bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epithelial‐Myoepithelial Carcinoma of the Salivary Glands: An Analysis of 246 Cases
Authors: Vazquez Alejandro , D'Aguillo Christine M. , Farver William , Abdou Rami Y. , Baredes Soly , Eloy Jean A. , Park Chan W. 
Published: September 2014

Objectives:Epithelial‐myoepithelial carcinoma (EMC) is a rare neoplasm of the salivary glands. In this study we aim to analyze the clinical features of EMC using national registry data.Methods:Retrospective cohort study. The Surveillance, Epidemiology, and End Results (SEER) database was queried. Data were analyzed with respect to various demographic and clinicopathologic factors. Survival was analyzed using the Kaplan‐Meier and Cox proportional hazards models.Results:A total of 246 cases were available for frequency analysis and 189 for survival analysis. Mean age at diagnosis was 63.8 (±15.4) years. EMC affected females more frequently (57.3%). Distant metastases were present in only 4.5% of cases. Overall disease‐specific survival (DSS) at 15 years was 80.2%. Patients with low‐grade histology had better DSS at 10 years than those with high‐grade tumors (96.2% vs 71.0%, P =. 0124). Tumors >4 cm exhibited the worst DSS at 15 years (64.5%, P =. 0009). In the survival analysis cohort, all but 6 patients underwent surgery, and a total of 78 (41.3%) received adjuvant radiation therapy (RT). However, no survival benefit was noted for patients who received RT when compared with those who did not (P =. 4594). Although a trend toward higher survival with RT (97.1% vs 83.5% without) was observed when high tumor grade and size >4 cm were excluded, it was not statistically significant (P =. 2058).Conclusions:This report represents the largest series of EMC to date. Despite being regarded as a low‐grade, indolent tumor, a significant fraction of our cohort underwent RT in addition to surgery, with no apparent added survival benefit.
Evaluation of Lymph Node Metastasis in Oropharyngeal Squamous Cell Carcinoma
Authors: Durmus Kasim , Boyce Brian J. , Ozer Enver 
Published: September 2014

Objectives:(1) Examine the association between histopathologic variables and neck metastasis. (2) Analyze the effect of human papillomavirus (HPV) status on lymph node (LN) metastasis.Methods:Medical records of 93 patients who underwent transoral robotic surgery (TORS) with concurrent neck dissection for oropharyngeal squamous cell carcinoma (SCC) between 2008 and 2013 were reviewed.Results:At the time of presentation, 60 (64.5%) patients had tonsil cancer, 14 (15%) had base of tongue, and 19 (21%) had carcinoma of unknown primary. High risk types of HPV and p16 positivity were 74.4% and 85.4%, respectively. Mean primary tumor size was 2.3 cm (range, 0.3‐5.1 cm). Nodal status based on pathologic examination were N0 in 7 (7.5%) patients, N1 in 12 (12.9%), N2a in 25 (26.9%), N2b in 37 (39.8), N2c in 5 (5.4%), and N3 in 7 (7.5%). Average positive LN number was 2.56 (range, 0‐37). Extracapsular spread (ECS) was identified in 29.1% of all patients. Primary tumor size had no effect on positive LN size, number or ECS. HPV positivity (rs = 0.25, P =. 021), p16 overexpression (rs = 0.36, P =. 001), and lymphovascular invasion (rs = 0.34, P =. 001) were significantly associated with increased positive LN number. Positive LN number correlates with ECS (rs = 0.28, P =.009).Conclusions:HPV positivity, p16 overexpression, and lymphovascular invasion increase the risk of cervical lymph node metastasis. Increased primary tumor size does not necessarily mean advanced neck disease.
Larynx Replacement by a Device after Total Laryngectomy: Initial Clinical Experience, Future Steps
Authors: Dupret‐Bories Agnès , Schultz Philippe , Vrana Nihal Engin , Hémar Patrick , Vautier Dominique , Lavalle Philippe , Debry Christian 
Published: September 2014

Objectives:To present the first cases of laryngeal rehabilitation by an artificial larynx performed after a total laryngectomy. The prosthesis aims at proposing an alternative to laryngeal transplantations and to techniques of tissular engineering and/or transplants by free fragments, used essentially in tracheal reconstructions.Methods:The artificial larynx was developed thanks to fundamental biomaterial research and long‐term animal experiments. The insertion is a 2‐stage procedure. The first step, performed immediately after the total laryngectomy, consists of connecting the trachea with a hollow titanium tube. After a 6‐week period of healing, or 3 months after radiotherapy, a swallowing valve is fixed over the integrated titanium tube (second step).Results:Four patients have been treated (2 whole prosthesis, 2 partial prostheses) from June to December 2012. Two patients were able to talk in a whispering fashion while the tracheostomy was temporarily closed; their functioning in the relevant postoperative problem areas, such as swallowing, breathing, and smelling were significantly improved.Conclusions:Our clinical trials demonstrated that a temporary closure of the tracheostomy opening can be achieved. Potential improvements of this larynx replacement open real perspectives of complete rehabilitation after total laryngectomy. The artificial larynx, which does not require immune‐suppressor treatment, would avoid the definitive tracheostomy, considered by most patients as a loss of physical and psychological integrity.
Facial Fractures Secondary to Bicycle Accidents
Authors: Orb Quinn T. , Taggart Michael , Williams Bryce , Ward Preston D. 
Published: September 2014

Objectives:(1) Determine the incidence of facial fractures. (2) Characterize the type of craniofacial injuries due to bicycle trauma.Methods:Using CPT codes, we completed a query of facial fractures treated at a tertiary medical center between 1999 and 2012. Individual chart review of 1108 patients revealed 28 patients who were treated for facial fractures secondary to bicycle accidents.Results:Of the 28 patients identified, 86% (n = 24) were male and 14% (n = 4) were female. The median age was 27.5 with a range from 4 to 78 years. Male patients between the ages of 13 and 39 showed the highest incidence of injury. Alcohol was involved in 18% (n = 5) of cases. A total of 18 (64%) patients were hospitalized, with 28% (n = 5) of hospitalized patients admitted to the intensive care unit. The most common injury type was nasal fracture (46%, n = 13), and the craniofacial region most commonly injured was the mid‐face (50%, n = 14), with tripod fractures (36%, n = 5) and Le Fort I fractures (29%, n = 4) as the most likely injuries. Ejection from the bicycle was the most common mechanism of injury cited (50%, n = 14). Though only 18% (n = 15) of patients were involved in a collision with a motorized vehicle, all of these patients required hospitalization. Complex surgery was required in 54% (n = 15) of patients. Nine patients (32%) required closed reduction of a fracture and 4 (14%) underwent maxillomandibular fixation.Conclusions:Bicycle accidents can cause significant craniofacial injuries with many patients requiring hospitalization and surgery, especially when a motor vehicle is involved.
Interpretation of Incidental Head and Neck Uptakes on PET/CT in Patients with Lung Cancer
Authors: Gobel Yves , Abgral Ronan , Potard Gael , Salaun Pierre‐Yves , Marianowski Remi , Valette Gerald 
Published: September 2014

Objectives:Smoking is the major risk factor for lung and head and neck cancer. The purpose of this study is to determine the clinical impact of the incidental head and neck positron emission tomography (PET)/computed tomography (CT) findings in patients undergoing investigation for lung cancer.Methods:The reports from PET/CT studies for patients with lung cancer from September 2005 and April 2012 were retrospectively reviewed. The incidental head and neck findings were interpreted as suggestive of second primary malignancy. These incidental findings were compared with the final diagnosis obtained from clinical and histological investigations.Results:A total of 592 patients were investigated for lung cancer in the study period. Head and neck PET/CT positive lesions suggestive of second primary malignancy were found in 65 (11%) patients. Twenty‐three patients had nasoendoscopy, and a biopsy was done in 10 patients. In 4 (0.68%) patients, these lesions were proven of second primary malignancy: 2 squamous cell carcinoma (larynx and oral cavity), 1 undifferenciated carcinoma (parotid), 1 osteosarcoma (mandible). At a median follow‐up of 13 months, 3 of 4 patients with a second primary died from a malignancy and 1 had no evidence of disease. Metastasis from lung adenocarcinoma was found in 2 (0.34%) patients.Conclusions:PET/CT detected unexpected head and neck primary malignant tumors in at least 0.68% of patients with lung cancer. Among patients who underwent clinical investigations, 26.1% had a head and neck malignant tumor.
Invasion of the Thyroid Gland in Advanced Laryngeal and Hypopharyngeal Squamous Cell Carcinoma
Authors: Mangussi‐Gomes João , Leonhardt Fernando D. , Moussalem Guilherme F. , Ahumada Nicolas G. , Oliveira Cleydson L. , Hojaij Flávio C. 
Published: September 2014

Objectives:(1) Evaluate the frequency of invasion of the thyroid gland in patients with laryngeal or hypopharyngeal squamous cell carcinoma (SCC) submitted to total laryngectomy (TL) or pharyngolaryngectomy (TPL) associated with thyroidectomy. (2) Determine whether clinico‐pathological characteristics can predict glandular involvement.Methods:A retrospective study was conducted in an academically affiliated tertiary care referral center. Charts and anatomopathological reports of surgical specimens of 93 patients treated in the period from January 1998 to July 2013 were reviewed. All patients presented with laryngeal or hypopharyngeal SCC and underwent TL or TPL in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required it. Sociodemographic data, frequency of thyroid gland invasion, and other clinico‐pathological variables were analyzed.Results:Tumor was staged as T2 in 10 patients, T3 in 26 patients, and T4 in 53 patients. Five patients had initial stage II and 88 had advanced stage III‐IV disease. The overall frequency of invasion of the thyroid gland was 16.1%. Carcinomas that invaded the thyroid gland were more advanced (P =. 005) and more frequently staged as T4a (P =. 001). Glandular involvement was associated with invasion of the anterior commissure (odds ratio [OR] = 5.9; confidence interval [CI]–95% 1.2‐27.7), subglottis (OR = 12.0; CI‐95% 1.5‐95.8), thyroid cartilage (OR = 4.2; CI‐95% 1.1‐16.1), and cricoid cartilage (OR = 18.7; CI‐95% 5.0‐70.2).Conclusions:Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal SCC. Clinico‐pathological features such as advanced tumors, T4a tumors, anterior commissure, subglottis, thyroid cartilage, and cricoid cartilage involvement are more associated with glandular invasion. Indications for thyroidectomy should be refined in order to reduce morbidity of the surgical treatment.
Need for Level V Neck Dissection in T3‐T4 Oral Squamous Cell Carcinoma
Authors: Marfani Muhammad S. 
Published: September 2014

Objectives:(1) Recognize the frequency of level V neck node involvement in T3‐T4 oral squamous cell carcinoma. (2) Analyze the need of level V neck dissection with N0 ‐ N1 neck in T3‐T4 oral squamous cell carcinoma (SCC).Methods:Noninterventional, descriptive study from January 2011 to August 2012 at Dow University of Health Sciences & Civil Hospital Karachi, Pakistan, a tertiary care teaching hospital. Sampling was nonprobability and purposive. Histopathologically proven cases of squamous cell carcinoma of oral cavity with T3‐T4 lesion and N0‐N1 neck on basis of clinical examination and computed tomography scan findings were included in this study. All patients underwent modified radical neck dissection type‐I along with excision of the primary growth.Results:Forty‐nine patients fulfilling selection criteria were assessed on the basis of histopathological reports. At level I, metastatic lymph nodes were positive in 12 patients; 4 had positive nodes at level II and 2 each at level III and IV. However, none were positive at level V. Primary lesion was involving cheek in 40 and tongue in 9 cases. Histopathology revealed moderately differentiated SCC in 33 and well‐differentiated SSC in 16 patients.Conclusions:Our study suggests that level V neck dissection is not needed in oral SCC with N0‐N1 neck even in T3‐T4 lesions. However, as the sample size is small, further study with a larger number of cases is required to establish future guidelines for the extent of neck node clearance in oral cancer.
Pathological Features Frequently Found in Recurrent Papillary Thyroid Cancer
Authors: McHugh Tobial , Forest Veronique‐Isabelle , Payne Richard J. , Hier Michael P. , Mlynarek Alex M. , Tamilia Michael 
Published: September 2014

Objectives:Despite the rising prevalence of malignant papillary thyroid carcinoma, locoregional recurrence remains low. Clinico‐pathological features associated with recurrence are not well defined. The objective of this study is to describe and evaluate the various pathological features found in patients with recurrent papillary thyroid carcinoma.Methods:A retrospective review was conducted identifying patients who were found to have recurrent papillary thyroid carcinoma between July 2006 and May 2013 at the McGill University Thyroid Cancer Centre.Results:There was a total of 552 patients with malignant papillary thyroid carcinoma. Over the study period, recurrent disease occurred in 2.0% of patients (n = 11), of whom 10 were pT3N1b and 1 was a pT4aN1. When these patients were compared with the 541 patients who did not have recurrence of their disease, there were significant differences for sex (P =. 0271), size of primary tumor (P =. 0355), positive margins (=0 0002), lymphovascular invasion (P <. 0001), extrathyroidal extension (P =. 0001), lymph node metastasis (P <. 0001), and extra‐nodal extension (P <. 0001). There was no significant difference for age, presence of multifocal disease, and perineural invasion. On regression analysis, positive margins, lymphovascular invasion, regional lymph node metastasis, and extra‐nodal extension were found to be independent predictors of recurrence (P =. 0011, P =. 0248, P =. 0146, and P =. 0007, respectively).Conclusions:In patients with papillary thyroid cancer, sex, tumor size, and extra‐thyroidal extension are features frequently found in patients with recurrence. However, positive surgical margins, lymphovascular invasion, lymph node metastasis, and extra‐nodal extension were found to be independent predictors of recurrence in this study.
Prophylactic PEG Tube and Swallowing following Chemoradiation in Head and Neck Cancer Patients
Authors: Pohar Surjeet , Demarcantonio Michael , Whiting Phillip B. , Crandley Edwin F. , Wadsworth J. Trad , Karakla Daniel W. 
Published: September 2014

Objectives:(1) Compare swallowing status in patients receiving a prophylactic gastrostomy (PPEG) tube versus relying on oral intake during chemoradiation (CRT) for head and neck cancer. (2) Discuss prognostic factors associated with gastrostomy tube dependence 1 year after completion of CRT.Methods:The Eastern Virginia Medical School Cancer registry identified patients with a new head and neck cancer diagnosis from January 1, 2001, to July 1, 2008. We excluded patients treated with primary surgical therapy, at an outside facility, and with radiation therapy only. Our final cohort of patients who lived at least 1 year with follow‐up was 105. Primary outcomes were oral intake status at 1 year and need for esophageal dilation.Results:Eighty‐one patients received a PPEG, and 24 did not. There was no difference in swallowing function at 6 months (P =. 27) or the rate of esophageal dilation (P =. 22). Stricture rates were 13% in the initial oral group versus 25% in the PPEG group. Univariate analysis predictors for PEG tube dependence at 1 year were Zubrod score >1 (P <. 001), PPEG (P =. 03), and higher T stage (P =. 008). On multivariate analysis, PPEG (P =. 05), Zubrod score >1 (P =. 000001), and higher T stage (P =. 02) were independent predictors for PEG tube dependence at 1 year.Conclusions:PPEG tube, Zubrod score >1, and higher T stage were independent predictors for PEG tube dependence after chemoradiation. An approach of initial oral intake with placement of therapeutic PEG due to inability to maintain adequate nutrition by mouth should be considered.
Sources and Quality of Online Surgical Videos: Using YouTube to Learn Thyroid Surgery
Authors: Sebelik Merry E. , Wilson Caleb 
Published: September 2014

Objectives:(1) Estimate the volume of thyroid surgery‐related video content readily available to the surgical trainee. (2) Stratify the sources of thyroid surgery‐related video content by source (patient, institution, surgeon, or other) and estimate the quality of the surgeon source by related scholarly output.Methods:A search of YouTube, a widely used source of open‐access video content, was undertaken using thyroid surgery as the search term. The first 50 hits were analyzed for source. When the video was surgeon‐sourced, the surgeon's name was used in a PubMed author query for thyroid surgery and publications noted.Results:Approximately 2750 videos were returned using thyroid surgery as the search term. The first 50 hits were stratified by source, assuming the typical surgical trainee would not delve further into the list. The sources were primarily surgeons, followed by patient testimonials and institutions. The surgeons were stratified by related publications listed in PubMed. The majority of surgeons were not published in thyroid surgery‐related topics.Conclusions:Internet video content is an increasingly utilized source of surgical education. Since video content can be posted without peer review or confirmation of veracity, this study measures the variety of sources of thyroid surgery information. Individuals without thyroid surgery publication history posted the majority of surgeon‐sourced video content, although this history serves only as a surrogate for an academic career. Trainees and educators alike should critically analyze the quality of video content.
Swallowing Outcomes after Salvage Transoral Laser Microsurgery for Laryngeal Squamous Cell Carcinoma
Authors: Sutton Collin B. , Fink Daniel S. , Kunduk Melda , McWhorter Andrew J. 
Published: September 2014

Objectives:Review the swallowing outcomes of patients undergoing salvage transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma.Methods:A retrospective chart review was conducted at an academic practice in a regional referral center. Forty‐one patients were identified with recurrent squamous cell carcinoma of the larynx after definitive radiation therapy from 2001 to 2013. Twenty‐seven patients had glottic recurrences while 14 had recurrences in the supraglottis. Swallowing outcomes were evaluated by the necessity for a gastrostomy tube and the M.D. Anderson Dysphagia Index (MDADI) questionnaire.Results:The mean value of patients with a preoperative MDADI was 78.25. The mean value of patients with a postoperative MDADI was 73.6. The mean change in patients who completed a pre‐ and postoperative MDADI was a decrease by 4.9 points. Seventeen patients required a gastrostomy tube either placed during radiation treatment or perioperatively to their TLM procedure. Thirteen gastrostomy tubes were removed, 2 gastrostomy tubes were still in place, and 2 patients died with their gastrostomy tubes in place. All living patients resumed a regular, nonmodified diet.Conclusions:TLM is a successful surgical option for recurrent laryngeal cancer with acceptable swallowing outcomes.
The Use of Electrochemotherapy as Neoadjuvant Treatment for Head and Neck Cancer
Authors: Domanico Rossana , Trapasso Serena , Franco Teresa , Allegra Eugenia 
Published: September 2014

Objectives:Electrochemotherapy (ECT) is a cancer treatment based on the transport of chemotherapic drugs such as cisplatin and bleomycin into cell cytosol through depolarization of cell membrane. A locally applied electric field modifies the membrane permeability allowing intracellular accumulation of the chemotherapeutic agent.Methods:Prospective study: 12 patients with head and neck cancer treated with ECT with bleomycin at the ENT Department of Catanzaro teaching hospital from January to December 2013 were recruited. The primary endpoint of the study was ECT efficacy in the neoadjuvant treatment of head and neck cancer. For each patient clinical‐anamnestic data were collected in a database and the local tumor control, survival, and effects on quality of life (Health Survey Questionnaire, SF‐36 [v1], and Quality of Life Questionnaire, EORTC QLQ‐C30, and EORTC QLQH&N35) and pain control (Analgesia Post‐Surgery, APS scale) were evaluated. The treatments were performed by Cliniporator IGEA according to the European Standard Operating Procedures of Electrochemotherapy (ESOPE, 2006). Response to ECT treatment was evaluated after 30 days. All patients received postoperative chemoradiotherapy.Results:Local control and impact on quality of life were evaluated. Six of 12 lesions exhibited a partial response, 4 of 12 exhibited a complete response, and in 2 cases disease progression was observed.Conclusions:ECT represents a safe and effective therapeutic approach that is associated with clear benefits in terms of quality of life (minimal discomfort, mild post‐treatment pain, and short duration of hospital stay).
Barriers to Adoption of Office‐Based Laryngeal Surgery
Authors: Verma Sunil P. , Merati Albert L. 
Published: September 2014

Objectives:Office‐based laryngeal surgery (OBLS) has been shown to be safe and efficacious for many common laryngeal disorders. Despite this, OBLS is not widely adopted by otolaryngologists. This study investigated what barriers exist to OBLS through a survey of practicing otolaryngologists.Methods:A questionnaire was sent to the membership of the Academy of Otolaryngology—Head and Neck Surgery in winter 2013.Results:A total of 173 otolaryngologists completed the survey. The availability of lasers for OBLS was cited as a major obstacle by 119 out of 173 (75%) of respondents. Reimbursement of disposables and lack of CPT codes for OBLS were the second and third major obstacles noted, respectively (85/173 [53%] and 68/173 [43%]). Reliability of results in the office was less commonly cited as a major obstacle by 24 out of 173 (15%) of respondents.Conclusions:Organizational and financial considerations continue to be barriers for adoption of OBLS.
Laryngeal Manipulation for Dysphagia from Muscle Tension Dysphonia
Authors: Depietro Joseph D. , Stein Daniel J. , Rippberger Matthew J. , Noordzij J. P. 
Published: September 2014

Objectives:(1) Appreciate the use of laryngeal manipulation as treatment for perceived dysphagia resulting from excessive paralaryngeal muscle tension. (2) Describe the patients likely to have symptomatic improvement.Methods:A retrospective review identified patients from 2007‐2011 with laryngeal manipulation for muscle tension‐caused dysphagia in an academic otolaryngology practice. Subjects with dysphagia not attributable to anatomic cause who attended therapy twice or more had symptoms, demographic information, treatment, and response to therapy abstracted.Results:Thirty‐five subjects were included, consisting of 28 women and 7 men. Race was recorded as black (11), Hispanic (8), white (9), and other (7). Improvement in dysphagia was seen in 25 (71.4%, 95% confidence interval 53.7% to 86.4%). No significant differences were seen in improvement based on sex (P =. 381) or race (P =. 439) in chi‐square testing. The combination of age and number of sessions were predictive of improvement (P =. 041) but were not individually significant (age P =. 096, sessions P =. 084) using logistic regression.Conclusions:We found improvement with laryngeal manipulation among individuals with muscle‐tension‐caused dysphagia. No significant differences in efficacy were seen among racial and sex subgroups. A model with age and number of sessions was significant. A prospective trial of this therapy appears warranted.