bluuebunny/crossref_metadata_2025_split huggingface dataset:
Volumetric Facelift: Evaluation of Rhytidectomy with Alloplastic Augmentation
Authors: Hopping Steven B. , Joshi Arjun S. , Tanna Neil , Janjanin Sasa 
Published: May 2017

Objectives Facial aging occurs as a result of soft tissue atrophy and resorption of the bony skeleton, which results in a loss of soft tissue volume and laxity of the overlying skin. Volumetric augmentation is a key component of facial rejuvenation surgery, and should be considered of equal importance to soft tissue lifting. Augmentation can be accomplished with synthetic fillers, autologous grafts, soft tissue repositioning techniques, and/or alloplastic implants. Only alloplastic implants, however, provide truly long-term volumetric correction. To date, there have been no large series dealing with the complications and results of implantation performed concurrently with rhytidectomy, which we have termed “volumetric rhytidectomy.” We present our experience with 100 patients treated with a combination of malar and chin implants and rhytidectomy, compared to 200 patients who underwent rhytidectomy alone. Methods The authors performed a retrospective review of patients treated with a combination of silicone malar and chin augmentation with rhytidectomy versus patients treated with rhytidectomy alone. Both groups of patients underwent close postoperative evaluation at 3 days, 1 week, 2 weeks, and 1 month. All patients were surveyed at 6 months to assess aesthetic satisfaction. Complication rates were noted and tabulated. Statistical analysis was performed to evaluate for any differences in the two groups. Results Between 2002 and 2006, 100 patients underwent malar and chin implantation along with rhytidectomy; 200 patients underwent rhytidectomy alone. In the first group, there were a total of 6 cases in which implant removal was necessary, and 2 cases in which revision was required. There were no statistically significant differences (p < 0.05) observed between the two groups with respect to major or minor hematoma, seroma, infection, sensory nerve injury, facial nerve injury, hypertrophic scarring, dehiscence, skin sloughing, or revision. Conclusions Volumetric rhytidectomy reliably augments the malar and mental areas, allows for subtle skeletal contouring, and results in successful rejuvenation. Rhytidectomy is relatively safe to perform concurrently with silicone augmentation, and does not result in an increased complication rate as compared to rhytidectomy alone.
Management of Recurrent Laryngeal Sensory Neuropathic Symptoms
Authors: Norris Byron K. , Schweinfurth John M. 
Published: May 2017

Objectives We identify management strategies for the treatment of upper respiratory tract symptoms stemming from dysfunction of the recurrent laryngeal nerve. Methods We present a retrospective case series of patients who had symptoms of sensory neuropathy, including persistent dysphonia, laryngospasm, and chronic cough. The patients were followed for symptomatic improvement after initiation of treatment with a neuromodulator. Treatment outcome was defined by improvement or resolution of symptoms on a self-reported outcome scale. Results Of 12 patients identified, 75% exhibited evidence of motor neuropathy on laryngoscopy and 83% had symptoms related to chronic cough treated with neuromodulator therapy over a mean follow-up of 20.4 months. The median dose of amitriptyline hydrochloride was 25 mg daily, and that of gabapentin was 300 mg 3 times daily. The mean time from the initiation of therapy to a complete response was 2 months. Conclusions Patients with suspected neuropathy of the recurrent laryngeal nerve frequently respond to neuromodulator therapy. The addition of reflux precautions and acid suppression therapy is helpful in cases of chronic and recurrent laryngospasm. Patients with evidence of motor neuropathy appear to have better outcomes with neuromodulator therapy.
Endoscopic Management of Airway Venous Malformations with Nd:YAG Laser
Authors: Glade Robert , Vinson Kimberly , Richter Gresham , Suen James Y. , Buckmiller Lisa M. 
Published: May 2017

Objectives The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser is a powerful tool in treating venous malformations (VMs) involving the upper airway. If left untreated, laryngeal VMs can lead to life-threatening airway obstruction. We aimed to evaluate the efficacy of endoscopic management of laryngeal VMs with the Nd:YAG laser. Methods We performed a 12-year retrospective review in a tertiary referral center. Patient records were reviewed for demographics, presenting symptoms, area of involvement, age at first Nd:YAG laser therapy, total number of treatments, time between treatments, and treatment response. Results Seventeen patients were treated endoscopically with an Nd:YAG laser for laryngeal VMs. The mean age at first treatment was 23.0 years (range, 18 to 45 years). The majority of patients presented with obstructive sleep apnea (58.8%), and 17.5% of patients presented with acute airway obstruction or stridor. The remaining patients presented with minor symptoms, including chronic cough and voice changes. The VMs involved the supraglottis, glottis, or both in 29%, 35%, and 35% of patients, respectively. An average of 4 treatments were required per patient (median, 3.5; range, 1 to 9). The time between treatments increased with each consecutive laser therapy, starting at a mean of 3.8 months between the first and second treatments to 21.7 months between the third and fourth. A marked reduction in VM size and symptom improvement were achieved in each patient after Nd:YAG therapy. Two complications (3%) were encountered among 66 total procedures. Conclusions Endoscopic management of VMs using an Nd:YAG laser appears to be both effective and relatively safe. Multiple treatments are often required, but increased time can elapse between consecutive therapies. Use of the Nd:YAG laser for laryngeal VMs helps avoid tracheotomy and open surgical resection.
Surgical Technique of Transoral Marsupialization for the Treatment of Nasopharyngeal Branchial Cysts
Authors: Tsai Tsung-Yen , Su Chih-Ying 
Published: May 2017

Objectives Nasopharyngeal branchial cysts (NBCs) are derived from a remnant of the branchial apparatus and originate from the lateral wall of the nasopharynx. Total excision of these cysts was the standard treatment in the past. We present a simpler and less invasive approach for NBC treatment, involving marsupialization, and report on its effectiveness and advantages. Methods The surgical approach was transoral. A circular incision 2 to 3 cm in diameter was made directly through the inferior wall of the cyst. After the NBC was drained, its opening was widened with scissors. A disk of oropharyngeal mucosa and the connecting inferior wall of the cyst were excised together. The cut edges of the inner lining of the cyst and the oropharyngeal mucosa were approximated with sutures. Results All 4 patients were female. One patient was observed because of poor cardiovascular health, the 3 patients who were managed surgically underwent successful transoral cyst marsupialization. The mean follow-up period was 21 months (range, 8 to 40 months). No obvious postoperative complication or recurrence was noted. Conclusions Transoral marsupialization is a simple, effective, and less invasive method for treatment of NBCs.
Inhibitory Effects of Hepatocyte Growth Factor and Interleukin-6 on Transforming Growth Factor-β1 Mediated Vocal Fold Fibroblast-Myofibroblast Differentiation
Authors: Vyas Bimal , Ishikawa Keiko , Duflo Suzy , Chen Xia , Thibeault Susan L. 
Published: May 2017

Objectives The role of myofibroblasts in vocal fold scarring has not been extensively studied, partly because of the lack of a robust in vitro model. The objective of this investigation was to develop and characterize a myofibroblast in vitro model that could be utilized to investigate the molecular mechanism of myofibroblast differentiation and function in injured vocal fold tissue. Methods Differentiation of human primary vocal fold fibroblasts (hVFFs) to myofibroblasts was stimulated with 5, 10, or 20 ng/mL of recombinant transforming growth factor-β1 (TGF-β1). Cultures were analyzed by immunofluorescence and Western blotting, with an α-smooth muscle actin (α-SMA) antibody used as a myofibroblast marker. Normal rabbit vocal folds were treated with 10 ng/mL of TGF-β1 for 7 days for in vivo corroboration. The effects of interleukin-6 (IL-6) and hepatocyte growth factor (HGF) on myofibroblast differentiation were studied with Western blots. Results The hVFFs demonstrated positive α-SMA labeling in cells stimulated by 10 and 20 ng/mL TGF-β1, indicating that hVFFs were capable of differentiation to myofibroblasts. Transforming growth factor—β1 induced the largest increase in α-SMA at 10 ng/mL on day 5 of treatment. Both HGF and IL-6 suppressed the expression of TGF-β1—induced α-SMA. Conclusions Our work characterizes a useful in vitro model of TGF-β1—mediated vocal fold fibroblast-myofibroblast differentiation. The extent of differentiation appears to be attenuated by HGF, suggesting a potential mechanism to support prior work indicating that HGF plays a protective role in reducing scar formation in vocal fold injuries. Paradoxically, IL-6, which has been shown to play a profibrotic role in dermal studies, also attenuated the TGF-β1 response.
Collagen Injection for Correcting Vocal Fold Asymmetry: High-Speed Imaging
Authors: Kimura Miwako , Nito Takaharu , Imagawa Hiroshi , Sakakibara Ken-Ichi , Chan Roger W. , Tayama Niro 
Published: May 2017

Objectives We hypothesized that high-speed digital imaging with videokymographic and laryngotopographic analysis would provide a quantitative method to evaluate the effect of collagen injection for the correction of asymmetric and irregular vocal fold vibration in unilateral vocal fold paralysis. Methods Videokymographic and laryngotopographic analysis was performed for high-speed digital recordings of vocal fold vibration for visualizing the glottal vibratory patterns, and for quantifying the frequency of vibration of each vocal fold, respectively, including comparisons between the paralyzed and normal vocal folds before and after surgery. This included prospective observations of 11 subjects with unilateral vocal fold paralysis (4 male, 7 female; mean ± SD age, 67.1 ± 12.0 years) using high-speed digital image analysis before and after collagen injection. Results Analysis of the laryngotopographs revealed 2 distinct frequencies of vibration for the paralyzed and contralateral vocal folds for 8 of the 11 subjects before surgery. After collagen injection, the vibration frequencies became identical, despite asymmetric vibration amplitudes. Asymmetric vibration amplitudes were also observed in the other 3 subjects before surgery, but the amplitudes became symmetric after collagen injection, despite a persistent phase shift. Conclusions Asymmetric vibration in vocal fold paralysis was exemplified by differences in vibration frequency and amplitude between the vocal folds. The present study showed that after collagen injection, these aspects of vibratory patterns improved toward symmetry. This surgical procedure could improve the functional symmetry of the larynx for phonation.
Characterization of Supraglottic Phonation in Children after Airway Reconstruction
Authors: Kelchner Lisa N. , Weinrich Barbara , Brehm Susan Baker , Tabangin Meredith E. , De Alarcon Alessandro 
Published: May 2017

Objectives We examined select acoustic (signal type), aerodynamic, and perceptual measures and associated surgical data in a cohort of children who were endoscopically identified as using supraglottic phonation after undergoing airway reconstruction. Methods Twenty-one children (4 to 18 years of age) who were seen in the Cincinnati Children's Hospital Medical Center for Pediatric Voice Disorders and identified as using supraglottic phonation were included in this study. According to standard protocol, each of these children underwent acoustic, aerodynamic, and perceptual analyses and laryngeal imaging. Their medical records were reviewed for surgical history. Results Four primary supraglottic compression patterns and 3 distinct sound sources for voice were identified. Signal type classification revealed that 20 of 21 voice signals were either type II or type III. Signal type was moderately associated with compression pattern (p = 0.01). No statistically significant findings were found in testing the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) Overall Severity score against compression patterns and vibration source. The mean Strain scores for participants who used a combined source of vibration were significantly higher than for those who used their ventricular folds. Conclusions The compensatory compression patterns and alternate sources of vibration used by these children resulted in moderate to severe dysphonias. How children compensate after undergoing airway reconstruction has important implications for behavioral and surgical interventions aimed at improving voice quality. Not all aspects of traditional voice evaluation are suitable for this population.
Dysphagia, Stricture, and Pneumonia in Head and Neck Cancer Patients: Does Treatment Modality Matter?
Authors: Francis David O. , Weymuller Ernest A. , Parvathaneni Upendra , Merati Albert L. , Yueh Bevan 
Published: May 2017

Objectives Dysphagia-related sequelae are common after head and neck cancer treatment. Our aims were 1) to document overall and site-specific dysphagia, stricture, and pneumonia rates in a Medicare population, 2) to calculate treatment-specific rates and adjusted odds of developing these complications, and 3) to track changes in rates between 1992 and 1999. Methods Head and neck cancer patients between 1992 and 1999 were identified in combined Surveillance Epidemiology and End Results (SEER) registry and Medicare databases. Multivariate analyses determined odds of dysphagia, stricture, and pneumonia based on modality. Results Of 8,002 patients, 40% of experienced dysphagia, 7% stricture, and 10% pneumonia within 3 years of treatment. In adjusted analyses, patients treated with chemoradiation had more than 2.5-times-greater odds of dysphagia than did those treated with surgery alone. Combined therapy was associated with increased odds of stricture (p < 0.05). The odds of pneumonia were increased in patients treated with radiation with or without chemotherapy. Temporally, the dysphagia rates increased 10% during this period (p < 0.05). Conclusions Sequelae of head and neck cancer treatment are common and differ by treatment regimen. Those treated with chemoradiation had higher odds of experiencing dysphagia and pneumonia, whereas patients treated with any combined therapy more commonly experienced stricture. These sequelae represent major sources of morbidity and mortality in this population.
Normal Muscular Activity during Swallowing as Measured by Surface Electromyography
Authors: O'kane Lisa , Groher Michael E. , Silva Kathleen , Osborn Lori 
Published: May 2017

Objectives Speech-language pathologists use surface electromyography biofeedback as a tool to facilitate swallowing treatment, particularly to improve swallowing strength and coordination. The present study sought to establish normative data of swallowing muscular activity as measured by surface electrodes in order to compare the performance of patients with dysphagia to normal swallow performance. Methods Thirty normal young (18 to 25 years of age) and elderly (60 or more years of age) subjects swallowed 3 bolus volumes (5, 10, and 20 mL) in 2 conditions: swallow-to-command and swallow-when-ready. Swallow muscular activity was measured in microvolts with a portable biofeedback unit. Results There were significant differences between the 2 swallowing conditions in both age groups. Neither age nor bolus volume had a significant effect on the findings. Conclusions In using surface electromyography biofeedback as an adjunct to swallowing rehabilitation, it may be more beneficial to use swallow-to-command techniques if one is interested in measuring maximum effort, regardless of patient age or volume selected.
Bacterial Coinfection and Antimicrobial Resistance in Patients with Paranasal Sinus Fungus Balls
Authors: Wang Jong Hwan , Lee Bong-Jae , Jang Yong Ju 
Published: May 2017

Objectives The aim of this study was to investigate the incidence of bacterial coinfection and antimicrobial resistance in cases of fungus balls of the paranasal sinuses. Methods Between December 1991 and August 2008, 229 patients underwent endoscopic sinus surgery or the Caldwell-Luc procedure for paranasal sinus fungus ball treatment. From 123 of these patients, a total of 124 specimens were obtained for aerobic and anaerobic culture. Antimicrobial susceptibility tests were performed. Results Ninety-one cultures (73.4%) were positive for bacteria, and 33 showed no bacterial growth. A total of 134 bacterial organisms were isolated: 65 gram-positive, 55 gram-negative, and 14 anaerobic. The most frequently isolated organisms were coagulase-negative Staphylococcus (14.9%), Staphylococcus aureus (12.7%), Enterobacter aerogenes (12.7%), viridans-group streptococci (8.9%), and Pseudomonas aeruginosa (8.2%). Among the gram-positive cocci, 12.2% were resistant to ciprofloxacin, 27.6% to clindamycin, 30% to oxacillin, 35.8% to erythromycin, 35.9% to trimethoprim-sulfamethoxazole, 56.5% to penicillin, 56.8% to gentamicin, and 0% to teicoplanin and vancomycin. Among the gram-negative rods, fewer than 10% were resistant to imipenem, piperacillin-tazobactam, amikacin, gentamicin, ceftazidime, cefepime, and tobramycin, whereas more than 80% showed resistance to ampicillin and cefazolin. When we compared the data from the periods 1991 to 2000 and 2001 to 2008, there were no significant differences in the isolation rates of particular bacterial species and no significant differences in resistance rates except for clindamycin-resistant gram-positive cocci and cefazolin-resistant gram-negative rods. Conclusions Bacterial coinfections were identified in more than two thirds of patients with fungus balls and purulent secretions. This finding suggests that bacterial infection may influence the development and persistence of clinical symptoms in a substantial portion of fungus ball cases.
Balloon Catheter Sinuplasty and Adenoidectomy in Children with Chronic Rhinosinusitis
Authors: Ramadan Hassan H. , Terrell Andrew M. 
Published: May 2017

Objectives Adenoidectomy is the first step in the surgical management of children with chronic rhinosinusitis (CRS). Adenoidectomy, however, is only effective in half of these children. Although endoscopic sinus surgery is effective for CRS, there is concern for facial growth retardation and major complications. We propose that balloon catheter sinuplasty (BCS) is a minimally invasive, effective procedure in the treatment of pediatric CRS. Methods We undertook a nonrandomized, controlled, prospective review of children with failed medical management of CRS who underwent BCS or adenoidectomy. Outcomes were assessed at 1 year of follow-up and were based on SN-5 scores and the need for revision surgery. Results Forty-nine children who satisfied the inclusion criteria were reviewed. Thirty of the children had BCS. The age range was 4 to 11 years (mean, 7.7 years), and the mean computed tomography score (Lund-Mackay system) was 7.5. Twenty-four of the 30 patients (80%) who underwent BCS showed improvement of their symptoms after 12 months of follow-up, compared with 10 of the 19 patients (52.6%) who underwent adenoidectomy (p < 0.05). A multivariate analysis using logistic regression analysis with age, sex, asthma, and computed tomography score as covariables showed that BCS was also more effective than adenoidectomy in older children. None of the other variables showed statistical significance. Conclusions Balloon catheter sinuplasty offers a procedure that is more effective than adenoidectomy and less invasive than endoscopic sinus surgery in the treatment of pediatric CRS.
Epiglottoplasty for Reconstruction of Defects after Laryngectomy with Partial Pharyngectomy
Authors: Fajdiga Igor , GrošElj Aleš , ŽUpevc Avgust 
Published: May 2017

Objectives We present a novel use of sliding epiglottoplasty as an alternative method for closing mucosal defects in selected laryngectomies with partial pharyngectomy. Methods Sliding epiglottoplasty as described and advocated by Sedlaček, Bouche, Kambiě, and Tucker for reconstruction in partial laryngectomies was used to close the defects after laryngectomy with partial pharyngectomy in 17 patients with advanced hypopharyngeal cancers as primary therapy (16 patients) and as post-radiochemotherapy therapy (1 patient). Results All reconstructions were successful. Primary closures were achieved without additional morbidity, there were no pharyngocutaneous fistulas, and all patients resumed deglutition. Ten patients acquired esophageal speech, speech valves were inserted in 5 cases, and 2 patients required the use of an electrolarynx. Conclusions If the oncological circumstances allow its preservation in laryngectomy with partial pharyngectomy, the epiglottis is an ideal structure for closing the defect; it is a local tissue with shape, thickness, rigidity, and borders that match the recipient site. In comparison to distant pedicled or free microvascular flaps, the epiglottoplasty is a shorter procedure, requires a smaller surgical team, results in less trauma, has a lower incidence of complications, and enables faster recovery. It is surprising that this elegant, successful, and generally accepted larynx preservation procedure has not been recognized as useful for larger reconstructions.
Neurosarcoidosis Affecting the Vagus Nerve
Authors: Alon Eran E. , Ekbom Dale C. 
Published: May 2017

Objectives Our objective was to review patients who presented to our medical center with a diagnosis of neurosarcoidosis affecting the vagus nerve and to present symptoms, progression, treatments, and outcome. Methods We performed a chart review of patients who presented to our medical center in the past 10 years with a diagnosis of neurosarcoidosis specifically affecting cranial nerve X. Results A chart review of 53 patients revealed only 4 with findings suggestive of vagal neurosarcoidosis. All were male and had a mean age of 50 years (range, 42 to 57 years) at presentation of symptoms. Two of the 4 patients presented initially with cough, 1 had recurrent syncope, and another presented with left facial pain. Vagus nerve involvement included vocal fold paresis or paralysis in all 4 patients, 2 of whom reported coughing with exposure to various odors and 2 of whom were found to have a unilateral palatal weakness. All but 1 had positive findings on magnetic resonance imaging of the head. Conclusions Neurosarcoidosis involving the vagus nerve is a rare finding, but should be considered in the differential diagnosis of vocal fold paresis or paralysis.