bluuebunny/crossref_metadata_2025 huggingface dataset:
Retropharyngeal Node Metastasis in Nasopharyngeal Carcinoma
Authors: Chen Mu‐Kuan , We Wu Iuan‐Sheng
Published: September 2011

Objective

PET/CT has been proposed to enhance pretreatment evaluation of cervical nodal status in patients with nasopharyngeal carcinoma (NPC). The purpose of this study was to compare PET/CT and enhanced CT in the detection of retropharyngeal lymph node (RLN) metastasis in NPC, and to ascertain the factors affecting its diagnostic performance.

Method

From 2007 to 2008, 33 patients with newly diagnosed NPC were prospectively studied. All patients underwent an enhanced CT scan and FDG‐PET/CT.

Results

The detection rate of RLN metastasis on PET/CT was significantly lower than that on enhanced CT (36.4% vs 75.8%), Pmax of RLNs was positively correlated with the minimal axial diameter (r=0.803), P < 5 mm, 9% for those 5 to 10 mm, and 73% for those ≥1 cm. The detection rate of PET/CT at C1 level was significant lower than that at C2 level (22% vs 67%, P =. 035), suggesting that RLNs in close proximity to the primary tumor hindered the recognition by PET/CT.

Conclusion

PET/CT is inferior to enhanced CT in detecting RLN metastasis in NPC, especially in lymph nodes with a diameter less than 1 cm or in close proximity to the primary tumor. Using enhanced CT in PET/CT is complementary in delineating the RLN metastasis in patients with NPC.
Retrospective Study of Esophageal Food Bolus Impaction
Authors: Bennett Warren , Bird Jonathan , Burrows Stuart , Reddy Venkat , Counter Paul R.
Published: September 2011

Objective

Establish the recurrence rate of food bolus impaction (FBI) and identify demographic/pathological features associated with food bolus obstruction recurrence.

Method

Retrospective case note review of patients (greater than or equal to 16 years) admitted to the hospital with FBI between 2002 and 2007. Patient demographics, co‐morbidities, interventions, radiological investigations, and results were recorded. Statistical analysis was performed using SPSS 13.

Results

A total of 99 patients fulfilled the inclusion criteria (65 males and 34 females; median ages 59 and 71.5 years), IQR 47‐74, and 53‐81 years respectively). A total of 22 patients died between first presentation with FBI and the time of this study being conducted (mean follow up 34 months ±17). A total of two patients had recurrences but died before this study. For all other patients without recurrences the mean follow‐up was 68 months ±20. Logistic regression demonstrated that only hiatus hernia demonstrated a statistical significance in its association with FBI recurrence (OR 4.77 95% CI 1.15‐19.82, P =. 032). All other variables were not statistically significant.

Conclusion

The recurrence rate of food bolus impaction of the esophagus was 9%. Hiatus hernia was the only esophageal pathology associated with recurrence of food bolus impaction.
Salivary Gland Cancer: Experience of Coimbra Cancer Institute
Authors: Simoes Ana Margarida , Neves Antonio , Cardoso Azenha , Cruz Carlos
Published: September 2011

Objective

1) Perform a comprehensive survey of the primitive malignant diagnoses of the salivary glands and characterize them in terms of clinical and biological behavior. 2) Draw conclusions on the treatment and disease control.

Method

Retrospective study with analysis of the patients with histological diagnosis of malignant epithelial disease of the salivary glands between 2000 and 2010 treated in Coimbra’s Portuguese Cancer Institute. Demographic information, location, risk factors, complementary evaluation, treatment modalities, histological features, follow‐up, and failures were analyzed.

Results

Presented 55 cases, aged between 23 and 86 years old, 56% male. A total of 75% were located at the parotid, 20% in the submandibular and 5% in minor salivary glands. Only 2 patients were not submitted to surgical excision. Most patients were in Stage II and IV. There were 12 (22%) adenoid cystic carcinoma, 10 (18%) mucoepidermoid carcinomas, 10 (18%) adenocarcinomas, 7 (13%) acinic cell carcinoma, and 16 (29%) of several other entities. A total of 55% underwent radiation and 18% chemotherapy. Survival rates at 1 year were 95% and at 5 years 78%. Failures were observed in 42% (local and distant).

Conclusion

The analysis of these cases is in line with the literature‐‐the stage of the tumor being the principal prognosis factor in salivary gland malignancies, even when dealing with different grade histology entities. Radiation seems to be an important option in controlling local disease.
Salvage Supracricoid Laryngectomy Oncologic and Functional
Authors: de Barros e Silva Botelho Maíra , Freitas Emilson , Soares Jose , Toscano Ullyanov B. , Dias Fernando Luiz , Barbosa Mauro , Lima Roberto
Published: September 2011

Objective

Evaluate the oncologic outcome and functional results of SCPL with CHEP or CHP in selected cases of glottic/supraglottic carcinoma recurrence after primary (surgery or radiotherapy) treatment.

Method

Retrospective analysis of medical records. Twenty‐three consecutive patients treated with salvage intent by SCPL from 1998 to 2007 were collected. Main outcomes measures were recurrence, overall survival, disease‐specific survival, cause of death, and functional results.

Results

Most of our patients were males (20/86.9%), with a mean age of 57 years. Eighteen (78%) were primarily treated with endoscopic laser resection, while 5 (22%) patients received external beam radiation. Disease‐free interval ranged between 2 and 59 months (mean, 10.2 months) after primary treatment and recurrence. SCL‐CHEP was carried out in 20 patients, whereas 3 patients underwent SCL‐CHP. Tracheostomy tube was removed in 20 patients (86.9%) between 7 and 300 days (mean, 30.1 days) after surgery. Mean swallowing recovery time was 9 days (range 7 to 185 days) and was achieved in 20 patients (86.9%). The 5‐year overall survival was 82.6%

Conclusion

SCPL with CHEP/CHP is a feasible, oncologically safe, functionally valid alternative to total laryngectomy in selected laryngeal recurrence.
Laryngotracheal Reconstruction with a Prefabricated Flap
Authors: Detwiller Kara Y. , Schneider Daniel S. , Schindler Joshua S. , Wax Mark K.
Published: September 2011

Objective

Laryngotracheal stenosis can severely alter anatomy and leave patients with airway compromise. The majority of patients can be managed with conservative or open surgical procedures. Occasionally patients cannot be reconstructed with local tissues. We describe our experience with a prefabricated composite free flap to reconstruct patients with complicated laryngotracheal stenosis.

Method

Case series of 2 patients with severe laryngotracheal stenosis treated with a prefabricated composite graft consisting of auricular cartilage and a radial forearm free flap. Both patients had compromised local tissue due to extensive neck surgery, previous radiation therapy, or chronic inflammation.

Results

The prefabricated cartilage free flap allowed for a customized reconstruction. Prefabrication, implantation of the cartilage into the arm 6 weeks prior to flap harvest, maintained the integrity of the vascular cartilage graft. Furthermore, this reconstructive method provided satisfactory cosmetic and functional results. Both patients were decannulated. As the etiology, extent of the defect, and overall tissue quality of patients with laryngotracheal stenosis are variable, this composite flap may provide surgeons with additional means of laryngotracheal reconstruction in patients who have failed previous attempts or have compromised tissue biology.

Conclusion

A prefabricated graft using auricular cartilage in a radial forearm free flap is a viable reconstructive option for laryngotracheal reconstruction in patients with large defects who are not candidates for conventional approaches.
Sensorineural Hearing Loss after Head‐Neck Radiation Therapy
Authors: Bhandare Niranjan , Morris Christopher , Antonelli Patrick J. , Mendenhall William M.
Published: September 2011

Objective

Sensorineural hearing loss (SNHL) has long been associated with radiation therapy (RT) for head and neck cancers (HNCa), but reporting criteria have been ill defined. The goal of this study was to evaluate the rate and severity of SNHL in HNCa patients receiving RT ± chemotherapy (chemo).

Method

Patients with audiometry pre‐ and post‐RT for HNCa were retrospectively assessed using air and bone conduction thresholds for the pure tone average (PTA, 0.5, 1.0, 2.0 kHz) and 4 kHz. A 10 dB decrement at 2 consecutive evaluations separated by 6 months defined RT‐induced SNHL.

Results

A total of 375 patients (750 ears) were evaluated. SNHL was observed at 4kHz in 246 ears (186 patients) and PTA in 79 ears (72 patients), over a median time of 2.7 (range, 0.3 ‐9.0) and 3.3 (range, 0.5‐10) years, respectively. Cochlear dose and chemo were associated with onset of 4kHz SNHL (p60), gender, fractionation and fraction size were not. Five‐year actuarial risk of 4kHz SNHL increased from 2% for doses 45 Gy to 52% for doses ≥ 45 Gy and from 39% for RT alone to 54% for chemo+RT.

Conclusion

Post‐RT SNHL is more prevalent at higher frequencies and increases with RT dose received by cochlea as well as adjuvant chemo. Future studies on RT‐induced SNHL should include high frequency bone conduction thresholds and account for cochlear dose and adjuvant therapy.
Site Effect Concentrations of Remifentanil and Propofol for Intubation without Use of Neuromuscular Agent for Thyroid Surgery
Authors: Valette Gerald
Published: September 2011

Objective

Thyroid surgery needs accuracy with the aim to limit major complications‐‐that is to say injury of recurrent laryngeal nerve. To help the surgeon, tracheal tube with recurrent laryngeal nerve monitoring can be used. This technique is possible when no muscle relaxant is injected. Remifentanil use with an objective of effect site concentration appears to be a solution for anesthesia for this type of surgery. Our work consists in studying the optimal concentration needed to realize the surgery without the necessity to use muscle relaxant and with the lowest side effects.

Method

Observation of practice in the department of Ear, Nose and Throat (ENT) surgery at Brest University Hospital. Fifty‐two patients undergoing thyroid surgery were assigned in 4 groups according to site effect remifentanil concentration: 4, 6, 7, and 8 ng/mL. Intubation was done by a tracheal tube with EMG electrodes to monitor recurrent laryngeal nerve during surgery. Noninvasive arterial blood pressure, heart rate changes, and BIS values were recorded every minute. Intubation conditions were assessed as excellent, good, or bad.

Results

Intubation conditions were better when remifentanil site effect concentration increased (P =. 001). With a 4 ng/mL concentration, intubation conditions were always bad. On the other side, an 8 ng/mL concentration always gave good intubation conditions. Furthermore, with 4 ng/mL concentration of remifentanil, heart rate was significantly increased. There was no significant difference for all other data.

Conclusion

In our study, tracheal intubation for thyroid surgery using recurrent laryngeal nerve monitoring can be performed without a neuromuscular blocking agent with good conditions when remifentanil site effect concentration is above 8 ng/mL. At this concentration, no hemodynamic adverse effect was observed.
Skin Metastases from Noncutaneous Head and Neck Cancers
Authors: Emanuel Henry John , Emanuel Patrick , Kleinberger Andrew J. , Genden Eric M.
Published: September 2011

Objective

Investigate the distribution of spread, histopathologic characteristics, and prognostic implications of skin metastases arising from primary cancers of the head and neck. We present a case series of patients with skin metastases from non‐cutaneous malignancies of the head and neck and perform a complete literature review on this topic.

Method

Patients with skin metastases arising from noncutaneous cancers of the head and neck were identified by a dermatopathologist and cases were reviewed. A comprehensive literature search was performed and appropriate articles were selected and analyzed for relevant cases.

Results

Twelve patients with skin metastases from noncutaneous carcinomas of the head and neck were identified. The most common primary site, histology, and location of spread was the parotid gland (33%), squamous cell carcinoma (42%), and scalp (25%), respectively. A literature search yielded 97 cases of dermal metastases from head and neck malignancies since 1972. Oral cavity was the most frequent site of origin, but many cases involved direct tumor extension rather than true metastatic spread. Skin metastases typically presented as a discrete nodule within the scalp, but morphology and distribution varied. Overall prognosis is poor with long‐term survivors occasionally reported.

Conclusion

Skin metastases are clinically rare, occurring in less than 1% of head and neck cancers, and when present typically herald a poor overall prognosis. Information regarding their distribution and clinical presentation is of particular importance to the otolaryngologist and oncologist in identifying, counseling, and treating patients diagnosed with skin metastases.
Squamous Cell Carcinoma of the Buccal Mucosa: A 40‐Year Review
Authors: DeConde Adam , Palla Beth , Chhetri Dinesh , Miller Mia E. , St. John Maie , Elashoff David
Published: September 2011

Objective

Evaluate the treatment results of buccal squamous cell carcinoma at a single institution during a 40‐year period.

Method

A retrospective review was performed by examining the records and reviewing the pathology of 48 patients with buccal squamous cell carcinoma treated at UCLA Medical Center from 1970 to 2009. Forty‐eight patients were identified that received first‐time surgical therapy for squamous cell carcinoma of the buccal mucosa and had adequate follow‐up.

Results

Treatment entailed surgery alone in 18 out of 48 patients (37.5%) and surgery followed by radiation therapy in 30 out of 48 patients (62.5%). Composite resection of the tumor was performed in 17 out of 48 patients (35.4%) and ipsilateral neck dissections were performed in 37 out of 48 patients (77.1%). One‐year observed actuarial disease‐free survival rates were 60%, 46%, 0%, and 40% for T1 through T4, respectively. Univariate analysis revealed increased age as a risk factor (P =. 062), and multivariate analysis demonstrated age as a risk factor and performance of neck dissection having a decreased risk of recurrence (P =. 029 and. 023, respectively).

Conclusion

We report fairly high disease‐free survival rates in this patient population. Performance of neck dissection and younger age were associated with a favorable prognosis. Performance of neck dissection may decrease the risk of recurrences in primary squamous cell carcinoma of the buccal mucosa.
Submucosal Dissection for Superficial Pharyngeal Cancer
Authors: Tateya Ichiro , Ki Muto Man , Kitamura Morimasa , Kada Shinpei , Morita Shuko , Ito Juichi , Hirano Shigeru
Published: September 2011

Objective

We have previously reported that narrow band imaging (NBI) combined with magnifying endoscopy is useful in detecting early superficial pharyngeal cancers, which are difficult to detect with a standard endoscopy. In this study, we investigated the usefulness of submucosal dissection for such superficial lesions of pharyngeal cancer retrospectively.

Method

Fifty patients with superficial pharyngeal cancer were treated since September 2007. Under general anesthesia, a curved laryngoscope was inserted trans‐orally, the extent of the lesion was determined by the NBI endoscope, and the lesion was dissected with an orally inserted curved electric knife.

Results

Tracheostomy was performed in 5 cases, which had synchronous multiple lesions in the hypopharynx. Regarding adverse effects, postoperative bleeding occurred in one case, which needed emergency tracheostomy. With a median follow‐up period of 20 months, metachronous multiple laryngo‐pharyngeal cancer occurred in 4 cases and recurrence occurred in 2 cases. All the metachronous cancer cases and the recurrent case were controlled with additional endoscopic submucosal dissection. The cause‐specific survival rates at 2 years were 100%. All the patients retained their pharynx and their speaking, breathing, and swallowing functions.

Conclusion

Endoscopic submucosal dissection for early pharyngeal cancer allows excellent survival and preservation of swallowing and voice functions. Early detection of superficial pharyngeal cancer with narrow band imaging technology and treatment with endoscopic submucosal dissection can be a new treatment strategy for head and neck cancer.
Survey of Post‐thyroidectomy Parathyroid Hormone (PTH) Assay Use by American vs European Thyroid Surgeons
Authors: Stein Daniel , Calo Piergiorgio , Kepchar Jessica J. , McLeod Ian K. , Noordzij Jacob P. , Brietzke Scott E.
Published: September 2011

Objective

1) Identify differences in PTH assay usage by European vs American physicians. 2) Analyze factors that correlate with these differences.

Method

Anonymous surveys of physicians regarding their use of post‐thyroidectomy PTH assay were collected in 2009 from members of the American Academies of Otolaryngology and Endocrine Surgery and compared with 2010 survey data from members of the European, Italian, French, Spanish, and British Societies of Endocrine Surgery.

Results

European respondents returned 61 surveys that were compared with 356 received from American physicians (11% vs 3% response rate). A total of 40.1% of the European physicians used the PTH assay vs 29.8% of the American physicians (chi‐square P =. 083). A total of 63% of US respondents were otolaryngologists, compared with 7% of the Europeans, but usage among US physicians was not significantly correlated with specialty. Fewer American physicians were fellowship trained (26.6% vs 44.3% (chi‐square P =. 003)). Using Mann‐Whitney testing, estimates of the rate of temporary hypocalcemia were similar, median 10% to 20% (P =. 708), but American respondents provided a lower estimated rate of permanent hypocalcemia (P =. 007).

Conclusion

We found a trend suggesting that more European physicians obtain PTH levels than US physicians and report higher rates of permanent hypocalcemia among thyroidectomy patients, perhaps accounting for their more frequent use of PTH assays.
Survival Differences in American Indians with Head and Neck Cancer
Authors: Dwojak Sunshine M. , Sequist Thomas , Deschler Daniel G. , Emerick Kevin S.
Published: September 2011

Objective

American Indians and Alaska Natives (AI/AN) experience poor overall survival. The specific aim of this study was to analyze disparities in survival between AI/AN and white patients with squamous cell carcinoma of the head and neck.

Method

We identified all incident cases of oropharyngeal, oral cavity, and hypopharyngeal/laryngeal squamous cell carcinoma among AI/AN and white patients from 1996 to 2007 using the SEER database. Univariate, multivariate, and sequential Cox proportional hazard models were fit to analyze racial differences in sex, age, stage, treatment patterns, and overall survival.

Results

For cancer of the oropharynx, AI/AN experienced decreased overall survival after adjusting for age, sex, stage, and type of treatment (hazard ratio (HR) = 1.4, P =. 008). For cancer of the oral cavity, AI/AN experienced decreased survival after adjusting for patient age and sex (HR =1.3, P =. 05). This difference was eliminated after adjusting for type of treatment (HR=1.2, P =. 17). AI/AN were significantly less likely to receive surgery (odds ratio=0.57, P =. 02). For hypopharyngeal/laryngeal cancer, AI/AN experienced decreased survival after adjusting for patient age and sex (HR = 1.6, P =. 04). Adjusting for stage at diagnosis eliminated the disparity (HR =1.4, P =. 12).

Conclusion

Significant disparities in survival exist among AI/AN patients with head and neck cancer. These disparities are variably related to stage at presentation and differential treatment patterns. Future research is needed to understand how to implement programs to reduce these differences in care and outcomes.
Temporalis Myofascial Flap for Maxillofacial and Oral Defect
Authors: Tananuvat Rak , Ruenmarkkaew Donyarat , Sittitrai Pichit , Srivanitchapoom Chronticha
Published: September 2011

Objective

Temporalis myofascial flap is a good option for the reconstruction of maxillofacial, oral cavity, and parotid defect.

Method

A total of 28 patients with postoperative defects located in the lower two thirds of the face and oral cavity in Chiang Mai University Hospital were included in this study.

Results

Sixteen patients had nasal cavity and maxillary sinus cancer, 6 patients had oral cavity and oropharyngeal cancer, 3 patients had parotid cancer, 1 patient had cementifying fibroma, 1 patient had facial palsy, and 1 patient had osteoradionecrosis of the mandible. Temporalis muscle flap provided profuse well‐vascularized tissue for the obliteration of orbital exenteration and totalor partial maxillectomy cavities and coverage of the surface of sinonasal and oropharyngeal defects.

Conclusion

Oral and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically simple flap can be preferred for the reconstruction of maxilla‐facial defects after ablative tumor surgery, especially in older and debilitated patients.
Management of Salivary Bypass Tube and Stent Migration in Pharyngoesophageal Microvascular Reconstruction
Authors: Skoner Judith Marie , Bowman Seth , Banks Caroline A.
Published: September 2011

Objective

Post‐chemoradiation salvage surgery with pharyngoesophageal reconstruction may be associated with postop fistula, even with free tissue transfer. Salivary bypass tubes and stents have thus been used to minimize this complication, but migration is a real risk. We present our series of bypass tube and esophageal stent distal migrations and management.

Method

A retrospective chart review at a tertiary academic medical center identified those patients undergoing pharyngoesophageal salvage resection, simultaneous complex pharyngoesophageal reconstruction, and salivary bypass tube or esophageal stent placement. Demographics, surgical details and postop management of tube or stent migration distally into the GI tract were investigated.

Results

Distal migration of the salivary bypass tube was identified in 2 patients, and migration of the esophageal stent was identified in 1 patient. All cases were in the setting of complex pharyngoesophageal flap reconstruction after salvage surgical resection. Dates of migration discovery ranged from weeks to months postop. All patients were asymptomatic and without fistula formation, but with the tubes/stent radiographically confirmed in the GI tract. Management was via a team approach with our GI colleagues, and all salivary‐channeling devices were successfully retrieved endoscopically, without complication.

Conclusion

Pharyngoesophageal reconstruction after salvage surgery carries the risk of fistula even in the setting of micro‐vascular tissue transfer. To minimize this dreaded complication, salivary bypass tubes/stents may be used, but migration is a well‐recognized risk. Our series presents successful management of such via a team approach.
The Method of Establishing a Xenograft Animal Model
Authors: Hou Fang , Saad Ali , Dai Yuemeng , Richter Gresham , Suen James Y. , Buckmiller Lisa M. , Fan Chun‐Yang
Published: September 2011

Objective

1) Establish a xenograft animal model of arteriovenous malformation (AVM), an uncommon and often incurable vascular anomaly. 2) Observe the morphological alterations and histological characteristics of xenograft AVM.

Method

AVM specimens harvested from 4 patients were sectioned (5x5x5mm) and implanted in the subcutaneous dorsum of 5‐Athymic Nude‐Foxn1nu mice. 4 implants per animal were placed (N = 20). Specimens were harvested monthly and stained for hematoxylin and eosin (H&E). Immunohistochemistry for anti‐human nuclear antigen and Ki‐67 was performed. Histologic observations were recorded by 2‐blinded pathologists.

Results

Clinical characteristics and pathologic diagnosis of AVM was confirmed in each donor patient. A total of 85% (n = 17) of AVM xenografts survived the xenograft implantation. Survival was unrelated to date of harvest. The majority of implants slightly decreased in size by date of harvest (1‐2mm). Pathologic diagnosis of a vascular anomaly was confirmed in each implant and demonstrated numerous small and medium‐size vessels. A total of 76.5% (n = 13) of implants of surviving xenografts were positive for Ki‐67 and anti‐human nuclear antigen, confirming survival of the human derived tissue.

Conclusion

We herein describe an animal model for AVM that may provide the first step for examining the pathophysiology and potential treatment of these difficult to treat lesions in vivo.
Tongue Base Resection in Workup of Unknown Primary Head and Neck Cancer
Authors: Wolford Brent , Lee Steve , Simental Alfred , Stewart Charles , Kim Paul
Published: September 2011

Objective

Often, extensive workup (H&P, CT/MRI/FDG‐PET, tonsillectomy and biopsies) is undertaken to detect the primary tumor of a cervical metastasis, in order to reduce morbidity of treatment. We report on transoral resection of the base of tongue (at the time of panendoscopy) in the diagnostic management of unknown primary HN cancers.

Method

In this retrospective study, we reviewed findings from workups of Loma Linda University patients with unknown primary HN cancer in the past 4 years (when base of tongue resection was instituted) and noted the number of primary unknowns detected by base of tongue resection vs traditional diagnostic modalities.

Results

In the past 4 years, 17 patients underwent panendoscopy for the diagnosis of an unknown primary cancer after careful outpatient workup, including CT/PET studies, failed to reveal a source. Of this group, a primary source was found in eight by tonsillectomy and directed biopsies. In the remaining 9, transoral laser resection of the ipsilateral base of tongue was performed, and a base of tongue source was found in 4. In all of these, no lesion was visualized or palpable, there were no procedure complications, patients returned to adequate PO intake immediately and operative time increased by forty minutes on average.

Conclusion

We conclude that transoral laser resection of the base of tongue in the workup of unknown primary HN cancers is safe, is well‐tolerated, and provides valuable information for therapeutic planning as a supplement to other traditional diagnostic modalities, when no primary source has been previously identified.
TP53 Mutations in Head and Neck Squamous Cell Carcinoma
Authors: Tokumaru Yutaka , Fuji Masato
Published: September 2011

Objective

The TP53 plays a critical role in a key pathway involving apoptosis and cell cycle control. The mutation of TP53 is one of the most common genetic alterations in cancer cells. We evaluated TP53 mutations and prognosis in patients with squamous cell carcinoma of the head and neck.

Method

A total of 60 patients with newly diagnosed squamous cell carcinoma of the head and neck in our hospital from 2005 through 2009 were enrolled in this study. TP53 mutations were analyzed using direct sequencing methods for exon 2 to 11. TP53 mutational status was compared with clinical outcome.

Results

Mutations were classified into 2 groups, disruptive and nondisruptive, according to the degree of disturbance of protein structure predicted from the crystal structure. Of the 60 tumors, 38 (63.3%) harbored a TP53 mutation including 17 (28.3%) disruptive mutations. While 75.0% of cases with wild type are alive without recurrence, only 25.0% of disruptive mutation cases are with no recurrence. In addition, the presence of disruptive TP53 mutation was associated with poor prognosis as compared with wild type TP53.

Conclusion

Disruptive TP53 mutations in tumor DNA are associated with poor prognosis and TP53 mutational status is considered to be useful as a molecular biomarker for personalized treatment in squamous cell carcinoma of the head and neck.
Transoral Robotic Surgery for Hypopharyngeal Carcinoma
Authors: Kim Se‐Heon , Lee Sei‐Young , Choi Eun‐Chang
Published: September 2011

Objective

Conventional surgical approaches for hypopharyngeal carcinomas have a great risk for developing treatment‐related morbidity. To minimize this morbidity, hypopharyngectomy by transoral robotic surgery (TORS) was performed, and the efficacy and feasibility of this procedure were evaluated.

Method

TORS was performed using Surgical Robot in 18 patients with T1 or T2 pyriform sinus cancer. Pyriform sinus was totally resected. Laterally, the inner perichondrium of the thyroid cartilage was peeled off to make sure of the safe margin. We evaluated the surgical margins, swallowing, decannulation, and surgery related complications.

Results

Transoral robotic hypopharyngectomy was performed successfully in all eighteen patients. The mean robotic operation time was 62.4 minutes, and an average of 17.5 minutes was required for the setting of the robotic system. There was no significant perioperative complication in the cases. Swallowing function returned to all patients within 8.3 days average. Decannulation was carried out within an average of 6.3 days after surgery. We can confirm the negative margins by frozen section. Average surgical margins are 7.5mm circumferentially.

Conclusion

Transoral robotic hypopharyngectomy is a feasible and oncologically safe technique for the treatment of early hypopharyngeal cancer.
Treatment of 183 Sinonasal Tumors: Updating Our Experience
Authors: Guilemany Jose M. , Montero Cristobal Langdon , Blanch Josep Lluis , Alobid Isam
Published: September 2011

Objective

The current study updated our previous study involving the outcomes and prognostic factors of sinonasal cancer patients treated at our institution.

Method

A total of 183 sinonasal cancer patients who were treated between 1974 and 2008 with a minimum follow‐up of 2 years were retrospectively reviewed and restaged using the seventh edition of the AJCC staging manual.

Results

The mean age was 60.89 years (+14.99 years SD), 70.4% males. Tumor stage distribution was: T1:72patients; T2:48p; T3:39p; T4:24p. Ninety‐six patients received surgery as primary treatment, 51 received surgery plus radiotherapy, 7 received surgery plus radiotherapy with/without chemotherapy, and 22 received radiotherapy with/without chemotherapy palliative treatment. The 1‐, 5‐, 10‐year disease free survival rate was 82.3%, 49%, and 34.9%, respectively. There was no significant survival difference between surgery alone and surgery plus radiotherapy. The parameters with statistical prognostic significance were tumor stage, tumor histology, and locoregional failure.

Conclusion

Although there is a significant advance in survival rates, the failure at the primary site is still the main problem. As a prognostic value of survival, therefore, we should put all our effort to improve the control of the locoregional failure.
Trends and Outcomes in the Management of Upper Esophageal Disorders
Authors: Gullung Jessica L. , Gibbs Kevin , Gillespie Marion B.
Published: September 2011

Objective

1) Compare the outcomes of 2 surgical modalities used to treat hypopharyngeal diverticulum and esophageal stenosis at the Medical University of South Carolina (MUSC) and analyze the economic efficiency of each. 2) Compare the MUSC experience with statewide treatment in South Carolina (SC) Medicare patients.

Method

Retrospective analysis was conducted of 50 patients treated at MUSC. The 2 approaches utilized were endoscopic laser diverticulotomy and transcervical open diverticulectomy with cricopharyngeal myotomy. SC Medicare data was collected for patients undergoing these procedures. Primary outcomes investigated were intraoperative complications, operative charge, hospital stay, and postoperative complications.

Results

Statistically significant differences between the 2 operative groups at MUSC were observed in length of stay (1.08 days endoscopic group and 4.75 days transcervical open group; P >. 0001) and operative charge (US $ 2842 endoscopic and US$ 3425 transcervical; P >. 0001). The perioperative complication and readmission rates were similar. The rate of reoperation was the same between the 2 groups; however, most of the patients who underwent transcervical open diverticulectomy were initially planned as endoscopic approaches. The Medicare data group differed significantly in length of hospital stay and patient charges compared to MUSC group.

Conclusion

The comparison of techniques reveals that long‐term outcomes are similar, but the immediate postoperative sequelae of prolonged hospital stay and increased operative charge with transcervical open diverticulotomy is evident. Although further cost analysis is indicated, endoscopic laser diverticulotomy is a safe, cost effective alternative to transcervical open diverticulectomy.
Ultrasound‐Guided FNA of Base of Tongue: A Cadaver Study
Authors: Meacham Ryan K. , Sebelik Merry E. , Boughter John D.
Published: September 2011

Objective

1) Determine the utility of ultrasound imaging to visualize the anatomy of the tongue base. 2) Demonstrate that ultrasound imaging can guide transcervical needle placement in the tongue base and thus serve as a surrogate for needle biopsy in the patient with a tongue base lesion.

Method

Design and subjects: Feasibility study of ultrasound‐guided needle placement in the tongue base in 37 adult cadavers. Interventions: Ultrasound imaging of tongue base anatomy and guidance of dye injection into the intrinsic muscles. Outcome Measurements: Tongue base anatomy visualization on ultrasound and placement accuracy of dye injection.

Results

Of 37 cadaver heads, 32 were noted to have excellent and identifiable anatomy of the geniohyoid, genioglossus, and intrinsic muscles of the tongue base. The intrinsic muscles were well visualized during methylene blue dye injection on most specimens, with confirmation of the needle tip location and “bloom” of the injection on real‐time ultrasound images. After bisection, 25 of 32 (78%) evaluable specimens were found to have accurate placement of dye within the posterior genioglossus and intrinsic tongue base muscles. Neck circumference was similar between those with accurate (mean 37.9 cm) and inaccurate (mean, 37.4 cm) dye placement (P =. 75).

Conclusion

This study utilizes a cadaver model to establish that ultrasound visualization of the tongue base provides excellent anatomic detail and demonstrates feasibility of transcervical ultrasound localization of the tongue base for image‐guided FNA. This technique has potential applicability to the clinical setting.
U‐shaped Skin Incision for Parotidectomy
Authors: Furuta Yasushi , Matsumar Michiya , Tsubuku Takashi
Published: September 2011

Objective

The facelift incision (FLI) has been reported to be a more cosmetic approach than the traditional Blair incision for parotidectomy. However, a long skin incision and a wide skin‐flap elevation are required for the FLI. To overcome the disadvantages of the FLI, we have employed a U‐shaped skin incision (UI).

Method

From July 2007, 79 parotidectomies were performed for benign parotid tumors. A Blair incision was used in 41 patients and an FLI in 25 patients. In the remaining 13 patients, a UI, which consists of pre‐ and postauricular incisions and curved incision around the lobe of the ear, was employed.

Results

In all patients with a UI, the tumors were located in the superficial lobe of the parotid gland. By contrast, 10 of the 25 (40%) patients with an FLI had a tumor in the deep lobe. The size of the tumor was significantly smaller and the time of surgery was significantly shorter in patients with a UI than in those with an FLI. The incidence of hematoma was higher in FLI than in UI (12% vs 0%). The incidence of temporal facial paralysis and salivary leak was comparable in both groups.

Conclusion

The UI is a safe alternative approach to parotidectomy for small benign tumors within the superficial lobe of the parotid gland.
Utility of Abdominal Computed Tomography in Head and Neck Cancer Patients
Authors: Kamdar Dev Prakash , Robinette Natasha , Yoo George H. , Kim Harold , Lin Ho‐Sheng , Lemonnier Lori A. , Pereira Lucio M.
Published: September 2011

Objective

Assess the role of abdominal computed tomography (CT) imaging in the staging and surveillance of patients with head and neck squamous cell cancer (HNSCC) for distant metastatic disease (DMD) and second primary tumors (SPT).

Method

Retrospective review of 172 HNSCC patients treated at an academic center who underwent abdominal CT imaging from 2003 to 2007. These scans were categorized as suspicious, positive, or negative for DMD or SPT. Charts of patients with suspicious or positive results were reviewed to determine resultant work‐up and outcomes.

Results

After consideration of exclusion criteria, 165 patients were included in this retrospective study. Normal abdominal CT scans were seen in 139 patients while the remaining 27 patients had abnormal abdominal CT findings. Of these 27, 16 patients (9.7%) were determined to have malignancy. Twelve patients had DMD, and 4 were diagnosed with SPT.

Conclusion

Abdominal CT imaging identified DMD or SPT in 9.7% of patients resulting in significant alteration in their comprehensive oncologic care. This rate is not inconsequential and might justify the use of abdominal CT in managing HNSCC patients. Prospective trials might help determine the impact of abdominal CT findings on survival.
Voice and Swallow after Supracricoid Partial Laryngectomy
Authors: Clayburgh Daniel R. , Schindler Joshua S.
Published: September 2011

Objective

1) Evaluate the long‐term voice and swallowing outcomes of supracricoid partial laryngectomy (SCPL). 2) Determine the effect of prior radiation therapy on voice and swallow outcomes.

Method

A retrospective chart review was performed on all patients that received SCPL at our institution between 2006 and 2010. Multiple parameters measuring voice and swallowing outcomes were recorded where available and descriptive statistics performed. Chi‐square and Student t‐test analysis were performed with P <. 05 used to denote significance.

Results

Fourteen patients were identified, including 2 cricohyoidopexies and 11 cricohyiodoepiglottipexies. Mean follow‐up was 650 ± 470 days. Decannulation occurred at 30 ± 16 days and feeding tube removal at 87 ± 43 days postoperatively. All patients tolerated regular diets and thin liquids. Maximum phonation time was 10.6 ± 6.1 sec, F0 was 161.7 ± 75.7 Hz, VHI was 35.6 ± 16.1, and CAPE‐V dysphonia score was 56.3 ± 11.0. Comparing previously irradiated patients with those without prior radiation, there was no difference in time to feeding tube removal (100 ± 18 vs 79 ± 8 days, P =. 32), maximum phonation time (9.3 ± 2.1 vs 12.6 ± 3.9 sec, P =. 49) or VHI score (32.5 ± 9.4 vs 49.3 ± 1.8, P =. 17), but F0 was significantly higher (235.5 ± 27.3 vs 115.1 ± 9.8 Hz, P =. 01).

Conclusion

SCPL is well tolerated; patients have excellent swallowing and serviceable voice postoperatively. Preoperative radiation therapy appears to raise F0; otherwise voicing and return of swallow function is similar to those patients who have not been irradiated. Prospective studies may define other prognostic markers for voice and swallow outcomes after SCPL.
Microscopically Assisted Open Structure Rhinoplasty
Authors: El‐Guindy Ahmed S.
Published: September 2011

Objective

Evaluate the use of the operating microscope during open structure rhinoplasty for achievement of preoperative goals precisely and accurately.

Method

A retrospective study was conducted on 82 patients with nasal aesthetic deformities and functional deviations for whom open rhinoplasty was done in tertiary care center. The operative microscope was used throughout operative steps. Results were checked against patients’ expectations and satisfaction and against conformance to aesthetic measures and functional parameters.

Results

A total of 91.4% of the surgeries met patients’ expectations while 93.3% fulfilled patients’ satisfaction. A total of 85.4% of cases conformed to aesthetic nasal measures while 92.7% to functional clinical parameters.

Conclusion

The use of the operative microscope afforded a better illumination especially in the depth, stereoscopic vision, and magnification that allowed accurate dissection and better preservation. It is user friendly, superb in photo documentation, and unpreceded in training courses as it offers to trainees an image identical to what the surgeon sees.
A New Classification of Laryngeal Synkinesis
Authors: Yumoto Eiji , Nishimoto Kohei , Sanuki Tetsuji , Kumai Yoshihiko , Toya Yutaka
Published: September 2011

Objective

1) Develop a new classification of laryngeal synkinesis in patients with unilateral vocal fold paralysis (UVFP) based on images of the vocal fold using 3‐dimensional computed tomography (3DCT) 2) Compare synkinesis type based on 3DCT image analysis with recruitment in electromyography during phonation.

Method

Retrospective. Subjects included 50 patients with UVFP who underwent framework surgeries between 2000 and 2010. Three‐dimensional images during phonation and inhalation preoperatively were assessed focusing on thickness of the affected fold to classify synkinesis. Recruitment of thyroarytenoid muscle was rated and compared with synkinesis type.

Results

Two subjects were excluded because of poor performance during scanning. Three synkinesis types were identified. The affected fold in 12 subjects showed some degree of thickening during phonation. The affected fold of the remaining 36 was thin during phonation. Thickening of the affected fold was evident during inhalation in 20 of the 36 subjects, while the affected fold in the rest (16 subjects) remained to be thin. Thirty‐one subjects underwent electromyography. Those with the latter 2 types of synkinesis had a tendency of less recruitment compared with those with the former type of synkinesis.

Conclusion

The use of the new classification of laryngeal synkinesis facilitates understanding of behavior of the affected vocal fold in patients with UVFP. The number of subjects who underwent electromyography was not sufficient to draw a conclusion about the relation between synkinesis classification and recruitment.
A Novel Approach to Tracheocutaneous Fistula Closure
Authors: Taraska Allison , Weisberger Edward , Ting Jonathan Y. , Royer Mark , Moore Michael
Published: September 2011

Objective

1) Describe a novel, 3‐stage approach to closure of a large tracheocutaneous fistula (TCF) and augmentation of an adjacent area of tracheal stenosis. 2) Present pre‐, intra‐, and postoperative photographs to illustrate surgical technique. 3) Discuss postoperative patient care considerations. 4) Review other techniques described for similar defects.

Method

Case report of patient receiving treatment from May 2010 to present. The patient presented with a 1.4 by 1.6 cm TCF and adjacent tracheal stenosis. This was repaired in a 3‐stage approach culminating in radial forearm free flap (RFFF) with banked conchal cartilage and buccal mucosal graft for tracheal closure.

Results

This case resulted in successful closure of a 1.4 by 1.6 cm TCF in a previously radiated patient using a novel, 3‐stage approach. The initial stage involved implanting a conchal cartilage graft in the left radial forearm. During the second stage a buccal mucosal graft was implanted to cover the conchal cartilage graft after removing the hair‐baring skin. The third stage involved transfer of the RFFF with cartilage and mucosal graft for closure of the TCF, augmenting the support with an absorbable miniplate. The patient had no issues with breathing, speaking, or wound healing immediately or at four months postoperative.

Conclusion

Large TCFs in irradiated patients present a unique surgical challenge. This case illustrates successful closure of an extensive TCF involving anterior trachea and partial bilateral sidewalls. The unique graft allowed for structural support with hairless mucosal lining on a fasciocutaneous flap.
CXCL12‐Induced Angiogenesis in Laryngo‐Hypopharyngeal Squamous Cell Carcinoma
Authors: Tan Ching‐Ting , Ko Jenq‐Yuh , Li Kai‐Chun , Kuo Min‐Liang , Huang Ying‐Hsuan
Published: September 2011

Objective

The success of solid tumor metastasis is dependent upon angiogenesis, and our previous result revealed that the CXCL12/CXCR4 axis could induce laryngeal and hypopharyngeal SCC (LHSCC) cells to produce angiogenic factors. Therefore, in this study, we will further elucidate the mechanisms of CXCL12‐induced angiogenesis in LHSCC cell lines.

Method

IHC staining and RT‐PCR were used to clarify the relationship of CXCR4 and angiogenesis. The Agilent oligoarray was used to study the angiogenesis profile, and investigate the relative contribution of different angiogenic factors. A mouse tumorigenicity model, the signal transduction pathways and the blocking effects of different antagonists were investigated.

Results

IHC staining and RT‐PCR revealed positive correlation of CXCR4 and CD31. Specific CXCR4 inhibitor AMD3100, neutralized antibody, 12G5, and shRNA could block the CXCL12‐induced angiogenesis. Agilent oligoarray and RT‐PCR discovered that CXCL12 induced IL‐8 expression. The expression could be blocked by specific CXCR4 inhibitors. Using IL‐8 neutralized antibody also effectively block the angiogenesis. Signal transduction study revealed that phosphorylation of Akt involved in the CXCL12/CXCR4 regulation of IL8 secretion.

Conclusion

Under such an investigation, a better understanding of angiogenic signaling and regulatory mechanisms in LHSCC were obtained and that may have benefit in searching for a new therapeutic agent to block this pathway as an adjuvant therapy for LHSCC might reduce the metastasis and improve the survival rates.
Dysphonia as the Only Presentation of Laryngeal Tuberculosis
Authors: Mano Patrícia , Ramírez Edna P. , Lima Marcos , Albertino Rafael , Simen Raphaella , Bissoli Rodolfo , Simas Tiago
Published: September 2011

Objective

Report a case of laryngeal tuberculosis in an immunocompetent patient who showed no changes in chest radiograph.

Method

Case report of laryngeal tuberculosis. Clinical findings are discussed and a review of the literature is made.

Results

The authors describe a case of laryngeal tuberculosis in a 50‐year‐old male patient who presented with a 3‐month history of dysphonia, without improvement or worsening, with no other systemic signs or symptoms. ENT examination was unremarkable. Laboratory tests were normal, and sputum smear was negative for AFB. Laryngoscopy revealed a tumor in the left vocal cord, from which a biopsy was obtained, and AFB staining was positive. After being treated with DOTS (Directly Observed Treatment Short‐course) therapeutic regimen for nine months, patient showed improvement in symptoms.

Conclusion

The authors emphasize the importance of suspecting the diagnosis of tuberculosis in patients who show malignant appearance lesions during laryngoscopic examination, even in the absence of classic clinical symptoms. Histological examination is essential for final diagnosis. Only early diagnosis and treatment are able to cure disease and prevent future complications.