bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival and Functional Outcomes following Total Glossectomy
Authors: Shockley Ross , Johnston Benjamin , Netterville James L. , Rohde Sarah L. 
Published: August 2013

Objectives:Total glossectomy is a morbid procedure offered to patients with advanced tumors of the oral cavity and oropharynx. Reconstruction of the resultant defect is typically performed immediately after resection, with regional and free tissue transfer being most commonly used. The goals of this study are to demonstrate: 1) long‐term survival, 2) long‐term swallowing outcomes, 3) rate of tracheostomy dependence, and 4) reconstructive techniques utilized after total glossectomy.Methods:Retrospective chart review of patients who received total glossectomy at Vanderbilt between 2000 and 2010. Survival and functional outcomes were followed from the day of the surgery to the last outpatient note.Results:22 patients were included in this study, and 15 patients were alive 1 year post‐surgery. Average length of survival after the operation was 715 days. 4 patients received concomitant total laryngectomy. 14 of 18 patients that received tracheostomy were able to be decannulated, with an average time to decannulation of 23 days. 6 of the 22 patients were able to maintain 100% of their nutrition with PO feedings at 12 months post‐surgery. Reconstructive methods included 8 anterolateral thigh free flaps, 4 pectoralis flaps, 4 radial forearm free flaps, 2 scapular free flaps, 1 latissimus free flap, 2 lateral arm free flaps, and 1 jejunal free flap.Conclusions:Total glossectomy can significantly extend the lives of patients with advanced tongue cancer. However, this operation carries significant morbidity in regards to swallowing, and potentially the need for long‐term tracheostomy.
Survival Outcomes of Early Stage Oral Cavity Squamous Cell Carcinoma: A Multi‐institutional Analysis
Authors: Zhang Han , Biron Vincent L. , Dziegielewski Peter T. , Al‐Qahatan Khalid H. , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi 
Published: August 2013

Objectives:Surgical resection is the standard of care in early stage oral cavity squamous cell carcinoma (OCSCC). Recent literature has shown, however, that adverse pathologic features are potential indications for adjuvant radiotherapy. Objective: 1) Evaluate survival outcomes of early‐stage OCSCC patients. 2) Determine whether a subgroup of patients may benefit from adjuvant radiotherapy.Methods:The setting for this study was the two tertiary cancer centers in the province of Alberta and was designed as a prospective population‐based multi‐institutional review. Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with early stage OCSCC from 1998 to 2010. Survival outcomes were calculated using Kaplan‐Meir and Cox‐Regression analysis.Results:A total of 343 patients were analyzed. Five‐year survival according to treatment modality were surgery, 83.3 %; surgery + radiation, 94.7 %; radiation, 56.4 %. Cox regression analysis did not show any significant differences between groups when considering age, gender, and CCI/ECOG score.Conclusions:Patients with early stage OCSCC have excellent survival when treated by primary surgical resection. A subgroup of patients may benefit from post‐operative radiotherapy.
Trigeminal Trophic Syndrome: Presentation of a Case in Its Early Stages
Authors: Schimelmitz‐Idi Jose , Bross‐Soriano Daniel , Valle Carlos 
Published: August 2013

Objectives:Be able to recognize and treat trigeminal trophic syndrome at an early stage.Methods:Case presentation.Results:The trigeminal trophic syndrome is a rare condition that arises after damage, induced or not, to the sensory part of the trigeminal root or nerve. After the nerve is damaged the patient experiences hemifacial anesthesia and paresthesias, mainly itching and burning that causes continuous touching, rubbing, and picking to relieve the perceived paresthesias. The repetitive trauma leads to an ulcer. If untreated or misdiagnosed, the ulcer may grow and cause disfigurement. In this case we presented a 43‐year‐old female with trigeminal neuralgia who underwent thermocoagulation of the second and third portions of the trigeminal nerve 6 months prior to her initial visit. She visited 4 other specialists before coming to us. She presented with the typical symptomatology and an ulcer of about half an inch in the left nasal vestibule. After explaining and educating the patient about the underlying causes of the ulcer (self‐induced trauma) we excised the ulcer and advanced a local island flap. The patient started with carbamazepine 200 mg daily and reported reduced paresthesias. One year after the reconstruction the ulcer has not returned.Conclusions:Trigeminal Trophic Syndrome is a rare entity that can be encountered by otolaryngologists. The unfamiliarity with the condition leads to misdiagnosis and delay of treatment that can result in disfigurement. Treatment encompasses surgical reconstruction, medical therapy, and education of the patient.
Trans‐axillary Robotic Thyroidectomy and Parathyroidectomy: A Preliminary Single Institution Experience
Authors: Wilson Meghan N. , Dileo Michael D. , Walvekar Rohan R. 
Published: August 2013

Objectives:1) Review our first 13 robotic assisted trans‐axillary thyroidectomy and parathyroidectomy (TART/TARP) cases, looking at the clinical and pathological data as well as technical challenges associated with this approach. 2) Examine and discuss complications associated with this approach.Methods:Retrospective series of 13 patients who underwent TART/TARP at our institution. Patient demographics, pathology and size of thyroid glands removed, intraoperative details, length of stay, and postoperative complications were recorded.Results:Over a 14‐month period from October 2011 to December 2012, 11 patients (12 female, 1 male) underwent TART, and 2 patients underwent TARP. Mean age was 54 years (range, 29‐76 years). All thyroidectomies were partial. Both left‐sided parathyroid adenomas had been localized with preoperative imaging to fit criteria for single gland exploration. The largest thyroid lobe removed was 6.5 x 3.5 x 2.8 cm. Pathology was benign thyroid disease in 9 and well differentiated papillary thyroid cancer in 2. Complications included a brachial plexus neuropraxia (n = 1), recurrent laryngeal nerve paresis (n = 1), and inadvertent parathyroid gland removal (n = 1). Both nerve injuries resolved completely in follow up. All patients were discharged within 2 days of surgery, most within 23 hours. Long‐term follow up suggest good patient outcomes and patient satisfaction.Conclusions:Robot‐assisted trans‐axillary thyroidectomy and parathyroidectomy are feasible procedures with good outcomes. Patient selection is key to successful outcome. Surgeons should recognize distant‐access related risks including brachial plexus injury and chest paresthesias in addition to conventional thyroidectomy risks and understand how best to diagnose, prevent, and manage these complications.
Ultrasound‐Guided Fine‐Needle Aspiration of Thyroid Nodules: Does Size Matter?
Authors: Zawawi Faisal , Varshney Rickul , Hier Michael P. , Mlynarek Alex M. , Forest Veronique‐Isabelle , Tamilia Michael , Payne Richard J. 
Published: August 2013

Objectives:Evaluate the accuracy and predictive values of ultrasound guided fine‐needle aspiration (USFNA) of nodules ≥4cm compared to smaller nodules. Authors have reported that fine‐needle aspiration (FNA) biopsies of thyroid nodules ≥4cm are unnecessary since they often yield inaccurate results compared to nodules <4cm. They therefore recommend diagnostic thyroid lobectomies for nodules ≥4cm and FNA for smaller nodules.Methods:A retrospective study at the McGill University Thyroid Cancer Center was performed on patients between 2006‐2012 comparing the USFNA and post‐operative pathology diagnoses of nodules ≥4cm versus those <4cm. Pre‐operative USFNA results were divided into benign, indeterminate and malignant/suspicious for malignancy subgroups. Postoperative results were separated into benign and malignant groups. SPSS was used for data analysis using the chi‐square method.Results:There were 225 patients with nodules ≥4cm and 773 patients with nodules <4cm. The sensitivity, specificity, positive predictive value, and negative predictive value for USFNA of nodules ≥4cm were 84.62% (confidence interval [CI] 71.91‐93.10), 91.49% (CI 79.6‐97.58), 91.67% (CI 80.0‐97.63) and 84.31% (CI 71.4–92.95), respectively. The sensitivity, specificity, positive predictive value and negative predictive value for USFNA of nodules <4cm were 90.48% (CI 86.1‐93.8), 85.92% (CI 75.6‐93.02), 95.8% (CI 92.41‐97.96) and 71.76% (CI 60.95‐81.0), respectively. The difference in diagnostic accuracy of USFNA between both groups was not statistically significant (P > 0.05).Conclusions:This study shows that USFNA of nodules ≥4cm is as accurate as smaller nodules. It is therefore suggested that these nodules be managed similarly to their smaller counterparts.
Comparison between OperaVOX™ and MDVP: Preliminary Results
Authors: Baki Marina Mat , Wood Gary , Alston Marion , Ratcliffe Philippa , Sandhu Guri , Rubin John S. , Birchall Martin A. 
Published: August 2013

Objectives:Objective evaluation of voice, such as acoustic analysis, provides additional evidence in treatment monitoring. Currently, it is only possible in voice laboratories in hospitals. OperaVOX™ (On Person RApid VOice eXaminer), a portable voice analysis running on an Apple™ iPod, iPhone, and iPad, was developed to enable remote voice assessment. Our goal was to evaluate the agreement between OperaVOX™ and Multidimensional Voice Program (MDVP, KayPentax, NJ, USA).Methods:A group of 16 healthy volunteers without voice complaints were recruited from the University College London Hospital NHS Trust from December 2012 until January 2013. Supervised recordings were performed in a quiet room. A five‐second recording of a sustained vowel /a/ was used to measure fundamental frequency (F0), jitter, shimmer, and noise‐to‐harmonic ratio (NHR). The audio files recorded using OperaVOX™ were also analyzed using the MDVP. 95% limit of agreement (LOA) between software was analyzed using the Bland Altman method.Results:The mean difference (SD) of F0, jitter, shimmer, and NHR between OperaVOX™ and MDVP measurements was ‐0.14 (1.28) Hz, ‐0.06 (0.32)%, ‐0.26 (0.67)%, and 0.12 (0.02) respectively. The 95% LOA of OperaVOX™„ to MDVP for F0 was ‐2.67Hz to +2.39Hz; jitter was ‐0.57% to +0.68%; shimmer was ‐1.6% to +1.09%; and NHR was +0.08 to +0.12 compared to MDVP.Conclusions:OperaVOX™ at this stage has been shown to be a promising portable voice analysis tool for measuring the F0, jitter, and shimmer of voice since the 95% LOA were within clinically acceptable levels. Agreement with PRAAT is currently being tested.
Development of 2D Scanning Videokymography
Authors: Wang Soo‐Geun , Lee Byung‐Joo , Lee Jin‐Choon , Lim Yun‐Sung , Park Young‐Min , Lee Won‐Yong 
Published: August 2013

Objectives:Videolaryngostroboscopy, electroglottography, and high‐speed video systems are now in use to evaluate vocal cord vibration, which is crucial for voice production. The limitations of videolaryngostroboscopy are 1) the images captured from stroboscopy are not a real vocal cord vibration, and 2) it is difficult to identify each vocal cord mucosal wave in aperiodic dysphonia. The line scanning videokymography was developed to overcome the limitations of stroboscopy, but it only selects one active horizontal line from the whole laryngeal image. The aims of this study are to evaluate the whole laryngeal mucosal wave simultaneously in real time, to overcome the distortions caused by patient movements, to quantify parameters from images using software, and to compare both vocal cord movements and mucosal wave.Methods:We developed 2D scanning videokymography using high brightness continuous light source, full HD camera, capture board, and analyzing software. The system makes it possible to observe fundamental frequency, amplitude, regularity, mucosal wave, phase difference, etc.Results:We can analyze whole vocal cord movement in real‐time and mucosal wave in any area. We can objectively measure specific parameters of vocal cord vibration.Conclusions:2D scanning videokymography is a very effective diagnostic tool for aperiodic vocal cord vibration case. It does not require post‐processing procedure. 2D scanning videokymography can prevent distortion of images from patient motion resulting from line scanning videokymography.
Four Cases of Multiple Cranial Nerve Involvement with Varicella‐Zoster Virus
Authors: Sakagami Tomohumi , Asako Mikiya , Tomoda Koichi 
Published: August 2013

Objectives:We report 4 cases of unilateral paralysis of the 7th, 8th, 9th, and 10th cranial nerves caused by varicella‐zoster virus.Methods:Retrospective study with 4 cases from May 2008 to May 2012. The patients were 58, 69, 72, and78 years old. There were 2 male patients and 2 female patients.Results:Every case confirmed 9th or 10th cranial nerve paralysis preceding 7th or 8th cranial nerve paralysis. Every case was treated by antiviral medicine and high‐dose prednisolone.Conclusions:There are various theories of the mechanisms involved in the spread of cranial nerve palsy. Our cases confirmed only 7th, 8th, 9th, or 10th cranial nerve paralysis. If cranial neuropathy spread via cerebrospinal fluid, lymph nodes, or by blood, other cranial nerves may be paralyzed. If cranial neuropathy spread by revitalization of every nerve ganglion, we cannot explain these systematic conditions. We discussed the spreading mechanisms of cranial neuropathy via intervention nerve (for example, tympanic nerve, less petrosal nerve).
Ho: YAG Laser‐Application to Laryngeal Microsurgery
Authors: Makiyama Kiyoshi , Matsuzaki Hiroumi , Hirai Ryoji 
Published: August 2013

Objectives:The Holmium:YAG (Ho:YAG) laser can perform evaporation, incision, and coagulation simultaneously. It enables the treatment of target tissue only, making surgery less thermally damaging to surrounding tissue. It provides a different range and depth of evaporation depending on the distance between the laser fiber tip and the mucosa. Clinical cases are presented, and the potential for treatment of laryngeal diseases is discussed.Methods:We designed the following three ways of irradiation. 1) Non‐contact irradiation: Evaporation occurs only at the mucosal surface. 2) Contact irradiation: When irradiated with light contact with the mucosa, the area of evaporation on the mucosal surface is smaller than in 1. 3) Shooting irradiation: When irradiated with pressing the tip of the fiber on the mucosa, only spots of evaporation are left on the mucosal surface. On the other hand, evaporation can be up to a depth of approximately 2 cm with irradiation for approximately 3 seconds.Results:Cases of hemorrhagic vocal cord polyp, laryngeal papillomatosis, and vocal cord cancer were presented. For evaporation of a narrow area and point evaporation, contact irradiation was suitable. Irradiation experiments on chickens showed that shooting irradiation can evaporate up to a depth of 2 to 3 cm despite the narrow area of evaporation at the shooting site. It is believed to have been proven by the experiences of treating patients with recurrent laryngeal cancer.Conclusions:Application of this technique to laryngeal surgery is expected.
Implantation of Contralaterally Harvested Nerve‐Muscle Pedicle Flap Combined with Arytenoid Adduction for Paralytic Dysphonia
Authors: Yumoto Eiji , Sanuki Tetsuji , Kumai Yoshihiko , Nishimoto Kohei , Kodama Narihiro 
Published: August 2013

Objectives:1) Describe operative procedures to reinnervate the thyroarytenoid muscle (TA) on the paralyzed side using a modified nerve‐muscle pedicle (NMP) flap implantation harvested on the contralateral side combined with arytenoid adduction (AA). 2) Assess time‐dependent improvement in vocal function during postoperative follow‐up.Methods:Prospective case series. Four patients underwent modified NMP flap implantation combined with AA for paralytic dysphonia between August 2009 and January 2013. The NMP flap was harvested on the contralateral side because of scar formation on the paralyzed side and was secured to the TA under microscopic control. Three of them were followed over one year, and their voice outcomes, determined by 5 objective and 2 subjective parameters, were evaluated preoperatively and at 4 different time points after surgery.Results:On average, maximum phonation time and mean airflow rate improved from 5.4s and 569mL/s preoperatively to 24.2s and 116mL/s 12 months postoperatively, respectively. Jitter, shimmer, and harmonics‐to‐noise ratio also improved from 10.5%, 16.4%, and 4.2dB preoperatively to 1.7%, 11.2%, and 6.8dB postoperatively, respectively. Grade overall and breathiness of GRBAS scale became much better from 2.6 and 2.4 preoperatively to 0.2 and 0.0 12 months postoperatively, respectively. Stroboscopic images together with voice during follow‐up period will be presented.Conclusions:Combination of AA and a modified NMP flap implantation harvested on the contralateral side improves long‐term voice outcomes of paralytic dysphonia. Therefore, patients in whom the ansa cervicalis nerve is unavailable due to high level scar formation could have a great benefit by these operative methods.
Indications and Outcomes of Montgomery Cannulas
Authors: Bayan Semirra L. , Hoffman Henry T. 
Published: August 2013

Objectives:1) Analyze the use and outcomes of Montgomery cannulas to manage the compromised airway. 2) Identify appropriate patient selection criteria for use of the Montgomery cannula.Methods:A retrospective chart review was performed on patients who had a Montgomery cannula inserted from 2003‐2012. Patient variables and outcomes analyzed included: BMI, medical comorbidities, indications for a Montgomery cannula, recorded reasons for cannula failure, and complications.Results:Indications for Montgomery cannula placement included glottic stenosis (n=7), obstructive sleep apnea (n=5), bilateral vocal cord paralysis (n=4), subglottic stenosis (n=4), supraglottic swelling after radiation or chemoradiation (n=4), bulbar dystonia with paradoxical vocal cord motion (n=1), vocal cord fixation secondary to arthritis and GERD (n=1), and seizure disorder associated with airway obstruction (n=1). 75% of patients (n=15/20) had successful use of a Montgomery cannula. 25% (n=5/20) required replacement with a Jackson tracheostomy due to persistent tracheostomal granulation tissue (n=2), patient sense of greater safety with the Jackson tracheotomy tube (n=1), a posterior scar band causing airway obstruction not adequately bypassed by the cannula (n=1), and inability to care for the cannula secondary to manual dexterity issues from rheumatoid arthritis (n=1). The Montgomery cannula was used as a successful decannulation tool in four patients.Conclusions:This case series is the first to analyze use of the Montgomery cannula as an airway management tool for indications other than obstructive sleep apnea. We identify features associated with successful use of the cannula and identify the additional indication for use of a Montgomery cannula as a step down management tool leading to decannulation.
Laryngeal Amyloidosis
Authors: Nadig Shrinath , Gurunathan Ramesh K. , Rao Trushna 
Published: August 2013

Objectives:Amyloidosis constitutes less than 1% of benign laryngeal tumors and may occasionally be associated with systemic disease. It commonly presents with long‐standing hoarseness or dyspnea. Diagnosis is established with histological features of acellular, amorphous, eosinophilic deposits which react positively with Congo red. We present 2 such cases of laryngeal amyloidosis, one localized and one with systemic involvement. Literature review, diagnostic work‐up, and treatment options are discussed.Methods:Case 1: A 63 year old non‐smoking male presented with hoarse voice for 2 months. Flexible laryngoscopy showed diffuse fullness on left hemilarynx. Microlaryngoscopy revealed submucosal lesion in anterior left vocal cord, which on deep biopsy confirmed AL type amyloid. Detailed work‐up by a hematologist ruled out systemic disease. Case 2: A 74 year old moderate smoker presented with 6 months of hoarse voice and burning sensation in the tongue. He had a mucosa‐covered growth in the right false vocal cord, which on biopsy confirmed amyloidosis (AL type). Further work‐up revealed systemic disease with elevated serum free light chains, IgG Kappa paraprotein, and positive abdominal fat biopsy.Results:Patient 1 is under follow‐up with no clinical recurrence. Patient two had treatment with CDT chemotherapy and is under hematologist surveillance. Past history includes carpal‐tunnel decompression. Localized laryngeal amyloidosis is best treated with cold steel resection or CO2 laser excision and may require repeated removal in some patients. Systemic amyloidosis is caused by plasma‐cell dyscrasia and treated with chemotherapy and or radiotherapy.Conclusions:Endolaryngeal treatment is sufficient with localized disease. Systemic disease needs more extensive treatment, and those with associated myeloma have poor prognosis.
Laryngeal Mucormycosis
Authors: Khichi Sunny S. , Morgan Charles E. , Newman John R. 
Published: August 2013

Objectives:Report our experience with mucormycosis of the larynx, an extremely rare clinical entity.Methods:A single case of laryngeal mucormycosis was reviewed. Data and history reviewed include initial presentation, operative reports, operative photographs, pathology reports, outpatient clinic data, and follow‐up reports.Results:In September of 2011, an individual presented to UAB with acute airway obstruction. An operative airway evaluation revealed mucosal necrosis and ischemia that on biopsy revealed non‐septate hyphae consistent with mucor. Despite appropriate pharmacologic therapy, his disease progressed. Ultimately total laryngotracheal involvement prevented surgical cure. He later succumbed to pulmonary manifestations of his disease.Conclusions:Mucormycosis is an aggressive disease that requires multi‐modality therapy and a high index of suspicion. Though the larynx is a rare subsite, the relative paucity of laryngotracheal blood supply makes mucor a diagnostic consideration in the immunocompromised patient.
Laryngeal Schwannoma in a Patient Presenting with Dysphonia
Authors: Taormina Yula A. , Yelverton Joshua C. , Reiter Evan R. , Powers Celeste N. 
Published: August 2013

Objectives:1) Describe a case of laryngeal schwannoma in a young male presenting with gradual voice changes. 2) Review the latest literature on laryngeal schwannomas, diagnosis, and treatment.Methods:Chart review and literature search.Results:A 21 year old previously healthy male nonsmoker presented with a 5 year history of worsening dysphonia without dysphagia or dyspnea. On exam, his voice was breathy, raspy, and weak. Fiberoptic laryngoscopy demonstrated a smooth, lobulated exophytic mass of the left false vocal fold extending into the true vocal fold and anterior commissure. Pre‐operative magnetic resonance imaging (MRI) demonstrated a T2‐enhancing mass with considerable transglottic extension. The patient underwent microsuspension direct laryngoscopy with en bloc excision of the lesion. Post‐operatively the patient reported significant improvement in voice with no dysphagia, despite left sided hypomobility.Conclusions:Laryngeal schwannoma is a rare tumor of the larynx. Although typically benign and slow‐growing, it can cause airway obstruction or compressive symptoms, manifesting as voice changes, as in our patient. Symptoms may resolve completely after complete excision.