facial nerve monitoring for both primary and revision middle ear or mastoid surgeries, or (2) facial nerve monitoring for revision surgeries only, or (3) no monitoring for any middle ear or mastoid surgeries. Results: Our results strongly favored the use of intraoperative facial nerve monitoring in all patients undergoing middle ear or mastoid surgery, adding about $222.73 to $528.00 to the total cost. The strategy to monitor primary and revision surgeries had the greatest effectiveness and lowest cost, with an average quality‐adjusted life‐year (QALY) of 45.68 at an average cost of $238. Facial nerve monitoring in revision patients only had similar QALYs (45.67) and higher costs ($292.1). Finally, the strategy not to monitor had the lowest QALY (45.65) and highest cost ($449.8). The analysis was robust across a wide range of changes in both costs and probabilities. Conclusions: Facial nerve monitoring is cost‐effective, and its routine use should be adopted to reduce the risk of iatrogenic facial nerve injury during otologic surgery.
Antibodies to HSP‐70 in normal donors and autoimmune hearing loss patients
Authors: Yeom Kristen , Gray J. , Nair T. S. , Arts H. A. , Telian S. A. , Disher M. J. , El‐Kashlan H. , Sataloff R. T. , Fisher S. G. , Carey T. E.
Published: November 2003

Objective: To evaluate serum antibody to heat shock protein (HSP) 70 as a marker for autoimmune sensorineural hearing loss (AISNHL). Design: Sera from 20 patients with rapidly progressive sensorineural HL and 20 control volunteers without HL were tested for antibody reactivity against multiple HSP 70 substrates. Substrates included recombinant human HSP (rHuHSP) 72, purified bovine brain heat shock cognate (HSC) 73 and HSP 72, as well as heat‐shocked and non‐heat‐shocked protein extracts from bovine kidney (MDBK) cells. All serum donors were previously tested for antibody to guinea pig inner ear supporting cells; 17 of 20 patients but none (0 of 20) of the controls were positive. Methods: Sera were tested using Western blots. Results: Reactivity with rHuHSP 70 was observed in 16 patients and 17 controls. Similarly, 15 of 20 patients and 17 of 20 controls stained for both HSP 72 and HSC 73 from the bovine brain. When tested against the heat‐shock‐induced and control MDBK extracts, six patients and nine controls had greater reactivity with the induced HSP 72. Conclusion: The frequency of antibodies to HSP substrates did not differ in patients and controls. Prior studies reported that HSP 72 is the 68 kD antigen commonly detected by AISNHL sera. However, we show that HSP 72 antibodies are no more prevalent in patients than in normal controls. Thus, it is unlikely that the 68 kD protein is HSP 72. Therefore, HSPs are not appropriate substrates for serodiagnosis of AISNHL.
Level of vocal folds as projected on the exterior thyroid cartilage
Authors: Cinar Ugur , Yigit Ozgur , Vural Cetin , Alkan Seyhan , Kayaoglu Semra , Dadas Burhan
Published: November 2003

Objective: This study aims to identify the level of the vocal folds as projected on the exterior thyroid cartilage. Study Design: Anatomic study of human cadaver larynges. Methods: The study includes 83 fresh larynges harvested at autopsy from 62 male and 21 female cadavers. The larynges were excised and divided in the midline posteriorly. One needle was inserted at the level of anterior commissure from endolarynx, and the other was inserted at the thyroid ala just anterior to the vocal process along the superior surface of the right vocal cord. Measurements of vocal cord projections on the thyroid ala were done with a caliper. Results: The mean value of the ratio of the distances from the superior thyroid notch to anterior commissure and the midline height from thyroid notch to the inferior border of thyroid cartilage was found to be 0.41 in males and 0.38 in females. No statistical differences were observed between these two groups (P = .062). We found that the distance from the anterior commissure to the inferior thyroid border in midline “c” was longer than the distance from the posterior border of the vocal cord to the inferior border of the inferior tubercle of the thyroid ala “d” in 44 (71%) males and in 7 (33%) females. On the other hand, “d” was longer than “c” in 8 (12.9%) males and in 8 (38.1%) females. These two distances were equal in 10 (16.1%) males and in 6 (28.6%) females. Conclusion: In this study, we found that the anterior commissure lies approximately at the juncture of the upper two fifths and lower three fifths of the midline height of thyroid cartilage in the majority of the larynges of the male and female cadavers. The position of the posterior border of the vocal cords was found to be at a lower level than anterior commissure in two thirds of males and in one third of females. This means that the vocal cords slope downward posteriorly in the majority of the larynges of the males. This may be one of the causes of failure of some type I thyroplasties.
Cutaneous head and neck squamous cell carcinoma metastatic to cervical lymph nodes (nonparotid): A better outcome with surgery and adjuvant radiotherapy
Authors: Veness Michael J. , Palme Carsten E. , Smith Mark , Cakir Burcu , Morgan Gary J. , Kalnins Ian
Published: November 2003

Objective: The aim of this study is to report on the experience of treating cutaneous squamous cell carcinoma (SCC) metastatic to cervical (nonparotid) lymph nodes at the Head and Neck Unit, Westmead Hospital, Sydney, Australia. Study Design: Retrospective chart review. Methods: Patients diagnosed with previously untreated metastatic cutaneous SCC to cervical lymph nodes (levels I‐V) and treated with radiotherapy, surgery, or surgery and adjuvant radiotherapy were identified. Relapse and outcome was analyzed using Cox regression analysis. Results: Between 1980 and 2000, 74 patients were treated with curative intent. There were 59 males and 15 females, with a median age of 66 (range 37–93) years. Median duration of follow up was 48 (range 12–187) months. Fifty‐two were treated with neck dissection and radiotherapy, 13 with neck dissection alone, and 9 with only radiotherapy. Most patients (85%) had an identifiable index lesion. Level I (38%) and II (36%) lymph nodes were the most often involved. In total, 25 (34%) patients developed recurrent disease, predominantly locoregional (22 of 25). Median time to recurrence was 5.2 (2‐34.3) months. Increasing nodal size (≥3cm) (P = .01), metastatic spread to multiple nodes (P = .05), and the presence of extranodal spread (P = .01) all predicted for worse survival. Patients undergoing combined modality treatment had a lower relapse rate (15%) and a significantly better disease free survival (P = .001) compared with single modality treatment. Conclusion: Metastatic cutaneous SCC is uncommon but potentially lethal. Surgery and adjuvant radiotherapy remain the best practice and provide the best chance of achieving locoregional control.
Subcutaneous mandibulotomy: A new surgical access for large tumors of the parapharyngeal Space
Authors: Teng Marita S. , Genden Eric M. , Buchbinder Daniel , Urken Mark L.
Published: November 2003

Objectives: Surgery for tumors of the parapharyngeal space (PPS) requires adequate exposure to identify and protect vital structures. Transcervical and transcervical‐transparotid approaches to the PPS may be enhanced by mandibulotomy. However, midline mandibulotomy traditionally requires lip‐splitting and extensive intraoral incisions, often necessitating tracheostomy and nasogastric feeding. We describe a new technique to gain exposure to the PPS while avoiding these consequences. Study Design: Case series. Methods: Five patients with PPS tumors underwent surgery using a new technique, the subcutaneous mandibulotomy approach (SMA). Each case was retrospectively assessed for tumor size, intraoperative access to the PPS, perioperative complications, and length of hospitalization. Results: In this series, the additional exposure achieved by SMA was adequate to safely remove large PPS tumors that could not be delivered through the transcervical‐transparotid approach. All patients started oral diets on postoperative day 1 and were discharged within 3 days. There were no intraoperative complications, and postoperative complications were self‐limited. The pathologic entities were a venous malformation, a paraganglioma, and three large, deep‐lobe pleomorphic adenomas of the parotid. Conclusions: We introduce a new technique, the SMA, which affords excellent access to the PPS without the lip‐split, chin‐split, and floor of mouth incisions. The SMA avoids both nasogastric feeding and a tracheostomy and offers improved cosmesis compared with a traditional midline mandibulotomy. Our current stepwise approach to achieve exposure to the PPS includes use of the SMA as an intermediate step for extensive PPS lesions, which are inaccessible through the transcervical approach yet do not require full labiomandibulotomy for safe and complete removal.
‘Push’ versus ‘pull’ percutaneous endoscopic gastrostomy tube placement in patients with advanced head and neck cancer
Authors: Tucker Anthony T. , Gourin Christine G. , Ghegan Mark D. , Porubsky Edward S. , Martindale Robert G. , Terns David J.
Published: November 2003

Objectives/Hypothesis: Percutaneous endoscopic gastrostomy tube (PEG) placement by means of the “pull” method has been reported to result in a significantly higher complication rate when compared with “push” PEG placement. These findings have led to a renewed interest in the push, or Russell introducer, method of PEG placement at the authors' institution when PEG is required before definitive treatment of advanced head and neck cancer. The authors sought to determine whether the push method of PEG placement is associated with a lower incidence of complications in this patient population. Study Design: Nonrandomized, retrospective patient analysis. Methods: The medical records of all patients presenting to the Medical College of Georgia (Augusta, GA) who received a diagnosis of squamous cell carcinoma of the head and neck between 1999 to 2001 were retrospectively reviewed. Patients who required PEG placement as part of their treatment comprised the study population. Results: The push PEG technique was used in 29 patients, and the pull technique was used in 50 patients. There was a statistically significant difference in the complication rate between the two techniques. Patients who underwent placement by means of the pull technique had an overall complication rate of 30% (15 of 50) versus a 0% (0 of 29) complication rate in patients undergoing the push technique (P = .0006, Fisher's Exact test). Conclusion: The push PEG technique appears to have a significantly lower risk of complications compared with the pull technique in patients with advanced head and neck cancer. The authors recommend considering the use of the push method when PEG placement is required.