bluuebunny/crossref_metadata_2025 huggingface dataset:
Synovial Sarcoma of the Head and Neck
Authors: Li Wen
Published: February 2015

Objective

To investigate the relationship between pathological diagnosis and clinical outcome of synovial sarcoma (SS) of head and neck.

Method

Thirty‐nine cases of SS in head and neck region from 1966 to 2011 were retrospectively studied by reviewing the pathological slices of the operative specimen and followed‐up from 1 to 16 years with a mean time of 4 years postoperatively.

Results

All patients were men aged from 8 to 66 years old with a mean age of 35 years and the disease demonstrated a predilection for lateral upper neck. Pathologically, 18 cases were biphasic, 17 cases were monophasic, and 3 cases were low‐differentiated SS. Four cases were proved by cytogenetic methods of either fluorescence in situ hybridization (FISH) or/and RT‐PCR. Six cases experienced repeated recurrence with the most up to 4 times operations after sole surgical approach. No lymphatic metastasis was observed during the 1‐ to 16‐year follow‐up. One patient developed scalp, arms, thoracic, and abdominal wall metastases during the postoperative 6‐year follow‐up, and one patient developed likely pulmonary metastatic foci but showed no growth and was not pathologically confirmed during the postoperative 2‐years’ follow‐up. Sixteen patients received adjuvant radiotherapy or chemotherapy. Nine patients died, but no death was directly associated with SS.

Conclusion

The locoregional control of SS seemed related more closely to the anatomy of the tumor location rather than pathological patterns. SS of head and neck is a special entity that has good prognosis, cytogenetic methods are recommended to be employed to ascertain the diagnosis in order to choose reasonable treatment protocols.
Technical Considerations in Sinonasal Tumor Recurrences
Authors: Singh Ameet , Joshi Arjun S. , Sadeghi Nader
Published: February 2015

Objective

1) To study the rate of reoperations and recurrences of endoscopically treated benign and malignant sinonasal tumors. 2) To propose technical considerations in preventing reoperations and recurrences for endoscopically treated sinonasal tumors.

Method

A retrospective review of all endoscopically treated benign and malignant sinonasal tumor pathologies from January 2002 to January 2012 was performed. Patient demographics, tumor characteristics, surgical approaches, and complications with a specific emphasis on reoperations and tumor recurrences were analyzed.

Results

Sixty‐four operative procedures were performed in 50 patients. Pathologies included 39 benign (21 IP, 5 JNA, 3 fibro‐osseous lesions, 3 meningiomas, 2 lymphomas, 5 assorted lesions) and 11 malignant (2 esthesioneuroblastomas, 3 SCC, 2 olfactory carcinomas, 1 SNUC, 1 hemangiopericytoma, 1 NPC, and 1 ACC) tumors. Fourteen reoperations (21%) were performed secondary to tumor recurrence (9 cases) or residual tumor (5 cases). The majority of reoperations resulted from inadequate surgical exposure, incomplete adherence to oncological principles, excessive concern for functional preservation, and lack of a well‐defined reproducible technique. Tumor biology played a key role in a small fraction of cases.

Conclusion

Advances in endoscopic techniques, equipment, and experience have increased the number of sinonasal tumors being treated endoscopically. Wide surgical access, adherence to oncologic principles, and well‐defined endoscopic techniques are paramount for successful treatment of these tumors. It is imperative that the endoscopic tumor surgeon balance oncologic principles with functional preservation.
The Role of PET/CT for Lung Lesions in Oral Cavity Cancer
Authors: Chang Yu‐chang , Hao Sheng‐Po
Published: February 2015

Objective

Determine the significant parameters of PET/CT in the prediction of the nature of lung lesions during the staging of newly diagnosed or recurrent oral cavity cancer.

Method

We retrospectively reviewed the charts of 183 patients from July 2010 to December 2011 with newly diagnosed or recurrent oral cavity cancer. Twelve cases with positive PET/CT lung lesions (SUVmax >4) subsequently underwent biopsy. The SUVmax, number of lesion, and side were studied.

Results

A total of 12 patients were collected as suspicious for lung metastases. One case with esophageal cancer was excluded. Five were lung metastases, 3 were second primary lung cancer, and the remaining 3 were chronic inflammation. Comparing with second primary and chronic inflammation, metastases had higher SUVmax but without significant difference (P value >.05). Metastases and chronic inflammation had higher incidence of multifocal lesions comparing with second primary (P value, metastases vs second primary:. 008, chronic inflammation vs second primary:. 09). There is no significant difference between the metastases and chronic inflammation (P value:. 38). For side and lesion, no significance was noted.

Conclusion

Based on our preliminary data, higher SUVmax value (mean: lung metastases: 6.65, second primary lung cancer: 3.96, chronic inflammation: 3.98) and multifocal lesions favor metastatic lung lesions compared with second primary or chronic inflammation.
The Value of the Exposure of Recurrent Laryngeal Nerve
Authors: Xiang Ming L. , Shen Chen L. , Wu Hao
Published: February 2015

Objective

To explore the value of dissecting the recurrent 1aryngeal nerve (RLN) in thyroid surgery to prevent RLN from injury.

Method

Retrospective study from 2005 to 2011. Disease studied: thyroid tumors. Setting: Xin Hua hospital, Shanghai Jiao Tong University School of Medicine. The recurrent laryngeal nerve was exposed in thyroid surgery. Outcome measurements: Recurrent laryngeal nerve injury rate. Preliminary snalyses: Chi‐square analysis.

Results

There were 12 cases of RLN injuries in the RLN anatomy group (the RLN injury rate was 2.2%) and 512 cases of RLN injuries in the non‐RLN anatomy group (10.7% injury rate). The difference of RLN injury between the 2 groups was statistically significant (P <. 01).

Conclusion

Exposure of RLN in the thyroid surgery is an effective step to prevent the nerve from injury.
Total Laryngectomy with Radiotherapy in Stage T3‐T4
Authors: Sobczyk Grzegorz , Kizler‐Sobczyk Krystyna , Kawecki Andrzej , Krzeski Antoni , Wójtowicz Piotr
Published: February 2015

Objective

Evaluation of the result of treatment with total laryngectomy and complementary radiotherapy in patients with cancer of the larynx in stage T3‐ T4 N0M0. Analysis of the impact of the primary cancer localization, feature G and T, unradical result of the surgery treatment.

Method

The study population included 136 patients with cancer of the larynx in stadium T3‐T4 N0M0 treated with curative intent by total laryngectomy with complementary radiotherapy. T3 was in 61 patients, T4 was in 75 patients.

Results

In coregression analysis of multivariate failure did not show the statistically related to the recurrence and death P > 0.1. Two‐ and 5‐year disease‐free survival was for all group adequately 83% and 76%. Two‐ and 5‐year disease‐free survival in cases T3 and T4 was adequately 88% and 76%. In patients with primary localization in glottis 2‐ and 5‐year disease‐free survival was adequately 81% and 73% in cases supraglottis 88% and 81%.

Conclusion

The primary cancer localization, feature G and T, unradical result of the surgery does not statistically relate to the result of the treatment by laryngectomy with complementary radiotherapy. Total laryngectomy with complementary radiotherapy has high finish result of treatment cancer of the larynx in stage T3‐T4 N0 M0.
Tracheal Perforation from Primary Thyroid Lymphoma
Authors: Chen Cynthia , Tibbetts Kathleen , Schiff Bradley
Published: February 2015

Objective

To describe a rare case of tracheal perforation due to invasive primary thyroid lymphoma and suggest that expectant management with temporary airway protection is an option to invasive interventions such as tracheotomy and tracheal stent placement.

Method

We report a case of primary B‐cell thyroid lymphoma causing acute airway obstruction in an elderly female who required emergency endotracheal intubation for airway protection.

Results

After receiving one cycle of chemotherapy with rapid response in terms of tumor size reduction, she was found to have extensive anterior tracheal wall necrosis and perforation on both radiologic imaging and direct bronchoscopic examination. She was able to be quickly extubated and survived without intervention.

Conclusion

There is currently no standard of care in terms of management of invasive thyroid lymphoma causing airway obstruction due to its rare incidence. We propose that expectant management with temporary airway protection is an option to procedures such as tracheotomy or tracheal stenting, even in the scenario of airway perforation.
Treatment of Laryngeal Cancer at the Brooklyn VA
Authors: Fraser Marika A. , Floyd Elizabeth , Rosenfeld Richard M. , Sundaram Krishnamurthi , Weiss Michael
Published: February 2015

Objective

1) To compare survival outcomes in patients treated with advanced laryngeal cancer. 2)To illustrate the prevalence of tracheotomy and percutaneous endoscopic gastrostomy (PEG) placement in the organ preservation group and its implication for counseling patients.

Method

A retrospective chart review was performed from January 1999 to December 2009 of patients with larynx cancer AJCC stages III and IV at the Brooklyn VA Hospital. The endpoints examined were 2‐year overall survival and disease‐free survival. The secondary endpoints were the rate of salvage laryngectomy, tracheotomy, and PEG in each cohort.

Results

Kaplan‐Meier survival for the surgery/RT group at 2 years was 75.6% (95% CI; 54.9% to 96.3%) and the survival for the chemo/RT group at 2 years was 62.2% (95% CI; 43.6% to 80.8%). There was no statistically significant difference in overall survival between the surgery/RT vs chemo/RT group. The laryngeal preservation rate was 19 out of 28 (68%) which was lower than the RTOG 91‐11 (84%), and over half these patients required a tracheostomy (52%) or a PEG (68%).

Conclusion

Our study has not shown a significant survival difference between surgery and radiation vs chemoradiation protocols. However, chemoradiation as an organ‐sparing technique does not ensure normal laryngeal function, particularly with frequent need for tracheostomy and gastrostomy. We hope our study will highlight the potential for problematic functional outcomes in these patients.
Treatment of Laryngeal Cancer: Rationale and Outcomes
Authors: Clayburgh Daniel , Schindler Joshua S.
Published: February 2015

Objective

1) Evaluate the rationale for choice of treatment modality in patients with laryngeal cancer. 2) Compare outcomes among various treatment modalities for patients with laryngeal cancer.

Method

A retrospective review was conducted of patients treated for laryngeal cancer between 2006 and 2011. Data were recorded on treatment modality and rationale (radiation therapy (RT), transoral laser microsurgery (TLM), open partial laryngectomy (PL), or total laryngectomy (TL)), and oncologic/functional outcomes. Statistics included chi‐square and bonferroni tests.

Results

Seventy‐nine patients were identified (18 RT, 19 TLM, 20 PL, and 22 TL). TLM was primarily used for early‐stage disease, RT and PL for all disease stages, and TL for advanced disease. RT and TL were usually chosen due to tumor extension or patient health precluding conservation surgery. No surgical patients, but 28% of RT patients required permanent tracheostomy. Voice quality was similar for RT and TLM patients, while PL was significantly worse. All TLM patients resumed a normal diet; a small percentage of RT (17%), PL (10%), and TL (18%) patients required permanent feeding tube use.

Conclusion

Multiple treatment modalities for laryngeal cancer exist, and treatment decisions are usually driven by a combination of tumor characteristics, patient health, and patient preferences. Future research may better define the relative merits of the various treatment strategies available.
Unusually Aggressive Squamous Cell Carcinoma of the Scalp
Authors: Chung Victor , Lee Arnold
Published: February 2015

Objective

To report a series of unusually aggressive squamous cell carcinoma of the scalp and to discuss the current strategies for the diagnosis and management of this disease state.

Method

Patients with well‐differentiated scalp squamous cell carcinoma, presenting with locally invasive disease and aggressive features were identified. We performed a chart review for each patient in this series. The literature is reviewed as it pertains to prior reports and diagnostic strategies for identifying these uncharacteristically aggressive lesions.

Results

We present a series of 5 patients with well‐differentiated squamous cell carcinoma of the scalp that behaved in an unusually aggressive pattern for its level of differentiation. This included local invasion of calvarium, recurrence, and satellite lesions. We did not identify in this case series any correlation between the degree of differentiation and the aggressiveness of the cancer. We did not elucidate any risk factors or histologic identifiers to explain this phenomenon, which has not been previously described in the head and neck literature.

Conclusion

Aggressive squamous cell carcinomas of the scalp may progress to the point of metastasis and death despite appropriate initial therapy. The clinician should be aware that these aggressive features, typically associated with poorly differentiated squamous cell carcinomas, may exist with any level of differentiation when found on the scalp.
Urinary Tract Infections after Head and Neck Cancer Surgery
Authors: Chan Jason Y. , Gourin Christine G. , Semenov Yevgeniy R.
Published: February 2015

Objective

Catheter‐associated urinary tract infections (UTI) have been identified as a preventable “never event” by the Centers for Medicare and Medicaid Services (CMS). We sought to determine the relationship between UTI and in‐ hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.

Method

Discharge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal or oropharyngeal neoplasm in 2003 through 2008 were analyzed using cross‐tabulations and multivariate regression modeling.

Results

UTI was diagnosed in 2% of patients. Patients with UTI were more likely to be over 80 years of age (OR = 3.3, P =. 008), female (OR = 1.9, P <. 001), have advanced comorbidity (OR = 1.8, P <. 012), undergo major surgical procedures (OR = 1.7, P =. 001), have predisposing bladder and prostate conditions (OR = 3.8, P <. 001), experience surgical complications (OR = 2.3, P <. 001), and have acute medical complications (OR = 3.1, P <. 001). UTI was associated with significantly increased length of hospitalization and hospital‐related costs, after controlling for all other variables.

Conclusion

UTI is unusual in HNCA surgical patients but is more common with extent of surgery and age and is significantly associated with postoperative complications, length of hospitalization, and hospital‐related costs. HNCA patients are a high‐risk group for this “never event,” particularly as the population ages.
Vessel Sealing System Thyroidectomy
Authors: Hirunwiwatkul Prakobkiat
Published: February 2015

Objective

To compare efficacy and adverse effects between vessel sealing system thyroid lobectomy (VSSL) and conventional thyroid lobectomy (CTL).

Method

Study design: Randomized, controlled study. Research methodology: Eighteen subjects with solitary thyroid nodule planned for thyroid lobectomy were enrolled consecutively. Intervention was randomized by mixed‐block randomization into 2 groups. Measured outcomes: Primary outcome was operative time. Secondary outcomes were intraoperative blood loss, postoperative blood loss and postoperative recurrent laryngeal nerve injury.

Results

There was clinically significant less operative time in VSSL group compared with CTL group (VSSL/CTL = 59.78 ± 11.83/85.22 ± 19.25 minutes, P =. 004). There was no significant difference of intraoperative blood loss (VSSL/CTL = 39.49 ± 23.24/57.56 ± 18.94 mL, P =. 089) and postoperative blood loss (VSSL/CTL = 49.44 ± 23.78/60.56 ± 41.57 mL, P =. 496) between both groups. There was no case of postoperative recurrent laryngeal nerve injury in both groups.

Conclusion

Thyroid lobectomy using vessel sealing system was clinically significantly better than conventional technique in terms of operative time. Intraoperative blood loss in VSSL group also had a tendency to be less than CTL group. Postoperative blood loss and recurrent laryngeal nerve injury were not significantly different between both techniques.
Anterior Cervical Discectomy and Fusion Is Not a Benign Procedure
Authors: White Zrria , Karakla Daniel W. , Sinacori John
Published: February 2015

Objective

1) Present 5 cases of esophageal injury following anterior cervical discectomy and fusion. 2) Discuss the existing literature on mechanism of injury, presentation, and treatment.

Method

This study is a retrospective case series conducted between 2009 and 2011, reviewing the presentation, and treatment of 5 cases of esophageal injury following anterior cervical discectomy and fusion.

Results

All 5 patients in the series presented with dysphagia. The esophageal injuries in 3 out of 5 cases were identified on barium swallow. In 2 of the 5 patients esophageal injury was not identified until direct laryngoscopy was performed. Four out of 5 of the patients presented in the case series were repaired with sternocleidomastoid flaps and one with endoscopic diverticulotomy alone. All patients had improvement in their symptoms and 3 of the 5 patients completely recovered esophageal function.

Conclusion

With the increased number of anterior cervical disk fusion cases being performed, there are more complications that otolaryngologists must be aware of. Esophageal perforation is a very serious complication and early recognition and treatment are necessary to prevent serious morbidity and mortality. As imaging does not easily identify esophageal perforation, endoscopy is recommended to optimize identification. Management of perforation is best conducted with sternocledoimastoid flaps, which are ideal for esophageal reinforcement because of their excellent blood supply and low donor site morbidity.
Brain Activity in Patients with Adductor Spasmodic Dysphonia
Authors: Kiyuna Asanori , Maeda Hiroyuki , Higa Asano , Uehara Takayuki , Shingaki Kouta , Suzuki Mikio
Published: February 2015

Objective

Spasmodic dysphonia (SD) is clinically characterized by irregular hyperadduction of vocal folds leading to a strained/strangled, hoarse, and effortful voice with break in pitch and phonation. The aim of the present study is to evaluate the cerebral activity in patients with adductor SD in response to phonation.

Method

Six patients with adductor spasmodic dysphonia and 29 healthy subjects participated. Brain activity was evaluated using functional magnetic resonance imaging (fMRI). The experimental task consisted of alternate phonation conditions: vocalization (a prolonged vowel, |i:|) and no vocalization. The cues of both conditions were randomly presented to subjects.

Results

Activation areas in SD, compared with controls, were in right inferior frontal gyrus, right supramarginal gyrus, right middle temporal gyrus, and right superior temporal gyrus. On the contrary, decreased brain activity in SD group was observed in bilateral primary sensory area, right inferior parietal cortex, bilateral precentral gyrus, bilateral rolandic operculum, bilateral SMA, left anterior cingulate cortex, bilateral middle cingulate gyrus, right temporal pole, right superior pole, bilateral cerebellum, left inferior frontal gyrus, right insula lobe, bilateral thalamus, and right basal ganglia.

Conclusion

The present fMRI study demonstrated that brain activity during phonation in SD resembled those in other local dystonia diseases, especially in sensorimotor area, supplementary motor area, basal ganglia, thalamus, and cerebellum. Although sample size was quite limited, it is likely that spasmodic dysphonia is one aspect of local dystonia.
Diffusion of Aniline Blue Injected into Thyroarytenoid Muscle
Authors: Hachiya Adriana , Alonso Valéria M. O. , Rui Imamura , Braga Natasha M. , Tsuji Domingos H. , Sennes Luis U.
Published: February 2015

Objective

Intralaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for the treatment of laryngeal focal dystonia. The side effects and the modification of the laryngeal configuration are probably due to the diffusion of the botulin toxin to nearby structures. Aim: Analyze the diffusion of aniline blue (liquid substance) injected into the TA to the adjacent intrinsic laryngeal muscles.

Method

Study Design: Experimental. Eighteen excised cadaveric larynges were analyzed after injection of aniline blue (0.2 mL) into the TA, using the intralaryngeal technique. After fixation by formaldehyde and decalcification using nitric acid, the larynges were sectioned in the coronal plane in 4 slices and the intrinsic muscles analyzed.

Results

The aniline blue spread to the lateral cricoarytenoid muscle, the cricothyroid muscle and the posterior cricoarytenoid muscle 94.3%, 42.9%, and 8.6%, respectively. Gender, height, and width of the TA had no effect on the likelihood of diffusion to any of the muscles.

Conclusion

The present study showed that, based on the methodology proposed, the diffusion of a solution injected into the TA occurs in almost all cases toward the CAL muscle. The CT muscle was affected in half of the cases. Although rarely, it can also achieve the PCA muscle.
Experimental Laryngeal Granuloma in Rats with GERD
Authors: Shimazu Rintaro , Kuratomi Yuichiro , Inokuchi Akira
Published: February 2015

Objective

Acid reflux and mucosal injury of the larynx may be involved in the development of laryngeal granuloma. This study developed an experimental laryngeal granuloma by mechanical injury to the vocal cord mucosa in rats with chronic acid refluesophagitis to clarify the pathological mechanism of laryngeal granuloma.

Method

An experimental rat model of chronic acid reflux esophagitis was surgically created. A plastic bar was inserted into the trachea of the model rat to mechanically injure the vocal cord mucosa. The pharynx, larynx, and esophagus of these rats were observed histologically every 2 weeks after the operation.

Results

A granuloma was observed in the vocal cord mucosa of the rat after 2 weeks of the surgery, and this presented the same pathological structure as human laryngeal granuloma. In contrast, only mucosal abrasions and blister formations of the vocal cord mucosa were observed in the control rats without surgery.

Conclusion

The current results showed both mechanical injury and acid refluwas involved in the development of a laryngeal granuloma.
Incidence of All‐Cause Chronic Laryngitis
Authors: Stein Daniel J. , Noordzij Jacob P.
Published: February 2015

Objective

1) Appreciate the most common causes of chronic laryngitis. 2) Understand the incidence of chronic laryngitis in a primary care population. 3) Describe the demographic profile of patients who present to care for treatment of chronic laryngitis.

Method

A review identified patients diagnosed with chronic laryngitis among an urban academic medical center primary care population from 2009 to 2010. One hundred subjects with chronic laryngitis were selected, and symptoms, first‐visit treatment, smoking, and demographics were recorded. Incidence was calculated by comparison to an existing database of all cases of idiopathic chronic laryngitis.

Results

Yearly incidence of chronic laryngitis was 19.5 per 1000 people. The 100 subjects consisted of 62 women and 38 men. Race was recorded as black (46), Hispanic (25), white (17), other (12). Age ranged from 20 to 75 years, with a mean of 52.6 years (standard deviation, 12.6 years). Therapies included a proton‐pump inhibitor (77%), voice therapy (21%), nasal steroid (15%), anti‐histamine (6%), amitriptyline (4%), and no treatment (10%). The most common symptoms reported were cough hoarseness (59%), cough (37%), pain/soreness (37%), globus (36%), excessive throat clearing (31%), subjective dysphagia (26%), and throat irritation (19%). 92% were seen by an otolaryngologist.

Conclusion

We found a yearly chronic laryngitis incidence of 19.5 per 1000 people. In an academic setting, most of these will present to otolaryngologists. The majority was treated using proton pump inhibitors. Hoarseness, cough, and pain were the most common symptoms. Population surveys could better define who presents to care.
Incipient Vocal Nodules in Singers without Voice Complaints
Authors: Hachiya Adriana , Baravieira Paula B. , Pimenta Regina A. , Dajer Maria E. , Montagnoli Arlindo N. , Tsuji Domingos H.
Published: February 2015

Objective

To investigate if the presence of incipient nodular lesions, ie, the presence of turbulence of secretion where the vocal fold preferably contacts during phonation, in patients without voice complaint can affect voice quality and vocal cord vibratory parameters.

Method

Twenty female professional voice users (singers) without voice complaints were included in the study. Twelve women had no vocal lesions on a previous videolaryngostroboscopy examination and 8 women showed incipient nodular lesions. The voices were recorded and submitted to auditory perceptual analysis (GRBASH) by 3 different evaluators. The examinations were recorded with a high speed imaging videolaryngoscope equipment (HS Endocam 5560, Richard Wolf GmbH, Knittlingen, Germany), running at 4000 fps. The following parameters were studied: F0, open quotient, speed quotient, time peridiocity index, and the amplitude periodicity index. The data were analyzed by X‐CAD software, and t tests were performed to compare the 2 groups.

Results

The auditory perceptual analysis of the voices of the 2 groups shows that both the control group and the study group have normal variability of voice quality in all vocal samples. There was no statistically significant difference in the studied vibratory parameters.

Conclusion

The presence of turbulence secretion in the transition of the anterior and middle third vocal fold named in the clinical practice as incipient nodules or prenodular lesions does not reflect in changes in voice quality or vocal fold vibratory parameters on high‐speed imaging in female singers without voice complaints.
Intubation‐Related Vocal Cord Palsy
Authors: Hsu Yu‐Ting , Hao Sheng‐Po
Published: February 2015

Objective

1) To review the incidence of intubation‐related vocal cord palsy. 2) To analyze the risk factors of intubation‐related vocal cord palsy and review literature.

Method

Prospective study of patients who received general anesthesia by intubation from January 2010 to August 2011 in otolaryngology department. Patients who complained of hoarseness after operation will undergo flexible laryngoscopy to look for vocal palsy and will be included in this study.

Results

A total of 2511 patients received general anesthesia by intubation in otolaryngology department. Six patients developed post‐operative vocal palsy, including 5 men and 1 woman ages 47 to 67 years old. Time of endotracheal cuff inflation varies from 45 minutes to 1675 minutes. These 6 patients had neck hyperextension during operation. Recovery time of vocal palsy in each patient was less than 10 weeks. The incidence of intubation‐related vocal palsy is around 0.2% in otolaryngology department, considerably higher than the literature reports. Prolonged endotracheal cuff inflation time and neck hyperextension could be the reasons for the higher incidence.

Conclusion

The incidence of intubation‐related vocal palsy in otolaryngology department is 0.2%. Risk factors are the same as the literature, including prolonged endotracheal cuff inflation time, and neck hyperextension position.
Long‐term Follow‐up of Laryngeal Amyloidosis
Authors: Robb Philip , Tulunay‐Ugur Ozlem E. , Suen James Y.
Published: February 2015

Objective

1) Laryngeal amyloidosis is a rare disease and most of the knowledge is from single case reports. In this paper, we aim to present one of the larger series of primary laryngeal amyloidosis reported in the English written literature. 2) To understand the disease course and be able to describe long term outcomes in these patients.

Method

Retrospective review of six patients with laryngeal amyloidosis followed at a tertiary university voice center. The patient charts were reviewed for initial presentation, workup, and surgeries or other treatments performed. Serial laryngoscopic examinations were reviewed. Voice handicap index was used to evaluate voice outcomes.

Results

Majority of the patients required multiple surgeries to control the disease. Endoscopic approach with CO2 laser excision was the preferred technique. Attention was given to preserve the function of the larynx. During follow‐up, patients who had an adequate vocal quality preferred observation only with no further surgeries or treatment. Long‐term follow‐up shows an indolent course of the disease.

Conclusion

The extended follow‐up allows us to provide recommendations on treatment options and surgical technique. Since this is a slowly progressing disease, the main objective should be to preserve laryngeal function as long as possible.
Novel Repair Technique of Transmural Tracheal Lacerations
Authors: Cervantes Sergio S. , Matthaeus Jamie L. , Lott David G. , Landry April M. , Jaroszewski Dawn E.
Published: February 2015

Objective

1) Demonstrate a novel method to repair a full thickness tracheal wall laceration. 2) Discuss the relationship of this new technique in regard to current accepted methods of treatment reported in the literature. 3) Learn that full thickness tracheal tears, although rare, are possible following routine tracheal balloon dilation.

Method

We review a patient’s case of symptomatic idiopathic subglottic stenosis. One year after initial dilation, balloon dilation was performed and an 8‐cm full‐thickness tracheal laceration occurred. We report successful repair with a covered tracheobronchial stent and review the literature relating our repair to other accepted techniques.

Results

Following tracheal balloon dilation, staying within recommended limits, a complete tear was identified. Using flexible endoscopy and fluoroscopic guidance the tear was measured to be 8 cm. An 80 × 20 mm covered tracheobronchial stent was deployed into position to overlie the area of tracheal disruption. Intraoperative computed tomography demonstrated minimal air extravasation, thus the patient was extubated. The patient’s course was uncomplicated and discharged three days later. Review of current literature demonstrates a variety of repair techniques including soft tissue reconstruction. Our technique is advantageous because it can be done at the time of surgery with excellent outcomes and less morbidity.

Conclusion

Endotracheal balloon dilation is an established and safe method to restore airway volume; however full thickness lacerations can occur. This case demonstrates that deployment of an appropriate tracheobronchial stent at the time of surgery is a viable treatment option with low comorbidity. Close postoperative monitoring is vital to successful outcome.
Novel Suction Holder Clips for Endolaryngeal Laser Surgery
Authors: Manickavasagam Jaiganesh , Jebreel Ala’eddin
Published: February 2015

Objective

Since the introduction of lasers in laryngeal surgery, a number of technological advances, as well as an improved understanding of disease pathogenesis, have enabled major evolutions in surgical techniques. Continuous smoke evacuation improves visualization. We have devised new simple and efficient suction clip holders for enolaryngeal surgery.

Method

Clip design and technical specifications are explained.

Results

We have devised suction clip holders which have the following distinct advantages over other types of suction holders. These clips can hold various sucker sizes as they feature an expandable slit. With this clip, the placement of the sucker in the proximal end of the laryngoscope and the position of the sucker tip at the distal end are both easily adjustable for optimal suction. It also clips easily into any laryngoscope without obscuring visual field. Furthermore, in the instance of any bleeding, this sucker is easily detachable and can be used for suction.

Conclusion

We routinely use these sucker clips to perform all endolarygneal surgery and overall, feel they are simple, easy to use, and extremely efficient in suctioning fumes.
Pulmonary Papillomatosis: HPV11 Mutation and Vorinostat Therapy
Authors: Woo Jennifer A. , Yuan Hang , Liu Xuefeng , Schlegel Richard , Grant Nazaneen , Harley Earl , Myers Scott
Published: February 2015

Objective

1) Report isolation of HPV‐11 with viral genome duplication in the lung tumor lesions of a 23‐year‐old man with a 20‐year history of recurrent respiratory papillomatosis (RRP). 2) Describe pulmonary RRP response to vorinostat therapy, following previous disease progression on alpha‐interferon, intralesional cidofivir, and oral methotrexate.

Method

Following RUL segmentectomy to remove a 4‐cm RRP lesion and laser ablation of laryngeal papillomas, HPV viral genome was isolated and sequenced. Lung tumor cells were screened for in vitro sensitivity to multiple therapies, including vorinostat. Success of vorinostat therapy was measured by radiologic evaluation of lung lesions.

Results

HPV‐11 DNA was isolated from laryngeal and pulmonary lesions. Genomic sequencing identified a 2kB duplication of the HPV‐11 genome in the lung lesions only, including a novel duplication of the upstream promoter and the E6/E7 oncogenes. Lung tumor cells demonstrated in vitro sensitivity to vorinostat. After 12 weeks of vorinostat therapy (tolerated at 400 mg/daily for 21 days q 4 weeks), repeat CT revealed significant reduction of most lung lesions compared to baseline. Pulmonary and laryngeal diseases remained stable after 12 months follow‐up on vorinostat.

Conclusion

We present the first documented case of progressive, chemoresistant pulmonary RRP responsive to vorinostat. Our data suggest a link between the duplication of HPV‐11 promoter and viral oncogenes and aggressive clinical phenotype. Use of novel cell‐culture technology and in vitro chemosensitivity screening may improve long‐term prognosis of this notoriously recalcitrant disease.
Severe Laryngomalacia: Management of 10 Cases with CO2 Laser
Authors: Pinto José A. , Kohler Rodrigo , Wambier Henrique , Mizoguchi Elcio I. , Ribeiro Renata C. , Gomes Leonardo M.
Published: February 2015

Objective

1) Be able to quantify the prevalence of severe laryngomalacia in our department and evaluate the impact of postoperative CO2‐laser supraglottoplasty. 2) Determine if CO2‐laser supraglottoplasty laser is beneficial for patients with severe laryngomalacia.

Method

Retrospective study. Ten patients diagnosed with severe laryngomalacia in our service from October 2001 to September 2011 who underwent unilateral or bilateral CO2‐laser supraglottoplasty. The main outcome measures were: type of laryngomalacia, resolution of clinically significant laryngomalacia, development of major complications, andlength of post‐operative hospital stay.

Results

A total of 10 pediatric patients aged 1 month to 14 years were enrolled. The mean age was 20.8 months. There were 6 men (60%) and 4 women (40%). Inspiratory stridor was the main clinical symptom (90%) and all children had significant relief of symptoms. Most common type of LM was the type I (60%). About 3 patients (30%) underwent a new surgery. None of them needed tracheotomy nor had major complications.

Conclusion

The majority of patients undergoing supraglottoplasty do not present complications. CO2‐laser supraglottoplasty is a secure and effective treatment option for severe laryngomalacia. Furthermore the postoperative clinical follow‐up is an important factor for the successful treatment of laryngomalacia.
Supraglottic Function in Unilateral Vocal Fold Paralysis
Authors: Van Deusen Mark B. , Gruss Calvin , Cleveland Thomas , Garrett C. G. , Francis David O.
Published: February 2015

Objective

Supraglottic hyperfunction is a compensatory behavior that occurs in patients with glottic incompetency. It is pronounced in unilateral vocal fold immobility (UVFI), where false vocal folds (FVF) can obfuscate evaluation of the true vocal folds. We sought to characterize supraglottic hyperfunction patterns in post‐surgical UVFI patients.

Method

Videostroboscopy examinations of 10 consecutive post‐surgical patients with complete UVFI diagnosed within 3 months of surgery were reviewed by 2 blinded, independent reviewers. Characteristics of supraglottic hyperfunction were scored for direction (AP or lateral) and whether laterality was asymmetric relative to UVFI (primary outcome). Kappa tests measured interrater reliability.

Results

The UVFI cohort was evaluated a median of 63.5 days postsurgery. UVFI was left‐sided in 6 out of 10 patients. All patients had asymmetric lateral FVF hyperfunction with predominant medial excursion by the FVF contralateral to the immobile vocal fold (kappa = 1, P <. 01). AP hyperfunction occurred in 1 out of 2 of cases, with its significance less agreed upon by reviewers (kappa = 0.4, P =. 09). Petiole deviation toward the immobile vocal fold occurred in 70% of cases (kappa = 1, P <. 01).

Conclusion

Supraglottic hyperfunction was universal in patients with UVFI. The most common pattern was 1) asymmetric lateral FVF hyperfunction with maximum medial excursion of the contralateral FVF, and 2) petiole deviation toward the side of UVFI. Understanding fiberoptic examinations of UVFI may aid our diagnostic accuracy in lesser vocal fold pareses.
Symptoms in Eosinophilic Esophagitis: A Longitudinal Study
Authors: Larsson Helen M. , Knutsson Karin H. , Bergquist Henrik , Bove Mogens
Published: February 2015

Objective

Evaluate dysphagia and health‐related quality of life (HRQL) in adults newly diagnosed with eosinophilic esophagitis (EoE) at diagnosis, after 2 months of treatment with topical corticosteroid, and at least 1 year later.

Method

Between February 2008 and November 2010, 39 consecutive patients were prospectively included at a university hospital and a secondary referral hospital. The questionnaires used for evaluation were the Watson Dysphagia Scale (WDS), the EORTC QLQ‐OES18 and the Short Form‐36 (SF‐36). The Wilcoxon signed‐rank test was used to compare scores.

Results

At inclusion, the mean scores of the WDS, the EORTC QLQ‐OES18 dysphagia scale and eating scale and the SF‐36 global health score were 19.1, 14.5, 35.1, and 71.2, respectively. After treatment the scores improved to 9.4 (P. 0004), 4.9 (P. 02), 18.9 (P. 01), and 74.4 (ns). At the second follow‐up (mean 2.5 years after inclusion), the corresponding scores, 12.9 (P. 01), 7.6 (P. 08), 20.4 (P. 02), and 76.0 (ns), were still improved compared to at inclusion. While 16 patients had a history of hospitalization due to esophageal bolus impaction, no such event occurred during the study period.

Conclusion

Newly diagnosed, untreated adult EoE is associated with a substantial burden of symptoms and impaired HRQL, which improve significantly after treatment. A partial remission is still noted more than two and a half years after diagnosis.
3D Anatomy of the Cochlea for Cochlear Implant
Authors: Tanioka Hisaya , Kaga Kimitaka
Published: February 2015

Objective

This study aimed to create a 3‐dimensional anatomy of the round window to hook region to identify the optimal site for cochleostomy in cochlear implantation and other endocochlear surgical procedures.

Method

Ten normal ears were studied. To develop 3‐dimensional reconstructed inner ear image based on high‐resolution temporal bone images obtained by a spiral CT. The axial data were applied to create 3‐dimensional images on the CT work station for post‐processing with the use of current workstation software (GE Advantage Navigation).

Results

The anatomy of the round window to hook region is complex, and spatial relationships can be difficult to evaluate using 2‐dimensional CT images. Three‐dimensional models of the round window membrane (RWM), cochlear duct, scala vestibule, scala tympani, ductus reuniens, and surrounding structures were generated. The relationship between these structures and the round window membrane (RWM) and adjacent otic capsule was easily identified.

Conclusion

This 3‐dimensional model has implications for surgical procedures to the inner ear that aim to minimize insertional trauma and decrease operation time. We can know the anatomic information before cochlear implant.
A Novel Volumetric Model of Vestibular Schwannomas
Authors: Prendes Brandon L. , Groppo Eli R. , Reynolds Catherine , Parsa Andrew T. , Cheung Steven W.
Published: February 2015

Objective

Evaluate an ellipsoid model of vestibular schwannoma (VS) tumor volume based on linear dimensions.

Method

MRI scans from 97 patients with VS from 2003 to 2011 were analyzed. Linear measurements of major axes defining an ellipsoid within the cistern and a cone within the internal meatus were made. From those dimensions, geometrically based conformational models of tumor volume were evaluated.

Results

Model estimates of tumor volume were compared to measurements made using software utility in Brainlab. Seventy‐two MRI scans were used for model optimization and 25 scans to validate model predictions and performance. Optimal model selection was determined based on the best trade‐off between time required to obtain measurements and the model’s ability to capture volumetric variance. Analyses showed the optimal tumor model as one where the cisternal component was modeled as an ellipsoid and the canalicular portion was modeled as a cylinder (r = 0.96, P <. 001). This model was robust for a broad range of tumor sizes.

Conclusion

Expected outcomes following treatment of vestibular schwannomas are dependent on tumor size, which has been variably described throughout the literature both by tumor volume and linear dimension of canalicular and cisternal components. Our model can be used to invert volumetric data to linear indices of volume. This tool will enable meta‐analysis of disparate data sets.
Auditory Tube Dysfunction Occurring after Plastic Surgery
Authors: Aoki Hideaki
Published: February 2015

Objective

Some patients with jaw anamorphosis symptom who underwent plastic surgery for lower jaw complain of earache, feeling of obstruction, and hearing disorders.By conducting auditory tube function tests before and after plastic surgery for the lower jaw, we studied pathophysiology, incidence, causes and treatment of auditory tube dysfunction.

Method

This study was carried out between 2000 and 2010. The 290 patients were divided into 4 groups(A to D) and compared for the rate of aggravation of auditory tube function and duration for the function to recover.

Results

Approximately 30% of patients with TM aggravation complained of ear symptoms. Among subjective ear symptoms, the most prevalent was feeling of ear obstruction, followed, in the order, by discuses. The number of patients who complained of ear symptoms was 23.9% in group A, 17.1% in group B, 6.7% in group C, and 9.1% in group D. Aggravation of auditory tube function (was determined by TM in 62.7% in group A, 44 (53.7%) in group B, 14 (46.7%) in group C, and 12 (54.5%) in group D.

Conclusion

Postoperative auditory tube dysfunction recovered spontaneously in an average of 3.48 days without providing ventilation treatment while patients were placed under observation. Patients with postoperative auditory tube dysfunction that lasted longer than 4 days or with complaints of subjective symptoms were given ventilation treatment. All cases were cured within 14 days.
Canal Wall‐up Tympanomastoidectomy: Recurrence Factors
Authors: Pereira Sonia , Baptista Sara , Barros Ezequiel
Published: February 2015

Objective

Canal wall‐up tympanomastoidectomy is gaining popularity in the treatment for cholesteatoma. The choice remains controversial because of the significant recurrence rate of this disease. We aimed to analyze tympanomastoidectomy success rate, to establish eventual predictive factors for failure, and to evaluate the computed tomography (CT) scan’s value in this pathology.

Method

We performed a retrospective cohort study regarding all patients submitted to tympanomastoidectomy for cholesteatoma at the otolaryngology department of Hospital São José, Lisbon, from January 1, 2005, to December 31, 2009. Clinical and demographic data were obtained from medical records.

Results

One hundred nineteen patients were submitted to tympanomastoidectomy. In most cases, preoperative CT scans showed cholesteatoma in the attic (50%) and large extension of the disease (tegmen, semicircular or fallopian canal erosion in 51%), not always confirmed during surgery (75%). Sixty percent had a canal wall‐down procedure. The overall postoperative air‐bone gap was within 20 dB in 44%. Second‐look surgery was performed in 24 patients: the overall recurrence rate was 23%, with conversion to canal wall‐down procedure in 67%. Factors identified as related to failure: cholesteatoma in the sinus tympani (33%), scutum erosion (29%), and large extension of disease (40%).

Conclusion

The recurrence rate was significant, despite the high percentage of canal wall‐down procedures. Factors for failure remain uncertain and CT scans presented limited value in the diagnosis and evaluation of cholesteatoma, especially postoperatively. In the absence of better diagnostic procedures, we recommend second look surgery to control cholesteatoma’s recurrence.
Cartilage Tympanoplasty for Retraction Pockets
Authors: Gulia Joginder S. , Yadav Samar Pal S. , Singh Balwan
Published: February 2015

Objective

To see the efficacy of cartilage tympanoplasty in retraction pockets of tympanic membrane.

Method

Prospective study conducted from 2009 to 2010. Disease studied: Retraction pockets in tympanic membrane. Subjects studied: Twenty. Setting: Tertiary care center. Interventions: The retraction pockets were excised and cartilage tympanoplasty using tragal cartilage and perichondrium was performed. Graft take‐up, hearing improvement was noted and statistical significance was calculated.

Results

Patients were followed up for a period of 6 months. Graft take‐up was seen in 16 (80%) cases with residual perforation in 2 cases and recurrence of retraction pockets in 2 cases. The average preoperative hearing loss was 39.50 + 1.44 decibels, while the average postoperative hearing loss was 26.75 + 1.86 decibels, with a gain of 12.75 decibels (P value less than. 01).

Conclusion

Retraction pockets management by excision and cartilage tympanoplasty provides the tympanic membrane with greater strength and greatly increases the rate of tympanic membrane closure without affecting audiometric results. Graft take‐up and improvement in hearing was noted in 80% of the cases (P <. 01).