bluuebunny/crossref_metadata_2025 huggingface dataset:
Reflux Disease and Proton Pump Inhibitor Therapy: Impact upon Sleep Disturbance
Authors: Regenbogen Elliot , Helkin Alex , Georgopoulos Rachel , Vasu Tajender , Shroyer A. Laurie W.
Published: February 2015

Objective

To perform a systematic literature review that evaluates the impact of proton pump inhibitor treatment of gastroesophageal reflux disease upon sleep disturbance‐related outcomes.

Method

PubMed, Web of Science, and Cochrane databases were searched from 1989 to present, identifying all radomized placebo‐controlled clinical trials where both proton pump inhibitor use and outcome measures of sleep disturbance were reported for esophageal refludisease patients. Using pre‐established systematic review protocol 4 co‐authors independently reviewed all articles.

Results

The original search idetified 20 articles; 9 were not directly relevant, and 3 were not placebo controlled. Sample sizes varied from 15 to 642; mean age was 47.4 ± 4.56; mean body mass index was 29.4 ± 2.90; the proportion of women varied widely across studies. Esopmeprazole was studied most frequently. Over 50% of publications permitted rescue antacids. Two studies reported polysomnography outcomes, without statistically significant improvement. All studies reported nonpolysomnography outcomes; 7 identified statistically significant improvements demonstrating drug treatment superiority over placebo.

Conclusion

The existing evidence supports the use of proton pump inhibitor as a treatment for esophageal reflux disease to improve quality of life sleep disturbance‐related outcomes. While variability in treatments and outcomes prevented direct comparisons, this conclusion appears robust for 7 of 8 studies, including the highest 3 quality studies.
Radiofrequency Volume Reduction of Tongue Base: A 12‐Year Experience
Authors: Kao Yi H.
Published: February 2015

Objective

1) To report on the evolution and success rate of radiofrequency volume reduction of the tongue base over a 12‐year period. 2) Introduce a novel method for deploying the RFVR probes to the tongue base without pulling the tongue forward. 3) Show reduced complication rates by avoiding nerves and vessels. 4) Show increased success rate with increased number of lesions per treatment session. 5) Demonstrate the possibility of treating the genioglossus and geniohyoid muscles to shorten these muscles and retract the tongue anteriorly.

Method

In an IRB‐approved prospective study at a community hospital, over 400 patients with obstructive sleep apnea over a 12 year period were selected for RFVR of the tongue base when there is evidence of hypopharyngeal involvement. Treatment evolved from single pronged to a double pronged probe with the rapid lesion mode and from to 2 lesions to 14 lesions. RFVR is usually performed in conjunction as part of multilevel treatment. Polysomnography prior to and 3 months after treatment were analyzed. Complications were recorded. Success is defined as RDI less than 20 and a greater than 50% reduction from preoperative levels.

Results

Success rates increased from 58% to 68% while the number of sessions of treatment decreased from 4 to 1 as the number of lesions increased from 2 to 14. There were no major complications.

Conclusion

RFVR of tongue base has evolved over a 12‐year period to become a more efficacious and integral part of multilevel treatment for OSA.
Targeted Hypoglossal Neurostimulation in Obstructive Sleep Apnea
Authors: Rombaux Philippe , Mwenge Gisele , Lengelé Benoit , Rodenstein Daniel
Published: February 2015

Objective

Airway management is the standard approach for the treatment of obstructive sleep apnea (OSA). CPAP remains the gold standard to treat OSAS, but about one‐quarter of the patients are poorly compliant or tolerant to the mask. The aim of the study was to evaluate the safety and efficacy of targetted neurostimulation of the hypoglossal nerve (THN Sleep Therapy) in CPAP non‐compliant subjects using the aura6000™ System from ImThera Medical Inc.

Method

The study was a single arm, prospective feasibility study on 13 OSA subjects. Apnea‐hypopnea indices (AHI) were measured at 3 and 12 months. A multi‐contact cuff electrode was implanted unilaterally on the proximal hypoglossal nerve and an implantable pulse generator placed subcutaneously in the ipsilateral upper chest wall.

Results

Significant improvement was found in the apnea hypopnea index: baseline 45.2 ± 17.8, 3 months 21.7 ± 19.9, and 12 months 21.0 ± 16.5 calculated for the 13 patients. Ten patients were classified as responders (76.92%) with a 65.55% improvement in the AHI at 3 months and 68.19% at 12 months and with a 67.09% improvement in the ODI at 3 months and 66.23% at 12 months.

Conclusion

THN Sleep Therapy™ proved to be a feasible and effective procedure for the treatment of the moderate to severe CPAP noncompliant OSA subjects.
Velopharyngeal Surgery for Patients with Small Tonsils
Authors: Ye Jingying , Zhang Junbo , Xian Junfang , Wang Jiangyong , Dong Jiajia
Published: February 2015

Objective

To explore the relationship between anatomical changes and treatment response in obstructive sleep apnea (OSA) patients with small tonsils (tonsil grades 0‐2 according to Friedman staging system) after velopharyngeal surgery.

Method

Thirty‐six patients with small tonsils underwent velopharyngeal surgery that consisted of revised uvulopalatopharyngoplasty with uvula preservation (H‐UPPP) and concomitant transpalatal advancement pharyngoplasty, 3‐dimensional CT of upper airway, and polysomnography performed before and after surgery were obtained for comparison and analysis.

Results

Overall apnea‐hypopnea index (AHI) decreased from 56.8 (37.5, 70.1) to 16.1 (10.8, 33.5) (P <. 001) after surgery. The changes of several anatomical parameters differed significantly between responders and non‐responders (P <. 05), and the change of minimal cross‐sectional area of velopharynx (VmCSA) was independently predictive of the change of AHI (P <. 001, r2 = 0.271). The correlation analysis showed that the change of VmCSA significantly correlated with preoperative VmCSA (r = −0.383, P =. 021).

Conclusion

In patients with small tonsils an increase in VmCSA is related to a good surgical response, and such patients who have a relatively smaller preoperative VmCSA are more likely to get favorable anatomical changes.
Closure of Large Oro‐antral Fistulas Using Septal Cartilage
Authors: Saleh Essam A. , Issa Islam A.
Published: February 2015

Objective

To describe a new technique for closure of large oro‐antral fistulas and report our results using this technique.

Method

A retrospective review in a tertiary referral hospital. Patients with large oro‐antral fistulas were treated surgically using autograft septal cartilage and buccal pyramidal flap.

Results

There were 11 patients, 8 of whom had chronic oro‐antral fistulas. The etiology was tooth extraction in 9 cases (81.8%), primordial maxillary cyst exicision in 1 case (9.1%), and dental implant in 1 case (9.1%). Four cases had extensive sinusitis and were managed by endoscopic sinus surgery. Complete closure of the fistula was obtained in 10 cases (90.9%), whereas 1 case (9.1%) failed. No other complications occurred.

Conclusion

The septal cartilage and pyramidal buccal flap technique is a viable alternative for the closure of large oroantral fistulas.The associated maxillary sinusitis can be safely managed by endoscopic sinus surgery.
Emergency Clinic Electronic Documentation Using Microsoft Access®
Authors: Awad Zaid
Published: February 2015

Objective

1) Assess the impact of using an electronic data collection form on medical documentation accuracy. 2) Test the model longitudinally for reliability and productivity.

Method

A prospective longitudinal audit 2008‐2012 before and after introducing a Microsoft Access database as the sole form of documenting all ENT emergency clinic ancounters. Documentation was evaluated across 3 domains over 2 months. We then introduced the form for 2 months. The third arm is an automatic continuous audit loop.

Results

Data acquired were divided into demographics, clinical, and clerical covering 18 parameters. The first arm included 319 patients and showed 32% booking errors. 61% had missing or illegible information. Only 36% had the source of referral, and 41% had no clear outcome. These improved to 5% booking errors and 3% missing information during the second phasing arm (n = 330) with 98% compliance in using the new database, then to 1% and 0% in the third arm where 6000 cases were seen (chi‐square, P <. 001) in 16 out of 18 parameters.

Conclusion

The form has been in use for nearly 4 years. Information like the number of patients seen, source, waiting time, procedures carried out, and outcome are all available instantly in an easily presentable and auditable format. The form saves time and effort, helps with research, and improves in documentation and communication.
Is Ductoplasty Necessary after Combined Sialolithectomy?
Authors: Pagliuca Giulio , Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili
Published: February 2015

Objective

Sialolithectomy with combined endoscopic and external approach is indicated for large sialoliths. The aim of this study is to establish whether ductoplasty is necessary to repair the Wharton’s duct or if simple suturing of the oral floor after stent placement may be sufficient to achieve duct healing.

Method

Ten patients underwent a combined approach to remove submandibular stones. Ductoplasty was performed in 6 cases whereas in 4 cases only the mucosa of the oral floor was sutured without repairing the duct. The stent was removed about 3 weeks after surgery. A diagnostic sialoendoscopy was performed after 6‐8 months.

Results

Sialoliths were completely removed in all cases. During follow‐up all patients were symptom‐free, and no recurrence was reported. Postoperative diagnostic sialoendoscopy showed a well‐canalized duct in all cases.

Conclusion

Suture of the ductal wall after combined approach is not necessary to obtain a correct recanalization of the duct. After stent placement, the suture of the oral mucosa overlying the ductal wall allows a regular restoration of the lumen, thus reducing duration of surgery and possibility of lingual nerve injury.
Joint Facial and Invasive Neck Trauma (J‐FAINT) Study
Authors: Feldt Brent A. , Salinas Nathan , Rasmussen Todd , Brennan Joseph A.
Published: February 2015

Objective

1) Describe the rate and type(s) of head and neck trauma in Iraq and Afghanistan theaters during 2003‐2011 using military trauma database. 2) Determine directions for future research in personal protective and tactical gear to help prevent injury and death from facial and neck trauma in war and civilian uses.

Method

Study of US servicemembers in Iraq and Afghanistan from 2003‐2011. Data were collected December 2011. Examples of data include type and severity of head and neck trauma, associated injuries, age, sex, theater of injury, injury severity score, and abbreviated injury scale. Data were collected using the Joint Theater Trauma System (JTTS).

Results

Data analysis is ongoing. The analysis demonstrates 7,177 service members who sustained head and neck trauma during the study period in Iraq and Afghanistan, combined. Of those patients sustaining head and neck trauma, 270 (3.8%) were killed in action or died of wounds. About one‐third sustained head and/or neck trauma alone, but most had associated torso and/or extremity injuries, which increased the injury severity score. The majority of injuries occurred in Iraq. Most of the injured were in the US Army (75%), followed by the Marine Corps (20%), Air Force (3%), and Navy (2%). Most injuries were minor‐moderate (AIS 1‐3).

Conclusion

Head and neck trauma is common in wartime, and the most recent conflicts confirm this. Many patients sustained injuries in Iraq, the majority were in the Army, and the majority were minor injuries. Most patients (96.2%) who sustained head and neck trauma survived their injuries, even when associated with extremity and torso injuries.
Mentorship in Otolaryngology: 10 Years of Experience
Authors: Geltzeiler Mathew N. , Lighthall Jessyka G. , Wax Mark K.
Published: February 2015

Objective

The Accreditation Council for Graduate Medical Education’s (ACGME) structuring of resident education attempts to utilize mentoring relationships to augment trainee development. The purpose of the current study is to better understand the nature of the mentor‐mentee relationship and find areas that should be strengthened or de‐emphasized.

Method

The Mentorship Program in the Department of Otolaryngology–Head and Neck Surgery at Oregon Health and Science University has existed for 10 years. Mentor‐mentee pairs are assigned upon matriculation. Pairs are required to meet biannually at minimum. Guidelines for discussion topics are provided. All residents and faculty participants were surveyed online.

Results

Nineteen mentors and 24 mentees completed the survey, a 100% response rate. Mentor personality traits most important to residents were honesty/integrity (93%) and supportiveness (88%), while the least important characteristics were race (100%) and gender (83%). Mentor‐mentee pairs discussed a wide variety of topics. At the completion of training, only 26% of residents felt comfortable with transition to private practice and contract negotiations. These topics were also the least frequently discussed. Eighty‐three percent of trainees sought additional mentorship from other faculty. Eighty‐seven percent of mentors would not care if mentees changed mentors. Overall, 82% of participants endorsed continuing the program.

Conclusion

Mentorship programs are an effective tool in facilitating resident development. Residents would prefer choosing their own mentor and value honesty and supportiveness. Topics relating to private practice and contract negotiations were the areas of greatest discomfort for residents and the least frequently discussed. This represents an area for improvement.
Multiple Mini Interview for Selection into OTL Residency
Authors: Campagna‐Vaillancourt Maude , Nguyen Lily H. P. , Manoukian John J. , Razack Saleem
Published: February 2015

Objective

1) To determine the reliability of the Multiple Mini Interview (MMI) for resident selection into an otolaryngology–head and neck surgery (OTL‐HNS) program. 2) To assess the degree of acceptance by major stakeholders (interviewers and applicants) towards the MMI when compared to traditional interviews.

Method

Canadian medical graduates applying to OTL‐HNS residency programs underwent MMI in 2011 and 2012. MMI had 7 stations evaluating unique candidate attributes. Stations include surgical skills assessment and 2 simulation scenarios with standardized actors for noncognitive traits. Reliability was determined, and upon completion, stakeholders rated aspects MMI using 7‐point Likert scale.

Results

Data were collected from a total of 45 applicants and 19 evaluators. Overall interrater reliability of the MMI was good. The majority of applicants (>80%) felt that MMI helped them present their strengths and that it did not have any gender, cultural, or age bias. Assessors (>85%) felt that the MMI evaluated a valid range of competencies and that it tested more aspects of an applicant than traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred the MMI over the traditional interview.

Conclusion

The MMI is a reliable tool for the selection of applicants to an OTL‐HNS residency program. It is well accepted by both applicants and assessors, with the majority of stakeholders preferring the MMI over traditional interviews.
National Operative Log Growth Charts in Otolaryngology–Head and Neck Surgery Training
Authors: Jabbour Noel , Tsue Terance
Published: February 2015

Objective

1) To report national standard developmental growth curves for operative procedures in otolaryngology. 2) To describe a method by which program directors can chart surgical case numbers over time to assess sufficiency of cases and parity between residents.

Method

National statistical operative log reports were obtained from the ACGME for otolaryngology graduate classes of 2009, 2010, and 2011 at set intervals during training. Mean numbers and 0.5 and 1 standard deviation from the mean were graphed against training level to create case log growth charts, akin to developmental growth charts.

Results

Case log developmental growth charts were made for each key indicator procedure and for total cases. Progress of an individual resident or of a cohort of residents may be graphed against this growth chart background over time.

Conclusion

National Operative Case Log Growth Charts allow residents and program directors to graphically assess progress in obtaining sufficient variety and number of operative procedures over time throughout training. This can provide early identification for need for intervention when residents begin to fall below the growth curve during training.
Sialoendoscopic Findings in Non‐lithiasic Sialoadenitis
Authors: Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili , Pagliuca Giulio
Published: February 2015

Objective

Inflammatory swelling of the salivary glands without radiological findings of sialolithiasis may present a serious diagnostic challenge. A case study of 49 diagnostic sialoendoscopies performed on 44 patients (age: 10‐62 years) affected by recurrent inflammatory swelling of salivary glands without radiological evidence of salivary stones is reported.

Method

Intraoperative findings of 49 diagnostic sialoendoscopies attempted on 44 patients were reviewed. All patients experienced episodes of swelling of salivary glands. All patients showed no signs of salivary stones at the preoperative ultrasonography. The patients were contacted by telephone to investigate changes in the symptoms approximatively 6 months after sialoendoscopy.

Results

Sialendoscopy revealed the presence of obstructive mucous plugs in 23 glands (14 submandibulars, 9 parotids) while ductal stenosis was found in 7 cases (2 submandibulars, 5 parotids). A combination of mucous plugs and stenosis was described in 12 glands. Parotid duct sialodochitis was diagnosed in 2 cases. In 1 case the avascular appearance of Stenson’s duct allowed the diagnosis of juvenile recurrent parotitis. Endoscopy revealed no disorders in 4 cases. Thirty‐eight patients (77.5%) referred symptom relief at interview.

Conclusion

Sialendoscopy is the procedure of choice in diagnosing chronic non‐lithiasic sialoadenitis. Salivary duct dilation by irrigation alleviates the symptoms in these conditions.
Throat Symptoms: The Importance in Peritonsillar Abscess
Authors: Powell Jason , Powell Emily L. , Conroy Katherine , Hopkins Claire , Moor James , Wilson Janet A.
Published: February 2015

Objective

The incidence of quinsy is rising in the UK for reasons which are unclear. There were >7000 hospital diagnosed episodes last year in England alone. Some suggest a link to the decline in elective tonsillectomy. Our aim was to compare chronic throat symptoms in quinsy patients and controls.

Method

The validated 16‐item Tonsillectomy Outcome Inventory (TOI‐16) was used to compare the impact of throat symptoms over the previous 6 months in 119 controls (no quinsy history) and 55 contactable (by telephone) quinsy patients (34M, 21F), who had an average experience of 1.4 (range 0‐4) quinsies. Analysis was in SPSS.

Results

The TOI‐16 Cronbach’s α =. 92, indicating high internal consistency. The mean 6‐month overall throat impact scores in quinsy patients (21.0) were significantly greater than that in volunteers (10.9 P <. 05). The post‐quinsy interval had only modest effect on the overall mean score. Younger people had higher scores in both groups. On item‐by‐item analysis, quinsy patients recorded significantly higher mean reported scores over the previous 6 months for snoring, visits to the doctor, and frequent use of antibiotics (all P <. 001) and halitosis, catarrh, missed social gatherings or events, missed work‐days, and depression due to throat problems (all P <. 05).

Conclusion

Ongoing throat problems are far more prevalent and severe in quinsy patients than controls, with a clear life impact. In many, quinsy represents an acute episode on a background of chronic throat problems. The optimal acute management—notably the place and timing of tonsillectomy—should take account of this.
A New Paradigm in Geriatric Head and Neck Surgical Oncology
Authors: Shuman Andrew G. , Goodman Stephanie M. , Korc‐Grodzicki Beatriz , Palmer Frank , Shah Jatin P. , Patel Snehal
Published: February 2015

Objective

Perioperative management of elderly patients with head and neck cancer poses unique challenges and may benefit from expert input from geriatricians. Our objectives are to 1) describe the implementation and 2) determine the feasibility of a novel intervention designed to improve perioperative care delivery in geriatric head and neck surgery.

Method

In this pilot study, patients with head and neck cancer over age 75 were offered preoperative consultation with fellowship‐trained geriatricians. Geriatric‐specific assessment included functional and social status, cognitive testing, medication review and nutrition; patients were also optimized and risk‐stratified for surgery. Thereafter, patients were seen postoperatively by the geriatric service.

Results

Between 2010 and 2011, a total of 176 head and neck patients (75‐93 years old) were seen by the geriatric service. Apart from preoperative medical optimization, geriatricians also assisted in complex decision‐making regarding the indications for cancer‐directed therapy. From the cohort, 148 (84%) subsequently underwent surgery; the majority of cases involved mucosal lesions (43%), cutaneous lesions (20%), and endocrine disease (16%). Postoperatively, geriatricians assisted in preventing and treating delirium, minimizing inappropriate prescribing and poly‐pharmacy, facilitating discharge planning, and initiating prompt rehabilitation. Surgeons, geriatricians, and nursing staff alike were enthusiastic about the initiative, which continues to expand within the institution.

Conclusion

Geriatric perioperative assessment of elderly head and neck cancer patients is feasible and well‐received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
Cost Analysis of Robotic Surgery of the Head and Neck
Authors: Kakarala Kiran , Durmus Kasim , Agrawal Amit , Carrau Ricardo L. , Old Matthew O. , Teknos Theodoros N. , Ozer Enver
Published: February 2015

Objective

1) Present results of cost identification analysis for robotic head and neck surgical procedures. 2) Identify drivers of cost for robotic procedures in the persioperative period including services, materials, and patient characteristics.

Method

Retrospective review of 128 robotic surgical procedures of the head and neck at an academic medical center between 2008 and 2011. Cost data for the perioperative period (operating room, recovery, hospital stay) were collected and matched with clinical data for each case to determine drivers of cost.

Results

Procedures analyzed included transoral robotic surgery (TORS) for oropharyngeal and supraglottic cancers, transaxillary robotic thyroidectomy, and transoral robot assisted approaches to the skull base. Average total cost was $14,455 with a wide range of $3,567‐$55,008. In a subset of 24 patients who underwent TORS alone, without neck dissection, the average cost was $6,450. The cost of the robot for these procedures is analyzed in relation to surgical volume. A subset of patients who underwent TORS with neck dissection for oropharyngeal cancer is analyzed in order to determine drivers of cost in a homogenous group.

Conclusion

Costs attributed to the surgical robot contribute a modest proportion of the total cost of procedures of the head and neck utilizing the robot at a high volume robotic surgery center. Further study examining the cost‐effectiveness of robotic surgery in comparison to other treatment modalities is indicated.
Creation of Novel Nanocomplexes to Target Head and Neck Cancer
Authors: Sanyal Samudra , Lajud Shayanne A. , Bezpalko Orysia , Han Ziying , O’Malley Bert W. , Li Daqing
Published: February 2015

Objective

It is critically important to develop novel targeted strategies that can efficiently inhibit specific molecular pathways in tumor growth and development. The study investigates the potential of adenoviral/chitosan‐PEG nanocomplexes with epidermal growth factor (EGF) for the targeting and treatment of EGF receptor (EGFR) overexpressing head and neck cancers (HNC).

Method

A construct with GFP‐expressing adenoviral vector was coated with a Chitosan‐PEG‐EGF nanocomplex. The EGFR‐expressing HNC tumor cells labeled with TdTomato were co‐cultured with CHO tumor cells with coxsackievirus and adenovirus receptor (CAR), and without EGFR. Fluorescence microscopy was used to detect GFP expression after the treatment with targeted adenoviral/chitosan nanocomplex.

Results

As compared to wild‐type adenovirus, the chitosan‐PEG polymer coating cloaks the viral nanoparticle and prevents interaction with cells through the native CAR‐mediated mechanisms. This significantly reduces nonspecific infection. Due to the TdTomato molecular marker being specifically expressed in the EGFR tumor cell line, the treated EGFR‐expressing cells can be visualized by co‐registration of GFP and TdTomato. The non‐EGFR‐expressing cells lack TdTomato and therefore only express the GFP. The adenoviral/chitosan‐PEG nanocomplexes with EGF ligand demonstrated significantly increased EGFR tumor cell‐specific GFP expression. The tumor cells without EGFR showed no GFP expression.

Conclusion

Our study suggests that the novel EGFR‐targeted adenoviral/chitosan‐PEG nanocomplex approach can effectively target HNC and has significant potential to deliver therapeutic agents specifically to the HNC tumor sites. It is also possible to track real‐time tumor growth and spread through molecular imaging by incorporating fluorescent proteins into the payload.
Disfigurement and Mental Health in Head and Neck Cancer
Authors: Fundakowski Christopher E. , Jean‐Pierre Pascal , Sargi Zoukaa
Published: February 2015

Objective

Evaluate the relationship between physician‐rated patient disfigurement and mental health status and quality of life variables in a 1‐year posttreatment head and neck cancer population.

Method

Cross‐sectional study, academic, tertiary referral center. One hundred fifty patients with a diagnosis of head and neck cancer at least 1 year status posttreatment completed a series of mental health and quality of life intake questionnaires. A single physician completed an observer‐rated disfigurement scale for all patients.

Results

Racial stratification included: 61% Caucasian, 33% Hispanic, 4% African American, and 2% other. Gender stratification included: 69% male and 31% female. Mean age: 63 (range 20‐89). Thirteen percent of the patient population was noted to have untreated depression/anxiety, 100% of which had undergone some type of surgical intervention. No anxiety/depression was noted in patients who had only undergone chemo and/or radiotherapy and no surgery. Physician rated disfigurement was higher in the surgical treatment group, though the highest physician‐rated disfigurement scores did not correlate to the highest anxiety/depression scores, nor the lowest quality of life scores.

Conclusion

While physician‐rated disfigurement is higher in surgically treated patients, the most disfigured patients did not report the worst quality of life. Therefore all head and neck patients should be assessed for adverse mental health and quality of life outcomes posttreatment, not only the most disfigured.
Endoscopic Skull Base Reconstruction: Lesson from 420 Cases
Authors: Gallo Stefania , Karligkiotis Apostolos , Turri‐Zanoni Mario , Volpi Luca , Ferreli Fabio , Pistochini Andrea , Castelnuovo Paolo
Published: February 2015

Objective

The ability to repair skull base defects resulting from the treatment of different skull base diseases has been a major challenge over the past decade. Aims of the study are to define different endoscopic techniques of reconstruction, focusing on their evolution, and evaluate their efficacy and indications, analyzing their failures.

Method

All cases submitted to endoscopic skull base reconstruction from 1995 to 2011 were divided into group A: patients treated for traumatic or non‐traumatic CSF‐leaks and group B: patients treated for skull base tumors. Patients were fully investigated prior to surgery with endoscopic evaluations and neuroimaging, eventually associated to other in‐depth examinations.

Results

420 patients underwent endoscopic skull base reconstruction: 263 in group A and 157 in group B. Primary closure was achieved in 251/263 cases of group A (95.4%) and in 143/157 cases of group B (91.1%). In 26/420 failures (6.2%) revision surgery reached an effective secondary closure of the defect in 100% of cases. Autologous materials were preferred for grafting in both groups, with prevalence for intranasal epithelial and connective tissues (mucoperiostium, bone, cartilage) in group A and for extranasal connective tissue (fascia lata) in group B. Vascularized flaps were employed in selected cases. Indications and details of each technique are provided.

Conclusion

The endoscopic technique should be considered a favorable, safe, and minimally invasive procedure for skull base reconstruction with effectiveness rates comparable to external approaches. Failures were related to mistakes in the choice of materials and reconstructive technique, based on the site of the defect and the biology of treated lesions.
Gene Markers as Predictors of Nodal Metastasis and Outcome
Authors: Mattos Jose L. , Trivedi Sumita , Ferris Robert L.
Published: February 2015

Objective

1) Investigate the correlation between percentage of metastatic tumor in lymph nodes from patients with squamous cell carcinoma (SCC) of the head and neck and level of expression of 3 marker genes: pemphigus vulgaris antigen (PVA), parathyroid hormone related peptide (PTHrP), and tumor‐associated calcium signal transducer (TACSTD1). 2.) Understand the relation of these markers and clinical outcomes.

Method

Four hundred forty‐eight grossly negative lymph nodes from 92 patients with SCC were evaluated for expression of the gene markers PVA, PTHrP, and TACSTD1 using real‐time PCR. Confirmation of metastasis was determined by histological examination. The expression of these markers was analyzed versus tumor percentage using correlation and linear regression.

Results

All 3 markers were studied independently and were statistically significant predictors of tumor percentage in the lymph nodes at a significance level of 0.05. PVA had the strongest correlation with tumor percent with a correlation coefficient of 0.68, an r squared of 0.46, and a P value <.001. PTHrP had a correlation coefficient of 0.39, r squared of 0.16, and a P value of. 003. TACSTD1 had a correlation coefficient of 0.38, r squared of 0.15, and a P value of. 004.

Conclusion

All 3 markers are statistically significant predictors of percent tumor in grossly negative lymph nodes. PVA had the strongest correlation. Further analysis will include a multivariate regression to account for possible confounding. Since expression correlates with tumor percent, we expect that expression levels will also correlate with clinical outcomes.
HPV E6 and E7 Mediated Regulation of HPV(–) HNSCC Cell Lines
Authors: Peters Robert D. , Graham Martin P. , Komarck Chris M. , Walline Heather M. , Prince Mark E. , Carey Thomas E.
Published: February 2015

Objective

1) Determine the capacity of HPV16 E6 and E7 viral oncoproteins to regulate cellular levels of p53 and Rb in the absence of the complete viral genome. 2) Understand the interaction between viral E6 and endogenous p53 by observing the effect of E6 on mutant p53.

Method

Two HPV negative HNSCC cell lines with DNA binding domain mutations of p53 were infected with lentiviral vectors containing either HPV16 E6, E7, and luciferase or luciferase alone. Naturally infected HPV16 and18 positive cell lines were evaluated as controls. Expression of p53 and Rb was evaluated with PCR and immunohistochemistry. Cell proliferation was monitored by time to confluence.

Results

PCR analysis of cDNA confirmed expression of E6 and E7 in the transduced and naturally infected cell populations and the absence of E6 and E7 expression in the HPV negative cell lines. E6 and E7 transduced cell lines demonstrated reduced staining intensity for p53 and Rb compared to the HPV negative parental cells. Naturally infected HPV positive cell line controls stained weakly for Rb and p53 as expected. Cell proliferation was modestly decreased in E6 and E7 transduced cell lines compared to the parental controls.

Conclusion

E6 and E7 viral oncoproteins affect cellular levels of p53 and Rb in the absence of a complete HPV genome. Viral E6 maintains the capacity to target p53 for degradation in HPV negative HNSCC cell lines with mutant p53. Individual oncoproteins can modify the behavior of HPV negative cell lines.
HPV Prevalence in a Multi‐ethnic Screening Population
Authors: Chen Kang Mei , Worsham Maria J. , Stephen Josena K. , Divine George , Ghanem Tamer A. , Stachler Robert J. , Gardner Glendon M.
Published: February 2015

Objective

For optimal feasibility using saliva rinse screening of HPV for head and neck cancer (HNC), the prevalence should be 5% or higher in the population screened. The aim of our study was to determine the prevalence of HPV16 infection in a screening population in Detroit, MI.

Method

Real time quantitative PCR was applied to detect HPV16 in saliva DNA from 349 screening subjects without HNC, 157 HNC, and 19 controls. Cut points for HPV positivity were: >0 and >0.001 copy/cell. Proportions were compared between groups using exact chi‐square or Fisher’s exact tests as appropriate (set at P <. 05).

Results

At cut point >0, each group had an overall HPV prevalence of over 5%, with a much higher prevalence of 31.2% in the HNC patient group. At cut point >0.001, the prevalence was lower in each group, 0% in the control, 1.2% in the screening, and 17.2% in the HNC group. At >0, females in the screening group had a higher prevalence of HPV than males (P =. 010), and at >0.001, prevalence was higher for males in the HNC group than females (P =. 043). In the screening group, at >0, only AA had higher prevalence than CA (P =. 025).

Conclusion

In the screening group, a 5% and 1.2% screening rate was noted at cut‐points >0 and >0.001, respectively. The results provide data to inform public health considerations of the feasibility of saliva as a screening tool in at‐risk populations with the long term goal of prophylactic vaccination against oral HPV.
Knowledge Regarding HPV and Head and Neck Cancer
Authors: Hapner Edie R. , White Laura , Creighton Francis P. , Wise Justin C. , Berg Carla
Published: February 2015

Objective

Compare the knowledge of the relationship between HPV and head and neck cancer (HNCA) in 3 unique populations: NASCAR race attendees, undergraduates, and medical students. Compare the self‐reported level of information disseminated by healthcare providers regarding HPV and HNCA, respectively.

Method

A 21‐item questionnaire was administered to 490 NASCAR race attendees, 186 undergraduate students, and 158 medical students. The survey assessed their knowledge regarding the relationship between HPV and HNCA using a Likert scale. The survey also assessed the level of information disseminated by healthcare providers regarding HPV and HNCA.

Results

NASCAR attendees evidenced significantly (P <. 001, η2 =. 10) lower levels of knowledge of the relationship between HPV and cervical cancer than college or medical students. NASCAR attendees evidenced significantly (P <. 001, η2 =. 02) lower levels of knowledge regarding relationship between HPV and HNCA than medical students or undergraduates. NASCAR attendees reported receiving significantly (P <. 001, η2 =. 10) higher levels of information regarding HNCA compared to college or medical students. Undergraduates and medical students reported receiving significantly (P <. 001, η2 =. 02) higher levels of information from healthcare providers about HPV than NASCAR attendees.

Conclusion

Significant group differences concerning knowledge of the relationship between HPV and cervical cancer and between HPV and HNCA were detected. However, all 3 groups demonstrated higher levels of knowledge of the relationship between HPV and cervical cancer compared to HPV’s relationship with HNCA.
Modified Brief Fatigue Inventory in Head and Neck Cancer
Authors: Aynehchi Behrad B. , Obourn Chelsea , Sundaram Krishnamurthi , Bentsianov Boris L. , Rosenfeld Richard M.
Published: February 2015

Objective

The aim of this study is to validate the Modified Brief Fatigue Inventory (MBFI). This is the first instrument designed to measure intensity and frequency of fatigue specifically in head and neck cancer patients, potentially allowing objective measurement in addressing this common symptom in a concise yet thorough fashion.

Method

The 9‐item MBFI was administered to 52 consecutive cancer patients and 57 consecutive controls from the outpatient otolaryngology clinic of an academic tertiary medical center. Subject demographics, co‐morbidities, cancer site, and cancer stage were recorded. Psychometric properties and predictors of the MBFI were analyzed.

Results

MBFI 1‐week test‐retest reliability was excellent (r = 0.800, P <. 001). Internal consistency was also excellent (Cronbach’s α =. 938). Construct validity of the MBFI compared to the previously validated Multidimensional Fatigue Symptom Inventory Short Form was excellent (r = 0.814, P <. 001). Discriminant validity of cancer versus controls was significant (P =. 027). Predictors of increased MBFI score included 1) American Society of Anesthesiologists (comorbidity) score (bivariate analysis r = 0.287, P =. 039), 2) cancer stage (analysis of variance P =. 007), and 3) adjuvant radiotherapy (t test P =. 016). No significant relationship was found with age, gender, marital status, education, ethnicity, feeding tube, tracheostomy, or laryngectomy.

Conclusion

The MBFI is a reliable and valid tool for measuring fatigue levels in head and neck cancer patients. In the context of initial assessment or posttreatment trending, this brief survey can be rapidly administered, providing valuable objective data on a very common and potentially debilitating symptom.
Optimal Timing for PTH Assay in Parathyroidectomy
Authors: Kanotra Sohit P. , Kuriloff Daniel B. , Vyas Priyam K.
Published: February 2015

Objective

1) To assess the feasibility of a novel criterion for intraoperative parathyroid hormonal assay (iPTH) based on a single 10‐minute postexcision PTH level and using the workup PTH (wPTH) level as the baseline. 2) To compare the predictive value of this criterion with other recommendations for the timing of PTH acquisition.

Methods

A review of a single surgeon prospectively maintained parathyroidectomy database over a 2‐year period. Patients with primary hyperparathyroidism who underwent minimally invasive parathyroidectomy were included in the study.

Results

A total of 77 patients with a mean age of 54 ± 13.6 years met the inclusion criterion. The mean preoperative calcium was 11.12 ± 0.42 mg/dL. There was no correlation between the wPTH (mean = 138.33 ± 29.36 pg/mL) and the preincision (mean = 201 ± 90.7 pg/mL) and the preexcision (114 ± 82.5 pg/dL) PTH values. The sensitivity, specificity, PPV, NPV, and accuracy of using the wPTH level as the baseline and a normal 10‐minute postexcision level as a criterion was 98.6%, 66.6%, 98.6%, 66.6%, and 97.4%, which was comparable to the already defined criterion.

Conclusion

The pre‐excision and the pre‐incision values do not seem to change the overall accuracy of predicting surgical success if a single 10‐minute postexcision normal level is taken into consideration. A single normal 10‐minute postexcision iPTH assay is a feasible criterion that avoids multiple PTH samples and provides an acceptable predictive value for surgical success in minimally invasive parathyroidectomy.
Partial Laryngeal Surgery for Intermediate Larynx Cancer
Authors: Beswick Daniel M. , Caicedo‐Granados Emiro E. , Cunningham Diana E. , Christopoulos Apostolos , Kubicek Gregory J. , Heron Dwight E. , Ferris Robert L.
Published: February 2015

Objective

Chemoradiation trials over the past 2 decades have assumed that the primary surgical option for intermediate stage laryngeal cancer (T2‐T3/N0‐N1) was total laryngectomy. However, partial laryngeal surgery (PLS), including transoral laser microsurgery (TLM) and supracricoid partial laryngectomy (SCL), can provide sound oncologic and functional outcomes, often without adjuvant therapy.

Method

We retrospectively evaluated oncologic and functional outcomes in laryngeal squamous cell carcinoma (LSCC) patients who underwent TLM or SCL from 1998‐2010. Overall survival (OS) and recurrence‐free survival (RFS) were calculated. The Communication Scale (CS) and Functional Outcome Swallowing Scale (FOSS) were used to evaluate speech and swallowing, respectively.

Results

Eighty‐one patients were analyzed with median follow‐up of 31 months. Eighty‐four percent were T2‐T3/N0‐N1. Two‐ and 5‐year OS probabilities were 84.2% (95% CI: 73.0‐91.0%) and 59.3% (95% CI: 41.4‐73.3%), respectively. There was no difference between the TLM and SCL cohorts in OS (P =. 781) or RFS (P =. 456). Ninety‐four percent of patients still had a larynx at median 31 months. Seventy‐five percent of patients avoided adjuvant therapy, including 67% of TLM and 84% of SCL patients. CS and FOSS were 2‐or‐better in 95% and 88%, respectively, designating functional postoperative voice and swallowing. TLM patients were more likely to have a CS of 2‐or‐better postoperatively (P =. 041).

Conclusion

PLS can provide good oncologic and functional outcomes for intermediate stage LSCC and is an alternative to chemoradiation or total laryngectomy in select patients.
Predicting Quality of Life in Oral and Oropharyngeal Cancer
Authors: Moubayed Sami P. , Sampalis John S. , Gologan Olga , Ayad Tareck , Guertin Louis , Christopoulos Apostolos
Published: February 2015

Objective

1) To evaluate p16 status as a predictor of quality of life (QOL) in oral and oropharyngeal squamous cell carcinoma (OSCC). 2) To identify independent predictive factors of QOL in OSCC.

Methods

1) We conducted a cross‐sectional study on 156 OSCC patients. Patients were evaluated using 3 validated QOL questionnaires (EORTC QLQ‐C30, EORTC QLQ‐HN35, HADS). HPV status was determined using p16 status on immunohistochemistry staining on paraffin blocks. Using chi‐square and t test analyses, we identified the value of p16 as a predictor of QOL. 2) Patient factors, tumor factors, risk factors, and treatment factors were then identified on medical record review. Bivariate analyses identified predictors of QOL, and multivariate regression analyses identified factors with independent significance.

Results

QOL data were collected for 156 patients. Mean and median follow‐up times were 63.2 and 35.0 months. Pretreatment tumor p16 status was available for 88 patients. Pretreatment p16 status did not significantly predict QOL as evaluated by our questionnaires. However, anemia at diagnosis independently predicted long‐term global QOL. T classification predicted long‐term depression, pain, function, and social contact. Number of medications was used as a surrogate of comorbidities, and predicted long‐term pain and depression. Mandibulectomy predicted long‐term pain.

Conclusion

This is the first study in the literature to evaluate the impact of p16 status on prediction of QOL in OSCC. Pretreatment anemia is an independent predictive factor of QOL. Number of medications is used as a surrogate of comorbidities in this study and is an independent and significant predictor of long‐term QOL in OSCC.
Prognostic Factors of Sinonasal Tumors in the Young and the Elderly
Authors: Halmos Gyorgy B. , Peters Thomas T. , Van Der Laan Bernard F.
Published: February 2015

Objective

Sinonasal malignancies are uncommon neoplasms with several histological subtypes, most commonly treated with surgery and postoperative radiotherapy. The aim of this study was to evaluate complications and survival, focusing on differences between elderly and younger patients undergoing surgery.

Method

Medical charts of 107 surgically treated patients (73 under 70 years and 34 aged 70 years or older) in a tertiary referral center with sinonasal malignancy were retrospectively analyzed. Comorbidity was scored according to the ACE‐27 system. Treatment outcomes were analyzed by collecting treatment‐related complications scores and survival data.

Results

Although comorbidity was more common in elderly patients, no significant difference was found in complications. In multivariate analysis length of surgery was the only predictor for complication. Furthermore, no significant difference was seen in survival or recurrence of young and elderly patients. Young patients with squamous cell carcinoma and melanoma had a worse overall survival than patients with other histological subtypes. However, in elderly patients no significant difference was detected in survival between histological subtypes.

Conclusion

For complications, survival, and recurrence no difference was seen between young and elderly patients. Therefore, based on this study, elderly sinonasal cancer patients should not be treated differently than younger counterparts.
Anastomotic Systems in Head and Neck Reconstruction
Authors: Frederick John W. , Magnuson J. Scott , Carroll William R. , Clemons Lisa , Peters Glenn E. , Rosenthal Eben L.
Published: February 2015

Objective

To assess the advantages of using mechanical anastomotic systems in head and neck free tissue transfer.

Method

A review of mechanical venous coupler devices in head and neck reconstruction performed at a university‐based tertiary care facility from 2004 to 2006. A total of 261 venous anastomosis performed in 234 consecutive patients. Five types of flaps were performed, and outcomes measured were flap survival and microvascular complications.

Results

A total of 261 venous anastomosis were performed, size ranging from 2.0 to 4.0 mm, with the majority being 3.0 mm (56%) followed by 3.5 mm (23%). The most common vein used for anastomosis was a stump of the internal jugular vein (75%), followed by the external jugular (18%). Microvascular complications were experienced in 8 patients (3%). The series produced 7 total flap failures (2.6%), 4 (1.5%) classified as acute failure (<5 days) and 3 as late unspecified failure. Of the acute failures, there was 1 confirmed venous congestion and 3 confirmed arterial insufficiencies. The venous coupler used in the 7 failures was 3.0 mm in diameter. The 3 flap failures resulting from arterial insufficiency involved coupling to the external jugular vein, while the remaining 4 failures used the internal jugular. The flap failure secondary to venous congestion involved a 3.0 mm coupler anastomosing the internal jugular vein to the inferior epigastric vessels of the rectus abdominus tissue transfer.

Conclusion

With an early venous failure rate of 0.38%, mechanical anastomosis is an adequate alternative to hand‐sewn anastomotic techniques.