bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Vitamin D Levels and Chronic Rhinosinusitis
Authors: Pinto Jayant , John Schneider , Rosanne Perez , De Tineo Marcy L , Baroody Fuad M , Naclerio Robert M
Published: August 2008

Objective

Vitamin D decreases the risk of chronic illnesses and has been implicated in asthma, allergic rhinitis, and anaphylaxis. We questioned whether vitamin D levels might be associated with chronic rhinosinusitis (CRS), using a case‐control sample.

Methods

Serum 25(OH)‐vitamin D (25(OH)D) levels were measured in African‐American (n=65) and Caucasian (n=89) adults with and without CRS, recruited at an urban, tertiary care, academic hospital. Case definition met consensus diagnostic criteria and included endoscopy and imaging, with normal imaging studies in controls. Data were stratified by sex, race, season, and body‐mass index (BMI), factors known to affect levels.

Results

There were no significant differences in 25(OH)D levels between Caucasian cases and controls in either sex, including when analyzed by season. Levels in African‐Americans with CRS were significantly lower than controls (males: cases 15.4 ± 2.1 ng/mL, controls 26 ± 2.6, P?0.01; females: cases 13.5 ± 2.0, controls 20.8 ± 2.6, P?0.03). Accounting for season, African‐Americans with CRS continued to show significantly lower 25(OH)D levels as compared to controls (winter: males: cases 22.3 ± 3.3 ng/mL, controls, P?0.03; females: cases 8.5 ± 0.96, controls 17.4 ± 2.5, P?0.003), with similar but nonsignificant trends in summer. Demographics were similar across comparisons (age, BMI).

Conclusions

Our data suggest that low levels of vitamin D may be involved in CRS in African‐Americans, a role that is biologically plausible, given its immunologic effects and its putative association with susceptibility to viral infections and other related diseases. Further study of this phenomenon may provide novel hypotheses for the development of CRS.
Bacterial Origin of Ostiomeatalcomplex after Viral Infection
Authors: Han Joseph , Hendley Joseph Owen , Winther Birgit
Published: August 2008

Objective

After a viral infection in the nasal cavity or sinus, superimposed bacteria infection is likely to occur. Therefore the carriage rate of bacterial pathogen in the nasal cavity (NC), nasopharynx (NP), and ostiomeatal complex (OMC) were determined during wellness and upper respiratory viral infection.

Methods

There were 2 groups in the study. The control group was well with no nasal or sinus problems. The cohort group had an upper respiratory viral infection. The NC, NP, and OMC cultures were taken from each study group. Agars cultured were used to detect S. pneumoniae, H. influenzae, and M. catarrhalis. Statistical comparison was made between the groups. The bacterial pathogens were also compared between the various sites of culture within a group.

Results

There were 91 subjects in the study‐51 subjects with an upper respiratory viral infection and 40 control participants. 59% of participants were female. There was no statistical difference in the rate of bacterial pathogen in the NP (p=0.2) or NC (p=0.06) between the control and cohort group. There was a significant increase (p<0.008) of bacterial pathogen in the OMC of viral illness group versus the control group. Bacterial pathogen present in the OMC had a similar pathogen in either the NC or NP.

Conclusions

This study defines the reservoir of bacteria in the NC or NP for the bacterial pathogen in the OMC during wellness and upper respiratory viral infection.
Classification System for Results in Eustachian Tube Surgery
Authors: Yanez Carlos , Mora Nallely
Published: August 2008

Objective

To present a new classification system for reporting results and severity of disease state preoperatively of Eustachian tube (ET) obstructive (ETOD) and non‐obstructive dysfunction (ETNOD) based in numerical scores, and to report the results obtained in 40 patients intervened by the author following this criteria.

Methods

A retrospective review of 25 patients was carried out. 20 patients presented obstructive and 5 patients presented non‐obstructive (patulous) Eustachian tube dysfunction. These patients were diagnosed and treated between May 2002 and Dec 2007. Patients with ETNOD received laser endoscopic tuboplasty (LEPT) and in patients with ETOD, a cartilage grafting reconstruction of the antero‐lateral wall of the ET (ETR) was carried out endonasally.

Results

Scores from patients were tabulated accordingly. 18 patients (90%) were symptom free, 1 patient (5%) had partial recurrence of symptoms and 1 patient (5%) had a full recurrence of symptoms at the end of the study in the obstructive dysfunction patients. 3 patients (60%) were symptom free, 2 patients (40%) had partial recurrence of symptoms after Eustachian tube reconstruction. Endoscopy, computed tomography, and audiologic results revealed the efficacy or failure of the interventions.

Conclusions

1) This suggested system could serve as a starting point for Eustachian tube surgeons to develop criteria. It could be adopted if eventually accepted in the field. 2) Results obtained indicate that LEPT is effective in relieving symptoms in selected patients. 3) EPTR for patulous disease may be not effective in some cases. New experiences are further needed.
Nasal Eosinophilia in Septal and Turbinate Surgery Outcomes
Authors: Melkane Antoine E , Abou Hamad Walid M , Akar Ramzi Abi , Moutran Homere , Haddad Amine C
Published: August 2008

Objective

1) Determine the clinical outcome of septal and turbinate surgery. 2)Evaluate the potential predictive value of the nasal mucosal eosinophilia in this outcome.

Methods

A retrospective review of all patients who had undergone septoplasty with inferior turbinate reduction for symptomatic nasal obstruction was conducted in our department between September 2004 and September 2005. The Nasal Obstruction and Septoplasty Effectiveness (NOSE) score was used to assess the preoperative status and the postoperative outcome at one year. Nasal congestion, nasal blockage, trouble breathing through the nose, trouble sleeping, and inability to get enough air through the nose during exertion were evaluated. A histological study was undertaken on paraffin embedded surgical specimens, and a mean chorionic eosinophil count per microscopic field (40x) was performed. Patients were classified into 4 categories according to their mean eosinophilic count (<1cell, 1–3cells, 3–5cells, >5cells).

Results

54 patients were included in the study (35 males and 19 females). The mean age was 31 years. A significant reduction of the NOSE score was noted a year after the intervention (22 vs. 61.7, p<0.0001), with a mean improvement rate of 67.5%. Better outcomes were observed in patients who had lower preoperative NOSE scores (p<0.0001), and lower eosinophil counts (p<0.0001).

Conclusions

Both preoperative NOSE score and histological eosinophilia seem to be major predictive factors of septal and turbinate surgery outcomes.
Novel Approach to the Sphenoid Sinus
Authors: Nogueira Joao‐Flavio , Kalish Larry Hilton , Hermann Diego Rodrigo , Silva Maria , Harvey Richard J , De Arnaldo Silva Vellutini Eduardo , Cassol Stamm Aldo Eden
Published: August 2008

Objective

Transnasal approaches to the pituitary and beyond are increasingly being utilized. Surgical access to the sphenoid sinus is the first step in any of these approaches. In order to allow a binostril approach, the posterior septum is removed, resulting in a large posterior septal perforation. Another consideration in many cases is harvesting material for repair of any cerebrospinal fluid (CSF) leak. We describe a novel endoscopic transseptal approach using a posterior nasal septal mucosal flap that allows a binostril approach for the surgeons, can cover skull base defects, and avoids posterior nasal septal perforations.

Methods

Retrospective chart review of endoscopic pituitary surgery patients, in a tertiary referral center between 2006 and 2008, was performed. Relevant post‐operative complications of CSF leak, epistaxis, crusting, synechiae and septal perforation were documented.

Results

20 consecutive patients undergoing pituitary surgery were reviewed: 12 males and 8 females aged 24 to 76 years old. No early perioperative complications were encountered. Surgical time was not increased. Two minor postoperative complications: 1 epistaxis and 1 partial flap retraction were noted. There were no CSF leaks and no septal perforations.

Conclusions

The approach has the advantage of allowing two surgeons to manipulate surgical instruments and a more robust pedicled flap is raised to assist the closure of a skull base defect. The nasal septal mucosa from one side is preserved, avoiding a nasal septal perforation. There is minimal additional morbidity.
The Role of Frontal Sinus Obliteration in the Era of FESS
Authors: BuSaba Nicolas , Gray Stacey T.
Published: August 2008

Objective

To determine the current indications for osteoplastic frontal sinus obliteration (OFSO) for the treatment of inflammatory frontal sinus disease.

Methods

Retrospective case series from a single tertiary care facility. The medical records of 35 patients who underwent OFSO for chronic frontal sinusitis (n=26) and frontal sinus mucocele (n=9) between 1995 and 2007 were reviewed. Data regarding age, gender, date and nature of previous frontal sinus operation(s), pre‐operative imaging, pre‐operative diagnosis, and operative complications were culled.

Results

There were 19 males and 16 females with an age range of 19 to 76 years. All patients had pre‐operative sinus CT, while 6 patients had additional MRI. Among the 9 patients diagnosed with frontal sinus mucocele, OFSO was first‐line treatment in 8 and salvage for 2 failed endoscopic masupialization procedures in 1. Among the 26 patients with chronic frontal sinusitis, OFSO was first‐line in 9 and salvage for failed frontal sinus surgery in 17. The failed surgeries were OFSO (n=7), Lynch procedure (n=2), and endoscopic frontal sinus surgery including drill‐out (n=10). Five patients failed multiple previous operations. The failed operations dated from 1 to 33 years prior to the present illness in the case of OFSO, 1 to 4 years in the case of Lynch procedure, and 1 to 7 years in the case of endoscopic frontal sinus surgery. There was one reported complication (orbital hematoma).

Conclusions

OFSO remains a key surgical treatment for frontal sinus mucocele, but is used more commonly as a salvage procedure for chronic frontal sinusitis.
Effectiveness of Pillar Implants in Snoring Management
Authors: Clarke Joseph , Gillespie Marion B , Smith Jacob E
Published: August 2008

Objective

Determine the effectiveness and complications of Pillar implants for snoring management in the course of routine clinical practice.

Methods

Retrospective series of adult patients receiving Pillar implants for snoring management between January 2005 and December 2007. Outcomes include procedure‐related complications and patient satisfaction with snoring control.

Results

A total of 58 males and 12 females with an average age of 56 years (range, 33 to 74 years) underwent placement of Pillar implants for socially disruptive snoring. 21 patients were snorers, whereas 49 had mild to moderate degrees of sleep apnea. 41 patients were treated with 3 implants, and 24 patients received 4 or more implants. The procedure was performed in the outpatient setting in 47 cases and in the operating room in 23 cases. Complications included poor placement requiring removal (5 patients), and implant extrusion (4 patients). Complications were more common with implants placed in the OR, compared to the outpatient office (p=0.004). Of the patients with sufficient 3‐month follow‐up, 35/54 (65%) reported reduction in snoring, however only 28/54 (52%) were completely satisfied with the level of snoring reduction. When the satisfied patients were compared to dissatisfied patients, there were no noted differences in mean age, diagnosis of OSA, the use of adjunctive nasal surgery, or the number of implants placed.

Conclusions

Pillar implants offer satisfactory snoring reduction in approximately 50% of patients. Additional study is needed to determine factors that increase the probability of success. Implants placed under general anesthesia have a higher risk of poor placement and extrusion.
Evaluation of Somnoplasty using Snoring Symptom Inventory
Authors: Srinivasan Venkat R , Low Christopher , Goodyear Paul W A , Derbyshire Steve , Veetil Aneesh
Published: August 2008

Objective

To assess whether radiofrequency volumetric tissue reduction of the palate can improve patients’ snoring symptoms and quality of life.

Methods

A prospective cross‐sectional study was undertaken. Over an 18‐month period, consecutive habitual snorers without sleep apnoea were asked to complete a validated Snoring Symptoms Inventory (SSI) questionnaire before and 3–6 months after radiofrequency surgical treatment. It contained 25 questions on the impact of snoring symptoms, including social, work, physical and emotional aspects. Most patients underwent 2 operations (Somnoplasty® Somnus device) with a 2‐month interval. A scale of 0 (no snoring) to 10(extremely loud snoring) was used to assess partners’ perception of the snoring intensity. Paired T‐test was used to compare the mean difference in the SSI before and after surgery. Partners’ scores were analysed with Wilcoxon signed ranks test.

Results

26 patients (19 male, 7 female) aged between 33 and 74 (mean=48) were recruited. Preoperative BMI scores ranged from 19 to 35 (mean=28). Pre‐ and postoperative mean SSI scores were 60.5 (SD 12.3) and 42.8 (SD 17.4). The difference between the 2 means is 17.6 (95% Confidence Interval, 11.0 to 24.2), P<0.0001. The median for pre‐ and postoperative partners’ scores is 10 and 5 respectively. and the difference is statistically significant (P<0.0001).

Conclusions

Radiofrequency volumetric tissue reduction can improve habitual snorers’ snoring symptoms, snoring‐related quality of life, and partner's perception of their snoring. Long‐term results of this procedure need to be ascertained with further studies.
S101 – Mometasone Reduces Congestion in Acoustic Rhinometry Study
Authors: Frances Salapatek Anne Marie , Patel Piyush , Deepen Patel , Gopalan Gokul Hiremagalur , Varghese Santosh Thomas
Published: August 2008

Objectives

In a double‐blind placebo‐controlled study of ragweed‐sensitive subjects with seasonal allergic rhinitis (SAR), mometasone furoate nasal spray (MFNS) was evaluated for improvement in nasal congestion, reportedly the most bothersome symptom of SAR.

Methods

On Day 1, 310 subjects were exposed to ragweed pollen in an environmental exposure chamber (EEC) for 2 hours pre‐dose, given MFNS 200 mcg or placebo, and studied for 6 hours post‐dose. Acoustic rhinometry (AcR) was used to measure congestion before and after exposure. Subjects (n=155) who received MFNS or placebo for 7 additional days returned to the EEC on Day 8 for 4 additional hours of pollen exposure at 24, 26, and 28 hours post‐dose.

Results

On Day 1, after 2 hours of EEC exposure pre‐dose, minimal cross‐sectional areas (MCAs) of each nostril measured with AcR decreased significantly for all subjects. At 6 hours post‐dose, MFNS significantly reduced congestion (increased nasal patency) vs. baseline (P equal to/less than 0.00001) and placebo (P equal to 0.005). On Day 8, MFNS significantly decreased congestion vs. placebo pre‐EEC pollen exposure (P equal to 0.04) and at 2 and 4 hours (P equal to 0.01 and 0.0008, respectively). MFNS protected subjects against nasal congestion throughout EEC pollen exposure on Day 8, while congestion continued to increase in subjects receiving placebo.

Conclusions

A single treatment of MFNS demonstrated significantly reduced nasal congestion, as assessed by AcR, a sensitive, objective measure of nasal patency. MFNS effectively reduced allergen‐induced nasal congestion, even at trough levels.
S113 – Facial Suspension & Free Flaps in Composite Parotid Defects
Authors: Skoner Judith M , Buchmann Luke , Hornig Joshua , Lentsch Eric J , Gillespie M. Boyd , Farrar Joshua , Day Terry
Published: August 2008

Objectives

1) Study efficacy of 2 methods of immediate static facial suspension after total composite parotidectomy, facial nerve sacrifice & free flap reconstruction. 2) Compare these regarding outcomes & patient satisfaction.

Methods

Retrospective review 2005–08 of all patients at academic tertiary referral center with advanced H&N malignancy necessitating extirpation, including parotidectomy, CN‐VII sacrifice, and microvascular reconstruction. Ipsilateral face addressed simultaneously with either acellular human dermal allograft (AHDA) ‘sling’ or suture suspension (SS). Follow‐up 2–18 months. Outcomes assessed: suspension status (commissure symmetry 1–4 complete ptosis), overall aesthetics (excellent 1–4 unsatisfactory), oral competence (no drooling 1–3 constant drooling) and patient/family satisfaction scores (very satisfied 1–4 very dissatisfied).

Results

9 patients underwent extirpation, CNVII sacrifice, fasciocutaneous microvascular reconstruction (forearm, ALT or parascapula) and facial suspension. 8 received postoperative radiation; 1 expired. 2 underwent AHDA facial ‘slings.’ 7 underwent SS using polybutilate‐coated braided polyester (Ethibond Excel). Both techniques used 3 distal suspension sites (nasolabial crease, upper/lower commissure) and proximal zygomatic stablization. Suspension grades were 1–3 for AHDA, 1–2 for SS; aesthetic 2–3 for AHDA, 1–3 for SS; competence 2 for AHDA, 1–2 for SS; satisfaction 1–2 for AHDA, 1–2 for SS.

Conclusions

Facial nerve rehabilitation in post‐extirpative oncologic setting remains challenging for optimizing function/aesthetics. In our series of patients undergoing extensive resection with facial nerve sacrifice and free flap reconstruction, suture suspension provided slightly better oral symmetry and overall aesthetics compared to AHDA ‘sling’ suspension. Patient satisfaction was high in both groups. Long‐term follow‐up and greater sample size are needed to determine if any observed advantage is real and sustained.
S117 – Gastropharyngeal Reflux and Eustachian Tube Dysfunction
Authors: Georges Eter Elias , Matar Nayla E , Haddad Amine C
Published: August 2008

Objectives

Determine the response of gastropharyngeal reflux (GPR) in the pathogenesis of Eustachian tube dysfunction (ETD) in adults, using a therapeutic trial.

Methods

18 adult outpatients with symptoms of ETD (associated or not to GPR symptoms) were randomized into two groups: The first group received nasal corticosteroids and Rabeprazole 20mg once daily for 6 weeks. The second group received nasal corticosteroids and placebo for 6 weeks. Symptoms’ severity was evaluated before and after treatment by a tympanometry and a self‐administered questionnaire of 7 items focusing on the severity of ETD. Each of the items was scored on a numeric scale. The local ethics committee approval was obtained and patients signed an informed consent before their participation in the study that was conducted between November 2002 and May 2003.

Results

8 patients were on Rabeprazole, 10 were on placebo. Patients in the 2 groups were comparable for all the variables except for the severity of symptoms. On enrollment, patients under Rabeprazole had more severe symptoms than those under placebo (SR = 12.4, SP = 7.15 with p = 0.035). At the end of the trial, the improvement of the symptom score under Rabeprazole was significantly higher than that of patients under placebo, using the Mann Whitney test (SR’ = 6.13, SP’ = 11.56 with p = 0.026).

Conclusions

By showing a significant improvement of ETD symptoms in patients under Rabeprazole compared to controls, this study suggests the response of GPR in the pathogenesis of ETD, but larger studies are needed.
S120 – Healthcare‐Associated Infections Can Be Reduced
Authors: Stalfors Joacim
Published: August 2008

Objectives

The WHO states that nosocomial infections occur in 9% of all patients and this mean figure has been confirmed at our hospital. As a result, a project was started, designed to reduce the number of patients with healthcare‐associated infections by means of improved compliance with hygiene guidelines (working clothes and hand hygiene). This prospective study assessed the frequency of healthcare‐associated infections and compliance with hygiene guidelines at an regional ENT ward. At intervention, information was given repeatedly about the current guiding principles, and equipment for hygiene, such as antiseptics, gloves, and aprons, was made more accessible.

Methods

Healthcare‐associated infections were assessed by questionnaires sent to a random sample of patients. Compliance with hygiene guidelines was assessed by randomly spot‐checking co‐workers. Assessments were performed before, during, and 6 months after intervention.

Results

Healthcare‐associated infections were registered in 9/67 (13.4%) of the patients before intervention. The rate of correct hand hygiene or clothing was 30% and 50% respectively. After 3 months of intervention, the guidelines for hand hygiene and clothing were followed by 80% and 90% respectively. The healthcare‐associated infections were reduced to 5/66 (7.6%). When repeating the assessment 6 months later, the healthcare‐associated infections were 13/193 (6.7%) and compliance with hand hygiene and clothing was 60% and 75% respectively.

Conclusions

By stressing the guiding principles for hygiene, the frequency of healthcare‐associated infections can be reduced. This reduction was not statistically significant (p=0.15).
S127 – Idiopathic Facial Nerve Paralysis: Analysis of 3T MRI Images
Authors: Mowry Sarah , Kirsch Claudia
Published: August 2008

Objectives

1) To describe the findings on 3 Tesla (T) MRI in patients with idiopathic facial nerve paralysis (IFP). 2) To compare 3T MRI and 1.5 T MRI images of the facial nerve in patients with and without facial paralysis.

Methods

A retrospective review of 3T MRI image from 2005–2008 for temporal bone imaging revealed 123 patients; 4 patients underwent imaging for facial paralysis. Images from 3T MRI and 1.5T MRI for these 4 patients were retrospectively assessed by a board‐certified neuroradiologist and otolaryngologist blinded to the affected side and compared to normative controls.

Results

All patients with facial palsy demonstrated significant enhancement of the affected nerve on post‐gadolinium T1 weighted images. In 3 patients with residual facial weakness (>12 months) demonstrated facial nerve enhancement at the geniculate ganglion and descending portions. In 1 patient, despite resolution of IFP, the nerve continued to enhance at the geniculate ganglion and descending portion of the facial nerve compared to the contralateral nerve. The 3T MRI images demonstrated improved visualization of the entire course of the facial nerve in both normal and IFP patients. Interestingly, in both normal and affected patients, the uninvolved facial nerve also demonstrated slight contrast enhancement throughout its entire course, although not as pronounced as the affected side.

Conclusions

3T imaging provides significantly improved visualization of the temporal facial nerve in both normal and patients with IFP. Gadolinium enhanced 3T imaging allowed better anatomical delineation of both normal and affected facial nerves when compared to 1.5T MRI.
S129 – Analysis of Fine Needle Biopsy for Malignant Lymphoma
Authors: Ashimori Naoki , Mineta Hiroyuki , Tsurita Minako
Published: August 2008

Objectives

To review fine‐needle aspiration biopsy‐(FNAB) diagnosis of malignant lymphoma retrospectively to determine the diagnostic accuracy and pitfalls.

Methods

68 cases of malignant lymphoma and 52 cases of non‐malignant lymphoma were identified between 1997 and 2004. All cases were recognized as cervical lymphadenopathy and evaluated by FNAB. Open biopsies were also performed to obtain final diagnoses. Malignant lymphomas were subclassified according to World Health Organization classifications. We compared the FNAB and final diagnostic results to determine the diagnostic accuracy and examine the false negative cases.

Results

41(60%) cases had a positive diagnosis of malignant lymphoma, 21(31%) had a suspicious diagnosis, and 6(9%) had a false negative diagnosis. On histological examinations, diffuse large B cell lymphomas yielded a high positive diagnosis, whereas follicular lymphoma and Hodgkin's disease had less positive diagnosis and there were also false negative cases. 14(39%) lymphadenitis cases had a suspicious diagnosis and some cases were difficult to differentiate from malignant lymphoma.

Conclusions

FNAB is considered a useful and efficient method of estimating malignant lymphoma but diagnostic accuracy varied among lymphoma subtypes. We should remain aware of the existence of false negative cases when using this diagnostic method.
S130 – Otolaryngologic Manifestations in Penphigus Vulgaris
Authors: Fernandez Secundino , España Agustín , San Miguel David Ruba , Marquina Miren
Published: August 2008

Objectives

Pemphigus vulgaris is an autoimmune disease characterized by mucocutaneous intraepithelial blisters and pathogenic autoantibodies against desmoglein 3. There are 2 clinical forms: mucosal and mucocutaneous. The frequency of ear, nose and throat involvement in pemphigus vulgaris is not clearly defined. Only a few individual cases have been reported. The objective of this study was to determine the incidence of otolaryngologic involvement in patients with pemphigus.

Methods

We have studied prospectively all 18 patients diagnosed with PV and treated by Otolaryngology and Dermatology departments of the University Hospital of Navarra between 2001 and 2007. They were 10 cases of mucosal pemphigus and 8 cases of mucocutaneous pemphigus. All patients were evaluated by endoscopic examination.

Results

15 patients presented with throat symptoms (83%), 13 pharyngeal (72%), and 8 laryngeal symptoms (44%). 16 patients (88%) had active pemphigus vulgaris lesions localized in pharyngeal and laryngeal mucosa. Laryngeal lesions were most commonly present in mucocutaneous patients. The frequency of nasal symptoms (38%) was lower than active pemphigus vulgaris lesions (63%). Oral symptoms and oral active lesions were the most frequent findings (94%). Only in 3 patients were sown erosions on the external auditory canal.

Conclusions

Endoscopic evaluation in patients affected by pemphigus vulgaris allows to study more extensive areas of mucosa. By obtaining more complete information concerning the extent of the disease, a more accurate diagnosis can be made, better choice of drug and dose may be decided, and ultimately, response to treatment may be improved.
S134 – Active MMP‐7 Expression in Buccal Cancer
Authors: Chuang Hui‐Ching , Chien Chih‐Yen , Huang Chao‐Cheng
Published: August 2008

Objectives

To evaluate the active MMP‐7 expression in buccal cancer and correlate the expressions with clinicopath‐ological features.

Methods

Tissue microarrays, immunohistochemistry, and Western blotting were used to detect the expression of active MMP‐7 in oral tumor from 24 patients with buccal squamous cell carcinoma (BSCC).

Results

Total MMP‐7 was detected on Western blots in 9 of 15 tumor tissue samples (60%) and in 2 of 15 normal mucosal samples (13.3%); this difference was significant (p = 0.008). Moreover, the active form of MMP‐7 was expressed in 8 (88.9%) of the 9 tumor samples that expressed MMP‐7, and in none of the normal tissue samples, regardless of the expression status of the pro‐form. Immunostaining of total MMP‐7 was observed histologically in both tumor and non‐neoplastic epithelium, but immunostaining of active MMP‐7 was present only in tumor nests. Expression of active MMP‐7 was associated with larger tumor size (p = 0.022) and was significantly higher in BSCC with skin or bone invasion (p = 0.036).

Conclusions

Active MMP‐7 expression was associated with more aggressive buccal squamous cell carcinomas.
S143 – Benign and Malignant Lipogenic Tumors of the Retropharynx
Authors: Mendelsohn Abie , Kedeshian Paul , Cohen Marc , Chhetri Dinesh K
Published: August 2008

Objectives

Lipogenic tumors of the retropharyngeal space are neoplasms that can grow to a considerable size before becoming symptomatic. In this study we compare clinical, radiologic, and histologic findings of benign versus malignant lipogenic tumors of the retropharyngeal space.

Methods

Retrospective review of a case series.

Results

2 patients were identified with large lipogenic tumors of the retropharynx. The first patient was 66‐year‐old female with a 6‐week history of progressive airway difficulty and dysphagia requiring tracheostomy and gastrostomy‐tube placement. Preoperative imaging revealed a lipoma of the retropharynx. A transcervical excision of her retropharyngeal mass revealed a 10⋉9⋉4.8 cm lipoma. The second patient was a 57‐year‐old female with a 4‐week history of progressive left neck swelling, airway compromise, and odynophagia. Preoperative imaging revealed a heterogeneous mass in the retropharynx with fatty and solid components. After an initial awake tracheostomy a transcervical excision of a 15⋉5.5⋉4.0 cm mass was performed. Pathology revealed liposarcoma with scattered dedifferentiated regions. Postoperative radiation therapy was given for focally positive surgical margins. Both patients are recurrence‐free at 36 months follow‐up.

Conclusions

Although lipogenic tumors of the retropharyngeal space are rare these cases illustrate that they present at advanced stages, often requiring tracheostomy for airway control. The clinical course of lipomas and liposarcomas can be similar. However, careful inspection of preoperative imaging will heighten suspicion for malignancy, which is critical in surgical planning.
S146 – COX‐2 & IL‐10 Polymorphisms with Head and Neck Carcinoma
Authors: Jeong Seung‐Won , Seokyoung Kang , Hee‐Ok Kim , Cho Seok Hyun , Kim Kyung‐Rae , Tae Kyung , Park Chul‐Won
Published: August 2008

Objectives

The objectives of this study are to investigate the frequencies of single nucleotide polymorphism (SNP) of COX‐2 and IL‐10 in control group and the head and neck squamous cell carcinoma (HNSCC) patient group in Korean population and to analyze the correlation of COX‐2 (−1329A>G, + 1266C>T, +6365T>C) and IL‐10(−1082A>G, +920T>G, +3917T>C) polymorphisms of HNSCC patient group in Korean population.

Methods

Study was performed for 290 Korean head and neck squamous cell carcinoma patients and 358 healthy controls. DNA extraction of peripheral whole blood was done and genotyping was done by single base extension(SBE) and Taq‐Man assay. We analyze the frequencies of SNP of cox‐2(−1329A>G, +1266C>T, +6365T>C) and IL‐10(−1082A>G, +920T>G, +3917T⋉C) and the following results were obtained.

Results

There is no statistical difference between carcinoma patients and healthy controls about frequencies of SNP of cox‐2(−1329A>G, +1266C>T, +6365T>C) and IL‐10 (−1082A>G, +920T>G, +3917T>C) except haplotype3(‐/‐, ht3/‐, ht3/ht3) of COX‐2 (−1329A>G, +1266C>T, +6365T>C) (Odds ratio: 0.60, p value: 0.03) in Korean populations.

Conclusions

Based on these results, it is suggested that COX‐2(−1329A>G, +1266C>T, +6365T>C), IL‐10 (−1082A>G, +920T>G, +3917T>C) genetic polymorphisms might not be correlated with head and neck squamous cell carcinoma in Korean populations but haplotype3 (ht3) of COX‐2 might be associated with HNSCC.
S147 – Pectoralis Major Flaps: A Workhorse in Today's Free Flap Era
Authors: Tan Barrie Yau‐Boon , Khoo Mark
Published: August 2008

Objectives

To study the use, complication rate, and efficacy of pedicled local regional flaps for head and neck reconstruction, and to compare these results with those of microvascular free flap reconstruction.

Methods

Retrospective analysis of all head and neck oncologic resections requiring flap reconstruction in a tertiary head and neck surgery centre over a 6‐year period from 2001–2007.

Results

In total, 77 operations with flap reconstruction were performed. 44 resections employed pedicled locoregional flaps, comprising 33 pectoralis major, 3 trapezius, 3 cervical rotation, 1 deltopectoral, 1 temporalis muscle, 2 nasolabial, 1 cheek rotation, and 2 bilobed rotation flaps. 2 patients had a combination of 2 regional flaps. There was 1 flap failure. Minor complications occurred in 25% of patients comprising wound seromas (3), wound dehiscence (6), fibrotic band formation (1) and pharyngocutaneous fistula (1). 33 resections employed free flap microvascular reconstructions, comprising 22 free radial forearm, 7 free rectus abdominis, 1 free jejunal, 1 free fibular, and 2 anterolateral thigh flaps. There was 1 flap failure. Minor complications occurred in 33% of patients, comprising donor site wound dehiscence (4), recipient site wound dehiscence or seroma (4), plate extrusion (1), abscess and wound breakdown (2).

Conclusions

Despite the ready access to free flap reconstruction today, pedicled flaps, especially the pectoralis major flap, remain a major workhorse in head and neck reconstruction. They are hardy, reliable, cost‐effective, and can be done in a short operative time. Moreover, for several regions, the functional outcome is no worse than free flap reconstruction.
S150 – Clinical Study of 13 cases of Olfactory Neuroblastoma
Authors: Uwa Nobuhiro , Yoshino Kunitoshi , Fujii Takashi , Terada Tomonori , Saeki Nobuo , Sagawa Kousuke , Sakagami Masafumi
Published: August 2008

Objectives

Olfactory neuroblastoma is a rare neuroendocrine tumor that arises in the upper nasal cavity of the olfactory epithelium. We examined 13 patients with olfactory neuroblastoma and report the findings.

Methods

The subjects were the primary treated patients of olfactory neuroblastoma at our departments between 1986 and 2008 (age: 29–72). Using the clinical staging proposed by Dulguerov, we examined the treatment methods, the sites of recurrence, and the prognoses in those cases.

Results

According to Dulguerov's staging, 1 patient was categorized as T1, 3 patients as T2, 8 patients as T3, and 1 patient as T4. Among the 4 cases in T1 and T2, 3 patients underwent radiotherapy as their primary treatment, whereas the remaining 1 patient underwent endoscopic surgery. Eight patients in T3 and T4, whose tumors were resectable, underwent skull base surgery combined with radiotherapy. Among the 13 cases, 4 patients developed primary recurrence, 3 patients developed neck lymph node metastasis, and one patient developed lung metastasis. The overall 10‐year survival rate of the 13 cases was 83.3%. The primary tumors could be controlled in all of the 8 patients who underwent skull base surgery and radiotherapy. All of those patients are currently alive without disease. There was 1 patient whose tumor recurred approximately 20 years after the initial treatment.

Conclusions

The survival rate can be improved performing skull base surgery combined with radiotherapy provided that the tumors are resectable. Long‐term clinical follow‐up is also significant.
S151 – The Impact of Second Primary Tumors on Survival
Authors: Rennemo Erlend , Zatterstrom Ulf Kaare
Published: August 2008

Objectives

1) Evaluate what impact second primary tumors have on prognosis in HNSCC. 2) Identify patients that run the highest risk of obtaining a second primary tumor after successful treatment of primary HNSCC.

Methods

A retrospective analysis of 2063 patients treated over a 15‐year period for tumors of the oral cavity, larynx, oropharynx, and hypopharynx, was undertaken. Survival was analysed for the group of patients presenting second primary tumors, and the descriptive characteristics of these patients were compared to the remaining group of patients.

Results

Second primary tumors correlated with low patient age (p=0.02), less advanced disease (p<0.05), and were more common after primary tumors of the larynx and oral cavity. Mean time to diagnosis of a second primary tumor was more than 4 years from the date of the initial tumor. From the date of primary tumor treatment, overall median survival among patients that later developed second primary tumors compared to all other patients was 6 years vs. 3 years. Prognosis was poor after the diagnosis of a second primary, as median survival was 12 months and 5‐year survival, 16%.

Conclusions

Patients at risk of a second primary tumor were younger than median with stage I and II primary tumors of the larynx and the oral cavity. This group had a favorable outcome after treatment of their primary tumor and therefore initially a better overall survival. However, after diagnosis of the second tumor, prognosis was extremely poor.
S180 – Change of Mucosal Immunity Due to Radiotherapy to Larynx
Authors: Nakashima Tadashi , Tomita Hideichiro
Published: August 2008

Objectives

Radiation‐induced xerostomia is known to be a significant complication in head and neck cancer patients receiving radiation. As the larynx is endowed with a rich supply of glands, the survey of the secretory immunoglobulins as well as the glandular distribution in human larynx should provide a valuable baseline for understanding the immunological status of the larynx. The aim of this study is to assess the influence of radiation on the larynx in patients who received radiotherapy on the neck.

Methods

Laryngeal fluids or tissues were obtained from 111 human adults who received surgery or radiation therapy for hypopharyngeal or laryngeal cancer. From patients who had to undergo a total laryngectomy, the larynges were examined histopathologically. The change of the glandular distribution was measured using the image analyzing system. The levels of immunoglobulins, as well as the concentration of laryngeal glands, were compared between individuals with or without radiotherapy.

Results

The laryngeal secretion contained immunological factors such as secretory IgA. The level of SIgA fell to low levels in patients with previous radiation therapy. The glandular acini are often replaced with fibrous connective tissue. The density of the glands decreased and the ratio of serous‐type glandular cells decreased.

Conclusions

These results indicate that not only the voice function, but also the local defense function of the larynx, might be impaired after radiotherapy.
S181 – Injection Laryngoplasty with Hyaluronic Acid
Authors: Lau David P , Lee Gwyneth , Wong Seng Mun , Chan Yiong Huak , Tan Nam Guan , Rammage Linda , Morrison Murray
Published: August 2008

Objectives

To determine if particle size affects durability of medialisation in patients undergoing injection laryngoplasty (IL) with hyaluronic acid (HA) for unilateral vocal cord paralysis (UVCP). Hypothesis: Larger particle‐size HA persists longer after injection to produce a more durable vocal result.

Methods

Study Design: Prospective randomized controlled single‐blind trial. Years conducted: 2005–2007. Condition studied: UVCP. Subjects: Patients over the age of 18 requiring medialisation for UVCP. Setting: Outpatient clinic setting. Intervention: Patients underwent transcutaneous IL with Restylane (small particle‐size HA) or Perlane (large particle‐size HA). Outcome measurement: The Voice Handicap Index (VHI) at 6 months post‐injection was the primary outcome measure. Secondary outcomes included videostroboscopic findings, and objective acoustic and aerodynamic measures. Statistical methods: Differences between groups were compared using the Mann Whitney U test and adjusted for age & gender using ANCOVA.

Results

17 patients (8 Restylane, 9 Perlane) were available for follow‐up at 6 months. Normalised VHI scores at 6 months after IL were significantly lower in the Perlane group compared to the Restylane group when not adjusted for age and sex (p=0.027). After adjustment the difference was not significant (p=0.053) but the Perlane group trended towards lower normalised VHI scores.

Conclusions

The findings support the hypothesis that the larger particle size of Perlane makes this material more durable than Restylane for IL. This material may be considered for temporary medialisation in patients with UVCP in whom medium‐term improvement of at least 6 months is desirable. The trans‐cutaneous route can be used safely in the office setting in non‐anti‐coagulated patients.
S182 – A Modified Collar for Post‐Tracheal Resection Immobilization
Authors: Goyal Neerav , Gaslin Michael , Boon Maurits
Published: August 2008

Objectives

1) Determine the possible use of a modified cervical collar as an effective immobilization technique post tracheal resection. 2) Demonstrate the use of this alternate technique in clinical practice.

Methods

2 patients requiring tracheal resection for tracheal stenosis were identified as having been placed in an Aspen cervical collar brace with modification in the postoperative period to keep the patient's neck immobilized and flexed. Cervical collar braces usually keep a patient's neck in constant extension, but with our modifications, we keep the neck in constant flexion. This method was used in lieu of the traditional ‘chin stitch’ to relieve tension on the tracheal anastamosis in the immediate postoperative period. Patients were assessed during the inpatient postoperative period for comfort level, pain, and mobility in the collar. Patients were followed up as outpatients to evaluate tracheal patency.

Results

Both patients utilized the cervical collar for the duration of their inpatient stay. One patient had some complaints of difficulty breathing and increased anxiety due to the collar. Overall, both patients found the collar tolerable and denied any pain due to the collar. Patients were followed after discharge from the hospital in the outpatient clinic, and neither patient had evidence of restenosis at 2‐month follow‐up.

Conclusions

Though more research needs to be conducted, this approach represents a possibly more comfortable, yet still effective, method of tracheal immobilization status post‐resection as compared to the traditional ‘chin stitch.’
S186 – Necessity of Drain Placement for Thyroplasty
Authors: Jackson Kenneth D. , Garnett James David , Larsen Christopher G. , Sykes Kevin J. , Nguyen Amy Mai
Published: August 2008

Objectives

Review the complication rate and drain output characteristics during the immediate postoperative period for open thyroplasty via anterior neck approach with drain placement.

Methods

A retrospective cohort review of patients requiring open thyroplasty at 2 academic medical centers in the Midwestern United States between 1/1/1997 and 6/30/2007. Charts of patients receiving a thyroplasty were selected by CPT code and reviewed for rates of postoperative hemorrhage, hematoma formation, seroma formation, and upper airway compromise. Drain output quantities were examined, where available.

Results

Charts of 107 patients and 112 total procedures were reviewed. 18 procedures were excluded from this series due to simultaneous performance of other procedures. One (1/94) patient developed postoperative hematoma with upper airway obstruction. Hematoma evacuation was performed and the patient was subsequently discharged in stable condition. Average patient age was 59.3 years. Postoperative drain output was recorded as “minimal” in 58/94 (62%) of cases. Average drain output was 17.7 mL for those which were recorded. Hospital stay was less than 24‐hours for 89/94 (95%) of cases.

Conclusions

In this series, patients having undergone open thyroplasty have had little to no drain output prior to the discontinuation of the drain. This, as well as the low rate of overall complication associated with this procedure, would support the opinion that such drains may be unnecessary in these cases.
S191 – Unilateral Vocal Fold Paralysis: Medialization Results
Authors: Lundy Donna , Casiano Roy R , Landera Mario Alberto , Bublik Michael
Published: August 2008

Objectives

Management of glottal insufficiency due to unilateral vocal fold paralysis (UVFP) has evolved from trans‐oral injection to external thyroplasty to revisited injections (transoral or transcutaneous). Currently, preference is given to the less invasive injection medialization. Multiple injectable materials have been utilized with newer ones being introduced to manage concerns over permanency and vocal fold vibratory patterns. The purpose of this study is to evaluate the long‐term results of injection medialization for UVFP in terms of stability of glottal closure and voice outcome vs. need for reinjection.

Methods

All patients with UVFP that underwent injection medialization and had follow‐up studies more than 6 months were eligible for inclusion. Parameters studied included demographic data (age, gender), side of paralysis, etiology, degree of pre‐injection glottal insufficiency, length of follow‐up, degree of post‐injection glottal closure, mucosal wave resolution, and Voice Handicap Index.

Results

146 patients were identified with a mean age of 61.7 years (17–94); males (55%) and females (45%). Etiology was idiopathic (56%); iatrogenic (48%); tumor‐related (9%); trauma (3%); and neurologic (2%). Degree of glottal insufficiency was mild (21%); moderate (29%); and severe (50%). Material injected was Cymetra in 80 patients and Radiesse in 66 patients. 45 (33%) patients underwent more than 1 injection. Details of patients requiring repeat injections with regards to the material injected and the other parameters will be presented.

Conclusions

Injection medialization via a transcutaneous approach has long‐lasting results making it an appropriate minimally‐invasive option for long‐term medialization for UVFP.
S193 – Voice and Swallowing after Jugular Foramen Surgery
Authors: Oestreicher‐Kedem Yael , Damrose Edward J , Agrawal Sumit Kishore , Jackler Robert K
Published: August 2008

Objectives

This study was designed to evaluate the role and timing of surgical procedures for voice and swallowing rehabilitation in patients after surgery for jugular foramen tumors.

Methods

A retrospective case series. The records of patients operated for jugular foramen tumors from January 2002 to February 2008 were reviewed for lower cranial nerves function, hoarseness, dysphagia and aspiration, recovery course and rehabilitation procedures.

Results

17 patients underwent surgery for jugular foramen tumors. Tumors included 12 glomus jugulare, 4 schwannomas and 1 meningioma. 3 patients had presented with vagal and glossopharyngeal paralysis and 6 more patients developed post‐operative paralysis. All patients with paralysis experienced dysphagia and hoarsheness. 6 experienced aspiration. Gastrostomy or nasogastric tube feeding were required in 3 patients. 7 patients did not recover nerve function by the end of follow‐up. Treatments to improve voice and swallowing included vocal cord medialization by collagen injection (n=3), thyroplasty type 1 (n=5) with arytenoid adduction (n=4), cricopharyngeal myotomy (n=2), and palatal adhesion (n=3).

Conclusions

Postoperative dysphonia, dysphagia, and aspiration are common in patients after surgery for jugular foramen tumors. Most patients are unlikely to regain vagal or glossopharyngeal nerve functions at 1 year of follow‐up, and will eventually elect to undergo corrective surgery to improve voice quality and swallowing function. Preoperative evaluation and close postoperative follow‐up by an experienced laryngologist will help identify patients who will benefit from early surgical rehabilitation.