bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of High Risk for Obstructive Sleep Apnea Using STOP‐Bang Questionnaire in Thai Population
Authors: Charakorn Natamon , Hirunwiwatkul Prakobkiat , Suksamran Apasee , Teerapraipruk Busarakum , Chirakalwasan Naricha
Published: September 2014

Objectives:

Determine the prevalence of high risk for obstructive sleep apnea (OSA) in general Thai population by using the STOP‐Bang questionnaire.

Methods:

Anonymous survey was conducted in Thailand at Health and Wellness exhibition. The exclusion criterion was age <18 years. The STOP‐Bang questionnaire was used in the survey. This questionnaire consisted of 4 simple yes/no questions: snoring, tiredness, observed apneas, blood pressure, and 4 clinical characteristics which were dichotomized according to specified cutoffs; body mass index >35, age >50 years, neck circumference >40 cm, sex = male. Scores of at least 3 were considered high risk for OSA. Epworth sleepiness scale (ESS) as well as detailed demographic information related to several aspects of sleep was also obtained.

Results:

The study included 414 Thai adults. The mean age of participants was 51 years old. Of the 414 participants, 305 participants (76%) were classified as high risk for OSA. High risk for OSA group was observed to have more males (88%). The STOP‐Bang yielded a mean score of 3.65. One hundred seventy‐two participants (41%) were noted to have excessive daytime sleepiness (ESS score >10). There was a significant correlation between STOP‐Bang questionnaire score and Epworth sleepiness scale score (P <. 05, r = 0.267).

Conclusions:

Over 70% of participants were identified as having high risk for OSA based on the STOP‐Bang questionnaire. Considering the serious adverse health and quality of life consequences of OSA, screening for OSA in general populations should be attempted.
The Aesthetic Impact of Modified Extracorporeal Septoplasty
Authors: Aldosari Badi , Disant Francois , Marin Patrick
Published: September 2014

Objectives:

Evaluate the aesthetic impact of our modified septal framework's self‐stabilizing design as a self stabilizing masterpiece.

Methods:

Retrospective cohort study at an academic tertiary care medical center. A total of 114 patients underwent an extracoporeal septoplasty between 2008 and 2012. Eleven parameters of facial analysis were examined closely on every patient's photograph.

Results:

Patients had great aesthetic improvement. In fact, a high percentage of patients had a better profile line, central axis, nasal base symmetry, sheen's line, tip symmetry, tip projection, and nasolabial angle. However, we also noticed a widening of the middle third in 27% of the patients and a filling of the nasofrontal angle in 21%. The latter showed a downward trend throughout the years.

Conclusions:

The modified extracorporeal septoplasty has a positive impact on aesthetic analysis.
Intracapsular Tonsillectomy for Keratosis Pharyngeous: Postoperative Recovery and Surgical Efficacy
Authors: Gaudreau Philip A. , Gessler Eric
Published: September 2014

Objectives:

(1) Compare the postoperative recovery of patients undergoing intracapsular tonsillectomy to subcapsular tonsillectomy for keratosis pharyngeous. (2) Determine the surgical efficacy of intracapsular tonsillectomy in preventing recurrent symptoms in patients with keratosis pharyngis.

Methods:

A prospective, single‐blinded, randomized controlled trial of adult patients ages 18 years or older diagnosed with keratosis pharyngis between December 2010 and February 2013 was performed. Patients were randomized to receive either intracapsular or subcapsular tonsillectomy with the coblator. Postoperative pain scores and amount of pain medication taken were recorded daily for 2 weeks postoperatively. A 6‐month follow‐up questionnaire was used to assess the efficacy of the procedure based on persistent symptoms.

Results:

Twenty‐two patients completed the study, with 11 in each group. There was a statistically significant difference in the amount of pain medication consumed on postoperative days 8, 9, and 10, with the intracapsular group consuming less medication (P =. 0293,. 0146,. 035). There was also a statistically significant difference in the recurrence of tonsilloliths at the 6‐month follow‐up point (P =. 0291). Patients who had an intracapsular tonsillectomy had a significantly higher recurrence rate than those patients who had a subcapsular tonsillectomy.

Conclusions:

In adult patients undergoing tonsillectomy for keratosis pharyngis, an intracapsular, coblation tonsillectomy resulted in lower consumption of pain medication than subcapsular tonsillectomy. However, intracapsular coblation tonsillectomy resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication usage in the intracapsular cohort may be offset by the increased likelihood that symptoms will recur.
Updated Systematic Review of Multilevel Surgery for Patients with OSA
Authors: Lin Hsin‐Ching , Friedman Michael
Published: September 2014

Objectives:

Perform an updated systematic review and meta‐analysis to determine the surgical success rate of multilevel upper airway surgery for patients with obstructive sleep apnea syndrome (OSA).

Methods:

A systematic review was performed to identify English‐language studies that evaluated the treatment of adult OSA patients with multilevel OSA surgery up to May, 2013. We used polysomnography as a metric of treatment success. Articles were included only if the surgery intervention involved at least 2 of the frequently involved anatomic sites: nose, oropharynx and hypopharynx. Seventy‐three studies fit the inclusion criteria and a meta‐analysis was performed to determine the overall success.

Results:

The meta‐analysis included 3147 subjects with a mean age of 45.0 years. The originally reported success rate in the included literature was 59.8%. A meta‐analysis was performed to redefine the success rate to be consistent with the commonly agreed upon criteria, “a reduction in AHI [apnea‐hypopnea index] of 50% or more and an AHI of less than 20.” The recalculated success rate was 61.4%. Standard meta‐analytic techniques for combining p‐values between studies after weighting for sample size found significant improvements in AI, AHI, %REM sleep, LSAT, snoring visual analog scale, and Epworth Sleepiness Scale.

Conclusions:

This study shows the significant benefits of multilevel surgery for OSA patients.
Microbial Flora and Antibiotic Resistance in Peritonsillar Abscesses in Upstate New York
Authors: Plum Ann W. , Mortelliti Anthony J. , Walsh Ronald
Published: September 2014

Objectives:

(1) Identify the most common bacteria in peritonsillar abscesses over the past decade. (2) Identify the prevalence of antibiotic resistance of pathogens responsible for peritonsillar abscesses to guide initial antibiotic treatment.

Methods:

This is a retrospective chart review looking at adult and pediatric patients who presented to a single tertiary academic center in upstate New York from 2002 through 2012 and underwent either incision and drainage or quincy tonsillectomy for a peritonsillar abscess (n = 69), during which cultures of the abscess were obtained. Cultures from the abscess were reviewed for bacteria and antibiotic sensitivities. Patient medical records were reviewed for age, medical comorbidities, prior episodes, immune‐compromised state, type of drainage procedure done and complications, and whether more than one procedure was needed.

Results:

Of the peritonsillar abscesses, 62.32% were polymicrobial and 34.78% were monomicrobial. The most common pathogens were beta hemolytic streptococcus (31.88%), alpha hemolytic streptococcus (21.74%), Neisseria (14.49%), and Streptococcus milleri (13.04%). Staphylococus was resistant to oxacillin (25%), erythromycin (25%), clindamycin (12.5%), and penicillin (12.5%). Alpha hemolytic streptococcus was resistant to clindamycin (6.67%) and erythromycin (6.67%). Streptococcus milleri was resistant to clindamycin (11.11%) and erythromycin (11.11%).

Conclusions:

Peritonsillar abscesses are most commonly polymicrobial, with beta and alpha hemolytic streptococci, Neisseria, and S milleri as the most prevalent pathogens. In addition, antibiotic resistance to clindamycin and erythromycin is common across streptococcal strains and staphylococcal strains, and methicillin resistance is also common in staphylococcal strains responsible for peritonsillar abscesses.
Myringotomy Ear Simulation Model
Authors: Ker Liang , Ng Chew Lip , Austin Felix , Foo Delane
Published: September 2014

Objectives:

Myringotomy and ventilation tube insertion is a common otolaryngologic surgical procedure with a steep learning curve for residents. Incorrect placement of incisions and external ear canal trauma are common complications when residents begin learning the procedure. With increasingly conservative guidelines on indications of myringotomy tubes, residents have less opportunities to refine this skill on real patients. The objective is to create a learner‐centric myringotomy simulator.

Methods:

Although the concept of simulation training in myringotomy is not new, we aim to reduce the learning curve by introducing learner‐guided features on a simulation model. Some of these include landmarks such as the handle of malleus, the anterior inferior quadrant guide, and modified instruments as part of the simulation. Working with the National University of Singapore, Division of Industrial Design team, a 3‐dimensional library of different variants of ear models, including modified ear canals for teaching, was created. We created a platform to house the different components including an auricle, an external ear canal, and a disposable tympanic membrane with landmarks.

Results:

The model is accurate with realistic consistency to mimic soft tissues encountered in the myringotomy procedure. The simulator allows for variance in anatomy between the side of the ear and also between adult and pediatric sizes.

Conclusions:

Our model can be used to train otolaryngology residents and will be employed as a proof‐of‐concept model for the purpose of simulation training.
A Randomized Controlled Trial Protocol for GeloRevoice Throat Lozenges as Adjunctive Analgesic in Post‐tonsillectomy Pain
Authors: Liu Zi Wei , Meghji Sheneen , Jayaraj Samuel
Published: September 2014

Objectives:

There has been recent controversy with regard to optimal postoperative pain control for tonsillectomy. Codeine is no longer recommended for children under the age of 12 years because of the risk of respiratory depression. Hence, identifying alternative/adjunct analgesia for post‐tonsillectomy pain is a high clinical priority. This is a protocol for a randomized controlled trial. The primary objective is to determine whether GeloRevoice throat lozenges (contain sodium hyaluronate) are effective as adjunct therapy to standard analgesia (paracetamol, ibuprofen, difflam spray) in post‐tonsillectomy pain.

Methods:

A total of 72 patients were randomized to 2 groups. Parents with children aged 6 to 18 years undergoing tonsillectomy were approached to participate in the study. The intervention group received GeloRevoice throat lozenges and the control group received a placebo. The study was subject to trust research and audit and safety reporting procedures, and ethical approval was applied for.

Results:

The primary endpoint was a pain score using a visual analog scale for pediatric populations. Pain scores were recorded on a diary card daily for 1 week postoperatively. Visual analog scale data were compared between 2 groups using a 2‐tailed t test where P <. 05 was considered to be statistically significant.

Conclusions:

This double‐blinded randomized controlled trial provides evidence on the safety and efficacy of GeloRevoice throat lozenges when used as adjunctive analgesia for post‐tonsillectomy pain.
Readability Assessment of Online Tracheostomy Care Resources
Authors: Hu Amanda , Kong Keonho (Albert)
Published: September 2014

Objectives:

(1) Assess the readability of online tracheostomy care resources. (2) Compare the readability of major versus minor websites and patient‐ versus professional‐oriented resources.

Methods:

A Google search was performed for “Tracheostomy care” in January 2014. The top fifty results were categorized into major versus minor websites, and patient‐ versus professional‐oriented resources. These websites were evaluated with the following readability tools: Flesch Reading Ease Score (FRES), Flesch‐Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (GFOG).

Results:

Readability scores for the 50 websites were FRES 57.21 ± 16.71 (possible range = 0 to 100), FKGL 8.33 ± 2.84 (possible range = 3 to 12), SMOG 11.25 ± 2.49 (possible range = 3 to 19), and GFOG 11.43 ± 4.07 (possible range = 3 to 19). There was no significant difference in all 4 readability scores between major (n = 41) and minor (n = 9) websites. Professional‐oriented websites (n = 19) had the following readability scores: FRES 40.77 ± 11.69, FKGL 10.93 ± 2.48, SMOG 13.29 ± 2.32, and GFOG 14.91 ± 3.98. Patient‐oriented websites (n = 31) had the following readability scores: FRES 67.29 ± 9.91, FKGL 6.73 ± 1.61, SMOG 10.01 ± 1.64, and GFOG scores 9.30 ± 2.27. Professional‐oriented websites had more difficult readability scores than patient‐oriented websites for FRES (P <. 00), FKGL (P <. 00), SMOG (P <. 00), and GFOG scores (P <. 00).

Conclusions:

Online tracheostomy care resources were written at a level more difficult than the recommended fourth‐ to sixth‐grade level for written health information. There was no significant difference in readability between major and minor websites. Professional‐oriented websites were more difficult to read than patient‐oriented websites.
Relation between Different Stages of Oral Cancer and Aberrant Methylation in Taiwan: Preliminary Report
Authors: Liu Chih‐Hsien , Wang Wen‐Hung , Wang Pa‐Chun , Lin Jia‐Cheng , Liu Fu‐Guo R.
Published: September 2014

Objectives:

During the past decade, oral cancer has become the fourth cause of death in Taiwan. After receiving treatment at the early stages of oral cancer (stage I and stage II), the 5‐year survival rate is up to 81.9%. However, as soon as cancer cells spread to the neighboring tissues accompanied with lymph node metastasis in the neck (stage III and stage IV), the 5‐year survival rate drops to 23‐25%. This indicates the importance of the early detection of carcinogenesis to high survival rate. Aberrant methylation in promoter regions of certain genes has long been noticed and evidenced as strongly correlative to carcinogenesis.

Methods:

The tissue samples were obtained from the patients of one medical center, and the tissue was divided into 3 parts: tumor, nearby tissue, and further (normal) tissue. Then, the tissue was deposited in liquid nitrogen for DNA and RNA extractions. Patient data were collected including age, sex, risk factors (alcohol/betelnut/cigarette use), clinical and pathological stage, and operation.

Results:

This study investigates the aberrant methylation level on seven genes, E‐cadherin, cyclinA1, cytoglobin, IGF2, MGMT, P16, and RARβ, in tissue samples of oral cancer.

Conclusions:

By means of the high sensitivity and accuracy technology, pyrosequencing, the methylation profiles of studied genes should be able to provide insight and evaluation of biomarkers of aberrant methylation in carcinogenesis.
Robot‐Assisted Sialolithotomy with Sialoendoscopy: A Novel Approach to Management of Large Submandibular Gland Stones
Authors: Razavi Christopher , Paschalis Celine , Samara Ghassan J. , Maroon Mark
Published: September 2014

Objectives:

(1) Describe robot‐assisted sialolithotomy with sialoendoscopy (RASS) for the management of large submandibular gland (SMG) stones. (2) Analyze symptom recurrence and lingual nerve damage following RASS in comparison to the combined transoral sialoendoscopic approach (CTA).

Methods:

A retrospective case series was performed on patients with large palpable SMG stones managed with RASS. Large stones were defined as >4 mm, the upper limit that can be removed via sialoendoscopy. Fourteen patients who presented between October 2012 and January 2014 with mean stone size of 11.9 mm were identified. Patients were questioned regarding symptom recurrence, symptoms of lingual nerve damage, and procedural satisfaction at mean follow‐up of 8 months. Procedural success was defined as absence of symptom recurrence in conjunction with gland preservation. These measures were compared to reported outcomes with CTA in the English literature.

Results:

Procedural success was 100% (14/14) for our series. No patients reported symptoms of lingual nerve damage at the time of follow‐up, while 2 patients reported transient lingual nerve paresthesia (mean duration 2.5 weeks). Mean patient satisfaction was 9.8 on a scale of 10. Literature review identified 137 patients who underwent CTA for large SMG stones between 2005‐2011. Procedural success rate for these patients was 75%. When commented on, lingual nerve damage was reported in 2% of patients.

Conclusions:

Preliminary data in management of large SMG stones with RASS shows improved procedural success in comparison to CTA. Furthermore, the morbidity of lingual nerve damage seen in CTA has yet to be encountered with RASS, likely due to improved visualization.
The Role of Psychological Factors in Burning Mouth Syndrome
Authors: Lee Yun Jae , Kwak Min K. , Ji Yong Bae , Song Chang Myeon , Lee Seung Hwan , Park Chul Won , Tae Kyung
Published: September 2014

Objectives:

Burning mouth syndrome (BMS) is characterized as a burning sensation in the mouth without definite oral pathology. Although BMS is not uncommon, the etiology and psychological profiles are not well established. The aim of this study is to evaluate the role of psychological factors in BMS patients.

Methods:

We prospectively compared the psychiatric symptoms using Symptom Checklist‐90‐Revised questionnaire (SCL‐90‐R) in 50 patients diagnosed with BMS and 52 controls who had no oral and pharyngeal disease from December 2012 to June 2013.

Results:

The mean age (56.8 vs 52.8 years, P =. 18) and male to female ratio (42% vs 46%, P =. 95) did not differ between the 2 groups. Somatization, obsessive‐compulsive, depression, anxiety, phobic anxiety, and psychoticism scores of SCL‐90‐R were significantly higher in the BMS group than in the control group (P <. 05). In the subgroup analysis according to sex, the male group showed similar patterns, whereas the BMS group showed higher somatization, anxiety, phobic anxiety, and psychoticism scores than the control group in the female group analysis. The psychiatric symptoms of SCL‐90‐R did not correlate with sex, age, and duration of symptoms in the BMS group. Comorbid disease such as hypertension, diabetes, rheumatoid disorder, or chronic hepatitis in BMS patients was significantly associated with higher somatization and obsessive‐compulsive scores compared with BMS patients without comorbidity.

Conclusions:

Based on the results of this study, it is suggested that psychosomatic factors may contribute to the development of BMS.
Sea‐Surface Simulator Device to Detect Motion Sickness Disease in Naval Personnel
Authors: Gurpinar Berk
Published: September 2014

Objectives:

This study aims to introduce a device, which has been widely used to train the personnel recruited for naval missions in frigates, used as a motion sickness detector in our study. We also compared the findings of the motion sickness patients to the normal population.

Methods:

Thirty adult male personnel were included. Sea intensity between level 1 and level 5 was simulated, and the parasympathetic and physical findings of the personnel were recorded.

Results:

The mean age was 22.6 ± 3.4. During level 2 intensity, 4 personnel (13.33%); level 3, 5 personnel (16.66%); level 4, 12 personnel (40%); and level 5, 9 personnel (30%) demonstrated motion sickness symptoms.

Conclusions:

Besides training purposes, these simulators could be helpful to identify motion sickness disease in the targeted personnel before naval missions.
Transoral Submandibular Gland Excision: A Review of 43 Patients
Authors: Fisher Michelle , Segel Jamie M. , Groves Michael , Brown Jimmy J.
Published: September 2014

Objectives:

(1) Review our experience with trans‐oral excision of the submandibular gland. (2) Compare outcomes of the transoral approach with the traditional transcervical approach.

Methods:

A retrospective chart review of prospectively collected data. Forty‐three patients with benign submandibular gland pathology who underwent trans‐oral excision of the submandibular gland from 2007‐2013 were identified. Data pertaining to patient demographics, conversion to open approach, recurrence of disease, length of operative procedure, length of hospital stay, and incidence of neurologic complications were collected.

Results:

Forty‐three patients underwent transoral excision of the submandibular gland over a 6‐year period. Of the 43 procedures performed, 1 transoral case required conversion to an open procedure, and therefore 98.6% of patients avoided a neck scar. Thirty‐four out of 42 (80%) of patients reported transient tongue parasthesias. No patient experienced hypoglossal or facial nerve dysfunction.

Conclusions:

Transoral submandibular gland excision is a safe and effective procedure. The approach allows for avoidance of an unsightly neck scar as well as lower rates of injury to the lingual, hypoglossal, and facial nerves when compared to a transcervical operation. This should become a routine part of the surgical armamentarium of the well‐trained otolaryngologist.
Comparative Finite‐Element Analysis for Defect Reconstruction with Rhomboid Flaps
Authors: Syamal Mausumi N. , Lovald Scott , Ochoa Jorge A. , Ghanem Tamer Abdel‐Halim
Published: September 2014

Objectives:

To view the utility of comparative 2D finite element analysis (FEA) of rhomboid flap models in analyzing how varying skin stiffness and directionality affects closure of a facial defect.

Methods:

Two‐dimensional (2D) finite element models based on prior validated 2D. Nonlinear hyperelastic human skin models of rhomboid surgical flaps were parameterized for reconstruction of a 2 × 2 cm facial defect. Skin stiffness and directionality were varied to simulate several real‐patient factors such as age, radiation, sex, etc. ANSYS 12.1 was used to compute the stress/strain and reaction force results.

Results:

The challenges of defect closure often include intrinsic factors of a patient's skin. As skin stiffness and directionality vary, the stress/strain patterns vary accordingly. FEA gives surgeons the ability to visually see how certain patient‐specific skin factors affect closure of a defect, allowing for anticipation of challenges such as dog‐earing or high strain fields near critical structures (eye, ear, and hairline).

Conclusions:

The utility of finite element models for analyzing and planning pre‐surgical endeavors has been well‐documented. Our study is the first of its kind for comparative surgical planning for varying skin conditions.
3D Assessment of Tongue Volume after Free Flap Reconstruction: Validation of Technique
Authors: Jeffery Caroline C. , Constantinescu Gabriela , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi , Cote David
Published: September 2014

Objectives:

Use 3‐dimensional volumetric analysis of postoperative computed tomography (CT) scans to characterize tongue volume and correlate measured values with swallowing function.

Methods:

Retrospective chart review of prospectively collected data. Fifteen patients treated with surgical resection and free flap reconstruction of the oral and base of tongue with or without postoperative irradiation between 2010 to 2012 were included in the study. Mimics program was used to obtain measurements of the oral tongue and tongue base volume, tongue base to oropharyngeal volume ratio, and tongue base to posterior pharyngeal wall distance by analyzing the postoperative 6‐month and 1‐year CT scans. Prospectively collected functional outcomes data, including aspiration/penetration score, perceptual evaluation of intelligibility, and G‐tube dependence rates, were evaluated and correlated with dimensional analysis measures.

Results:

Adequate but not excessive tongue base volume correlated with reduced aspiration/penetration score and improved speech intelligibility. Oral tongue volume did not correlate with functional outcomes. Overall G‐tube dependence rate was low in this cohort (13.3%).

Conclusions:

Three‐dimensional analysis of tongue volume can be used to help predict postoperative swallowing outcomes.
4D‐CT for Localization of Nonlocalizing Parathyroid Adenomas in Primary Hyperparathyroidism
Authors: Hobbs Bradley A. , Fitzgerald Ryan , Bodenner Donald L. , Stack Brendan C.
Published: September 2014

Objectives:

(1) Present the application of 4‐dimensional (4D) computed tomography (CT) in preoperative localization of parathyroid adenomas that do not localize with technetium‐99 (Tc‐99) single‐photon emission computed tomography (SPECT)/CT or ultrasound. (2) Present indications for 4D‐CT use. (3) Understand radiologic dosimetry issues of 4D‐CT.

Methods:

A retrospective review of over 15 consecutive patients at an academic medical center with primary hyperparathyroidism who underwent preoperative 4D‐CT after nonlocalizing preoperative ultrasound and Tc‐99 SPECT‐CT scans between November 2013 and June 2014. This was a mixture of patients presenting for their first operations and others requiring revision surgery. Intraoperative radioguided parathyroidectomy results, excised gland weight, patient demographics, and parathyroid hormone levels were recorded. Sensitivity, specificity, and positive and negative predictive values of 4D‐CT for preoperative adenoma localization were calculated.

Results:

4D‐CT resulted in successful localization and biochemical cure in all primary or revision cases in which it was utilized. Radiation doses from 4D‐CT will be presented and compared to radiologic dosimetry from SPECT‐CT.

Conclusions:

4D‐CT offers a sensitive and specific modality for preoperative parathyroid adenoma localization which is useful in cases where ultrasound and SPECT‐CT sestamibi are nonlocalizing.
Analysis of Predisposing Factor for Pharyngocutaneous Fistula in Laryngeal Carcinoma Patients
Authors: Kong Hong , Wang Yanli , Zheng Jun , Zhang Xuhe
Published: September 2014

Objectives:

Pharyngeal fistula is the most common and troublesome postoperative complication after surgery of larynx, lower pharynx, and cervical esophagus carcinoma. This study aims to identify (1) the potential predisposing factors of pharyngeal fistula in laryngeal carcinoma patients after laryngectomy and (2) how nutritional support during treatment would contribute to improve prognosis.

Methods:

Retrospective review of 156 consecutive cases of laryngeal carcinoma patients who underwent laryngectomy from 2011 to 2013 at China‐Japan Union Hospital, Jilin University. Nutritional support and other potential predisposing factors were analyzed between patients with and without pharyngeal fistula.

Results:

Among the 156 cases studied, 6.4% of patients demonstrated postoperative pharyngeal fistula. Many predisposing factors showed statistical significance (P <. 05 or P <. 001) in this study, such as smoking history (P <. 05), neck dissection (P <. 001), duration of operation (P <. 05), postoperative serum albumin/total protein level (P <. 001and P <. 001, respectively), and body weight change after surgery (P <. 05). Other factors, such as age, sex, hemoglobin level, tumor stage, surgical option, and hypertension, did not show any statistical significance. Furthermore, patients with malnutrition have much higher risk of developing pharyngeal fistula.

Conclusions:

The occurrence of pharyngeal fistula in laryngeal carcinoma patients is highly associated with the duration of smoking, neck dissection, duration of operation, postoperative serum albumin/total protein level, and body weight change. By optimizing the patients’ general preoperation conditions and synchronous nutritional support, it would largely enhance the therapeutic response, reduce incidence, and improve prognosis.
Audit of Patients Undergoing Thyroid Surgery in an Attempt to Improve the Standard of Care
Authors: Farboud Amir , Chandra‐Mohan Alagar
Published: September 2014

Objectives:

Improve the standard of care for patients undergoing thyroid surgery. Recognized complications include hypocalcemia and recurrent laryngeal nerve (RLN) damage. We aimed to review our practice and improve it by adhering to the criteria set out by the National Institute of Clinical Excellence (NICE).

Methods:

Retrospective audit looking at patients undergoing thyroid surgery over a 6‐month period (09/2012). Pro forma methods were used to establish the adequacy of documentation including the use of nerve monitoring equipment, identification and stimulation of the RLN, and the recording of pre‐ and postoperative vocal cord checks (n = 18). Retrospective re‐audit after recommendations to complete the loop (n = 8) over a 4‐month period.

Results:

The first part of the audit cycle identified haphazard management of calcium levels in the postoperative period, incomplete documentation of vocal cord checks, and RLN identification and testing during surgery. Recommendations and guidance to staff, as well as a revised protocol on calcium management, resulted in improved care overall following re‐audit. In part 2 of the audit cycle; only 1 patient became hypocalcemic in the postoperative period and was managed successfully following the protocol. RLN detection, testing, and monitoring were documented in all patients. The 2nd loop showed that all patients were receiving documented RLN identification and stimulation intraoperatively; all patients had documented pre‐ and postoperative cord checks and use of a nerve monitor (n=10).

Conclusions:

The audit shows we were able to meet the criteria set out by NICE.
Can Computed Tomography Characteristics of the Oropharynx in Cancer of Unknown Primary Predict Primary Tumor Site?
Authors: McSpadden Ryan P. , Sullivan Thomas P. , Rosenblum Jordan , Bier‐laning Carol M.
Published: September 2014

Objectives:

(1) Measure axial and coronal parapharyngeal space area (PPSA) and parapharyngeal mucosal thickness (PMT) in patients who present with cancer of unknown primary (CUP). (2) Determine if PPSA and PMT differences between affected and unaffected sides of the oropharynx were found based on site of primary (tonsil vs base of tongue [BOT]) or body mass index (BMI).

Methods:

Institutional review board–approved retrospective chart and preoperative computed tomography (CT) review of consecutive patients presenting between 2007‐2013 with CUP to a tertiary university hospital. Subjects did not have an identified primary on clinical or imaging examinations including positron emission tomography/CT but did have an identified primary after surgery. Two blinded radiologists reviewed CT scans. Measurements of PPSA and PMT at defined levels in the axial and coronal planes and prediction of the primary site were made. Independent variables were primary tumor site and BMI. Comparisons were made using Student t test.

Results:

There was no significant difference in PPSA or PMT between the affected and unaffected sides of the oropharynx for the entire group (n = 17, ΔPPSA axial 0 mm2, P =. 5; ΔPPSA coronal 16 mm2, P =. 2; ΔPMT 0.3 mm, P =. 2) or for subgroups based on primary site (tonsil vs BOT) or BMI (≤25, >25). Blinded examiners correctly predicted the primary site in 7/17 (41%) of cases.

Conclusions:

Differences in axial PPSA and PMT were not useful to predict the primary site in patients with CUP. Although not statistically significant, coronal PPSA in subjects with BMI >25 may be useful in identifying the primary tumor site.
Comparison of Self‐Esteem Status in Aesthetic and Functional Rhinoplasty Patients
Authors: Naraghi Mohsen , Atari Mohammad
Published: September 2014

Objectives:

Self‐esteem is one's attitude toward oneself. It is one of the most important psychological aspects of rhinoplasty. Some findings indicate the improvement of patient self‐esteem after the operation. The aim of this study was to compare self‐esteem in patients seeking aesthetic or functional rhinoplasty.

Methods:

A total of 45 patients ranging in age from 17 to 36 filled out the Rosenberg Self‐Esteem Scale (RSES) over a 3‐month period. RSES consists of 10 items measuring general self‐esteem. The subjects took a validated form of RSES preoperatively. Twenty‐one aesthetic surgery patients and 21 functional surgery patients had filled out the questionnaire and 3 patients had left it blank.

Results:

Using t‐test for independent groups, the analysis of the data demonstrated that the mean self‐esteem score in the aesthetic surgery group was significantly lower than that of the functional surgery group (P <. 05). Age, sex, socioeconomic status (SES), and educational backgrounds were analyzed as potential extraneous variables and comparative analysis of each showed no significance between the 2 groups. Cohen's d was also calculated as a measure of effect size (ES). The value of ES measure was high (d = 0.78).

Conclusions:

The findings of the present study showed that aesthetic rhinoplasty patients had lower self‐esteem in comparison with functional rhinoplasty patients.
Clinical Study of Carcinomas of the External Auditory Canal: Histologic and Treatment Groups
Authors: Hosokawa Seiji , Mizuta Kunihiro , Takahashi Goro , Okamura Jun , Takizawa Yoshinori , Hosokawa Kumiko , Mineta Hiroyuki
Published: September 2014

Objectives:

Evaluation of the clinical and pathological factors associated with treatment and outcomes for external auditory canal (EAC) carcinomas.

Methods:

Over the 20‐year period from 1993 to 2013, a retrospective review of clinical and pathological analysis was performed on 23 patients who were histologically diagnosed with EAC carcinomas and treated at Hamamatsu University Hospital. We evaluated the clinical staging, treatment methods, pathological diagnosis (particularly squamous cell carcinoma [SCC])), and patient outcomes. Main outcome measures included staging, treatment procedures, pathological features, and estimated survival rates.

Results:

The 5‐year overall survival (OS) of the subjects was 75.2%, and the 10‐year OS was 60.2% with the Kaplan‐Meier method. The prognosis for SCC was poor when compared with other carcinomas (P =. 0462). The prognosis following treatment with surgery alone and following postoperative radiotherapy or chemoradiotherapy was significantly better than for the group of patients with unresectable tumors (P =. 0004 and P =. 0001). There was no significant difference between the 4 tumor stage groups. Information on patients’ survival status was obtained after a median follow‐up period of 57.5 months (range, 7‐151 months).

Conclusions:

Our survival analysis data for carcinoma of the EAC demonstrates that SCC and unresectable cases are associated with poor outcomes, and outcomes for subjects with operability more closely parallel the survival curves of advanced stage T4 disease. Patients with SCC should be strictly categorized as cases with severe disease.
Comparison of Robotic versus Conventional Lateral Neck Dissection for Differentiated Thyroid Carcinoma
Authors: Tae Kyung , Ji Yong Bae , Song Chang Myeon , Lee Seung Hwan , Park Chul Won
Published: September 2014

Objectives:

In advances in robotic thyroidectomy, we have performed robotic lateral neck dissection by a gasless unilateral axillo‐breast (GUAB) or axillary (GUA) approach for differentiated thyroid carcinoma (DTC) to avoid long visible scars in the neck. The aim of this study is to evaluate technical feasibility and efficacy of robotic lateral neck dissection compared with conventional neck dissection.

Methods:

We studied 72 patients with DTC who underwent total thyroidectomy with robotic selective neck dissection by GUAB or GUA approach (23 cases) or conventional open neck dissection (49 cases) in the unilateral neck between January 2010 and July 2013.

Results:

The mean age and body mass index was lower, and female sex was more common in the robotic group compared with the open group (P <. 05). Stage was more advanced in the open group (P <. 05). The mean total operative time was significantly longer in the robotic group (319 ± 65 minutes) than the conventional group (214 ± 110 minutes; P <. 001). The mean number of lymph nodes removed in the lateral compartment was not different between the 2 groups (24.7 ± 11.3 in the robotic group and 30.9 ± 17.7 in the conventional group, P =. 091). The postoperative complication did not differ between the 2 groups. Postoperative cosmetic satisfaction was superior in the robotic group than the conventional group (P <. 05).

Conclusions:

Robotic lateral selective neck dissection by GUAB or GUA approach is comparable to conventional lateral neck dissection in selected patients with DTC and provides better postoperative cosmesis than conventional neck dissection.
Effect of HPV on Posttreatment Weight in Head and Neck Squamous‐Cell Carcinoma: A Pilot Study
Authors: Zhang Zi , O'Malley Bert W. , Brown Justin C. , Bauml Joshua , Dean Lorraine T. , Weinstein Gregory S. , Schmitz Kathryn H.
Published: September 2014

Objectives:

Unlike head and neck squamous cell carcinoma (HNSCC) caused by tobacco and alcohol use, human papillomavirus (HPV)–related HNSCC has better survival outcomes. The aim of our study was to determine if post‐treatment weight change was different between HPV positive and negative oral tongue and oropharyngeal squamous cell carcinoma (OPC) patients.

Methods:

We conducted a retrospective cohort study. Oral tongue and OPC patients with initial surgery or radiation/chemotherapy in 2010 were identified using the University of Pennsylvania Tumor Registry. Those with p16 testing as a surrogate marker for high‐risk HPV were enrolled. Patient characteristics at diagnosis were collected, and the outcomes were mean weights at pretreatment and 0‐6, 6‐12, 12‐18, and 18‐24 month posttreatment visits.

Results:

We identified 50 survivors with p16 testing and follow‐up weights. Seventy‐four percent (n = 37) were p16‐positive. Compared with p16‐negative patients, p16‐positive patients were significantly more likely to be younger (56 ± 11 vs 72 ± 12, P =. 0001), at AJCC TNM stage 4 (72% vs 27%, P =. 010), and have higher mean weights at pretreatment and all posttreatment visits (P <. 05). Mean weights at pretreatment and posttreatment 0‐6, 6‐12, 12‐18, and 18‐24 month follow‐up visits were 164 ± 40, 160 ± 40, 159 ± 39, 160 ± 38, and 154 ± 35 pounds, respectively, in p16‐negative patients, but were 194 ± 47, 171 ± 38, 172 ± 39, 174 ± 44, and 187 ± 53 pounds, respectively, in p16‐positive patients, which improved from 0‐6 to 18‐24 month visits.

Conclusions:

Although the traditional post‐treatment weight loss was still seen in p16‐negative patients, p16‐positive patients were able to gain weight during 24‐month post‐treatment follow‐up after the initial rapid posttreatment weight loss.
The Effect of Intraoperative Hetastarch Administration on Microvascular Surgical Outcomes
Authors: Galloway Tabitha L. , Castellano Alexa , Jorgensen Jeffrey B.
Published: September 2014

Objectives:

The plasma volume expander hetastarch has a suggested subclinical toxicity that increases activated partial thromboplastin time and decreases Factor VIII of the coagulation cascade. The goal of this study was to determine if free tissue transfer patients who received hetastarch intraoperatively had a decreased risk of developing microvascular anastomotic venous thrombosis.

Methods:

The records of all patients undergoing free tissue transfer between January 1, 2009, and May 1, 2013, were selected for retrospective chart review. Background data including patient demographics, surgical indications, and free flap types were collected. Intraoperative medication records were analyzed to determine hetastarch administration. The primary outcome evaluated was anastomotic venous thrombosis. Secondary outcomes assessed included anastomotic arterial thrombosis, hematoma formation, and flap failure.

Results:

During the collection period, a total of 106 patients received hetastarch intraoperatively as a plasma volume expander, compared with 43 who did not. No statistical difference was demonstrated between groups with regard to demographic information, surgical indications, and free flap types. There was no significant difference between groups in the rate of venous thrombosis (P = 1.000), arterial thrombosis (P = 1.000), hematoma formation (P =. 4392), or flap failure (P =. 5571).

Conclusions:

This study demonstrates that the intraoperative administration of hetastarch during free tissue transfer procedures does not significantly decrease the rate of postoperative venous thrombosis, arterial thrombosis, or free flap failure and, despite its anticoagulatory effects, does not significantly increase the rate of hematoma formation. Therefore, we conclude that utilization of intraoperative hetastarch does not significantly impact the complication rate of microvascular anastomoses.
EGR‐1 Regulates Radiation‐Induced Apoptosis in Human Head and Neck Squamous Cell Cancer
Authors: Cho Wan Seok , Lee Jae Hun , Yoon Tae Mi
Published: September 2014

Objectives:

(1) Investigate that early growth response‐1 (EGR‐1) expression is expressed in human head and neck squamous cancer (human HNSCC). (2) Evaluate whether EGR‐1 affects radiation‐induced apoptosis in human HNSCC and would thus serve as the proper prognostic biomolecular marker of radiation therapy.

Methods:

The protein expression of EGR‐1 by immunohistochemistry was investigated in human HNSCC tissues. EGR‐1 expression was evaluated at different time points after irradiation in human HNSCC cell lines. To evaluate the impact of EGR‐1 knock‐down on radiation‐induced apoptosis of human HNSCC cell lines, cell apoptosis assays using small‐interfering RNA were performed. Western blot analysis was used to assess alteration in apoptosis related protein expression after irradiation in human HNSCC cell lines.

Results:

EGR‐1–positive immunoreactions were observed relative to adjacent mucosal tissue in 15 tissues (58.6%) of 28 human HNSCC tissues. After 5Gy and 8Gy irradiation, EGR‐1 increased with peak activation at 2 hours. The cleaved caspase 3, cleaved caspase 7, and cleaved PARP were increased at 2 hours after irradiation. Proapoptotic protein Bax was increased at 2 hours after irradiation. EGR‐1 knock‐down cells displayed decreased radiation‐induced apoptosis, compared with control cells in cell apoptosis assay. Cleaved caspase 3, cleaved caspase 7, cleaved PARP, and Bax activation was decreased by EGR‐1 knock‐down after irradiation.

Conclusions:

EGR‐1 had abundant expression in human HNSCC tissue. EGR‐1 knock‐down decreased radiation‐induced apoptosis through caspase 3, caspase, 7, PARP, and Bax. EGR‐1 may play an important role in treatment response after radiation therapy in human HNSCC.
Endoscopic Endonasal Transphenoidal Approach for Pituitary Adenomas: Outcomes of Our Center
Authors: Correia Isabel A. , Sousa Heredio , Sousa Vítor , Sagarribay Amets , Barros Ezequiel
Published: September 2014

Objectives:

Report the results of a consecutive series of patients who underwent an endoscopic endonasal transphenoidal approach (EETA) for resection of a pituitary adenoma.

Methods:

A retrospective review of patients who underwent EETA at our center between 2010 and 2013, in a collaboration between head and neck surgeons and neurosurgeons, and a description of the technique used.

Results:

Nineteen patients underwent an EETA for removal of a pituitary adenoma. Decreased visual acuity or a visual field defect was the presenting complaint in 63.2% patients and headache in 26.3%. Nonfunctioning adenoma was the most frequent (52.6%). Sixteen (84.2%) patients had a macroadenoma (>1 cm) and 3 (15.8%) had a microadenoma (<1 cm). The overall postoperative cerebrospinal fluid leak rate was 5.3%. Other perioperative complications were epistaxis (5.3%), postsurgical hematoma (5.3%) with urgent evacuation, and meningitis (5.3%). The rate of gross total ressection was 70% in patients with nonfunctioning adenomas. The remission rate of secretory adenomas was 75%. Of the patients presenting with visual symptoms, 91.7% improved or normalized.

Conclusions:

EETA is an excellent alternative to other classic approaches for pituitary adenoma, providing similar results with less morbidity. It allows a better panoramic visualization of sellar and parasellar spaces and a better preservation of the normal anatomy and physiology of nasal cavity. This minimally invasive approach is now the standard of care in transasal pituitary surgery. Our outcomes, including remission and complication rates, are comparable with those reported in previous series of endoscopic and microscopic approaches.
Expression of Livin and the Inhibition of Tumor Progression by Livin Silencing in Laryngohyopharyngeal Cancer
Authors: Yoon Tae Mi , Cho Wan Seok , Lee Jae Hun , Lee Dong Hoon , Lee Joon Kyoo , Lim Sang Chul
Published: September 2014

Objectives:

Livin, a member of the inhibitors of apoptosis protein family, is expressed in various cancers and is associated with tumor progression. However, there is no report about the significance of Livin in laryngohypopharyngeal sqaumous cell carcinoma (LHSCC). In this study, we evaluated the expression of Livin in human LHSCC and investigated whether Livin knockdown using small interfering‐RNA (siRNA) affects tumor aggressiveness in LHSCC cells.

Methods:

Livin expression in human LHSCC tissues was detected by immunohistochemistry. The relationships between Livin expression and clinicopathologic variables were analyzed. Livin specific siRNA was used to silence the endogenous Livin gene expression in SNU1041 and PCI1 human LHSCC cell lines. Cell invasion, cell migration, and cell apoptosis assays were performed to assess the impact of Livin on cancer cell behavior in human LHSCC cells.

Results:

High immunoreactivity of Livin was observed in 22 (36.7%) of the 60 LHSCC tissues relative to adjacent normal mucosa. In the positive Livin expression group, distant metastasis tended to occur frequently, but the difference was not statistically significant (P =. 06). Livin knockdown by siRNA induced cell apoptosis through activation of caspase 3, caspase 7, and poly ADP ribose polymerase in LHSCC cells. Livin knockdown also resulted in significantly reduced cell invasion and migration in LHSCC cells.

Conclusions:

These results suggest that Livin silencing mediated siRNA may be associated with the reversal of invasive capacity in LHSCC.