bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeted Hypoglossal Neurostimulation in Obstructive Sleep Apnea
Authors: Rombaux Philippe , Mwenge Gisele , Lengelé Benoit , Rodenstein Daniel 
Published: February 2015

ObjectiveAirway management is the standard approach for the treatment of obstructive sleep apnea (OSA). CPAP remains the gold standard to treat OSAS, but about one‐quarter of the patients are poorly compliant or tolerant to the mask. The aim of the study was to evaluate the safety and efficacy of targetted neurostimulation of the hypoglossal nerve (THN Sleep Therapy) in CPAP non‐compliant subjects using the aura6000™ System from ImThera Medical Inc.MethodThe study was a single arm, prospective feasibility study on 13 OSA subjects. Apnea‐hypopnea indices (AHI) were measured at 3 and 12 months. A multi‐contact cuff electrode was implanted unilaterally on the proximal hypoglossal nerve and an implantable pulse generator placed subcutaneously in the ipsilateral upper chest wall.ResultsSignificant improvement was found in the apnea hypopnea index: baseline 45.2 ± 17.8, 3 months 21.7 ± 19.9, and 12 months 21.0 ± 16.5 calculated for the 13 patients. Ten patients were classified as responders (76.92%) with a 65.55% improvement in the AHI at 3 months and 68.19% at 12 months and with a 67.09% improvement in the ODI at 3 months and 66.23% at 12 months.ConclusionTHN Sleep Therapy™ proved to be a feasible and effective procedure for the treatment of the moderate to severe CPAP noncompliant OSA subjects.
Velopharyngeal Surgery for Patients with Small Tonsils
Authors: Ye Jingying , Zhang Junbo , Xian Junfang , Wang Jiangyong , Dong Jiajia 
Published: February 2015

ObjectiveTo explore the relationship between anatomical changes and treatment response in obstructive sleep apnea (OSA) patients with small tonsils (tonsil grades 0‐2 according to Friedman staging system) after velopharyngeal surgery.MethodThirty‐six patients with small tonsils underwent velopharyngeal surgery that consisted of revised uvulopalatopharyngoplasty with uvula preservation (H‐UPPP) and concomitant transpalatal advancement pharyngoplasty, 3‐dimensional CT of upper airway, and polysomnography performed before and after surgery were obtained for comparison and analysis.ResultsOverall apnea‐hypopnea index (AHI) decreased from 56.8 (37.5, 70.1) to 16.1 (10.8, 33.5) (P <. 001) after surgery. The changes of several anatomical parameters differed significantly between responders and non‐responders (P <. 05), and the change of minimal cross‐sectional area of velopharynx (VmCSA) was independently predictive of the change of AHI (P <. 001, r2 = 0.271). The correlation analysis showed that the change of VmCSA significantly correlated with preoperative VmCSA (r = −0.383, P =. 021).ConclusionIn patients with small tonsils an increase in VmCSA is related to a good surgical response, and such patients who have a relatively smaller preoperative VmCSA are more likely to get favorable anatomical changes.
Closure of Large Oro‐antral Fistulas Using Septal Cartilage
Authors: Saleh Essam A. , Issa Islam A. 
Published: February 2015

ObjectiveTo describe a new technique for closure of large oro‐antral fistulas and report our results using this technique.MethodA retrospective review in a tertiary referral hospital. Patients with large oro‐antral fistulas were treated surgically using autograft septal cartilage and buccal pyramidal flap.ResultsThere were 11 patients, 8 of whom had chronic oro‐antral fistulas. The etiology was tooth extraction in 9 cases (81.8%), primordial maxillary cyst exicision in 1 case (9.1%), and dental implant in 1 case (9.1%). Four cases had extensive sinusitis and were managed by endoscopic sinus surgery. Complete closure of the fistula was obtained in 10 cases (90.9%), whereas 1 case (9.1%) failed. No other complications occurred.ConclusionThe septal cartilage and pyramidal buccal flap technique is a viable alternative for the closure of large oroantral fistulas.The associated maxillary sinusitis can be safely managed by endoscopic sinus surgery.
Emergency Clinic Electronic Documentation Using Microsoft Access®
Authors: Awad Zaid 
Published: February 2015

Objective1) Assess the impact of using an electronic data collection form on medical documentation accuracy. 2) Test the model longitudinally for reliability and productivity.MethodA prospective longitudinal audit 2008‐2012 before and after introducing a Microsoft Access database as the sole form of documenting all ENT emergency clinic ancounters. Documentation was evaluated across 3 domains over 2 months. We then introduced the form for 2 months. The third arm is an automatic continuous audit loop.ResultsData acquired were divided into demographics, clinical, and clerical covering 18 parameters. The first arm included 319 patients and showed 32% booking errors. 61% had missing or illegible information. Only 36% had the source of referral, and 41% had no clear outcome. These improved to 5% booking errors and 3% missing information during the second phasing arm (n = 330) with 98% compliance in using the new database, then to 1% and 0% in the third arm where 6000 cases were seen (chi‐square, P <. 001) in 16 out of 18 parameters.ConclusionThe form has been in use for nearly 4 years. Information like the number of patients seen, source, waiting time, procedures carried out, and outcome are all available instantly in an easily presentable and auditable format. The form saves time and effort, helps with research, and improves in documentation and communication.
Is Ductoplasty Necessary after Combined Sialolithectomy?
Authors: Pagliuca Giulio , Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili 
Published: February 2015

ObjectiveSialolithectomy with combined endoscopic and external approach is indicated for large sialoliths. The aim of this study is to establish whether ductoplasty is necessary to repair the Wharton’s duct or if simple suturing of the oral floor after stent placement may be sufficient to achieve duct healing.MethodTen patients underwent a combined approach to remove submandibular stones. Ductoplasty was performed in 6 cases whereas in 4 cases only the mucosa of the oral floor was sutured without repairing the duct. The stent was removed about 3 weeks after surgery. A diagnostic sialoendoscopy was performed after 6‐8 months.ResultsSialoliths were completely removed in all cases. During follow‐up all patients were symptom‐free, and no recurrence was reported. Postoperative diagnostic sialoendoscopy showed a well‐canalized duct in all cases.ConclusionSuture of the ductal wall after combined approach is not necessary to obtain a correct recanalization of the duct. After stent placement, the suture of the oral mucosa overlying the ductal wall allows a regular restoration of the lumen, thus reducing duration of surgery and possibility of lingual nerve injury.
Joint Facial and Invasive Neck Trauma (J‐FAINT) Study
Authors: Feldt Brent A. , Salinas Nathan , Rasmussen Todd , Brennan Joseph A. 
Published: February 2015

Objective1) Describe the rate and type(s) of head and neck trauma in Iraq and Afghanistan theaters during 2003‐2011 using military trauma database. 2) Determine directions for future research in personal protective and tactical gear to help prevent injury and death from facial and neck trauma in war and civilian uses.MethodStudy of US servicemembers in Iraq and Afghanistan from 2003‐2011. Data were collected December 2011. Examples of data include type and severity of head and neck trauma, associated injuries, age, sex, theater of injury, injury severity score, and abbreviated injury scale. Data were collected using the Joint Theater Trauma System (JTTS).ResultsData analysis is ongoing. The analysis demonstrates 7,177 service members who sustained head and neck trauma during the study period in Iraq and Afghanistan, combined. Of those patients sustaining head and neck trauma, 270 (3.8%) were killed in action or died of wounds. About one‐third sustained head and/or neck trauma alone, but most had associated torso and/or extremity injuries, which increased the injury severity score. The majority of injuries occurred in Iraq. Most of the injured were in the US Army (75%), followed by the Marine Corps (20%), Air Force (3%), and Navy (2%). Most injuries were minor‐moderate (AIS 1‐3).ConclusionHead and neck trauma is common in wartime, and the most recent conflicts confirm this. Many patients sustained injuries in Iraq, the majority were in the Army, and the majority were minor injuries. Most patients (96.2%) who sustained head and neck trauma survived their injuries, even when associated with extremity and torso injuries.
Mentorship in Otolaryngology: 10 Years of Experience
Authors: Geltzeiler Mathew N. , Lighthall Jessyka G. , Wax Mark K. 
Published: February 2015

ObjectiveThe Accreditation Council for Graduate Medical Education’s (ACGME) structuring of resident education attempts to utilize mentoring relationships to augment trainee development. The purpose of the current study is to better understand the nature of the mentor‐mentee relationship and find areas that should be strengthened or de‐emphasized.MethodThe Mentorship Program in the Department of Otolaryngology–Head and Neck Surgery at Oregon Health and Science University has existed for 10 years. Mentor‐mentee pairs are assigned upon matriculation. Pairs are required to meet biannually at minimum. Guidelines for discussion topics are provided. All residents and faculty participants were surveyed online.ResultsNineteen mentors and 24 mentees completed the survey, a 100% response rate. Mentor personality traits most important to residents were honesty/integrity (93%) and supportiveness (88%), while the least important characteristics were race (100%) and gender (83%). Mentor‐mentee pairs discussed a wide variety of topics. At the completion of training, only 26% of residents felt comfortable with transition to private practice and contract negotiations. These topics were also the least frequently discussed. Eighty‐three percent of trainees sought additional mentorship from other faculty. Eighty‐seven percent of mentors would not care if mentees changed mentors. Overall, 82% of participants endorsed continuing the program.ConclusionMentorship programs are an effective tool in facilitating resident development. Residents would prefer choosing their own mentor and value honesty and supportiveness. Topics relating to private practice and contract negotiations were the areas of greatest discomfort for residents and the least frequently discussed. This represents an area for improvement.
Multiple Mini Interview for Selection into OTL Residency
Authors: Campagna‐Vaillancourt Maude , Nguyen Lily H. P. , Manoukian John J. , Razack Saleem 
Published: February 2015

Objective1) To determine the reliability of the Multiple Mini Interview (MMI) for resident selection into an otolaryngology–head and neck surgery (OTL‐HNS) program. 2) To assess the degree of acceptance by major stakeholders (interviewers and applicants) towards the MMI when compared to traditional interviews.MethodCanadian medical graduates applying to OTL‐HNS residency programs underwent MMI in 2011 and 2012. MMI had 7 stations evaluating unique candidate attributes. Stations include surgical skills assessment and 2 simulation scenarios with standardized actors for noncognitive traits. Reliability was determined, and upon completion, stakeholders rated aspects MMI using 7‐point Likert scale.ResultsData were collected from a total of 45 applicants and 19 evaluators. Overall interrater reliability of the MMI was good. The majority of applicants (>80%) felt that MMI helped them present their strengths and that it did not have any gender, cultural, or age bias. Assessors (>85%) felt that the MMI evaluated a valid range of competencies and that it tested more aspects of an applicant than traditional interviews. Both applicants and assessors (>70%) agreed that the MMI was a fair process, and both preferred the MMI over the traditional interview.ConclusionThe MMI is a reliable tool for the selection of applicants to an OTL‐HNS residency program. It is well accepted by both applicants and assessors, with the majority of stakeholders preferring the MMI over traditional interviews.
National Operative Log Growth Charts in Otolaryngology–Head and Neck Surgery Training
Authors: Jabbour Noel , Tsue Terance 
Published: February 2015

Objective1) To report national standard developmental growth curves for operative procedures in otolaryngology. 2) To describe a method by which program directors can chart surgical case numbers over time to assess sufficiency of cases and parity between residents.MethodNational statistical operative log reports were obtained from the ACGME for otolaryngology graduate classes of 2009, 2010, and 2011 at set intervals during training. Mean numbers and 0.5 and 1 standard deviation from the mean were graphed against training level to create case log growth charts, akin to developmental growth charts.ResultsCase log developmental growth charts were made for each key indicator procedure and for total cases. Progress of an individual resident or of a cohort of residents may be graphed against this growth chart background over time.ConclusionNational Operative Case Log Growth Charts allow residents and program directors to graphically assess progress in obtaining sufficient variety and number of operative procedures over time throughout training. This can provide early identification for need for intervention when residents begin to fall below the growth curve during training.
Sialoendoscopic Findings in Non‐lithiasic Sialoadenitis
Authors: Gallo Andrea , Martellucci Salvatore , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili , Pagliuca Giulio 
Published: February 2015

ObjectiveInflammatory swelling of the salivary glands without radiological findings of sialolithiasis may present a serious diagnostic challenge. A case study of 49 diagnostic sialoendoscopies performed on 44 patients (age: 10‐62 years) affected by recurrent inflammatory swelling of salivary glands without radiological evidence of salivary stones is reported.MethodIntraoperative findings of 49 diagnostic sialoendoscopies attempted on 44 patients were reviewed. All patients experienced episodes of swelling of salivary glands. All patients showed no signs of salivary stones at the preoperative ultrasonography. The patients were contacted by telephone to investigate changes in the symptoms approximatively 6 months after sialoendoscopy.ResultsSialendoscopy revealed the presence of obstructive mucous plugs in 23 glands (14 submandibulars, 9 parotids) while ductal stenosis was found in 7 cases (2 submandibulars, 5 parotids). A combination of mucous plugs and stenosis was described in 12 glands. Parotid duct sialodochitis was diagnosed in 2 cases. In 1 case the avascular appearance of Stenson’s duct allowed the diagnosis of juvenile recurrent parotitis. Endoscopy revealed no disorders in 4 cases. Thirty‐eight patients (77.5%) referred symptom relief at interview.ConclusionSialendoscopy is the procedure of choice in diagnosing chronic non‐lithiasic sialoadenitis. Salivary duct dilation by irrigation alleviates the symptoms in these conditions.
Throat Symptoms: The Importance in Peritonsillar Abscess
Authors: Powell Jason , Powell Emily L. , Conroy Katherine , Hopkins Claire , Moor James , Wilson Janet A. 
Published: February 2015

ObjectiveThe incidence of quinsy is rising in the UK for reasons which are unclear. There were >7000 hospital diagnosed episodes last year in England alone. Some suggest a link to the decline in elective tonsillectomy. Our aim was to compare chronic throat symptoms in quinsy patients and controls.MethodThe validated 16‐item Tonsillectomy Outcome Inventory (TOI‐16) was used to compare the impact of throat symptoms over the previous 6 months in 119 controls (no quinsy history) and 55 contactable (by telephone) quinsy patients (34M, 21F), who had an average experience of 1.4 (range 0‐4) quinsies. Analysis was in SPSS.ResultsThe TOI‐16 Cronbach’s α =. 92, indicating high internal consistency. The mean 6‐month overall throat impact scores in quinsy patients (21.0) were significantly greater than that in volunteers (10.9 P <. 05). The post‐quinsy interval had only modest effect on the overall mean score. Younger people had higher scores in both groups. On item‐by‐item analysis, quinsy patients recorded significantly higher mean reported scores over the previous 6 months for snoring, visits to the doctor, and frequent use of antibiotics (all P <. 001) and halitosis, catarrh, missed social gatherings or events, missed work‐days, and depression due to throat problems (all P <. 05).ConclusionOngoing throat problems are far more prevalent and severe in quinsy patients than controls, with a clear life impact. In many, quinsy represents an acute episode on a background of chronic throat problems. The optimal acute management—notably the place and timing of tonsillectomy—should take account of this.
A New Paradigm in Geriatric Head and Neck Surgical Oncology
Authors: Shuman Andrew G. , Goodman Stephanie M. , Korc‐Grodzicki Beatriz , Palmer Frank , Shah Jatin P. , Patel Snehal 
Published: February 2015

ObjectivePerioperative management of elderly patients with head and neck cancer poses unique challenges and may benefit from expert input from geriatricians. Our objectives are to 1) describe the implementation and 2) determine the feasibility of a novel intervention designed to improve perioperative care delivery in geriatric head and neck surgery.MethodIn this pilot study, patients with head and neck cancer over age 75 were offered preoperative consultation with fellowship‐trained geriatricians. Geriatric‐specific assessment included functional and social status, cognitive testing, medication review and nutrition; patients were also optimized and risk‐stratified for surgery. Thereafter, patients were seen postoperatively by the geriatric service.ResultsBetween 2010 and 2011, a total of 176 head and neck patients (75‐93 years old) were seen by the geriatric service. Apart from preoperative medical optimization, geriatricians also assisted in complex decision‐making regarding the indications for cancer‐directed therapy. From the cohort, 148 (84%) subsequently underwent surgery; the majority of cases involved mucosal lesions (43%), cutaneous lesions (20%), and endocrine disease (16%). Postoperatively, geriatricians assisted in preventing and treating delirium, minimizing inappropriate prescribing and poly‐pharmacy, facilitating discharge planning, and initiating prompt rehabilitation. Surgeons, geriatricians, and nursing staff alike were enthusiastic about the initiative, which continues to expand within the institution.ConclusionGeriatric perioperative assessment of elderly head and neck cancer patients is feasible and well‐received with promising potential. The tangible impact and direct benefits of this pilot initiative require additional study.
Cost Analysis of Robotic Surgery of the Head and Neck
Authors: Kakarala Kiran , Durmus Kasim , Agrawal Amit , Carrau Ricardo L. , Old Matthew O. , Teknos Theodoros N. , Ozer Enver 
Published: February 2015

Objective1) Present results of cost identification analysis for robotic head and neck surgical procedures. 2) Identify drivers of cost for robotic procedures in the persioperative period including services, materials, and patient characteristics.MethodRetrospective review of 128 robotic surgical procedures of the head and neck at an academic medical center between 2008 and 2011. Cost data for the perioperative period (operating room, recovery, hospital stay) were collected and matched with clinical data for each case to determine drivers of cost.ResultsProcedures analyzed included transoral robotic surgery (TORS) for oropharyngeal and supraglottic cancers, transaxillary robotic thyroidectomy, and transoral robot assisted approaches to the skull base. Average total cost was $14,455 with a wide range of $3,567‐$55,008. In a subset of 24 patients who underwent TORS alone, without neck dissection, the average cost was $6,450. The cost of the robot for these procedures is analyzed in relation to surgical volume. A subset of patients who underwent TORS with neck dissection for oropharyngeal cancer is analyzed in order to determine drivers of cost in a homogenous group.ConclusionCosts attributed to the surgical robot contribute a modest proportion of the total cost of procedures of the head and neck utilizing the robot at a high volume robotic surgery center. Further study examining the cost‐effectiveness of robotic surgery in comparison to other treatment modalities is indicated.
Creation of Novel Nanocomplexes to Target Head and Neck Cancer
Authors: Sanyal Samudra , Lajud Shayanne A. , Bezpalko Orysia , Han Ziying , O’Malley Bert W. , Li Daqing 
Published: February 2015

ObjectiveIt is critically important to develop novel targeted strategies that can efficiently inhibit specific molecular pathways in tumor growth and development. The study investigates the potential of adenoviral/chitosan‐PEG nanocomplexes with epidermal growth factor (EGF) for the targeting and treatment of EGF receptor (EGFR) overexpressing head and neck cancers (HNC).MethodA construct with GFP‐expressing adenoviral vector was coated with a Chitosan‐PEG‐EGF nanocomplex. The EGFR‐expressing HNC tumor cells labeled with TdTomato were co‐cultured with CHO tumor cells with coxsackievirus and adenovirus receptor (CAR), and without EGFR. Fluorescence microscopy was used to detect GFP expression after the treatment with targeted adenoviral/chitosan nanocomplex.ResultsAs compared to wild‐type adenovirus, the chitosan‐PEG polymer coating cloaks the viral nanoparticle and prevents interaction with cells through the native CAR‐mediated mechanisms. This significantly reduces nonspecific infection. Due to the TdTomato molecular marker being specifically expressed in the EGFR tumor cell line, the treated EGFR‐expressing cells can be visualized by co‐registration of GFP and TdTomato. The non‐EGFR‐expressing cells lack TdTomato and therefore only express the GFP. The adenoviral/chitosan‐PEG nanocomplexes with EGF ligand demonstrated significantly increased EGFR tumor cell‐specific GFP expression. The tumor cells without EGFR showed no GFP expression.ConclusionOur study suggests that the novel EGFR‐targeted adenoviral/chitosan‐PEG nanocomplex approach can effectively target HNC and has significant potential to deliver therapeutic agents specifically to the HNC tumor sites. It is also possible to track real‐time tumor growth and spread through molecular imaging by incorporating fluorescent proteins into the payload.