bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Early-Stage Glottic Cancer by Transoral Laser Resection
Authors: Hartl Dana M. , de Monès Erwan , Hans Stéphane , Janot François , Brasnu Daniel
Published: October 2014

Objectives:

We reviewed outcomes of treatment of early glottic carcinoma by transoral laser resection.

Methods:

We performed a retrospective study of tumor stage, type of cordectomy (European Laryngological Society), resection margins, local control, and laryngeal preservation.

Results:

Of 142 patients treated with curative intent, 79 (92% male; average age, 63 years) were retained for this study, on the basis of availability of information regarding resection margins, the absence of adjuvant radiotherapy, and follow-up of at least 2 years. The tumors were classified pTis (n = 21), pT1a (n = 51), or pT1b (n = 7) and were treated by cordectomy types I (23%), II (30%), III (27%), IV (6%), and V (14%). The average follow-up was 56 months (range, 24 to 150 months). The overall 5-year actuarial recurrence-free survival rate was 89%, and the 5-year actuarial disease-specific survival rate was 97.3%. There were 11 local recurrences (14%); 7 were treated by another laser resection, 1 by radiotherapy, 1 by supracricoid partial laryngectomy, and 2 by total laryngectomy. The overall rate of final local control with the laser alone was 100% for patients with initially positive margins, 95% for those with initially suspicious margins, and 94% for those with free margins. The overall rate of organ preservation was 100% for patients with positive or suspicious margins and 96% for those with free margins. Margin status (p = .39), cordectomy type (p = .67), and anterior commissure involvement (p = .16) were not statistically related to recurrence (Kaplan-Meier calculations with nonparametric univariate analysis). The recurrence rate was significantly higher for T1b tumors, however (p = .001).

Conclusions:

Laser microresection provides high rates of local control and organ preservation for early glottic cancer. Positive or suspicious margins were not related to recurrence, nor was anterior commissure involvement. This study implies that suspicious margins can be managed with a “watch-and-wait” attitude. Re-treatment with laser, external partial laryngectomy, and radiotherapy remain therapeutic options for recurrences.
Role of Computed Tomography and Bronchoscopy in Speech Prosthesis Aspiration
Authors: Brenner Michael J. , Floyd Larry , Collins Sharon L.
Published: October 2014

Tracheoesophageal puncture prostheses (TEPPs) are an integral aspect of speech rehabilitation for many patients who have undergone total laryngectomy. Because one flange of the prosthesis sits in the trachea and the other in the esophagus, these devices can be aspirated or swallowed if dislodged. Five cases of prosthesis aspiration that occurred in 4 veterans within a 16-month period are described. The 5 aspirated TEPPs resulted in highly variable clinical presentations ranging from complaints of “lost” TEPPs in asymptomatic patients to near-asphyxiation. Furthermore, the aspirated TEPPs were not reliably demonstrated on chest radiographs, often leading to delayed diagnosis. Aspiration of TEPPs may be more common than formerly recognized, and chest computed tomography or bronchoscopy is indicated in cases of missing TEPPs not demonstrated on plain films.
Long-Term Botulinum Toxin Dose Consistency for Treatment of Adductor Spasmodic Dysphonia
Authors: Holden Paul K. , Vokes David E. , Taylor Michael B. , Till James A. , Crumley Roger L.
Published: October 2014

Objectives:

Botulinum toxin (BTX) injection is currently the primary and most common treatment for adductor spasmodic dysphonia (ADSD). A variety of injection strategies and dosage regimens have been described. This study reports on our experience with the dosage schedule and dosing consistency of BTX for the treatment of ADSD.

Methods:

We retrospectively reviewed our laryngeal BTX database for the period 1991 to 2005. Our strict inclusion requirements limited our selection to 13 patients who had received a minimum of 6 injections (average, 11.5; range, 6 to 19) of BTX for ADSD.

Results:

The average total dose of BTX to the larynx for each treatment episode was 3.9 units (range, 1.5 to 7.5). The total dose administered tended to trend downward among patients who began treatment from 1991 to 1998, indicating that the initial dose (usually 2.5 units per side) may have been high. Those patients who began from 1999 onward had a more stable dose, indicating that the initial dose (usually 1.5 units per side) was more suitable. The subjects underwent an average of 2.2 injections (range, 1 to 5) before reaching their optimal BTX dose. The total number of treatments performed in this group of patients was 150, of which 145 were successful (96.7%).

Conclusions:

The BTX dose for the optimal treatment of ADSD usually remains consistent over time, as does the treatment interval. An initial dose of 1.5 units per side or less appears to improve dosing stability, indicating that the initial dosing of 2.5 units per side in our study was often greater than required. The optimal BTX dose was usually ascertained by the second or third injection. In our patient population, the long-term dosing consistency of BTX confirmed that neither tachyphylaxis nor increasing sensitivity to BTX occurred during the course of treatment for ADSD.
Successful Cochlear Implantation in a Patient with Bilateral Progressive Sensorineural Hearing Loss after Traumatic Subarachnoid Hemorrhage and Brain Contusion
Authors: Fujimoto Chisato , Ito Ken , Takano Shingo , Karino Shotaro , Iwasaki Shinichi
Published: October 2014

Objectives:

We address the proper indications for cochlear implantation for profound deafness with possible retrocochlear involvement by reporting successful implantation in a patient with traumatic subarachnoid hemorrhage and brain contusion.

Methods:

We present a patient (55-year-old man) who had bilateral progressive sensorineural hearing loss after traumatic subarachnoid hemorrhage and brain contusion. Preoperative imaging and functional studies were done, as well as routine tests, to evaluate the possible performance of the cochlear implant.

Results:

Sensorineural hearing loss developed promptly after head trauma with progressive deterioration. The cause of progressive sensorineural hearing loss remained unknown. Distortion product otoacoustic emissions demonstrated bilateral inner ear (outer hair cell) damage. Highly impaired speech discrimination despite less marked pure tone average elevation and a focal lesion in the left middle temporal gyrus suggested the possibility of coexisting retrocochlear lesions. After thorough discussion of the possible outcomes, cochlear implantation was successfully performed 25 months after the trauma. The patient became able to use a telephone.

Conclusions:

We advocate that profound bilateral sensorineural hearing loss caused by traumatic head injury, even with possible involvement of central auditory pathways, should not be regarded as a contraindication to cochlear implantation, as long as bilateral inner ear dysfunction is clearly demonstrated and there is no obvious evidence of central deafness.
Receptor-Mediated Uptake of Pepsin by Laryngeal Epithelial Cells
Authors: Johnston Nikki , Wells Clive W. , Blumin Joel H. , Toohill Robert J. , Merati Albert L.
Published: October 2014

Objectives:

Previous data suggest a mechanistic link between exposure to pepsin and cellular changes that lead to laryngopharyngeal disorders. Initial confocal microscopy analysis of pepsin uptake by cultured hypopharyngeal epithelial cells revealed that pepsin may be taken up by a specific process. The objective of this study was to use electron microscopy to confirm the initial confocal findings and to determine whether uptake of pepsin by laryngeal epithelial cells is receptor-mediated.

Methods:

Cultured human hypopharyngeal FaDu cells and human laryngeal biopsy specimens, taken from the posterior larynx of “control” patients without symptoms or findings of laryngopharyngeal reflux, were exposed to purified human pepsin 3b with or without transferrin (a marker for receptor-mediated endocytosis) in vitro. Uptake of pepsin was documented by electron microscopy.

Results:

Pepsin co-localized with transferrin in intracellular vesicles; this finding confirms that pepsin is taken up by laryngeal epithelial cells by receptor-mediated endocytosis.

Conclusions:

This is a novel finding that further defines the role and mechanism of pepsin-mediated injury in laryngopharyngeal reflux. The objective of ongoing research is to identify the receptor and investigate potential antagonists as a new therapeutic option for patients with reflux-attributed disease — In particular, those patients who have persistent symptoms despite acid suppression therapy.
Utilization of the LifeStat Emergency Airway Device
Authors: Mouadeb Debbie A. , Rees Catherine J. , Belafsky Peter C.
Published: October 2014

Objectives:

Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device.

Methods:

A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use.

Results:

One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported.

Conclusions:

The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.
Ansa Cervicalis-to-Recurrent Laryngeal Nerve Anastomosis for Unilateral Vocal Fold Paralysis: Experience of a Single Institution
Authors: Lorenz Robert R. , Esclamado Ramon M. , Teker Aysenur M. , Strome Marshall , Scharpf Joseph , Hicks Douglas , Milstein Claudio , Lee Walter T.
Published: October 2014

Objectives:

One treatment option for unilateral vocal fold paralysis (UVFP) is ansa cervicalis-to-recurrent laryngeal nerve (ansa-RLN) anastomosis to provide reinnervation to the affected vocal fold. The advantages of this treatment approach are that it 1) provides vocal fold tone, bulk, and tension, 2) is technically simple, and 3) does not preclude other medialization procedures. We present all patients who have undergone ansa-RLN anastomosis for UVFP at our institution.

Methods:

An Institutional Review Board-approved retrospective chart review was performed to include all patients who had undergone an ansa-RLN anastomosis procedure for UVFP at our institution. Data from clinical and endoscopic laryngoscopy with stroboscopy were recorded. Statistical analysis was performed on visual and perceptual vocal data.

Results:

A total of 46 patients were included in the study. Stroboscopic analysis and perceptual vocal evaluation was performed in a blinded fashion on the 21 patients who had preoperative and postoperative stroboscopy. Severity, roughness, breathiness, and strain all improved significantly over time. Glottic closure, vocal fold edge, and supraglottic effort all significantly improved after operation. Of the 38 patients with at least 3 months of follow-up, all except 1 demonstrated evidence of reinnervation.

Conclusions:

This technique for treating UVFP results in significant improvements in patients' voice and on visual examination.
Cricotracheal Resection in Nontracheotomized Adults: A Prospective Case Series
Authors: Sittel Christian , Blum Sebastian , Streckfuss Alexandra , Plinkert Peter K.
Published: October 2014

Objectives:

Cricotracheal resection is a modern technique of airway reconstruction used in cases of subglottic stenosis. We report a case series of adult, nontracheotomized patients.

Methods:

Fifteen patients with significant subglottic stenosis were identified as presenting with dyspnea and stridor. The stenosis was grade III in 14 cases and grade II in 1 case, according to the Cotton classification. The causes were manifold, with intubation and tracheostomy being the predominant risk factors. Cricotracheal resection was performed in all cases with preoperative and postoperative videotracheoscopy.

Results:

The mean postoperative intubation time was 41.7 hours (11 to 103 hours), and the mean length of stay in the intensive care unit was 2.6 days (3 to 9 days). Videotracheoscopy for reassessment was performed after 96 days (average). In 13 of the 15 patients the subglottic lumen was returned to a normal diameter. In 1 case a recurrent stenosis was managed with repeated endoscopic interventions. One patient died on postoperative day 4 because of a pulmonary embolism. Additional complications consisted of 1 axillary venous embolism, 4 cases of ventilator-associated pneumonia, and 1 case of transient unilateral recurrent nerve palsy that recovered completely.

Conclusions:

Cricotracheal resection is a reliable and versatile technique for the reconstruction of the subglottic airway, almost regardless of the underlying cause. Most complications observed have not been associated directly with the procedure, but reflect the significant comorbidity of the patient population. There seems to be an increased risk for thromboembolic events that may be a consequence of the preoperative immobilization of dyspneic patients.
Orocutaneous and Pharyngocutaneous Fistula Closure Using a Vacuum-Assisted Closure System
Authors: Andrews Brian T. , Smith Russell B. , Hoffman Henry T. , Funk Gerry F.
Published: October 2014

Objectives:

The vacuum-assisted closure (VAC) system is a topical negative pressure dressing that has been used extensively to manage a multitude of complicated wounds, including enterocutaneous fistula. We hypothesize that the VAC system may also facilitate the closure of orocutaneous and pharyngocutaneous fistulas.

Methods:

A retrospective chart review was performed.

Results:

Three patients were identified. Two patients developed fistulas after undergoing salvage laryngectomy, and 1 patient developed a fistula after having a hemiglossectomy defect reconstructed by a radial forearm free flap. The VAC system was successful in closing the fistula in 2 of the 3 patients. Complete fistula closure took 3 and 11 days in the 2 cases. The 1 failure of fistula closure was due to poor collapsibility of the neck tissue along the fistula tract caused by fibrosis following prior radiotherapy.

Conclusions:

The VAC system is a feasible treatment option for closing head and neck fistulas, especially when collapsible tissue is present at the fistula site.
Expression of Oncostatin M in Chronic Obstructive Sialadenitis of the Submandibular Gland
Authors: Lee Heung-Man , Cho Jae-Goo , Kang Hee-Joon , Chae Sung-Won , Hwang Soon-Jae , Jung Kwang-Yoon , Woo Jeong-Soo
Published: October 2014

Objectives:

We investigated the expression of oncostatin M messenger RNA (mRNA) and protein in normal submandibular glands and those with chronic obstructive sialadenitis and localized the expression of o costatin M protein.

Methods:

Submandibular glands from 10 patients with chronic obstructive sialadenitis as a study group and 10 normal submandibular glands as a control group were examined. Oncostatin M mRNA extracted from submandibular gland was used for reverse transcription–polymerase chain reaction and analyzed semiquantitatively. The difference in expression level of oncostatin M protein between the 2 groups was analyzed through Western blot analysis, and oncostatin M protein was localized immunohistochemically.

Results:

The expression levels of oncostatin M mRNA and protein were significantly increased in the study group. The protein was predominantly localized in ductal epithelia and infiltrating inflammatory cells and was more strongly expressed in the study group also.

Conclusions:

Oncostatin M is expressed in both chronic obstructive sialadenitis and normal submandibular gland, and is up-regulated in chronic obstructive sialadenitis. These results suggest that oncostatin M is involved in the pathologic process of chronic obstructive sialadenitis. However, the physiologic role in normal glands, as well as a possible role in the development of chronic obstructive sialadenitis, remains to be elucidated.
Glycosaminoglycan Composition of the Vocal Fold Lamina Propria in Relation to Function
Authors: Hahn Mariah S. , Jao Cindy Y. , Faquin William , Grande-Allen K. Jane
Published: October 2014

Objectives:

This study was designed to quantify the specific glycosaminoglycans (GAGs) in the midmembranous vocal fold (VF) lamina propria (LP) and to interpret their presence in relation to the known stresses borne by each LP layer.

Methods:

GAGs from normal human LP and from both normal and scarred canine LPs were analyzed by fluorophore-assisted carbohydrate electrophoresis (FACE). Immunostaining was conducted to give insight into the spatial distribution of each GAG type.

Results:

Hyaluronan composes roughly 0.64% ± 0.41% of the human LP as measured relative to tissue total protein. Chondroitin sulfate and/or dermatan sulfate (CS/DS), keratan sulfate, and heparan sulfate chains constitute approximately 23.9% ± 12.1%, 14.7% ± 6.1%, and 61.4% ± 13.6%, respectively, of human LP sulfated GAGs.

Conclusions:

Observed CS/DS sulfation patterns imply that versican is a major contributor to human LP CS levels. In addition, examination of LP GAG with respect to gender revealed a significant variation in total levels of CS/DS and a potential difference in the levels of versican relative to decorin and biglycan. In dogs, LP scarring appeared to result in a reduction in hyaluronan and CS/DS. These FACE results were combined with histologic data to update current descriptive models linking LP microstructure with the regional variations in LP loading.
Coblation-Assisted Lingual Tonsillectomy for Dysphagia Secondary to Tongue Base Hypertrophy
Authors: Bock Jonathan M. , Trask Douglas K.
Published: October 2014

Objectives:

Lingual tonsillar hypertrophy is an underappreciated cause of dysphagia and is believed to impede swallowing function by inhibition of laryngeal elevation and epiglottic inversion due to mechanical interference by bulky tongue base tissue. We present a case of severe dysphagia secondary to idiopathic tongue base hypertrophy that was treated with coblation lingual tonsillectomy and tongue base reduction.

Methods:

We report a case and discuss the relevant literature regarding tongue base hypertrophy and surgical interventions to treat the enlarged base of the tongue.

Results:

Symptoms of dysphagia and globus sensation and signs of decreased epiglottic inversion and laryngeal penetration improved markedly after surgical reduction of hypertrophied lingual tonsillar tissue using coblation. Preoperative and postoperative clinical imaging and radiographs are presented to show the reduction of tongue base size, correlated with the patient's improved clinical function.

Conclusions:

Coblation-assisted lingual tonsillectomy and tongue base reduction can successfully treat dysphagia secondary to tongue base hypertrophy.
Prospective Study of the Impact of Thyroid Hormone Replacement on Objective Voice Parameters
Authors: Birkent Hakan , Karacalioglu Ozgur , Merati Albert L. , Akcam Timur , Gerek Mustafa
Published: October 2014

Objectives:

Hypothyroidism has long been considered to have an impact on phonation. In this study, objective evaluation of vocal function in women with hypothyroidism was performed in order to characterize potential dysphonia; their subsequent response to thyroid hormone replacement was prospectively studied. It was hypothesized that thyroid hormone replacement therapy in this cohort would have an objectively measurable impact on vocal function.

Methods:

Prospective evaluation of objective voice parameters and concurrent determination of serum thyroid status was executed both before and after thyroid hormone replacement in a cohort of patients who had had total thyroidectomy. Objective voice parameters before and after treatment were compared.

Results:

Twenty-four female subjects were recruited over an 18-month period. After surgery, all subjects were hypothyroid (mean thyroid-stimulating hormone level, 81.38 mIU/L; range, 25.26 to 100.00 mIU/L) before replacement. After hormone therapy, their mean thyroid-stimulating hormone level dropped to 1.20 mIU/L (range, 0.28 to 3.83 mIU/L). The mean fundamental frequency significantly increased from a pretreatment average of 223.48 ± 36.10 Hz to 237.64 ± 38.81 Hz. Other measured voice parameters (jitter, shimmer, amplitude perturbation quotient, pitch perturbation quotient, noise-to-harmonics ratio, and maximum phonation time) were not affected.

Conclusions:

Thyroid hormone replacement therapy following total thyroidectomy has a measurable impact on mean fundamental frequency in female patients. The mechanism of this effect is not known.
Optical Coherence Tomography—Enhanced Microlaryngoscopy: Preliminary Report of a Noncontact Optical Coherence Tomography System Integrated with a Surgical Microscope
Authors: Vokes David E. , Jackson Ryan , Guo Shuguang , Perez Jorge A. , Su Jianping , Ridgway James M. , Armstrong William B. , Chen Zhongping , Wong Brian J. F.
Published: October 2014

Objectives:

Optical coherence tomography (OCT) is a new imaging modality that uses near-infrared light to produce cross-sectional images of tissue with a resolution approaching that of light microscopy. We have previously reported use of OCT imaging of the vocal folds (VFs) during direct laryngoscopy with a probe held in contact or near-contact with the VFs. This aim of this study was to develop and evaluate a novel OCT system integrated with a surgical microscope to allow hands-free OCT imaging of the VFs, which could be performed simultaneously with microscopic visualization.

Methods:

We performed a prospective evaluation of a new method of acquiring OCT images of the VFs.

Results:

An OCT system was successfully integrated with a surgical microscope to permit noncontact OCT imaging of the VFs of 10 patients. With this novel device we were able to identify VF epithelium and lamina propria; however, the resolution was reduced compared to that achieved with the standard contact or near-contact OCT.

Conclusions:

Optical coherence tomography is able to produce high-resolution images of vocal fold mucosa to a maximum depth of 1.6 mm. It may be used in the diagnosis of VF lesions, particularly early squamous cell carcinoma, in which OCT can show disruption of the basement membrane. Mounting the OCT device directly onto the operating microscope allows hands-free noncontact OCT imaging and simultaneous conventional microscopic visualization of the VFs. However, the lateral resolution of the OCT microscope system is 50 μm, in contrast to the conventional handheld probe system (10 μm). Although such images at this resolution are still useful clinically, improved resolution would enhance the system's performance, potentially enabling real-time OCT-guided microsurgery of the larynx.
Post-Laryngectomy Speech Respiration Patterns
Authors: Stepp Cara E. , Heaton James T. , Hillman Robert E.
Published: October 2014

Objectives:

The goal of this study was to determine whether speech breathing changes over time in laryngectomy patients who use an electrolarynx, to explore the potential of using respiratory signals to control an artificial voice source.

Methods:

Respiratory patterns during serial speech tasks (counting, days of the week) with an electrolarynx were prospectively studied by inductance plethysmography in 6 individuals across their first 1 to 2 years after total laryngectomy, as well as in an additional 8 individuals who had had a laryngectomy at least 1 year earlier.

Results:

In contrast to normal speech that is only produced during exhalation, all individuals were found to engage in inhalation during speech production, and those studied longitudinally displayed increased occurrences of inhalation during speech production with time after laryngectomy. These trends appear to be stronger for individuals who used an electrolarynx as their primary means of oral communication rather than tracheoesophageal speech, possibly because of continued dependence on respiratory support for the production of tracheoesophageal speech.

Conclusions:

Our results indicate that there are post-laryngectomy changes in the speech breathing behaviors of electrolarynx users. This has implications for designing improved electrolarynx communication systems, which could use signals derived from respiratory function as one of many potential physiologically based sources for more natural control of electrolarynx speech.
Laryngeal Carcinoma in Nonsmoking Patients
Authors: Hamzany Yaniv , Hadar Tuvia , Feinmesser Raphael , Guttman Dan , Shvero Jacob
Published: October 2014

Objectives:

Smoking is a known risk factor for laryngeal carcinoma. We sought to describe the clinicopathologic characteristics and outcomes of nonsmoking patients with laryngeal carcinoma.

Methods:

Of 1,443 patients treated for laryngeal carcinoma between 1960 and 2006, 55 (3.8%) were nonsmokers: 40 (73%) had never smoked and 15 (27%) had stopped smoking 12 years or more before diagnosis. Patient characteristics and outcomes were reviewed.

Results:

The study group consisted of 87% men; the mean age at diagnosis was 67 years. All lesions but one were located in the glottis. The 5-year survival rate for the whole group was 85%. Most tumors were detected early. Of 38 patients (69%) with stage T1 disease, there was no significant difference in prognostic features between those who had never smoked and those who had smoked in the past.

Conclusions:

Fewer than 5% of patients with laryngeal carcinoma were nonsmokers. Like smokers, this subgroup was characterized by a male predominance and an approximate age at diagnosis in the seventh decade. Unlike smokers, nonsmokers show a greater predilection for glottic rather than supraglottic disease. There was no difference in prognosis between smokers and nonsmokers, regardless of whether they had smoked in the past.
Partial Lesions of the Intratemporal Segment of the Facial Nerve: Graft versus Partial Reconstruction
Authors: Bento Ricardo F. , Salomone Raquel , Brito Rubens , Tsuji Robinson K. , Hausen Mariana
Published: October 2014

Objectives:

In cases of partial lesions of the intratemporal segment of the facial nerve, should the surgeon perform an intraoperative partial reconstruction, or partially remove the injured segment and place a graft? We present results from partial lesion reconstruction on the intratemporal segment of the facial nerve.

Methods:

A retrospective study on 42 patients who presented partial lesions on the intratemporal segment of the facial nerve was performed between 1988 and 2005. The patients were divided into 3 groups based on the procedure used: Interposition of the partial graft on the injured area of the nerve (group 1; 12 patients); keeping the preserved part and performing tubulization (group 2; 8 patients); and dividing the parts of the injured nerve (proximal and distal) and placing a total graft of the sural nerve (group 3; 22 patients).

Results:

Fracture of the temporal bone was the most frequent cause of the lesion in all groups, followed by iatrogenic causes (p < 0.005). Those who obtained results lower than or equal to III on the House-Brackmann scale were 1 (8.3%) of the patients in group 1, none (0.0%) of the patients in group 2, and 15 (68.2%) of the patients in group 3 (p < 0.001).

Conclusions:

The best surgical technique for therapy of a partial lesion of the facial nerve is still questionable. Among these 42 patients, the best results were those from the total graft of the facial nerve.
Digastric Muscle Sew-up Procedure for the Repair of the Floor of the Mouth following Pull-through Operation for Oral Cancers
Authors: Suzuki Hideaki , Matsuura Kazuto , Hiraki Nobuaki , Kadokawa Yohei , Hashida Koichi , Udaka Tsuyoshi , Nagatani Gunji
Published: October 2014

Objectives:

We report the digastric muscle sew-up procedure for the repair of the floor of the mouth following the pull-through operation for advanced oral cancers.

Methods:

Eleven patients with advanced oral cancers (of the tongue in 8 cases and of the floor of the mouth in 3 cases) were retrospectively analyzed. One-third glossectomy and hemiglossectomy were performed in 4 patients each; the other 3 patients underwent tumor resection on the floor of the mouth. After neck dissection and tumor resection via the pull-through approach, the floor of the mouth was repaired simply by sewing the digastric muscle to the mandibular base. The surfaces of the transected musculature of the tongue and the floor of the mouth were left uncovered and exposed to the oral cavity.

Results:

The postoperative wound healing was fairly good in all of the patients. Neck infection or the formation of a fistula on the floor of the mouth was not seen. The patients started transoral ingestion by the 10th postoperative day. Temporary difficulty in swallowing occurred in all patients, but was totally alleviated within 1 month. Their clarity of speech recovered to a tolerable level.

Conclusions:

We believe that the digastric muscle sew-up procedure is a simple, safe, and timesaving method for the repair of small to medium-sized defects of the floor of the mouth created by ablative surgery in patients with advanced oral cancers.
Retrograde Labeling of the Rat Facial Nerve with Carbocyanine Dyes to Enhance Intraoperative Identification
Authors: Dogru Salim , Van Daele Douglas , Hansen Marlan R.
Published: October 2014

Objectives:

Removal of head and neck neoplasms, especially those of the parotid gland and those of the internal auditory canal and cerebellopontine angle, often requires microdissection of the facial nerve. Displacement or splaying of the nerve can make it difficult to identify facial nerve fibers and/or distinguish them from surrounding tissues. Here we tested a method of labeling the facial nerve with fluorescent lipophilic dyes as a method of providing intraoperative visual confirmation of nerve fibers.

Methods:

The facial nerves of adult rats were retrogradely labeled with 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI), 3,3′-dioctadecyloxacarbocyanine perchlorate (DiO), or 3,3′-dilinoleyloxacarbocyanine perchlorate (Fast DiO) either by direct application to the nerve sheath or by microinjection into the facial muscles. The nerves were examined 30 days after dye application by means of a dissecting stereomicroscope equipped with epifluorescence filters.

Results:

Of the dyes tested, Fast DiO proved to be the most effective, providing labeling of the nerve sufficient to be seen with combined fluorescent and bright field stereomicroscopy. Nerve conduction studies indicated that fluorescent labeling did not adversely affect nerve function.

Conclusions:

These results raise the possibility of using fluorescent lipophilic dyes to label nerves as a method of enhancing identification and distinguishing nerve fibers during surgery.
Morphometric Study on the Anatomy of the Fetal Cricoid Cartilage and Comparison between its Inner Diameter and Endotracheal Tube Sizes
Authors: Lima Leila F. R. , Nita Luciana M. , Campelo Victor E. S. , Imamura Rui , Tsuji Domingos H.
Published: October 2014

Objectives:

The high incidence of respiratory disorders is one of the main problems in perinatal medical care. With the increased use of intubation, the incidence of laryngeal injury causing stenosis has also increased. The principal constriction point in the infant's larynx is the midcricoid area. We sought to provide detailed morphometric data on the anatomy of the cricoid cartilage and its relationship with growth and body characteristics of fetuses at 5 to 9 months of gestational age.

Methods:

Nineteen larynges obtained from 17 stillborn infants and 2 newborn infants ranging in gestational age from 5 to 9 months were studied. Measurements of the cricoid cartilage were made with a millimeter-graded caliper.

Results:

Weight was the variable most correlated with cricoid measurements. The cricoid lumen configuration showed an almost elliptic shape and did not change with gestational age. The mean inner subglottic cricoid area was 19.27 ± 9.62 mm2 and was related to weight and body surface area. Cricoid growth was more pronounced at the outer portion of the cartilage.

Conclusions:

The cricoid lumen configuration was elliptic, and its mean area was smaller than that of available endotracheal tubes. This lumen area was most influenced by weight and height.
Unique Transgenic Animal Model for Hereditary Hearing Loss
Authors: Cosetti Maura , Culang David , Kotla Sumankrishna , O'Brien Peter , Eberl Daniel F. , Hannan Frances
Published: October 2014

Objectives:

This study capitalizes on the unique molecular and developmental similarities between the auditory organs of Drosophila and mammals, to investigate genes implicated in human syndromic and nonsyndromic hearing loss in a genetically tractable experimental animal model, the fruit fly Drosophila.

Methods:

The Drosophila counterparts of 3 human deafness genes (DIAPH1/DFNA1, ESPN/DFNB36, and TMHS/DFNB67) were identified by sequence similarity. An electrophysiological assay was used to record sound-evoked potentials in response to an acoustic stimulus, the Drosophila courtship song.

Results:

Flies with mutations affecting the diaphanous, forked, and CG12026/TMHS genes displayed significant reductions in the amplitude of sound-evoked potentials compared to wild-type flies (p < 0.05 to p < 0.005). The mean responses were reduced from approximately 500 to 600 μV in wild-type flies to approximately 100 to 300 μV in most mutant flies.

Conclusions:

The identification of significant auditory dysfunction in Drosophila orthologs of human deafness genes will facilitate exploration of the molecular biochemistry of auditory mechanosensation. This may eventually allow for novel diagnostic and therapeutic approaches to human hereditary hearing loss.
Postoperative Monitoring of Esophageal Pressure in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome Who Have Undergone Tonsillectomy with Uvulopalatopharyngoplasty
Authors: Suzuki Masaaki , Saigusa Hanako , Kurogi Ryoko , Morita Shigeho , Ishizuka Yoichi
Published: October 2014

Objectives:

To realize better postoperative management in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), we elucidated the need for the postoperative monitoring of esophageal pressure (Pes).

Methods:

A prospective randomized controlled study was performed. Adult patients with OSAHS were divided into 2 groups: Those administered autoadjusted continuous positive airway pressure (CPAP) before, on, and after the first postoperative night (CPAP group) and those not administered CPAP before or after the surgery (non-CPAP group). Tonsillectomy with uvulopalatopharyngoplasty (UPPP) under general anesthesia was performed on all of the patients. On the first postoperative night, continuous overnight monitoring of Pes and oxygen saturation level was carried out simultaneously with oxygen supplementation in both groups in the patient's room in the general ward.

Results:

The CPAP group showed a significantly improved mean inspiratory maximal end-apneic Pes swing on the first postoperative night as compared with the non-CPAP group, although there was no significant difference in oxygen desaturation index on the first postoperative night between the 2 groups.

Conclusions:

Continuous Pes monitoring and CPAP administration were beneficial in the detection and minimization of respiratory disturbances in patients with OSAHS who underwent tonsillectomy with UPPP under general anesthesia.
Vocal Fold Paralysis in Infants with Tracheoesophageal Fistula
Authors: Oestreicher-Kedem Yael , DeRowe Ari , Nagar Hagit , Fishman Gad , Ben-Ari Josef
Published: October 2014

Objectives:

We describe the clinical characteristics and management of vocal fold paralysis in infants who were born with a tracheoesophageal fistula (TEF).

Methods:

This retrospective case series included all infants born with TEFs who presented to our pediatric otolaryngology unit and intensive care unit because of dyspnea or aphonia in the years 2005 and 2006, and who were found to have vocal fold paralysis.

Results:

Five boys and 1 girl were studied. One infant had stridor before TEF repair, and 5 after it. All children underwent flexible laryngotracheobronchoscopy and were treated in the pediatric intensive care unit before diagnosis of the vocal fold paralysis (5 bilaterally and 1 unilaterally) was made. The ages at diagnosis of paralysis ranged between 14 days and 14 months. Five infants required tracheostomy.

Conclusions:

Vocal fold paresis in infants is difficult to diagnose. The risk for recurrent laryngeal nerve injury associated with TEF and TEF repair should be emphasized in these children. We recommend that all newborns with TEF should be examined by an otolaryngologist before operation to confirm the mobility of the vocal folds and to rule out other associated airway malformations, and examined after operation if respiratory difficulties develop.
Contralateral Maxillary Sinus Lesions in Patients with Nasal Cavity and/or Paranasal Sinus Carcinoma: Analysis of Computed Tomography Findings
Authors: Wang Jong Hwan , Lee Jeong Hyun , Han Ju Hee , Lee Bong-Jae , Jang Yong Ju
Published: October 2014

Objectives:

The incidence of bilateral maxillary sinus carcinoma is very low in patients with primary maxillary sinus carcinoma. However, surgeons should perform careful diagnosis of any contralateral maxillary sinus lesions to avoid missing a second primary maxillary sinus carcinoma. We therefore investigated the computed tomography (CT) findings of the contralateral maxillary sinus in patients with nasal cavity and/or paranasal sinus carcinoma.

Methods:

Between August 1994 and September 2006, 66 patients (41 male, 25 female; age range, 22 to 85 years; mean age, 56.9 years) with nasal and/or paranasal sinus carcinoma were treated. Preoperative and follow-up CT scans of their contralateral maxillary sinuses were retrospectively reviewed.

Results:

Of the 66 patients, 26 (39.4%) had rhinosinusitis, 6 (9.1%) had retention cysts, and 33 (50.0%) showed normal findings on CT. One patient (1.5%) had bilateral enhanced mass-like lesions. Both masses were diagnosed histologically as poorly differentiated squamous cell carcinoma. The rhinosinusitis findings included mucoperiosteal thickening, sclerotic bone thickening, hyperdense secretion, and an air-fluid level, in order of decreasing frequency. Twenty-three of the 32 patients with benign lesions were included in the follow-up CT analysis, ranging from 24 to 108 months (mean, 45 months). On the final CT scan, rhinosinusitis was aggravated in 5 of 19 cases and improved in 14 cases, and the size of the retention cyst decreased in 4 cases. During the follow-up period, no definite abnormality suggesting tumor development in the contralateral maxillary sinus was detected.

Conclusions:

Even though most contralateral maxillary sinus lesions are benign and the incidence of bilateral maxillary sinus carcinoma is very low, second primary maxillary sinus carcinoma should be kept in mind in the differential diagnosis of contralateral maxillary sinus lesions in patients with nasal cavity and/or paranasal sinus carcinoma.
Matrix Metalloproteinases 2 and 9 are Concentrated in the Luminal Aspect of the Cricoid Cartilage, Diminish with Loss of Perichondrium, and are Reinstated by Transforming Growth Factor Beta 3
Authors: Martinez-Alvernia Efrain A. , Mankarious Leila A.
Published: October 2014

Objectives:

We determined the location of matrix metalloproteinases (MMP) 2 and 9, and whether the luminal perichondrium or transforming growth factor (TGF) β3 influences the presence of MMP-2 and/or −9 within the chondrocytes of the cricoid cartilage.

Methods:

Subglottises from 15 neonatal mice were divided into group A (N = 5; luminal epithelium intact, grown in basic medium), group B (N = 5; epithelium-free, with sections of luminal perichondrium removed, grown in basic medium), and group C (N = 5; epithelium-free, with sections of luminal perichondrium removed, grown in basic medium with supplemental TGF-β3). Immunohistochemical analysis was done to identify MMP-2 and −9 distributions.

Results:

Group A demonstrated concentrations of MMP-2 and −9 in the luminal perichondrial and adjacent chondrocytes with a gradual decrease in signal intensity toward the outer perichondrium. Group B showed findings similar to those in group A, but in the region of removed perichondrium, the adjacent chondrocytes lost MMP-2 and −9 signal. The group C rings demonstrated reestablishment of MMP-2 and −9 signal in regions of luminal perichondrial loss.

Conclusions:

Localization of MMP-2 and −9 is predominantly in the luminal perichondrium and gradually decreases toward the outer perichondrium. The luminal perichondrium maintains expression of MMP-2 and −9 within the adjacent chondrocytes. Exogenous TGF-β3 reestablishes production of at least MMP-9, and probably MMP-2, in cricoid cartilages missing luminal perichondrium.
Malpractice Litigation Involving Iatrogenic Surgical Vocal Fold Paralysis: A Closed-Claims Review with Recommendations for Prevention and Management
Authors: Shaw Gary Y. , Pierce Elizabeth
Published: October 2014

Objectives:

We describe the nature of malpractice claims filed involving surgical iatrogenic vocal fold paralysis, review surgical literature for recommendations for prevention of this complication, and suggest management of this complication.

Methods:

Data collection was made regarding any closed claims that involved vocal fold paralysis. The results were then analyzed and categorized. The PubMed literature regarding this complication was reviewed, and recommendations on prevention were compiled. Finally, suggestions regarding management based on the current literature and the senior author's 17-year experience in his laryngeal practice are offered.

Results:

From 1986 to 2007, 112 closed claims involving vocal fold paralysis were reported by the 16 largest malpractice insurers. More than US $10 million ($18 million adjusted for inflation [AJI]) has been paid thus far. The average indemnity was $285,000 ($513,000 AJI). The surgical physician defendants were from multiple specialties, including general surgery (31%), cardiothoracic surgery (12%), neurosurgery (12%), otolaryngology (10%), and orthopedic surgery (5%). The most common procedures were thyroid and parathyroid surgery (32%), cervical disc procedures (16%), thoracic procedures (12%), endarterectomy (9%), and open neck biopsy (6%). The most common claims cited were improper performance (61%), failure to recognize a complication (36%), and consent issues (19%).

Conclusions:

Vocal fold paralysis is a complication of many different surgical procedures across multiple specialty lines. Closed-claims analysis can offer a unique glimpse on what went wrong and why patients sue. Modification of techniques and incorporation of new technology may significantly reduce this complication. Preoperative written information on potential complications, and early referral to and management by laryngeal specialists, we believe, may significantly reduce malpractice litigation.
Inflammatory Cytokine Response to Injury in the Aging Rabbit Subglottis
Authors: Pires Valerie L. , Mankarious Leila A.
Published: October 2014

Objectives:

We performed a pilot study to determine whether there is an age-related change in inflammatory expression in the subglottic mucosa of rabbits in response to a one-time injury.

Methods:

Twenty-seven rabbits of 3 different ages meant to represent infant, adolescent, and adult stages underwent a unilateral, subglottic soft tissue injury. The animal groups were allowed to heal for 3 different durations to reflect the early, middle, and late stages of inflammation. Animal subglottises were then analyzed for quantitative differences in thickness and expression of multiple inflammatory cytokines within the soft tissue relative to the uninjured side.

Results:

The animals in the youngest age group demonstrated a thickened-tissue response to injury yet a lower level of inflammatory cytokines than did the older animals at the early and middle stages of healing.

Conclusions:

Pronounced tissue thickness was an unanticipated finding in the youngest age groups and suggests better regulatory control by older animals. Also, a developmental difference in the inflammatory response to injury is suggested by the data.
Safety and Feasibility of Balloon Sinuplasty for Treatment of Chronic Rhinosinusitis in Children
Authors: Ramadan Hassan H.
Published: October 2014

Objectives:

Balloon sinuplasty is a new technique that was recently introduced for the treatment of chronic rhinosinusitis (CRS). The initial experience in adults has been promising. The technique allows for restoring ventilation to the sinuses with minimal risk and trauma to the tissues. I present our initial experience of its use for treatment of CRS in children.

Methods:

I performed a prospective study of 30 children in whom medical therapy failed and who were scheduled for surgery. They were offered treatment with balloon sinuplasty of selected sinuses. The data collected included age, computed tomography score, and comorbid conditions. The primary outcome was the intraoperative success of dilation of the sinuses and the rate of adverse events due to the procedure.

Results:

The procedure was successful in 51 of 56 sinuses (91%) in 30 children. Five sinuses, of which 4 were hypoplastic maxillary sinuses and 1 was a frontal sinus, were not amenable to dilation. No complications or side effects were noted.

Conclusions:

The initial experience with balloon sinuplasty in children seems to be very encouraging. Because there is no bone or tissue removal, the procedure seems to be suitable for use in children. A hypoplastic sinus may not be amenable to balloon sinuplasty.
Postauricular Approach Atticotomy: A Modified Closed Technique with Reconstruction of the Scutum with Cymbal Cartilage
Authors: Pennings Ronald J. E. , Cremers W. R. J.
Published: October 2014

Objectives:

We studied the results of postauricular approach atticotomy in patients with cholesteatoma of the anterior epitympanum.

Methods:

Twenty-six patients were selected for removal of cholesteatoma of the anterior epitympanum by postauricular approach atticotomy, a closed transcanal procedure that is used to expose and remove cholesteatoma. After removal of cholesteatoma, reconstruction of the scutum is performed with cymbal cartilage.

Results:

Postauricular approach atticotomy can be performed as part of a canal wall–up procedure in selected cases in which cholesteatoma invades the anterior epitympanum. Especially if the ossicular chain is intact and if there is an anteriorly curved medial outer canal wall, this technique is useful in avoiding an open technique. A second-look procedure is recommended because of a relatively high percentage of recurrent and residual disease.

Conclusions:

Postauricular approach atticotomy with reconstruction of the scutum is a useful technique to remove cholesteatoma from the anterior epitympanum.