bluuebunny/crossref_metadata_2025 huggingface dataset:
Esthesioneuroblastomas in an Asian Population: Similarities and Differences
Authors: Chua Dennis Yu Kim , Ho Rachel , Goh Christopher
Published: September 2011

Objective

Esthesioneuroblastomas is an uncommon malignant tumor of the olfactory neuroepithelium in the white population. However, in our series with predominantly Asian patients, it is the most common anterior skull base malignancy requiring a craniofacial resection.

Method

Twenty‐four patients who underwent craniofacial resections for malignant anterior skull base tumors and were diagnosed with esthesioneuroblastomas were recruited in this prospective study over a 10‐year period. All patients were operated on by the same surgeon with the same technique.

Results

Twenty‐four out of 48 patients with anterior skull base malignancies had esthesioneuroblastomas. The mean age of patients with esthesioneuroblastomas was 53 years old with no bimodal distribution. Most patients were Chinese (92%) with a male predominance (62%). Major complication rate was 13% and we had 1 unrelated perioperative mortality. Fifty percent of our patients had either local or regional recurrence. Three patients passed away in our series from tumor‐unrelated reasons. Two‐thirds of the patients in our series are alive more than 5 years after the initial diagnosis. The overall 5 year survival rate was 86%.

Conclusion

The predominant malignant anterior skull base tumor requiring a craniofacial resection was an esthesioneuroblastoma (50%). This is much more common than described in other series. There is a good curability with this tumor, with most patients surviving well beyond 5 years.
FMISO‐PET Is a Predictor of Survival Prognosis in Head and Neck Squamous Cell Carcinoma
Authors: Kikuchi Masahiro , Fujiwara Keizo , Senda Michio , Yasushi Naito , Shinohara Shogo , Yamane Tomohiko
Published: September 2011

Objective

Evaluate the usefulness of [18F]fluoromisonidazole ([18F]FMISO)‐positron emission tomography (PET) prior to treatment of head and neck squamous cell carcinoma.

Method

We evaluated 30 lesions from 17 patients with HNSCC underwent pretreatment FMISO‐PET. SUVmax and tumor‐to‐muscle ratios (TMR) were measured as hypoxia indicators and tumors were defined as hypoxic or normoxic. Between the hypoxic tumor group and the normoxic tumor group, local control rates with radiotherapy and survival prognosis were compared.

Results

Radiotherapy outcome: Local control rates with radiotherapy (20‐month median follow‐up duration) were significantly lower for the hypoxic tumor group using either SUVmax or TMR as the hypoxic indicator (P =. 02 and. 04‐respectively). Patient Prognosis (operation or radiotherapy): No significant difference was found between the hypoxic and the normoxic patient groups for event‐free survival rate (12‐month median follow‐up duration) using either SUVmax or TMR as the hypoxic indicator (P =. 07 and. 13, respectively). On the other hand, disease specific survival rate (21‐month median follow‐up duration) was significantly lower in the hypoxic group defined by SUVmax (P =. 04), but was not by TMR (P =. 57).

Conclusion

The current results suggest that the radiotherapy outcome and survival prognosis (operation or radiotherapy) in HNSCC may be predicted by carrying out [18F]FMISO ‐PET/CT before treatment.
Frontal Mucocoeles: The Frontal Pick
Authors: Herman Philippe , Verillaud Benjamin , Tran Hugo , Ruellan Katell , Sauveget Elisabeth , Ba‐Huy Patrice Tran , Kania Romain E.
Published: September 2011

Objective

Treatment of frontal mucocoeles through an endoscopic approach is a cornerstone of minimally invasive surgery. However lysis of the posterior wall of the frontal sinus may provide significant morbidity. The focus of this study is to propose an algorithm to select mucocele drainage versus sinus obliteration.

Method

Retrospective review based on 37 cases of frontal mucocoeles with erosion of the posterior wall treated from 2000 to 2009.

Results

While most of the cases with extensive posterior wall lysis have been successfully addressed through minimal invasive treatment, two patients presented with a “frontal pick” (ie, localized posterior wall deformity). The first patient underwent intractable CSF rhinorrhea 3 months after endoscopic marsupialization of the cyst. A “frontal pick” could be visualized, which had torn open the dura due to the relief of mucocele counterpressure. A subfrontal approach allowed obliteration of the sinus and performance of a duraplasty. The second patient was identified and successfully approached subfrontally, which allowed dissection of the frontal pick.

Conclusion

When posterior wall of the frontal sinus results in a sharp‐angled deformity of the posterior wall, then endoscopic marsupialization may result in CSF rhinorrhea due to tearing of the dura after relieving the counter pressure exerted by the mucocele. A sinus obliteration should then be performed.
Gene Silencing with siRNA Targeting E6/E7 against HPV‐HNSCC
Authors: Adhim Zainal , Kawabata Masato , Otsuki Naoki , Morishita Naoya , Nibu Ken‐Itchi , Shirakawa Toshiro
Published: September 2011

Objective

1) Investigate whether siRNA selectively alters viral gene expression and cellular proliferation of HNSCC containing HPV16. 2) Compare the effectiveness of siRNA for E6 and that of E7 on the inhibition of cellular proliferation and induction of apoptosis in HNSCC.

Method

HNSCC (UM‐SCC47) and Cervical Cancer (Caski) cell lines were used for this study and have been confirmed to contain HPV16. Expressions of HPV oncogene E6/E7 and their cellular targets p53 and pRb were evaluated by real‐time PCR, western‐blotting and immunofluorescence. The cellular‐proliferation and apoptosis by in vitro cytotoxicity assay and flow‐cytometry.

Results

HPV16 E6 and E7 oncogenes were down‐regulated by either HPV16 E6 or E7 siRNAs, respectively. Furthermore, reduction of E6 and E7 oncogenes expression up‐regulated the expression of P53 and pRb protein, and induced apoptosis in both UM‐SCC47 and Caski Cells. In UM‐SCC47 (E6/E7 siRNA groups), real‐time PCR analysis showed that the levels of E6 (P =. 005/P =. 027) and E7 (P =. 002/P =. 011) mRNA were significantly down‐regulated compared with those of control groups. The inhibition of cellular proliferation and induction of apoptosis in combination of E6 and E7 siRNA groups was higher than that of E6 or E7 siRNA group alone and control.

Conclusion

Introduction of HPV16 E6/E7 siRNA might be a potentially potent and specific approach to inhibit proliferation and induce apoptosis of HNSCC containing HPV16 cell lines. For clinical we are currently preparing to test the effects of HPV16 E6/E7 siRNA on xenograft of HNSCC containing HPV16 cell lines.
Endonasal Endoscopic Repair of Orbital Floor Defects
Authors: Ângelo Pedro , Ribeiro Helena G. , Filipe Joana , Subtil João , Dinis Paulo Borges , Oliveira Matos Teresa M.
Published: September 2011

Objective

We have previously published an endonasal endoscopic technique of inferior orbital floor reconstruction, for the surgical management of the “silent sinus syndrome” and “blow‐out” orbital fractures. Based on the same principles, we present an alternative version of the technique with the advantage of an “overlay” approach to the bone defect.

Method

After creating a large middle meatal antrostomy, an autologous septal bone graft is placed over the orbit floor defect, in the subperiostal plane between orbital contents and bony floor, through an incision on the lamina papyracea.

Results

At long‐term follow‐up we achieve, in most, if not all, cases, resolution of enophthalmos and ipsilateral chronic maxillary sinus atelectasis, with minimal morbidity.

Conclusion

This technique provides excellent functional and aesthetic results in the surgical reconstruction of the orbit floor.
HPV and Its Role in Anterior Oral Cavity Dysplasia
Authors: Cashman Emma , Bin‐Woo Sook
Published: September 2011

Objective

1) Access the role of HPV in anterior oral cavity dysplasia in a sample population. 2) Review the literature with respect to the role of HPV as a potential marker of propensity for malignant transformation.

Method

Tissues were obtained from the department of oral pathology, Brigham and Women’s hospital, Harvard Medical School. DNA was extracted using lysis buffer and proteinse K. Detection of HPV 6/11, 16, 18 was performed by PCR using E6 gene region primers. PCR were hybridized with type‐specific probes and visualized with alkaline‐phosphatase immunoassay.

Results

A total of 18 patients with moderate (13/18) and severe (5/18) dysplasia. Mean age was 59.6 years (range, 36‐79 years). All patients were smokers. HPV DNA was detected in (18/18) 100% of samples.

Conclusion

Determination of HPV status in OPC is recognized as a valuable prognostic indicator. However, HPV has rarely been identified in dysplasia of the anterior oral cavity. Recent studies provide conflicting results. Our results and meta‐analysis of the literature suggest a potential role.
HPV and Other Risk Factors: Oropharyngeal Tumor Survival
Authors: Kaschke Oliver , Zakarneh André , Knoedler Maren , Zimmermann Ulrike , Woelke Katharina , Keilholz Ulrich
Published: September 2011

Objective

Oropharyngeal carcinomas are associated with tobacco smoking and alcohol but also HPV infection. HPV‐associated carcinomas have a more favorable prognosis in contrast to tobacco‐ and alcohol‐induced carcinomas. Frequency and outcome of HPV‐associated oropharyngeal carcinomas (tonsils and base of tongue) in a cohort with high prevalence of smoking are reported.

Method

A group of 114 patients with oropharyngeal squamous cell carcinomas (60 tonsil tumors, 54 base of tongue tumors) was controlled. Surgery, chemoradiation, or radiotherapy was performed according to the stage of disease. Complete follow‐up was obtained in fall 2010. Histologic slides were retrieved and stained for p16 as HPV association indicator.

Results

All 114 patients (81% smokers, 64% tumors stained positive for p16, tonsils 73%, base of tongue 54%). With a median follow‐up of 28 months, 31 patients had disease progression and 39 patients died. Three‐year PFS rates were 79% and 52% in patients with p16+ vs p16‐ tumors (P =. 001 by log‐rank test). In Cox regression analysis, only stage and p16 were independent prognostic factors. For PFS p16 had a hazard ratio (HR) of 0.44% (95% CI, 0.25 to 0.78).

Conclusion

Even in a European population with high prevalence of tobacco smoking, p16 positivity remains a strong favorable and independent risk factor, as has previously been shown in US cohorts with far lower smoking prevalence.
HPV E6/E7 mRNA Expression in Oropharyngeal Carcinoma
Authors: Hasegawa Masahiro , Meda Hiroyuki , Agena Shinya , Suzuki Mikio
Published: September 2011

Objective

Although patients with human papillomavirus (HPV)‐positive oropharyngeal carcinoma (OC) respond well to radiation therapy and have good prognosis, HPV integration in OC has not yet been fully analyzed. Therefore, we aimed to clarify the correlation between HPV infection or integration and prognosis of OC in a prospective study setting.

Method

From 2006 to 2010, 56 patients with OC participated in the study. All patients were treated with 70 Gy concurrent chemoradiotherapy (CCRT). If OC did not show a partial or complete response at 40‐Gy irradiation, radical resection for residual tumor was performed.

Results

A total of 26 patients (46.4%) had HPV‐positive OC, and 70% of HPV‐16‐positive OC cases showed integration with the host genome. Control samples obtained from chronic tonsillitis patients showed 1 of 47 specimens as positive for HPV. Patients with high HPV load also showed E6/E7 mRNA expression. Recurrent‐free survival at 3 years was 100% in HPV‐positive cases and 88.9% in HPV‐negative cases. Cases with HPV integration or E6/E7 mRNA expression tended to respond well to CCRT in spite of advanced tumor extensions.

Conclusion

Although HPV testing is useful for OC, HPV integration or E6/E7 mRNA expression is a more specific marker for predicting a fair response to CCRT and good prognosis. These findings also indicate that HPV plays a key role in the development and extension of OC.
Hybrid Tracheostomy: A Safe, Effective Compromise
Authors: Makowski Renee Lynn , Moe Kris S.
Published: September 2011

Objective

1) Describe a minimally invasive hybrid tracheostomy technique that combines the advantages of open and percutaneous techniques. 2) Compare the safety of hybrid tracheostomy to a historical cohort of open tracheostomy.

Method

We developed a rapid, efficacious technique of hybrid tracheostomy (HT), combining the advantages of standard (ST) and percutaneous (PT) techniques. This paper will review 173 patients, then describe the technique and present an outcome study and cohort comparison demonstrating the procedure’s efficacy.

Results

HT uses a minimal approach similar to the percutaneous procedure but provides an open surgical view of the airway to ensure safety. It is significantly more rapid than PT, and bronchoscopy is not required. The typical procedure duration for resident surgeons performing HT ranges from 4 to 7 minutes. There were no intra‐operative complications in the HT or ST groups. In a cohort of 15 cases matched for statistical assessment, there was no significant difference in postoperative bleeding, infection or accidental decannulation rates. There were no complications requiring operative intervention.

Conclusion

HT appears to be more efficacious than either PT or ST. It provides the excellent airway control and visualization of ST, while being similarly or less invasive than PT. In our experience, there were no significant complications with either technique.
Impact of Age on Chemotherapy Response in Head and Neck Cancer
Authors: Cashman Emma , Lorch Jochen , Posner Michael
Published: September 2011

Objective

1) Determine if an association exists between age and overall survival (OS) and progression‐free survival (PFS) in induction chemotherapy (IC) for head and neck cancer (HNC). 2) Compare age‐specific response to 2 different chemotherapy regimen in HNC.

Method

A total of 501 patients enrolled on TAX 324 study (1999 to 2003) were evaluated. Patients had nonmetastatic, unresectable stage III/IV HNC. A total of 255 patients received IC with docetaxel, cisplatin, 5FU (TPF), and 246 received cisplatin, 5 fluorouracil (PF). The cohort was split into 2 groups; 55 years.

Results

Fisher exact test and general linear model approach compared clinical and demographic characteristics between treatment arms. Kaplan‐Meir method estimated OS and PFS. Stepwise Cox regression modeled OS and PFS functions. A total of 249 patients were 55 years, 127 were assigned to TPF arm and 125 to PF arm, Total failures reached statistical significance between the 2 arms; there were 50 total failures in the TPF arm and 58 in the PF arm (0.65, 0.42‐0.98; 0.04).

Conclusion

Our study contradicts the small amount of published evidence on age‐specific responses to chemotherapy regimen in breast, prostate, and lung cancer. It is the first study of its kind evaluating the role of age in overall survival in chemotherapy in HNC.
Impact of Regulatory T Cells in Oropharyngeal Cancer
Authors: Boucek Jan , Rihova Blanka , Betka Jaroslav , Eckschlager Tomas , Zabrodsky Michal , Betka Jan
Published: September 2011

Objective

Oropharyngeal cancer is the most frequent type of malignancy in the head and neck area. Regulatory T cells (Treg, CD4+CD25+Foxp3+) and Th17 cells were described as critical factors for regulation or inhibition of effective anti‐cancer immune response and, consequently, prognosis and survival.

Method

We examined Treg and Th17 from periphery blood and tumor samples of patients with oropharyngeal cancer before the start of anti‐tumor therapy. We particularly focused on lymphocytes subpopulations (CD3+, CD3‐CD16+CD56+, CD4+, CD8+, CD19+, CD4+CD45RA+, CD3+CD4+CD25+, CD161+CD4+ a CD161+CD8+) and tumor markers (SCC, CEA, AAT, Cyfra 21‐1).

Results

In comparison with control group (nononcologic surgery), the Treg population in the peripheral blood of the patients with oropharyngeal cancer was 1.6‐fold higher. Infiltration of Treg in specimens from primary tumors and metastatic neck lymph nodes was higher (8.7% and 9.6%) in comparison with oropharyngeal tissue and neck lymph nodes without tumor or metastatic extension (3.12% and 3.3%, both p+CD161+cells and 12.8% CD8+CD161+ cells, and in tumor tissue, 1.66% CD4+CD161+ cells and 3.9% CD8+CD161+ cells. Level of tumor marker CEA correlated with higher T stadium (T3+4, t‐test, P <. 005).

Conclusion

We can conclude that regulatory T cells and Th17 generally represent a highly important factor in the progression of many types of malignancies and our data indicated their particular importance for oropharyngeal cancer.
Initial Experience Training Otorhinolaryngology Residents in Transoral Robotic Surgery
Authors: Sperry Steven , O’Malley Bert W. , Weinstein Gregory S.
Published: September 2011

Objective

1) Describe a safe, efficient, and effective pathway for the development of transoral robotic surgical skills in otorhinolaryngology residency training, and 2) Report initial results of resident experience in the training modules.

Method

A curriculum for training otorhinolaryngology residents in transoral robotic surgery (TORS) was defined. The training included PGYII‐V residents and progressed through modules, including Didactics, Skills, and Operative. In the skills module, performance measurements in the simulator were recorded. Surveys of PGY‐V residents completing the curriculum assessed the program effectiveness.

Results

Didactics teach the device setup, controls, and surgical approaches, via video and texts. Skills‐training is primarily completed with a robotic surgery simulator. Introduction to the TORS approach is completed on cadaver models. The operative experience includes live case observation, bedside surgical assistant, and finally console surgeon. The surgical experience advances in a stepwise fashion, with the resident progressing after demonstrating proficiency with preceding steps. Proficiency in the robotic simulator with performance of simple tasks was demonstrated by all participants within a 2‐hour initial session. Residents completing the modules expressed satisfaction with their comfort level in performing basic procedures via TORS.

Conclusion

An efficient and effective curriculum for training residents in TORS was developed. This formal training is necessary and effective for residents to acquire the knowledge and skills to perform TORS safely. Further evaluation is warranted to improve the training curriculum and increase training experiences during otorhinolaryngology residency.
Longitudinal TEP Size Stability
Authors: Lundy Donna , Landera Mario , Weed Donald T.
Published: September 2011

Objective

Tracheoesophageal speech rehabilitation is considered the gold standard after laryngectomy. Changes in size of the prosthesis are common in the early period after initial fitting. Size may be affected by factors over time necessitating continued assessment. This study will determine size stability in laryngectomized patients over a 5‐year period.

Method

Individuals s/p total laryngectomy and TEP with a minimum 5‐year follow‐up will be accrued. Data will be derived from chart review including demographic, surgical, medical, and prosthesis factors by stability of size over time after the first three‐month initial fitting phase.

Results

Thirty‐seven patients, 32 males and 5 females, met the criteria and were included in the study. Mean age was 63.7 years (range, 41‐78 years). Medical factors leading to total laryngectomy changed over the follow‐up period with more recent patients only undergoing laryngectomy for either extremely advanced disease or recurrence versus persistent disease after chemo‐radiation therapy. A total of 80% of patients required a change in the length and/or diameter of their prosthesis over the 5‐year follow‐up period regardless of other medical and surgical factors.

Conclusion

Clinicians need to continually reassess prosthesis fit for the life of the patient to prevent inadvertant closure of the posterior fistula tract from a prosthesis that is too short or pistoning resulting in aspiration from a prosthesis that is too long. This contrasts previous reports of stability after initial fitting.
Endoscopic Removal of Subcutaneous Pyogenic Granuloma of the Nasal Radix
Authors: Badran Karam , Gu Mai , Rothholtz Vanessa S. , Wong Brian
Published: September 2011

Objective

This case report describes the removal of a subcutaneous pyogenic granuloma (lobular capillary hemangioma) on the left nasal bone in a 51‐year‐old woman. A minimally invasive surgical approach using rhinoplasty techniques combined with endoscopes is described, along with indications and contraindications for use.

Method

The nontender nasal mass developed over 5 weeks. It was soft like a lipoma and clearly subcutaneous with no visible puncta or cutaneous irregularity, and was lateral to the nasal bones between radix and rhinion. The patient wanted to avoid a skin incision at all costs.

Results

Under anesthesia, an intercartilagenous incision was made and sharp dissection over the upper lateral cartilage and nasal bone was performed to approach the mass. Using endoscopes and dissectors, the mass was removed with a cuff of soft tissue. It appeared blue and grossly consistent with a vascular neoplasm. Frozen section evaluation was nondiagnostic. Final histopathology showed the characteristic lobular configuration with a central branching vessel with solid growth pattern of endothelial proliferation. At 12 weeks no contour defect along lateral nasal sidewall was appreciated. The indications and limitations of this minimally invasive approach will be discussed.

Conclusion

This presentation of a pyogenic granuloma is rare and unusual. An endonasal rhinoplasty approach utilizing endoscopy instrumentation spared the patient a cutaneous scar. This approach should be considered for patients with similar deep subcutaneous benign neoplasms over the osseous or cartilage nasal framework as it spares a visible incision.
Long‐Term Cosmetic Outcomes of Parotidectomy Reconstruction: AlloDerm versus Free Dermal Fat Graft
Authors: Mitchell Joshua R. , Robinson Jamie , Rangarajan Sanjeet , Netterville James L. , Athavale Sanjay M. , Dhulipala Sravan
Published: September 2011

Objective

Parotid neoplasms generally require surgical resection with adequate margins. Cosmetic contour deformities resulting from parotidectomy can cause significant postoperative dissatisfaction. Therefore, we seek to compare the functional and cosmetic success of 2 postparotidectomy reconstructive modalities: autologous free dermal fat grafting (FDFG) and AlloDerm implantation.

Method

We conducted a retrospective review of all patients who underwent a parotidectomy with either AlloDerm or autologous FDFG reconstruction by a single surgeon since January 1997. Complications were identified and patients from both cohorts were contacted by telephone to assess cosmetic satisfaction using a novel analogue scale.

Results

Sixty‐five patients who received AlloDerm reconstruction and 35 patients who received FDFG reconstruction were analyzed. The incidence of complications following FDFG was 3% (n = 1) compared with 5% (n = 3) after AlloDerm implantation (P = 1.000). Both cohorts rated their reconstruction on symmetry (1‐worst to 5‐best), degree of change (1‐least to 5‐most), and overall satisfaction (1‐worst to 5‐best). Patients with FDFG reconstruction reported favorable cosmesis with respect to symmetry (4.5 ± 0.7) and overall appearance (4.8 ± 0.4), while indicating mild changes in their appearance over time (2.0 ± 1.2). At the time of this writing, cosmetic assessment of AlloDerm patients was underway but incomplete.

Conclusion

FDFG and AlloDerm are cosmetically and functionally viable options to reconstruct the post‐ablative parotid bed. Both modalities demonstrated similarly low complication rates (P = 1.000), and an assessment of long‐term patient satisfaction with AlloDerm will determine how it compares to the cosmetically efficacious FDFG.
Methylome Analysis of HPV‐Associated Head and Neck Cancer
Authors: Lechner Matthias Alexander , Feber Andrew , Teschendorff Andrew , Boshoff Chris , Wilson Gareth , Butcher Lee M. , Beck Stephan
Published: September 2011

Objective

A significant proportion of HNSCC is caused by human papillomavirus. Patients diagnosed with this subtype have a significantly better outcome. It is the aim of the UCL Head and Neck Cancer Epigenome Project to generate and analyze comprehensive, genome‐wide profiles of epigenetic aberrations in this specific type of human cancer.

Method

Whole‐genome DNA methylation (methylome) analysis of 3 HPV positive and 3 HPV negative frozen HNSCC samples (obtained from the UCL Head and Neck Cancer Tissue Bank as part of a larger discovery set) was conducted using methylated DNA immunoprecipitation coupled with next‐generation sequencing (MeDIP‐Seq).

Results

On average, each sample in the pilot phase generated 2 x 107 sequencing reads and 70% coverage of all CpG sites within the host genome. HPV type 16 was observed in all HPV positive samples and, interestingly, methylated regions of this virus were identified—most notably at genes E1 and L1 (previously shown to have been methylated in cervical cancer). We also detected multiple methylation changes between HPV positive and HPV negative host’s methylomes, of which a significant proportion mapped to genes previously shown to display down‐regulated expression in transcriptionally active HPV positive oropharyngeal cancer.

Conclusion

The observed epigenetic differences between the 2 types might explain the different clinical behavior of HPV‐associated HNSCC. Although preliminary, these pilot data are encouraging with respect to the possibility of identifying potential diagnostic and prognostic markers, as well as putative therapeutic targets in this subtype of HNSCC.
Nodal Disease in Post‐chemoradiotherapy Neck Dissection
Authors: Ahsan Farhan , Junor Elizabeth , Ironside Janet , Vernham Guy A. , Ganly Ian , Keh Siew M.
Published: September 2011

Objective

1) Determine the rate of residual neck node disease in patients with squamous cell carcinoma of the larynx, hypopharynx, and oropharynx undergoing neck dissection post‐chemoradiation; and 2) Determine the impact on outcome.

Method

Design: Retrospective case series. Patients: Thirty‐three consecutive patients with residual neck disease following chemoradiotherapy for advanced stage laryngopharyngeal cancer were identified at a single institution between May 2003 and October 2007. Main outcome measure: Neck node pathological positivity, neck recurrence free survival, and disease specific survival.

Results

Thirty‐eight neck dissections were carried out in 33 patients (median ± STD age, 59 ± 7.8 years; 85% male). The oropharynx was the most common primary site (n = 27; 73%). The follow‐up duration ranged from 9 to 61 months. Pathologically, 39.4% (13/33) of patients had viable tumor cells identified in dissection specimen. Three patients (9%) developed primary site recurrence. One patient (3%) died from local/regional disease and 2 patients (6%) died from distant metastasis. There was no statistically significant (P =. 37) increase in neck recurrence rate in the SND group when compared to the MRND and RND groups.

Conclusion

Viable tumor results in poorer outcome even after complete resection by neck dissection.
Oncologic Validity of Cervical Recipient Vessel Preservation
Authors: DeConde Adam , Vira Darshni , Blackwell Keith E.
Published: September 2011

Objective

Determine whether preservation of cervical recipient vessels affects surgical resection margins in patients who undergo microvascular free flap procedures for defects of reconstruction of the head and neck after the treatment of neoplasms.

Method

Consecutive patients with adventitial biopsies of recipient neck vessels were identified over the previous 6‐month period, and pathology was reviewed. Patient clinical information (age, sex, diagnosis, tumor site, tumor stage, prior treatment with surgery, radiation therapy, chemotherapy) was reviewed as potential risk factors for tumor involvement of recipient vessels.

Results

A total of 57 patients with recipient vessel biopsies were identified between June 2010 and January 2011. Tumor sites included oral‐oropharnygeal (n = 38), laryngopharyngeal (n = 8), scalp (n = 7), skull base‐midface (n = 3), and neck (n = 1). Tumor pathology included squamous cell carcinoma (n = 45), osteoradionecrosis with a history of squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), ossifying fibroma (n = 2), as well as a case each of ameloblastma and melanoma. One (1.7%) recipient vessel biopsy was positive for squamous cell carcinoma. This vessel looked grossly abnormal and was sent for frozen section analysis.

Conclusion

Microvascular free flap reconstruction uses recipient vessels in the neck, which can potentially adversely affect resection margins by requiring preservation of recipient vessels in proximity to tumors. However, our results show that frozen section biopsy is necessary only when intra‐operative findings are concerning for tumor involvement of the recipient vessels.
Overexpression of CIP2A in Head and Neck Cutaneous SCC
Authors: Koide Jade , Sauer David , Wong Melissa , Gross Neil D. , Clayburgh Daniel
Published: September 2011

Objective

Determine if 1) Cancerous Inhibitor of Phosphoprotein 2A (CIP2A), which increases c‐myc activity by inhibiting the c‐myc inhibitor Phosphoprotein 2A (PP2A), is overexpressed in cutaneous squamous cell carcinoma of the head and neck (cSCCHN). 2) PP2A expression is altered in cSCCHN.

Method

Specimens of normal skin, early stage cSCCHN, late stage primary cSCCHN, and metastatic cSCCHN were sectioned and subjected to immunofluorescence staining for CIP2A and PP2A. CIP2A and PP2A expression was quantitated using the validated open‐source software CellProfiler. Expression changes were assessed with ANOVA and Bonferroni tests, with p < 0.05 denoting significance.

Results

A total of 38 specimens were examined (5 normal skin, 9 early stage cSCCHN, 12 late stage cSCCHN, and 12 metastatic cSCCHN). CIP2A was significantly overexpressed in early stage cSCCHN relative to normal skin (30.0 vs 17.7% of cells positive for CIP2A, P =. 049), while expression was even higher in late stage primary cSCCHN (46.3% positive) and metastatic cSCCHN (49.4% positive, P =. 004 vs normal, ANOVA among all 4 groups: P =. 002). However, PP2A expression was completely unchanged among all 4 groups (P =. 9754 by ANOVA).

Conclusion

While PP2A expression is unchanged, CIP2A is overexpressed in cSCCHN, and increasing expression of CIP2A is correlated with metastatic progression of cSCCHN. Thus, CIP2A activity may be important to cSCCHN tumorigenesis and serve both as a prognostic marker and as a novel target for new therapeutic agents.
Parathyroid Ectopia‐Development of a Surgical Algorithm
Authors: Gunasekaran Sinnappa P. , Mikl Dan , Wallace Helen C. , England James
Published: September 2011

Objective

Study the incidence of ectopic parathyroid adenomata from a single surgical series and devise a surgical algorithm from the results to follow when an adenoma cannot initially be located.

Method

Retrospective review of a prospectively collected senior author’s (RJAE) database of 357 patients who underwent parathyroidectomy between June 2001 and February 2008. From the database, an ordered surgical protocol has been developed for the location of both ectopic superior and inferior parathyroid adenomata in order of incidence.

Results

Parathyroid ectopia occurs in approximately 10% of cases of hyperparathyroidism. It is more common in superior than inferior parathyroid glands. The most common superior location is the left retroesophageal position, and the most common inferior location is within the left thymic remnant.

Conclusion

Prospective data collection and subsequent analysis can lead to the development of a systematic surgical protocol to aid the location of ectopic enlarged parathyroid glands in the surgical management of hyperparathyroidism.
Parotid Gland Tumors: A Survey of UK Management Practice
Authors: Bradley Paula Theresa , Homer Jarrod J.
Published: September 2011

Objective

Identify if practice variations exist in the management of parotid lesions between otolaryngologists and oral maxillofacial specialists (OMFS). Benign and malignant parotid surgery is undertaken by both otolaryngologists and OMFS. Between the specialties there is debate about the surgical approach to parotid tumors.

Method

An online questionnaire (SurveyMonkey) was sent to members of ENT‐UK via email. The members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) were posted a questionnaire that was either returned by post or completed online.

Results

A total of 108 otolaryngologists and 98 OMFS res‐ponded to the questionnaire, all of whom performed parotid surgery. The majority (75.2%) of otolaryngologists used facial nerve monitors in all/most cases whereas 73.1% OMFS used them never/seldom. In revision surgery 88.3% of otolaryngologists mostly/always used a facial monitor compared to 38% of OMFS with 39.1% never/seldom using one. The choice of surgery for a presumed pleomorphic adenoma showed the most difference between the two groups: 87.6% of otolaryngologists would perform a partial parotidectomy, yet 34.5% of OMFS would remove the tumor by extracapsular dissection of the tumor without a cuff.

Conclusion

There are marked differences in the approach to parotid disease between OMFS and otolaryngologists, particularly in the intra‐operative monitoring and the surgical approach.
Feasibility of Endoscopic Intramedullary Fixation of Fractures of the Mandibular Condyle
Authors: Frake Paul C. , Joshi Arjun S. , Goodman Joseph F.
Published: September 2011

Objective

1) Describe a novel technique for internal fixation of mandibular condyle fractures, as well as a new type of implant for the same. 2) Demonstrate surgical feasibility of this technique in a cadaver model.

Method

A transoral endoscopic approach was used to access the osteotomized mandibular condyle in 2 human cadavers. Titanium intramedullary implants were placed endoscopically after reaming of the medullary space without the need for transbuccal puncture or facial incisions.

Results

Both cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg type implant and screwing a threaded implant into the condylar head are possible. The inferior portion of the implant remains exposed and the ramus of the mandible can be manipulated into position on the implant using retraction at the sigmoid notch.

Conclusion

True total endoscopic repair of fractures of the mandibular condyle is possible by utilizing novel intramedullary titanium implants and a transoral endoscopic approach. This is the first description of the technique and implants for endoscopic intramedullary fixation of fractures of the mandibular condyle.
Percutaneous Gastrostomy Complications and the Management of Head and Neck Cancer
Authors: Gal Thomas J. , Sokoya Fiyin , Valentino Joseph
Published: September 2011

Objective

1) Understand the surgical site morbidity of percutaneous gastrostomy (PEG) in the head and neck cancer population. 2) Understand the implications of PEG morbidity on the therapy for head and neck cancer.

Method

A retrospective review was performed on patients with head and neck cancer undergoing PEG in a tertiary care center. Patients treated between 1998 and 2008 were eligible for inclusion. Demographic and oncologic data were recorded. Primary outcome measures were surgical complications and complication type arising from the gastrostomy itself.

Results

A total of 153 patients were identified with sufficient data available for review. A total of 61.6% of patients were male. Mean age was 58.1 years. Complications were observed in 28.1% of patients. The most common documented complication was leakage around the gastrostomy site (9.2%). Other observed complications included cellulitis of the abdominal wall (8.5%), abdominal wall abscess (1%), buried or extruded bumper (8%), and non‐patent tubes (2.3%). Major complications were documented in 4 patients (2.6%) and included hemorrhage, perforated viscus, and peritonitis. No association of complications of any type with age, gender, tumor site, stage, or surgical service were observed.

Conclusion

Complications resulting from PEG in the head and neck cancer population are for the most part minor, self limited, and likely underreported. Major complications are infrequent but can be significant. Management and treatment implications with regards to head and neck cancer are discussed.
Prevention of Complications in Salvage Pharyngolaryngectomy
Authors: Sakai Akihiro , Okami Kenji , Iida Masahiro
Published: September 2011

Objective

Salvage pharyngolaryngeal surgery can often cause severe complications. We applied surgical techniques, including pectoralis major myocutaneous flap (PMMCF) or deltopectoral flap (DPF) and some additional techniques, and could reduce the PCF and severe complications. Herein, we report the usefulness of our surgical techniques in salvage pharyngolaryngeal surgery.

Method

This retrospective study was based on a review between 2001 and 2010. Additional surgical techniques were applied since 2008. Our surgical techniques included covering with PMMC or DP, leakage test, thyroid lobe preserving, and suturing the tracheal cartilage to sternoclavicular joint. The complication rate and PCF rate were analyzed.

Results

Salvage surgeries were undergone in 36 patients between 2001 and 2008. The wound complication rate was 30.5%. The incidence of PCF was 22.2%. In the chemoradiation group, 3 out of the 5 PCF cases suffered severe bleeding. Since 2008 salvage surgery was performed in 18 patients. The wound complication rate was 28% and PCF rate was 5.5%. We had no lethal complication, such as carotid rupture.

Conclusion

We could not reduce the complication rate because the complications of flap were increased. However, we could reduce the PCF rate and lethal complications using additional surgical techniques. We must improve the surgical techniques to reduce the risk of complications in salvage pharyngolaryngeal surgery in the era of organ preservation therapy.
Prognostic Value of PET‐CT for Oropharyngeal Carcinoma
Authors: Wallin Jordan L. , Mintz Akiva , Young Evan , Isom Scott , Browne J. Dale , Greven Katherine
Published: September 2011

Objective

Understand local, nodal, and distant cure rates and the prognostic value of [18F]Fluorodeoxyglucose positron emission tomography (PET‐CT) after chemoradiation (CRT) for advanced oropharyngeal squamous cell carcinoma (OPSCC). Propose a potential algorithm for surveillance PET‐CT based on patient history.

Method

A retrospective chart review of 53 patients treated from 2005 to 2008 with CRT for stage 3 (6%) or stage 4 (94%) OPSCC at a tertiary referral center. Variables reviewed included type of CRT, PET‐CT results, and smoking history. Outcomes evaluated included patterns of recurrence, survival, and progression free survival (PFS).

Results

Overall PFS rate was 77% at 3 years. The first post‐treatment PET‐CT obtained a median of 2.3 months after CRT was normal in 32 patients, however 5 patients ultimately relapsed. Sixteen patients had elevated FDG uptake of which 3 recurred. The result of the first PET‐CT was not significantly associated with recurrence (P =. 2988). The second post‐treatment PET‐CT, obtained a median of 8.6 months after CRT, was normal in 28 patients, of which only one relapsed. Four out of 12 patients with abnormal scans recurred. A normal delayed PET‐CT predicted the absence of disease (P =. 0211).

Conclusion

A normal PET‐CT early after CRT for OPSCC did not reflect the absence of disease. A normal PET‐CT 6 to 8 months after treatment predicted good control of disease. The optimal time for PET‐CT to demonstrate prognostic value may be 6 to 8 months after completion of CRT.
Proliferative Verrucous Leukoplakia: Rare but Lethal
Authors: Abadie Wesley M. , Schmalbach Cecelia
Published: September 2011

Objective

Proliferative verrucous leukoplakia (PVL) is a rare, recalcitrant, and lethal form of leukoplakia necessitating special attention. The purpose of this review is to further educate the otolaryngology community and to characterize the risk factors, clinical course, and optimal treatment for this highly aggressive, premalignant oral lesion.

Method

A retrospective review was performed on all PVL cases treated at WMHC from 1985 to 2010. This data was pooled with additional PVL cases identified following a systemic review of the English‐language literature. Only articles addressing epidemiology, histopathology, treatment outcomes, and malignant progression were pooled and analyzed with our data.

Results

A total of 243 PVL cases met inclusion criteria. The mean patient age was 66 years. The majority of patients were female (72%) and nonsmokers (64.6%). HPV has not been found to be a risk factor. The average length of follow‐up was 5.5 years, with an average of 10.7 biopsies per patient during this period. PVL exhibits histopathologic features along a progressive spectrum, evolving from leukoplakia and verrucous hyperplasia eventually to invasive carcinoma. Definitive treatment was rarely successful, with PVL recurrence rates reaching 88%. Rate of progression to verrucous carcinoma or oral squamous cell carcinoma was high (63.6%).

Conclusion

PVL is a rare but recalcitrant form of leukoplakia with a malignant transformation rate reaching 64%. PVL warrants high clinical suspicion, to include a lifetime of close follow‐up by a physician well versed in oral carcinoma. Repeat biopsy should be considered an integral part of this routine follow‐up.
PTH Level, Gland Radioactivity, and Gland Weight in MIRP
Authors: Moore Evan Robert , Spencer Horace , Stack Brendan C. , Bodenner Donald
Published: September 2011

Objective

Better understand the relationships of parathyroid hormone production (PTH), adenoma gamma counts, and adenoma weight in patients undergoing minimally invasive parathyroidectomy for primary hyperparathyroidism due to single gland disease.

Method

A retrospective review of 68 patients that had minimally invasive parathyroid surgery for single gland disease. All patients underwent intraoperative PTH monitoring as well as radioguided parathyroid surgery. All glands were weighed and examined by a pathologist.

Results

Adenoma weight was 0.58 gms ± 0.44 gms. Day of surgery preoperative PTH was 132 ± 68 pg/mL. Intraoperative PTH level dropped to 35 ± 22 pg/mL. The drop in PTH was 72.1 ± 17.2 %. Ex‐vivo gamma counts of the adenomas were 2233 counts per second ± 2058. Percentage of background for the adenoma was 107.2 ± 86.8%. Correlations between the preoperative PTH and percentage of background gamma counts showed a likely correlation. There were significant correlations between both percentage of background and preoperative PTH levels with adenoma weight and preoperative PTH and adenoma weight.

Conclusion

Correlation exists between gland weight, radioactivity, and PTH. Radiation counts are not a proxy for changes in PTH levels as claimed by some authors. A radioguided parathyroid surgery technique and intraoperative parathyroid hormone measurements can provide complementary information in making an assessment of completion of focused/minimally invasive parathyroid procedures.
Injection Filler, Vascular Occlusion, and Tissue Necrosis
Authors: Czyz Craig , Allen Shannon H.
Published: September 2011

Objective

Case report examining an incident of distant tissue necrosis following glabella radiesse injection. Review current literature on injection fillers, incidence of resulting tissue damage, patterns, and treatment options.

Method

Literature review: 1) Calcium hydroxylapetite; 2) Hyaluronic acids; 3) All injection fillers. Identifying patterns of injury and treatment consensus.

Results

Literature reviewed and presented on patterns to injury and treatment.

Conclusion

Based on available data and identified patterns of damage and treatment.
Quantitative Frozen Biopsy of Central Metastasis in PTC
Authors: Lim Yun‐Sung , Lee Yoon Se , Lee Byung‐Joo , Lee Jin‐Choon , Wang Soo‐Geun
Published: September 2011

Objective

Nodal metastasis in PTC occurs in the central compartment of the ipsilateral neck and spreads laterally. Occult lateral neck metastasis can be predictable by lymphatic status of central compartment. This study was to evaluate the diagnostic accuracy of frozen biopsy for quantitative nodal evaluation of central neck metastasis.

Method

A total of 264 patients with papillary thyroid cancer underwent total thyroidectomy with central compartment neck dissection as an initial operation. All fresh tissues from ipsilateral central neck dissection were examined by frozen biopsy for central neck metastasis with quantitative nodal analysis.

Results

Among them, 134 patients (51% [134/262]) had central neck metastasis. The sensitivity and specificity of frozen biopsy for the detection of central neck metastasis were 100% and 99.2% in 264 patients who underwent total thyroidectomy with bilateral central neck dissection. The diagnostic accuracy for the number of metastatic ipsilateral central lymph nodes was 85.8% compared with permanent biopsy in 134 patients who had central neck metastasis.

Conclusion

Frozen biopsy for quantitative analysis of central compartment is a precise tool for intraoperative evaluation of central lymphatic status and would also be helpful for prediction of nodal involvement of lateral neck.
Regional Control of Head and Neck Melanoma with Selective Neck Dissection
Authors: Geltzeiler Mathew , Givi Babak , Vetto John , Monroe Marcus M. , Gross Neil D. , Andersen Peter E.
Published: September 2011

Objective

Historically, patients with cervical metastases from melanoma of the head and neck were treated with a modified radical or radical neck dissection. The purpose of our study was to evaluate the efficacy of therapeutic selective neck dissection (SND) in this high‐risk population.

Method

Retrospective, single‐cohort study from a prospective institutional database. Patients underwent therapeutic SND for clinically node positive head and neck melanoma (n = 14) or pathologically node positive disease after sentinel lymph node biopsy (SLNB) (n = 27). Univariate and multivariate analyses were conducted. Primary end points were regional recurrence and regional recurrence free survival.

Results

Forty‐one patients underwent therapeutic SND from 2001 to 2010. The median number of positive nodes was 1 (range, 1‐16 months). Twenty‐six patients (63%) received adjuvant radiation and 23 patients (56%) received adjuvant immunotherapy or chemotherapy. The median follow‐up time was 17 months (range, 1‐116 months). Regional control was achieved in 29 patients (71%). Median regional recurrence‐free survival was 21 months (range, 1‐116 months). Advanced age was a significant predictor of regional recurrence (P =. 012) while tumor depth, extracapsular spread, number of nodes positive, prior SLNB, extent of neck dissection, adjuvant radiotherapy, and adjuvant immunotherapy were not significant.

Conclusion

Therapeutic SND with frequent use of adjuvant radiation therapy is effective in achieving regional control of head and neck melanoma with cervical metastases. Older patients may be at increased risk of regional recurrence after SND for head and neck melanoma.