bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Allergy 2011: State of the Science
Authors: Reisacher William R. , Calhoun Karen H. , Veling Maria C. , Damask Cecelia
Published: September 2011

Program Description

Food allergies are difficult for the patient to understand and challenging for the clinician to treat. The CDC has recently reported that the prevalence of reported food allergies increased 18% over the past 10 years in children under 18. In addition, children with food allergies are 2 to 4 times more likely to suffer from asthma and other allergies. Allergic reactions to foods can produce life‐threatening anaphylaxis, but have also been associated with other head and neck problems such as Meniere’s disease, migraine headache, chronic rhinitis, and chronic serous otitis media. There is a wide range of symptoms attributed to food allergies, such as nausea, cramping, diarrhea, dermatitis, urticaria, asthma, and joint pain. However, despite the fact that otolaryngologists see a large number of patients with food allergies, diagnosis and treatment strategies still remain controversial. The first part of the miniseminar will focus on the scientific basis of food allergies by taking a critical look at the latest scientific evidence available in the literature. A basic review of the relevant immunology will be provided along with a comparison of IgE‐mediated food reactions versus non‐IgE‐mediated food reactions. The impact that food preparation and food spoiling has on allergic pathways will also be examined. In the second part of the miniseminar, the manifestations of food allergies will be discussed. The recent literature concerning the rise in prevalence of food allergies will be analyzed and the impact of food allergies on the head and neck and airway will be reviewed. We will examine the role of oral tolerance in human evolution and the relationship of failure to achieve oral tolerance on the health of the individual. The next section will be devoted to the current diagnostic modalities available for the diagnosis of food allergies. The use of structured patient‐completed surveys to maximize thoroughness and efficiency will be discussed. We will compare the performance and accuracy of the different methods of food allergy testing, including skin and in vitro methods vs. the traditional gold standard of double‐blind, placebo‐controlled food challenge. The final part of the presentation will be devoted to treatment strategies for food allergies. Traditional methods, such as elimination diets and recognizing emergencies will be reviewed, as well as more cutting‐edge techniques, such as oral and sublingual desensitization and genetically modified foods, will also be discussed. Audio‐visual materials will be used to help present this information to the audience.

Educational Objectives

1) Analyze the literature comparing different methods for diagnosing food allergy. 2) Evaluate the scientific basis of IgE and non‐IgE mediated food allergy. 3) Understand the currently available treatments for food allergy as well as future directions.
Topical Therapies in Chronic Sinonasal Disease
Authors: Harvey Richard J. , Wormald Peter J. , Cohen Noam A. , Psaltis Alkis , Schlosser Rodney J. , Chiu Alexander G.
Published: September 2011

Program Description

There has been an explosion in the understanding of the mechanisms of chronic sinonasal inflammation. Multiple approaches to control and modify the inflammatory reaction in chronic rhinosinusitis have lead to many new agents being introduced topically to the nose. This miniseminar aims to provide an evidence‐based approach to the science behind topical management of sinonasal disease. Current research into irrigation dynamics and delivery device will be discussed. There are a range of products available to deliver solutions topically to nose. The scientific basis behind high and low volume along with negative and positive pressure delivery is presented. The general therapeutic goal of topical management often lies between, potentially competing actions of mechanical and pharmaceutical intervention. Distribution research behind nebulizers, sprays, irrigations, and other delivery techniques is discussed within this framework. The over‐the‐counter (OTC) market for topical sinonasal treatments is likely to exponentially grow over the next few years. Increasingly, the pharmaceutical options have also grown. Antibiotics, such as mupriocin, and steroids are often added to solutions. Novel innate immunity enhancers and modifiers of mucus rheology are also emerging. The science behind the OTC agents and pharmaceutical additions to saline are presented. Potential adverse risks also needs to balanced with greater local intervention. The influence of pre‐ and postsurgical distribution efficacy is an important factor that significantly changes how these solutions should be used. The miniseminar is presented by rhinologists actively involved in the topical management of chronic sinonasal conditions both clinically and in research. Presentations for delivery, device, saline, and pharmaceutical additives will be given with video used to illustrate research. There is direct clinical application of current research and available products to the management of chronic sinonasal disease in general otolaryngology practice.

Educational Objectives

1) Define the therapeutic goals of topical therapies. 2) Understand the influence of device and surgical state on topical delivery. 3) Learn about the science behind novel topical agents.
OSA Surgery: Reviewing the Reviews and Their Implications
Authors: Kezirian Eric J. , Weaver Edward M. , Brietzke Scott E.
Published: September 2011

Program Description

The American Academy of Sleep Medicine and Agency for Healthcare Research and Quality have recently published controversial systematic reviews of the obstructive sleep apnea (OSA) surgery literature. These are now being used by third‐party payors to reconsider coverage policies, including those for soft palate procedures such as uvulopalatopharyngoplasty. The purpose of this miniseminar is to present these reviews and the debates they raise, examine the available higher level studies, and present a framework for evaluating OSA surgery outcomes. AASM and AHRQ reviews. Systematic reviews can synthesize are powerful but challenging tools that can help guide clinical decisions. Any review has general as well as specific strengths and weaknesses, whether related to methods that require oversimplification of each study’s findings, selection of outcome measures to compare results across studies, or the scope of the review that leaves certain studies excluded. This segment will examine the reviews’ methods and findings, highlighting their importance as well as gaps, particularly those regarding multilevel OSA surgery and the evaluation of sleep study outcomes alone. As for most surgical fields, the bulk of the OSA surgery literature consists of case series studies, with all of their inherent limitations. However, there are a number of higher level OSA surgery studies, including randomized trials and cohort studies. The program will review these higher level studies and provide grades for the available evidence concerning OSA surgical interventions. As for every surgical intervention, outcomes after OSA surgery vary widely, not only among various procedures but also for individual patients. There is a tendency to criticize or discard procedures that do not achieve ideal outcomes universally. The alternative is to pursue a nuanced evaluation of whether those patients who appear to respond to surgery achieve meaningful clinical improvements and also to match procedures and patients in order to increase the proportion of treated patients who do respond to surgery. This portion of the miniseminar will review evidence showing that there is a subgroup of patients who obtain meaningful clinical improvements after surgery, strategies to match procedures and patients, and a framework for presenting and reading results of sleep surgery trials that is based on this variation in outcomes.

Educational Objectives

1) Learn the findings of recent OSA surgery reviews, along with their strengths and weaknesses. 2) Understand the findings of higher‐level studies in the field. 3) Appreciate the variation in outcomes across procedures and patients, along with the implications.
Online Script Concordance Test for ENT
Authors: Kania Romain E. , Verillaud Benjamin , Tran Hugo , Mardion Nicolas Bon , Charlin Bernard , Ba‐Huy Patrice Tran , Herman Philippe
Published: September 2011

Objective

The Script Concordance Test (SCT) involves the use of authentic clinical scenarios to compare a medical trainee’s judgment skills with those of experts. The aim of this work is to produce valid, reliable SCT for the ear, nose, and throat (ENT) discipline.

Method

In total, 132 participants were asked to test an online ENT‐SCT of 20 cases and 94 questions based on the major educational objectives of the ENT residency program. Three levels of experience were tested: medical students, ENT residents, and board‐certified otorhinolaryngologists as an expert panel.

Results

The 65 respondents with useable data were medical students (n = 21), ENT residents (n = 22), and experts (n = 22). Total mean test scores significantly differed: 76.81 ± 3.31 for the expert panel, 69.05 ± 4.35 for residents, and 58.29 ± 5.86 for students. The Cronbach alpha coefficient was 0.95. More than two‐thirds of the participants found the test realistic and relevant for assessing clinical reasoning. The test was also considered interesting and intuitive.

Conclusion

The web‐based ENT‐SCT is feasible, reliable, and useful for assessing clinical reasoning. This online assessment tool may have applications for residency programs and continuing medical education.
Deviated Nose Affects Surgical Success and Quality of Life
Authors: Cingi Cemal , Eskiizmir Görkem
Published: September 2011

Objective

Analyze and compare the surgical outcome and quality of life in patients with and without deviated nose in rhinoplasty.

Method

A total of 191 patients who underwent primary rhinoplasty between 2006 to 2009 were enrolled. The study population was separated into nondeviated or deviated groups. The surgical outcome, pre‐ and postoperative quality of life were assessed using rhinoplasty outcome evaluation (ROE) and EuroQol, and statistically analyzed.

Results

A hundred ten cases had deviated nose and 81 cases had nondeviated nose. The vast majority of cases were operated using endonasal approach except 3 cases. When non‐deviated and deviated groups were compared according to satisfaction with appearance, breathing problems, friends’ satisfaction with appearance, social interactions, self‐confidence, need for additional procedures, ROE score, statistically significant differences were determined. The comparison of pre‐ and postoperative change in EuroQol (EQ‐5 index, living quality index and visual analogue scale) between 2 groups also demonstrated statistically significant differences.

Conclusion

The deviated nose is a challenging nasal morphology which may lead to lesser satisfaction in surgical outcome and inadequate improvement in quality of life. Therefore, it should be precisely evaluated in candidates of rhinoplasty.
DNA Aneuploidy and Its Role in Oral Leukoplakia
Authors: Cashman Emma , Bin‐Woo Sook
Published: September 2011

Objective

1) Determine the presence, if any, of aneuploidy in premalignant oral leukoplakia (OL). 2) Review the literature with respect to the relevance of aneuploidy as in OL.

Method

Tissue was mechanically disaggregated, and cell suspensions were centrifuged (300 rpm/ 5 minutes). After 10 minutes trypsin digestion and treatment with RNAase inhibitors, cell suspension was stained with propidium iodide and spermine. Nuclear DNA content FCM (flow cytometry) measurements were preformed using FACS Calibur FCM with argon laser (488 nm beam).

Results

Scrapings from 17 patients for FCM and tissue for morphological evaluations were obtained. Thirteen out of 17 (76%) patients were male. A total of 4 out of 17 were female (24%). All patients were smokers. A total of 4 out of 17 (82%) patients were graded as moderate dysplasia by 2 different oral pathologists, and 3/17 (18%) were graded as having severe dysplasia. The rate of detection of aneuploidy was 0% (0/17).

Conclusion

Most published studies focus on DNA aneuploidy in HNC, and evidence for its role in OL is scant. On the basis of our results and the few published trials on this subject, we analyze whether aneuploidy plays a role in the prediction of risk of malignant transformation in OL.
Evaluation of Trends in Use of IMRT in Head and Neck Cancer
Authors: Mundi Jagmeet , St. John Maie
Published: September 2011

Objective

Evaluate the trends of use of IMRT for head and neck cancer (HNC), with emphasis on Medicare reimbursement patterns and their effect on clinical use.

Method

All patients are selected from the Surveillance, Epidemiology, and End Results (SEER) database with HNC who were treated with radiation. These were then subdivided into those that were treated with IMRT. We then analyzed Medicare records for reimbursement patterns for Planning and Delivery of IMRT (CPT Codes 77301 and 77418).

Results

Regression analysis was then performed on the SEER data to evaluate cancer subsites, regional differences, and outcomes. Reimbursement for IMRT for Head and Neck cancer has increased since the introduction of CPT codes for Medicare from $1579 to $2643 from 2002 to 2010. In 2000 Medicare reimbursement for IMRT was 4x that of conventional radiation. This has more recently been adjusted to 3x conventional radiation. Compensation has been cited as a major factor in the adoption of this technology. The percentage of patients receiving IMRT vs traditional radiation has increased substantially from 3% in 2001 to 46% in 2005.

Conclusion

Advantages of IMRT include decreased xerostomia and improved quality‐of‐life. No reports have demonstrated improved local‐regional control/survival. We show recent Medicare adjustments have not had a significant change in utilization of IMRT. This study raises questions about the role of economic incentives potentially driving IMRT usage.
Functional Impact of the Arytenoidectomy in SCPL
Authors: Kim Min Sik , Joo Young Hoon , Park Jun Ook , Cho Kwang‐Jae , Nam Inn Chul
Published: September 2011

Objective

The arytenoid is one of the components of sphincteric function of the larynx, and arytenoid resection during supracricoid partial laryngectomy (SCPL) may negatively affect the functional results. The purpose of this study was to evaluate the functional results in patients who underwent unilateral arytenoidectomy during SCPL.

Method

Retrospectively reviewed medical records of 116 patients who received SCPL. Regarding the extended procedure of unilateral arytenoidectomy, the patients were divided into 2 groups: Nonextended group and extended group. We evaluated and compared the functional results between the 2 groups.

Results

There was a significantly higher rate of aspiration pneumonia (P =. 003*), delay of oral feeding (P =. 038*), and longer hospitalization time (P =. 008*) in the extended group. There was no significant difference in the score of “normalcy of diet,” “eating in public,” and “understandibility of speech” of PSS‐HNS (Performance status scale for head and neck cancer patients) at last follow‐up between the 2 groups (P =. 675, P =. 645, P = 1.000).

Conclusion

Resection of the arytenoid may interrupt physiologic airway protection in the early postoperative period, so special cautions may be needed to prevent aspiration pneumonia. However, extended SCPL including arytenoidectomy allows avoidance of functional handicap and social maladjustment.
IMRTSIB and Concurrent CT for LAHNC: Toxicity and Quality of Life
Authors: Piccinini Alessia , Rocchi Andrea , De Marco Giuseppina , Marra Laura , Ghidini Angelo , Molteni Gabriele , Presutti Livio
Published: September 2011

Objective

Evaluate the acute toxicity of postoperative radiotherapy with intensity modulated simultaneous integrated boost (IMRT‐SIB) and the impact of this treatment on quality of life for patients with head and neck cancer locally advanced (LAHNC).

Method

A total of 21 patients with histologically confirmed LAHNC received, from July 2008 to August 2010, postoperative IMRT‐SIB and concurrent Cisplatin 100mg/m2 every 3 weeks. Quality of life was evaluated in 13 patients with M.D. Anderson Dysphagia Inventory, Karnofsky Performance Status, Performance Status Scale for Head & Neck Cancer, and EORTC H&N35.

Results

Median follow‐up was 10 months (range, 2‐30 months). Acute mucositis ≥ G2 occurred in 18 patients. Acute reactions ≥ G2 on salivary glands in 15 patients. Acute reaction ≥ G3 appeared in 4 patients on mucosae and in 5 on pharynx. At time of analysis 18 patients were free from locoregional recurrence.

Conclusion

IMRT‐SIB and concurrent cisplatin is feasible and well tolerated in LAHNC and is not correlated with a decrease in healthy functioning, global health status, or subjective evaluation of level of illness.
Is sIL2R Helpful for Diagnosis of Malignant Lymphoma in Neck Lymph Node Swelling?
Authors: Shinohara Shogo , Fujiwara Keizo , Kanazawa Yuji , Yamazaki Hiroshi , Kikuchi Masahiro , Naito Yasushi
Published: September 2011

Objective

Soluble interleukin2 receptor (sIL2R) is secreted from activated lymphocytes and is known to be a biomarker of collagen disease, retroviral infection, and malignant lymphoma (ML). The purpose of this study is to evaluate the usefulness of serum sIL2R value for diagnosis of ML in patients with cervical lymph nodes swelling.

Method

A retrospective study from 155 patients who received open biopsy of a cervical lymph node in suspicion of ML and examined serum sIL2R. The differences of sIL2R value among histology were examined by Mann‐Whitney U test, and the diagnostic accuracy of sIL2R value for ML was calculated using ROC analysis.

Results

The patients consisted of 67 B‐cell lymphoma, 30 T‐cell lymphoma, 15 Hodgkin lymphoma, 11 metastatic carcinoma, and 31 other benign lymphadenopathy including 14 reactive lymphadenitis. The serum sIL2R value was significantly higher in the ML group than the other diseases (P <. 001: median 2230 U/mL vs756 U/mL). T‐cell lymphoma showed highest sIL2R value (median 4380) among other ML groups (B‐cell median 2040 and Hodgkin median 1400). Applying the cut‐off value of 1350, which is higher than the reference range (220‐530), diagnosis of ML could be predicted with a sensitivity of 70.5% and a specificity of 89.1%.

Conclusion

The value of serum sIL2R was helpful for diagnosis of ML in cervical lymph nodes swelling if the cut‐off value was properly applied.
Methylome Analysis of HPV‐Associated Head and Neck Cancer
Authors: Hernandez Maria Ivette Mucino , Ojeda Alejandro Gonzalez , Alvarea Alfonso Bencomo , Jeahns Elias Morales , Camacho Jose Gonzalo Vazquez , Rodriguez Luz Margarita Baltazar , Fuentes Hector Montoya
Published: September 2011

Objective

Estimate the HPV frequency and types in neoplastic thyroid tissue by means of Polymerase Chain Reaction‐Restriction Fragments Length Polymorphisms (PCR‐RFLP).

Method

Transversal study. We analyzed 157 samples from malignant and benign thyroid tumors of paraffin‐embedded tissue. All the paraffin blocks were randomly chosen from the archive of Pathology Tissue Bank (Centro Medico Nacional de Occidente, IMSS). The molecular detection and typing was performed at Molecular Microbiology II Laboratory in CIBO.

Results

The HPV observed frequency was 2.5% (4 cases). HPV‐6 was found in 2 cases of thyroid hyperplasia (2.5%) and HPV‐33 in 2 cases of Papillary Cancer (4.6%).

Conclusion

HPV is not frequent in thyroid neoplasms, at least in the studied population. The HPV types found were HPV‐6 in hyperplasia and HPV‐33 in papillary cancer.
Neuroendocrine Neoplasms of the Larynx: Outcomes of 15 Cases
Authors: Mello Paulo , Klingerman Jacob , Milet Pedro , Soares Jose , Toscano Ullyanov B. , Dias Fernando Luiz , Lima Roberto
Published: September 2011

Objective

Neuroendocrine neoplasms of the larynx (NNL), although rare, are the most common nonsquamous tumors of this organ. The aim of the study is to evaluate the presentation, treatment, and outcome of a consecutive series of 15 patients with NNL of the larynx and to provide information for therapeutic decision making.

Method

Retrospective analysis of medical records. Cases were identified from databases maintained by the medical informatics and pathology departments. Main outcome measures were recurrence, overall survival, and disease‐specific survival (OS and DSS).

Results

Fifteen patients (12 males) seen between 1990 and 2009, with a median age of 56.7 years. Seven patients had the diagnosis of moderately differentiated neuroendocrine carcinoma, and 8 were diagnosed as small cell neuroendocrine carcinoma. Multimodal treatment was established in 13 (92.8%) patients. Eight patients underwent surgical treatment. Neck node metastases developed in 6 patients (42.5%), and distant metastases occurred in 12 patients (80%). Cause of death was distant metastases in 11 patients (73.3%). At last follow‐up, only two patients were alive. The 3‐year OS and DSS were, respectively, 35.7% and 28.5%.

Conclusion

Laryngeal neuroendocrine malignant neoplasms (LNMN) are aggressive malignancies with a high frequency of distant metastasis. The optimal therapy for patients with LNMN remains a subject of debate.
Oropharyngeal Cancer with Neck Complete Response
Authors: Mun Sue Jean , Song Chang Myeon , Kim Kwang Hyun , Hah Jeong‐Hun , Kwon Tack‐Kyun , Jeong Woo‐Jin , Sung Myung‐Whun
Published: September 2011

Objective

Evaluate the necessity of planned neck dissection in patients with oropharyngeal cancer by analyzing N2, N3 with complete response after primary treatment.

Method

A retrospective chart review of 327 patients with oropharynx squamous cell carcinoma over a 24‐year period was conducted. Overall survival rate was analyzed using the Kaplan‐Meier method.

Results

Among the 64 patients, all the recurrent cases had T staging more than 3, and N staging more than N2b without any evidence of metastasis except 1 case. Recurrence varied from 3 to 43 months. Disease recurrence was reported in 8 cases which include 3 primary recurrences, 2 neck recurrences, and 3 both primary and neck recurrences. Distant metastasis was reported in 2 cases. Survival according to initial treatment modality didn’t show any statistical significance. Overall 5 year survival rate reached 80% using the Kaplan‐Meier method.

Conclusion

Neck metastasis in oropharyngeal squamous cell carcinoma is well treated with chemotherapy and radiotherapy resulting in low neck recurrence and high 5‐year survival rate. Patients with oropharyngeal cancer with complete cervical response can be safely observed without planned neck dissection.
Patterns of Lateral Lymph Node Metastasis in Papillary Thyroid Cancer
Authors: Tae Kyung , Sung Eui‐Suk , Jung Joo Hwan , Bae Ji Yong , Kim Kyung‐Rae , Cho Seok‐Hyun
Published: September 2011

Objective

Analyze the patterns and factors of lateral lymph node metastasis in papillary thyroid cancer (PTC) patients. Based on this, we can suggest the optimal surgical extent of neck dissection for PTC patients with lateral compartment lymph node metastasis.

Method

From January 2000 to December 2009, the patient group consisted of 88 patients who underwent total thyroidectomy concomitant therapeutic neck dissection. A total of 86 (97.7%) patients confirmed as having PTC and lateral compartment neck metastasis by pathologic examination were enrolled this study.

Results

A total of 86 patients underwent 100 lateral compartment neck dissection. Level IV was found to be the predominant site for lateral compartment lymph node metastasis (83%). Level III, Level II, and Level V were 65%, 54%, 17%, respectively. Level VI lymph node metastasis was found in 84.9% (73/86). Multiple level nodal metastasis was correlated with lymphovascular invasion of PTC. Skip metastasis was correlated with age.

Conclusion

In PTC patients with lateral nodal invasion, total thyroidectomy concomitant bilateral central compartment neck dissection and ipsilateral lateral compartment neck dissection including Levels II‐V may be the optimal treatment.
Placement of NP Airways after Skull Base Tumor Resection
Authors: Spector Matthew E. , Sullivan Stephen , McKean Erin L. , Pepper Jon P. , Marentette Lawrence J.
Published: September 2011

Objective

1) Assess the efficacy of nasopharyngeal (NP) airways in lieu of tracheotomy to prevent tension pneumocephalus after open resection of anterior skull base (ASB) tumors. 2) Determine predictors of tension pneumocephalus in patients undergoing NP airway placement after open resection of ASB tumors.

Method

A total of 121 ASB resections (mean age, 48.5 years; M:F 73:47) performed between 1994 to 2009 with documented NP airway placement were identified and charts retrospectively reviewed. Main outcome measures were presence of tension pneumocephalus, while controlling for other clinical parameters (presence of CSF leak, placement of lumbar drain, type of reconstruction).

Results

All patients were extubated on the day of surgery and NP airways remained in place for 3 days; no complications from NP airways were seen (eg, nasal septal pressure necrosis, displacement of the tubes). A total of 3 (2.5%) cases of tension pneumocephalus occurred. There were 34 (28%) lumbar drains placed and 14 (12%) CSF leaks. Although only 3 events were recorded, there was a statistically significant difference in the rate of tension pneumocephalus stratified by lumbar drain placement (P =. 02), presence of CSF leak (P =. 04), and both together (P =. 004). Type of reconstruction did not affect rate of tension pneumocephalus (P = 1.0).

Conclusion

Resection of anterior skull base tumors does not necessitate prophylactic tracheotomy and use of a nasopharyngeal airway to divert airflow is well tolerated and highly successful. Lumbar drainage, the presence of a CSF leak, or both together may increase the risk of tension pneumocephalus.
Polymorphous Low‐Grade Adenocarcinoma
Authors: Fife Tim , Smith Brooks , Waltonen Joshua
Published: September 2011

Objective

We present a series of 18 cases of polymorphous low‐grade adenocarcinoma.

Method

We retrospectively reviewed all documented cases of polymorphous low‐grade adenocarcinoma at our institution since 1984. Each case was confirmed by pathologic examination.

Results

The median age of this series is 59 years. Eleven out of the 18 patients were female and 13 were white. Fifteen of the tumors were located on the hard/soft palate. Nearly every patient was treated with wide local excision, and 8 required reconstruction with flaps. Only 3 patients were treated with postoperative radiation. 4 patients were treated for recurrences, 2 of which were originally treated 20 years prior.

Conclusion

Polymorphous low‐grade adenocarcinoma is a rare and slow growing entity. Surgical excision is the treatment of choice and radiation therapy is generally not needed. Long term follow‐up is required, as recurrences have been noted after long periods of time. Differentiation from adenoid cystic carcinoma can be difficult.
Predictive Value of Laryngeal Cartilage Sclerosis on CT‐Scan
Authors: Poirier Jackie Bibeau , Nguyen Félix , Bélair Manon , Moubayed Sami P. , Ayad Tareck
Published: September 2011

Objective

The value of laryngeal sclerosis as a sign of neoplastic invasion on CT‐scan is controversial. We investigated the value of laryngeal cartilage sclerosis on CT‐scan as a predictor of locoregional control, success of organ preservation, and survival for patients treated with radiation therapy for laryngeal carcinoma.

Method

Retrospective chart review on patients treated for laryngeal carcinoma with radiation therapy at the CHUM between 2002 and 2007. A head and neck radiologist revised each patient’s pretreatment CT‐scan to determine the presence of laryngeal cartilage sclerosis. This variable was correlated with locoregional control, laryngectomy, and survival rates.

Results

Of the 111 patients, 76% were male and 24% female. Their mean age was 61 years. Forty‐eight had supraglottic tumors and 63 had glottic tumors. Seven percent had thyroid cartilage sclerosis, 5% cricoid cartilage sclerosis, 55% arytenoid cartilage sclerosis, and 16% arytenoid cartilage sclerosis with adjacent tumor. There was no significant correlation demonstrated between cartilage sclerosis and locoregional control rate, laryngectomy rate and global and disease‐free survival.

Conclusion

Cartilage sclerosis on CT‐scan cannot be identified as a powerful predictor of treatment failure for patients with laryngeal carcinoma treated with radiation, which confirms our therapeutic attitude.
Preoperative Testing for Radial Forearm Free Flaps
Authors: Wood John , Chen Karen , Philips Sharon , Burkey Brian B.
Published: September 2011

Objective

Determine whether Doppler ultrasound (DUS) is a necessary preoperative test for all patients undergoing radial forearm free flaps (RFFF) or if it can safely be omitted in patients with a normal clinical Allen test (CAT).

Method

Retrospective analysis of 143 consecutive patients who underwent RFFF at Vanderbilt University Medical Center between 1992 and 2006. Charts were reviewed for the Allen test, Doppler ultrasound, intraoperative vascular findings, and clinical outcomes. Data were recorded in a Redcap Database and statistical analysis performed by the Vanderbilt Department of Biostatistics.

Results

Ninety percent of DUS and 92% of CAT were normal. The relationship between DUS and CAT was statistically significant. For patients with sufficient flow on CAT, 98% were in agreement with the SAT. Of the 3 patients with insufficient flow intraoperatively, 2 had documented normal CAT and DUS. Two patients developed hand ischemia. Both had normal CAT and no preoperative DUS. One hundred percent of abnormal DUS were abnormal by CAT.

Conclusion

Postoperative RFFF hand ischemia is an extremely rare condition, but it does cause significant postoperative morbidity. DUS testing highly correlates with the findings of CAT and does not appear to be superior in predicting intraoperative findings or postoperative complications. DUS should be limited to patients who have an abnormal CAT.
Qualitative Analysis of the Experience of Oral Tongue Cancer Survivors
Authors: Sperry Steven , Philiponis Genevieve , Chalian Ara A. , Malloy Kelly M. , Kagan Sarah H.
Published: September 2011

Objective

Patient experience of oral tongue cancer and life as a survivor is poorly understood and not well described in the literature. This qualitative analysis of interviews with oral malignancy survivors aims to: 1) Describe the common experiences of patients, and 2) Identify surprising findings previously under‐recognized in this patient population.

Method

Oral tongue cancer survivors from a single surgical practice at a tertiary‐care center participated in open‐ended interviews discussing their experience. The interviews were transcribed and analyzed using constant comparative technique. Open and axial coding identified common themes that are discussed in this descriptive analysis.

Results

Sixteen patients, aged 30 to 80 years with stage II to IV disease, participated; all but one patient underwent surgery as primary treatment. Interviews were conducted 3 months to 12 years after treatment. Patients described variable levels of physical pain throughout their experience, but particularly during radiotherapy, when it was severe. Patients’ emotional distress was most pronounced at the time of diagnosis; few described sustained emotional distress. Concerns about altered speech, taste, swallowing, and dry mouth persisted, while changed appearance and social isolation were rarely reported. Interestingly, the majority of patients focused on pervasive dry mouth sensation, regardless of radiotherapy treatment.

Conclusion

Our findings describe significant variation in physical and emotional pain during disease diagnosis and treatment, with persistent concerns regarding disrupted speech, taste, and swallowing function. Troubling dry mouth sensation is pervasive, independent of adjuvant radiation treatment. Further research should focus more specifically on these experiences and their causal relationships.
Radiation Deteriorates Functional Outcome after Glossectomy
Authors: Shin Yoo Seob , Kim Won Sik , Lee Hyoung‐Shin , Hong Hyun Jun , Kim Se‐Heon , Koh Yoon Woo , Choi Eun‐Chang
Published: September 2011

Objective

Quality of life could be deteriorated by surgical treatment of tongue cancer. Adjuvant therapy may also affect the functional outcome. Therefore, we intend to evaluate the influence of radiotherapy on the postoperative functional outcome after partial glossectomy with free flap reconstruction in early tongue cancer patients.

Method

We measured the functional outcome and reviewed the charts of 31 oral tongue cancer patients. We evaluated speech integrity with Diadochokinetic test (DDK). Mobility of tongue was checked with measurement of upward, protrusion, and lateral deviation distance. We also evaluated swallowing capacity with the M.D. Anderson Dysphagia Inventory.

Results

DDK rates of the surgery‐only group and the postoperative radiotherapy group were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery only group. Tongue mobility was not statistically different between the groups.

Conclusion

The functional outcome regarding speech and swallowing is negatively influenced by postoperative radiotherapy.
Relation between PGS Invasion and LN Metastasis in SCPL
Authors: Nam Inn Chul , Joo Young Hoon , Park Jun Ook , Cho Kwang‐Jae , Kim Min Sik
Published: September 2011

Objective

Transglottic cancer invading PGS is characteristically known to show a high incidence of laryngeal skeleton invasion and cervical metastasis. The objective was to determine the role of paraglottic space (PGS) invasion in lymph node metastasis in patients undergoing supracricoid partial laryngectomy (SCPL).

Method

We retrospectively reviewed the clinical and pathological data of 98 patients who were diagnosed with glottis laryngeal carcinoma and underwent SCPL. We examined the relationship between PGS invasion and clinicopathological factors such as age, gender, tumor stage, vocal cord mobility, anterior commissure invasion, thyroid cartilage invasion, and subglottic extension.

Results

The PGS invasion rate was 60.2% (59/98). Significant correlations were found between PGS invasion and cervical lymph node metastasis (P =. 022). Fifteen of the 59 patients (25.4 %) with the PGS invasion had cervical lymph node metastasis, whereas only 3 of the 39 patients (7.7%) without any evidence of PGS invasion had lymph node metastasis. There was also a significant correlation of PGS invasion with T stage (P =. 008), vocal cord mobility (P =. 001), and subglottic extension (P =. 014). Patients with no evidence of PGS invasion may have a survival benefit even without statistical significance (P =. 118).

Conclusion

PGS invasion was found to be significantly related to the presence of cervical lymph node metastasis, which suggests that could be used to predict the presence of lymph node metastasis and to determine operative extent and prognosis in patients undergoing SCPL.
Residual Lymph Node Metastasis in Planned Neck Dissection
Authors: Agena Shinya , Maeda Hiroyuki , Hasegawa Masahiro , Suzuki Mikio
Published: September 2011

Objective

Clarify the effectiveness of planned neck dissection (PND) after concurrent chemoradiotherapy (CCRT), we investigated residual lymph node metastasis; imaging tests such as positron emission tomography (PET), computed tomography (CT), and ultrasonography at pre‐ and post‐CCRT; and the adverse effects of PND.

Method

CCRT combined with PND was performed on 13 patients with oropharyngeal carcinoma, 4 with hypopharyngeal carcinoma, and 2 with laryngeal carcinoma. All primary lesions showed complete response to CCRT. Histopathologic examination of neck specimens and imaging tests were employed to evaluate the effect of CCRT.

Results

Eight of 19 patients (47%) had viable carcinoma in their lymph nodes. Patients with poorly differentiated carcinoma in the primary lesion tended to have residual lymph nodes. Most of the residual neck specimens belonged to the level III or level IV lymph node group. Major complications of PND were prolonged laryngeal edema, dysphasia, and disturbance of shoulder movement. Tracheotomies were performed in 42% of all cases. Positive and negative predictive values of PET examination before PND were 50% and 73%, respectively. None of the patients with PND experienced local or lymph node recurrence.

Conclusion

Residual lymph nodes were frequently observed in head and neck carcinomas. Of the imaging tests, PET was sufficient for detecting residual regions. Although PND is a useful tool, related complications were frequently observed. A more accurate detection system is needed to reduce unnecessary neck dissections.
Screening for Head and Neck Cancer in Childhood Irradiation
Authors: Chu Eugenia , Davidson Bruce J. , Blau Jenny E.
Published: September 2011

Objective

Except for thyroid disease, no guidelines exist for screening the various sites at risk after a history of childhood irradiation. We sought to develop a formal screening algorithm used to target these high risk patients.

Method

Four patients who each demonstrated 3 or more potentially radiation induced tumors of the head and neck are described. Evidence from the literature describing the relationship between these tumors and childhood irradiation provided the basis for screening recommendations.

Results

Four patients, ages 63 to 76 years, who received childhood irradiation are reported. Three patients had salivary tumors and developed hyperparathyroidism secondary to adenoma. Other tumors included papillary thyroid cancer, benign thyroid nodules, basal cell carcinoma, and ear canal osteoma. We propose an algorithm in evaluating these patients. Initially, patients receive a head and neck physical, baseline laboratories and thyroid ultrasound. Suspicious thyroid lesions or ones greater than 8 mm undergo FNA. An audiogram is recommended and potentially MRI if clinical suspicion exists for acoustic neuroma. If pathology is absent on screening, patients merit follow‐up with examination and labs every 1 to 3 years.

Conclusion

Patients with a history of childhood irradiation present a risk for a multitude of head and neck neoplasms and need thorough screening and evaluation. The proposed algorithm provides a comprehensive tool for head and neck cancer screening in this population emphasizing the diversity of manifestations that may present.
Temporoparietal Fascia Flap Reconstruction for Lateral Skull Base Tumors
Authors: Patel Rusha J. , Hunt Jason P. , Buchmann Luke
Published: September 2011

Objective

1) Determine the efficacy of the temporoparietal fascia flap (TPFF) in preventing cerebrospinal fluid (CSF) leaks during skull base reconstruction for lateral skull base tumors. 2) Learn which factors lead to success of the TPFF.

Method

A retrospective chart review was conduced of lateral skull base resections from 2005 to 2010 at a tertiary academic hospital. Patients were divided into TPFF versus non‐TPFF groups. Data on tumor size, intradural extension, and presence of postoperative CSF leak were recorded and compared between groups.

Results

A total of 62 patients underwent lateral skull base resection and were available for review. Sixteen patients had a TPFF reconstruction and 46 patients had other forms of reconstruction. The rates of CSF leak in TPFF versus non‐TPFF groups were 6% and 11%, respectively. Patients with TPFF reconstruction were more likely to have large tumors (25% vs 9%) and to undergo intradural surgical dissection (25% versus 13%). The TPFF group had a higher number of paragangliomas (93% vs 32%) and the non‐TPFF group had a higher rate of squamous cell carcinoma and meningioma (19% and 10%, versus 0%).

Conclusion

TPFF reconstruction of lateral skull base defects is effective in preventing postoperative CSF leaks. Since the procedure has low morbidity, it should be considered in all lateral skull base defects at risk for CSF leaks, especially for patients with large tumors or intradural involvement.
The Feasibility of 18‐FLT PET for the Detection of Metastatic Lymph Node of Head and Neck Cancer
Authors: Kishino Takehito , Hoshikawa Hiroshi
Published: September 2011

Objective

Investigate the diagnostic efficacy of FLT PET for evaluating the nodal metastatic lymph nodes in head and neck cancers.

Method

The diagnosis of metastatic lymph nodes was based on CT findings. The sensitivity, specificity, positive predictive value, and negative predictive value with FLT PET were determined based on CT findings. Ten patients underwent surgical treatment, and those cases were all evaluated histopathologically.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value with FLT PET were 90%, 91%, 96%, and 80%, respectively. While the accuracy was 98% in the lymph nodes with a minimum diameter greater than 10 mm, the accuracy decreased to 80% in lymph nodes with a minimum diameter less than 10mm. A histopathological examination of 191 lymph nodes from 10 patients revealed that FLT PET had a sensitivity, specificity, positive predictive value, and negative predictive value for lymph node of 61%, 99%, 90%, and 93%, respectively.

Conclusion

FLT PET was found to have a high sensitivity for detecting metastatic lymph nodes with a minimum diameter greater than 10 mm. However, it was difficult to detect the occult metastatic lymph nodes which could not be detected with CT imaging.
The Learning Curve of Video‐Assisted Thyroidectomy
Authors: Kania Romain E. , Verillaud Benjamin , Tran Hugo , Bon Mardion Nicolas , Sauveget Elisabeth , Ba‐Huy Patrice Tran , Herman Philippe
Published: September 2011

Objective

Minimally invasive video‐assisted thyroidectomy (MIVAT) has been demonstrated to be a safe procedure for the removal of small thyroid nodules in order to improve cosmetic results and reduce pain. The aim of this study was to evaluate the learning curve of this procedure.

Method

Thirty‐four patients were consecutively operated by MIVAT and were arbitrarily split in 2 groups: group 1 (n = 17) for the first 17 patients who underwent MIVAT and group 2 (n = 17) for the following 17 patients. MIVAT was performed through a unique cervical incision of 2 cm length.

Results

Twenty‐one lobectomies and 13 total thyroidectomies were performed. The mean operative time was significantly shorter in group 2 (59 ± 22 min) than in group 1 (81 ± 33 min) (P =. 03). There was neither significant difference between groups for the occurrence of postoperative complications nor for the other outcome measurements: scar length was 2.1 ± 0.2 cm and 1.85 ± 0.4 cm in group 1 and 2 respectively, postoperative pain was 2.7 ± 1.5 and 2.2 ± 1.8 in group 1 and 2 respectively, and the mean time of hospital stay was 2.8 ± 1.0 days.

Conclusion

MIVAT requires a learning curve. This study showed that the surgical time was significantly shortened with experience. Recommendations should define the number of lobectomies and the training program to be performed for the surgeon and assistants in order to lower mean operative time and reduce complications for MIVAT.
The Utility of Frozen Section Margin Analysis in Transoral Robotic Surgery
Authors: Martin Eliot J. , Moore Eric J. , Olsen Kerry D. , Olsen Steven
Published: September 2011

Objective

Determine the benefit of frozen section margin analysis on oncologic specimens resected via Transoral Robotic Surgery (TORS).

Method

A retrospective, single institution chart review of 150 consecutive patients with upper aerodigestive tract malignancies who underwent Transoral Robotic Surgery with intraoperative frozen section margin analysis between April 2007 and November 2010.

Results

A total of 105 of the 150 cases were found to have negative tumor margins on initial tumor extripation. None of these patients were found to have delayed positive margins on permanent section analysis. Forty‐five patients were found to have 1 or more positive margins on frozen section analysis following initial tumor, and/or tumor margin resection. These positive margins were all re‐resected until frozen section pathology was consistent with tumor free margins (no evidence of CIS or invasive carcinoma). Of the 45 patients who underwent re‐resection of initial tumor involved margins, 2 were found to have positive margin disease on permanent section pathology.

Conclusion

Frozen section margin analysis is a critical intraoperative tool in Transoral Robotic Surgery that accurately accesses margin free tumor resection. This technique allows for a single operative encounter consisting of initial tumor biopsy with rapid diagnosis, followed by immediate complete primary tumor resection with synchronous neck dissection when oncologically indicated.
Traditional vs Advanced Thyroidectomy: Patient Preference
Authors: Snissarenko Eugene P. , Bradford Benjamin , Simental Alfred
Published: September 2011

Objective

Several thyroidectomy techniques are available today, both traditional and advanced. However, little data is available regarding patients’ preference and understanding of their options. The purpose of this study is to 1) evaluate patents’ choice prior to thyroid surgery; and 2) examine factors that influence it.

Method

This study was conducted at the tertiary medical center between October 2010 and February 2011. Patients visiting the surgery clinic for evaluation of thyroid pathology were given a 2‐part questionnaire regarding their knowledge of different thyroidectomy techniques and factors which influence their choice.

Results

The majority of patients had no prior knowledge of thyroidectomy techniques (82.3%) and did not conduct research on their own prior to surgical consultation (70.6%). Patients who reported research spent less then 6 hours, used various sources, and traveled less then 30 miles to the clinic. No patients claimed knowledge of different advanced thyroidectomy techniques. More females than males reported cosmesis as an important concern (64% vs 11%), while both groups cited safety as the most important factor. Patients showed preference of neck scar to axillary/sternal scar (56% vs 21%). 90% of patients said that the visit changed their knowledge.

Conclusion

While patients are interested in different thyroidectomy techniques, their preference is driven primarily by concern for safety. Cosmesis is more important for females than males, although both genders prefer cervical scar. Despite the availability of information, patients conduct little research and most of them rely on their surgeon for education.
Transoral Resection of the Pharyngeal and Laryngeal Cancers
Authors: Okami Kenji , Sakai Akihiro , Maki Daisuke , Ebisumoto Kouji , Iida Masahiro
Published: September 2011

Objective

Evaluate the efficacy and safety of the transoral en bloc resection of superficial pharyngeal and laryngeal cancers. Transoral tumor resection is one option of minimally invasive surgery.

Method

From 2008 to 2010, 34 lesions (from 31 patients) were resected transorally under microscope with monopolar cautery.

Results

Twenty‐four hypopharyngeal, 4 oropharyngeal, and 6 laryngeal cancers were operated on using this method. Operation field was widely exposed with wide caliber scope or extending laryngoscope. Bimanual procedure under microscope enabled us to achieve en bloc resection. Radical neck dissection was done simultaneously in one case. Local control rate was 97%. No postoperative dyspnea or dysphagia was observed. Two‐thirds of the patients had no symptoms, which were detected by screening of the esophageal cancer patients. Narrow Band Imaging (NBI) system was very useful for detection of the superficial lesions.

Conclusion

Transoral robotic surgery is now applied for minimally invasive surgery, which is not applicable yet in Japan. Our technique of en bloc resection can be easily introduced and was effective in maintaining the quality of life after treatment.