bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypopharyngeal Cancers Requiring Reconstruction
Authors: Joshi Poonam , Nair Sudhir , D’Cruz Anil K. 
Published: February 2015

Objective1) The type of reconstructions used; 2) complication rates; 3) duration of hospital stay; 4) perioperative mortality; and 5) disease‐free interval. In this retrospective analysis, we audit the hypopharyngeal cancers that required some form of tissue augmentation for pharyngeal reconstruction after primary surgery.MethodRetrospective analysis of predominantly hypopharyngeal cancer patients who underwent surgery at the Tata Memorial Hospital, between 2005 and 2010. Of the total 390 patients, 103 required some form of pharyngeal reconstruction. The mean age of this population was 56 years with a male to female ratio of 4:1.ResultsFifty‐three patients had reconstruction with pectoralis major myocutaneous flap. Thirty‐two had gastric pull up, 12 had free jejunum, and 6 had free radial artery forearm flap. The mean hospital stay was 22 days. While the overall perioperative mortality was 10% (10/103), majority (6/10) had GPU as part of treatment. A total of 18% of patients had re‐explorations, 6% had flap failures, and 23% had pharyngocutaneous fistula. Twenty percent had stricture of neopharynx and 44% had tracheostomal stenosis. The mean disease‐free intervals for all patients were 12 months and 11 months with close or involved margins.ConclusionThe choice of reconstruction should be decided preoperatively based on the overall health status of the patient. Patients undergoing GPU have higher mortality rates. Low preoperative albumin level is an indicator for perioperative mortality (P value equal to. 02). Final HPR margin status may influence disease‐free interval.
Intravascular Papillary Endothelial Hyperplasia Presenting as a Lateral Neck Mass
Authors: Tracy Jeremiah C. , Wein Richard O. 
Published: February 2015

Objective1) To present an abnormal presentation of intravascular papillary endothelial hyperplasia (IPEH) as a lateral neck mass. 2) Discuss typical pathologic and radiographic findings associated with IPEH.MethodCase presentation representing a patient who presented with a lateral neck mass. The ultimate pathologic diagnosis was IPEH, a rare benign condition. The typical radiographic and pathologic characteristics of this rare entity are presented and discussed.ResultsIPEH is a proliferation of vascular endothelial cells that typically presents as a subcutaneous mass. In the aerodigestive tract it may also present as a tender submucosal nodule or a bluish, raised mucosal lesion. The mass manifested in IPEH represents an exaggerated growth response by endothelial cells as they respond to an inciting stimulus. It may present in a normal blood vessel, a vascular malformation, or in response to trauma. IPEH occurs in the setting of recannalization after thrombosis. IPEH shares many clinical and histopathologic features with angiosarcoma. It is important to differentiate this benign proliferative process from malignant disease.ConclusionIPEH is a rare cause of a slowly growing neck mass. This condition is not a true neoplasm but rather reactive hyperplasia of the vascular endothelium. Diagnosis is based on micropathology and it is important to differentiate it from angiosarcoma. The primary curative management of these lesions is surgical excision.
Retained Crossbow Bolt after Penetrating Facial Trauma
Authors: Shah Manan U. , Ambro Bryan T. , Sridhara Shankar , Wolf Jeffrey S. 
Published: February 2015

Objective1) Describe a challenging case of removal of a retained crossbow bolt from the maxillofacial region. 2) Review the surgical management techniques. 3) Review of the literature on crossbow injuries to the head and neck.MethodCase report is of a unique mechanism of penetrating maxillofacial trauma with retained foreign body threatening airway and neurovascular injury. Pertinent literature is reviewed.ResultsA 31‐year‐old man presented after being shot twice in the head with crossbow bolts. He was stable on clinical evaluation, and CT revealed an 8.5‐cm retained crossbow bolt extending from the right infratemporal fossa through the pterygopalatine fossa, traversing the nasopharynx with the tip just medial to the left mandibular ramus. There was no apparent vascular injury on CT angiogram. After awake tracheostomy for airway control, the bolt was removed by mandibular swing approach combined with nasal endoscopic assistance. Postoperative course was uneventful and follow‐up showed excellent wound healing without complications.ConclusionOtolaryngologists often encounter penetrating injuries and retained foreign bodies to the maxillofacial region. The unique shape of a crossbow bolt, along with threat of airway and neurovascular injury, created a management challenge. Herein we discuss various surgical approaches and review the literature on crossbow injuries to the head and neck.
Juvenile Angiofibroma: The “Anchorage” Concept
Authors: Andrade Jose S. C. , Andrade Nilvano A. 
Published: February 2015

ObjectiveTo present the Anchorage Concept, a set of characteristics shown by juvenile nasopharyngeal angiofibroma (JNA) that hinder the surgical resection and contribute to intraoperative complications and incomplete excisions.MethodCase series consisting of 46 JNAs in the past 10 years (2001‐2011) and including tumors I to IIIb in Radowski staging classification. Surgical technique varied according to tumor stage and included exclusive endoscopic surgery, external access and combined, with or without preoperative embolization.ResultsMultiplicity of vascular pedicles: The maxillary artery, JNA’s principal irrigation source, commonly presents as an extension of the lesion, laterally positioned. This characteristic makes vascular clipping difficult and demands a careful surgical dissection next to the external carotid vascular trunk. Besides its main vascular trunk, JNA has many other vascular pedicles which become an anchoring factor and provoke intraoperative bleeding. Vector and growth angles: During its growth, JNA may dispose vectors that form angles in relation to nasal cavity. Sometimes, these angles are 90° shaped. From its origin at the upper margin of the sphenopalatine foramen, JNA grows forward and backward into the nasal cavity and maxillary sinus, upward into the sphenoid, laterally toward the pterygopalatine fossa, and inferiorly toward the infratemporal fossa, via the pterygomaxillary fissure.ConclusionThe Anchorage Concept must be taken into account in the management of JNA. Knowledge of these points is of great value to facilitate the removal of the tumor, which persists being a surgical challenge in most cases.
Minimally Invasive Directed Parathyroidectomy Is Effective
Authors: Sadeghi Nader , Joshi Arjun S. , Terry Valentine , Knoll Stanley 
Published: February 2015

Objective1) To evaluate the outcome of minimally invasive targeted parathyroidectomy (TP) in managing primary hyperparathyroidism. 2) To report on the predictive value of preoperative imaging in success of targeted parathyroid exploration.MethodProspective noncontrolled cohort study of 208 patients with primary hyperparathyroidism managed in a single academic institution from 2002 to 2011. Patients underwent targeted parathyroidectomy based on preoperative parathyroid sestamibi scan and sonography. Intraoperative rPTH assay was used to determine success and extent of exploration. Follow‐up serum calcium levels were obtained.ResultsOf the 208 patients with primary hyperparathyroidism, data were available for 202. One hundred seventy‐seven underwent targeted parathyroidectomy (89%), 25 underwent bilateral exploration (11%). Of the 202 patients, follow‐up calcium data were available for 170 (162 targeted, 8 bilateral explorations). There was a total of 4 out of 170 (2%) recurrences or failed explorations. Of the 4 recurrences, 2 were in targeted and 2 in the bilateral exploration group. Targeted parathyroidectomy was successful in 159 out of 161 (99%) for first‐time explorations. Following negative or false‐positive imaging, bilateral exploration carried a failure rate of 25% (2/8).ConclusionTargeted parathyroidectomy following preoperative localization studies with parathyroid sestamibi scan and sonography is highly effective for primary hyperparathyroidism with a success rate of 99%. Among patients with negative or false positive imaging, bilateral exploration carries a failure rate of 25%.
Outcomes after Orbital Exenteration
Authors: Golden J. Blake , Sweeny Larissa , Carroll William R. , Magnuson J. Scott , Rosenthal Eben L. 
Published: February 2015

Objective1) To report surgical and oncologic outcomes for patients who underwent orbital exenteration for malignancies involving the orbit. 2) To understand rationale behind choice of reconstruction technique used after orbital exenteration.MethodA retrospective study of all patients requiring orbital exenteration for malignancy between April 2000 and April 2010 at a tertiary referral academic institution was performed. Demographic data, treatment details, reconstructive outcomes, and survival/recurrence rates were compiled and disease characteristics predictive of poor outcomes were identified.ResultsThere were 52 patients requiring orbital exenteration for surgical management of malignancy. Malignant etiology was cutaneous squamous cell carcinoma (SCC) in 24 (46%), sinonasal SCC in 15 (29%), and non‐SCC histology in 13 (25%). Recurrence rate at 1 year was 47% for all histologies after orbital exenteration. The majority of recurrences were local (65%). Average time to recurrence was 8.3 months. Surgical margin status had no effect on overall recurrence rate. Radiation therapy was part of the treatment for 73% of patients, with 23% of the overall group having received previous XRT and 50% of the group receiving postoperative radiation. The surgical defect created a communication between the sinonasal cavity and the orbital wound 77% of the time, which correlated with a higher rate of late wound complications (P =. 02). Free flap reconstruction was performed in 83% of patients, with rectus myocutaneous flap being the most common. Overall wound complication rate was 44%.ConclusionMalignancy requiring orbital exenteration is a complex disease, requiring aggressive and specialized management of both healing and oncologic issues.
Outcomes for Parotid Carcinoma in a Teaching Hospital
Authors: Brodskyn Fabio , Manoel Evandro M. , Guilherme Luiz Henrique , Palumbo Marcel D. N. , Cervantes Onivaldo , Abrahao Marcio 
Published: February 2015

Objective1) Analyze the epidemiological, clinical, surgical and histologic characteristics of patients submitted to surgery for parotid carcinoma in a teaching hospital.MethodA retrospective study of patients’ records diagnosed with parotid carcinoma between 2003 and 2010. We included only the patients submitted with a parotidectomy for primary parotid carcinoma with no previous treatment.ResultsA total of 20 patients were included, with a median follow‐up of 29.6 months. The median age at diagnosis was 42.6 years, with a male:female rate of 1:1. The most prevalent histological type was the low grade mucoepidermoid carcinoma (35%). There was a balance between patients with pathologic stage I (40%) and IV (40%). Treatment involved total parotidectomy, neck dissection and post‐operative radiotherapy in, respectively, 75%, 45%, and 45%. Four patients (20%) presented lymph node cervical metastasis, which was the same rate of patients with locoregional recurrence.ConclusionThe patients presented similar characteristics to the literature, although the average age at diagnosis was lower than other studies.
Outcomes in Salvage Laryngectomy with Free Tissue Transfer
Authors: Jorgensen Jeffrey B. , Showmaker Jason A. 
Published: February 2015

Objective1) Report the incidence of complications and feeding outcomes in salvage laryngectomy performed with free tissue transfer compared to primary closure. 2) Evaluate factors that may be associated with an increased rate of complications.MethodRetrospective case series from a single institution between 2007 to 2012. Thirty‐two patients met the following inclusion criteria: patients undergoing salvage laryngectomy with primary wound closure (16 patients) and those patients undergoing salvage laryngectomy with wound closure augmentation by microvascular free tissue transfer (16 patients).ResultsWe performed a retrospective case series comparing complications in salvage laryngectomy closed primarily vs repair with free tissue transfer. Smoking status at surgery was similar between the 2 groups. In the primary closure group we report major fistula in 37.5%, minor fistula in 19%, dysphagia requiring dilatation in 25%, and feeding tube dependence in 14% of patients. In the free tissue transfer group we report major fistula formation in 12.5%, dysphagia requiring dilatation in 12.5%, and feeding tube dependence in 8% of patients. Minor fistula did not occur in the free tissue transfer group.ConclusionMultiple factors were compared and preliminary data suggests that free tissue transfer reduces major and minor fistula rates. Additionally, fewer patients required dilatation and fewer patients were feeding tube–dependent in the free tissue transfer group. Formal statistical analysis will be performed.
Pressure Ulcer Prevention Strategies in Prolonged Surgery
Authors: Alrasheed Abdulaziz S. , Aldhahri Saleh , Kennedy Linda , Ferreras Benson 
Published: February 2015

Objective1) To determine the incidence of pressure ulcers (PU) post‐prolonged head and neck surgery. 2) To determine the outcome of interventional strategies on PU development.MethodA prospective study between June 2008 and March 2011.Using the FOCUS‐PDCA model, an improvement plan was developed in KFMC for patients undergoing surgery of 4‐hour duration. A patient monitoring protocol was developed including a full demographic database, a preoperative risk assessment, an intraoperative prevention method with a skin integrity check list, and a postoperative skin assessment handover. The patients were monitored for signs of PU for the next 7 days. Possible risk factors along with pressure ulcer reduction interventions were evaluated.ResultsDuring the study 230 H&N patients were monitored. The initial incidence of PU was 23.5%. After implementation of the specialty mattress, it decreased to 10%. With the use of additional mattresses, intra‐ and postoperative PU prevention documentation the incidence deceased to 5%. The PUs that developed were stage I or II; none of them progressed. Duration of surgery was the most important risk factor (P <. 05). The site of PU was in the back in 50% (scapula 29%) of patients. Increased length of stay was associated with PU development (P <. 05).ConclusionPatients undergoing prolonged H&N surgery are at higher risk of developing PU than patients going for other types of surgeries. Downward trends in PU development were related to the implementation of interventional strategies. The high level of awareness and continuous monitoring prevented further progression of early stage PU.
Protection of Radiotherapy‐Induced Xerostomia with Vitamin E+C Complex
Authors: Park Ki‐Nam , Son Young‐Ik , Baek Chung Hwan 
Published: February 2015

ObjectiveSalivary tissues are easily damaged by radiotherapy (RT) and therefore xerostomia becomes the most common complaint in patients who receive RT in the head and neck area. This study aimed to elucidate the effective of antioxidant vitamin E and C complex on the protection of RT‐induced xerostomia.MethodA trial group received a vitamin E (200 IU) + C (500 mg) complex for 3 months of peri‐RT period. A control group took placebo which had no inner contents. Subjective questionnaires, objective grading by a nurse‐specialist, and scintigraphs were obtained before and after 1 and 6 months of RT.ResultsSixty‐five patients were initially enrolled and 39 patients completed the study as scheduled. There were no differences in age, sex, RT dosage, tumor staging, and treatment modality between the 2 groups. The trial group reported less discomfort in 2 items of subjective evaluation; “impaired speech” and “difficulty of mastication” (P <. 05). Pre‐ and poststimulatory oral salivary scan were higher in the trial group (P <. 034 and P <. 026, respectively). In the trial group, maximum accumulations in submandibular gland were significantly higher at 1 month as well as at 6 months after RT (P <. 041 and P <. 004, respectively).ConclusionShort‐term administration of antioxidant vitamin E and C complex during the period of RT has protective roles against xerostomia. Higher oral activity in the trial (vitamin E+C) group is probably based on the protection of accumulatory function of the SMG.
Results from the Swedish Head and Neck Cancer Register for Oral Cancer
Authors: Hammerlid Eva B. , Holmberg Erik , Högmo Anders , Laurell Göran , Niklasson Magnus , Wennerberg Johan , Westerborn Anders 
Published: February 2015

ObjectiveThe Swedish Head and Neck Cancer Register (SweHNCR) started in 2008. The purpose was to register all new patients with head and neck cancer and collect data about tumor stage, planned and received treatment, relapse and survival. Data for oral cancer from the first 3 years will be presented.MethodThe SweHNCR is covering more than 95% of all HN cancers in Sweden. Between 2008 and 2010, 3701 new cases were registered including 1029 of oral cancers (28%). The most common location was tongue (42%), followed by gingival (21%), buccal mucosa (19%), floor of the mouth (14%), and hard palate (3%). Less than 10% were treated with palliative intent.ResultsSixty percent of all gingival cancers were diagnosed as T4 while 70% of the tongue cancers were diagnosed as T1‐T2. A total of 25% had lymphnode metastasis, range 27% (tongue) to 12% (hard palate). Surgery was the most common treatment (38%), followed by combinations of surgery and radiotherapy (36%), 19% were treated with radiotherapy alone or combined with chemotherapy, and 7% did not receive any treatment. The 2‐year survival was 69% (hard palate 83%, buccal mucosa 74%, gingival 70%, tongue 69%, and floor of the mouth 63%). Data regarding treatment and stage of the disease will be further analyzed together with survival data.ConclusionOral cancer is the most common HN cancer location in Sweden. Almost all patients are given curative treatment (90%) consisting of surgery alone or in combination with radiotherapy (70%). The 2‐year survival rate varied between 63% to 83%. Different treatment policies and survival rate was found within the country.
Robotic‐Assisted Thyroidectomy: The First UK Experience
Authors: Arora Asit , Sharma Sunil D. , Garas George , Awad Zaid , Darzi Ara , Tolley Neil S. 
Published: February 2015

ObjectiveTo review our initial experience of robotic thyroidectomy, describe modifications for a Western population, and establish a robust framework for implementation in the UK.MethodProspective feasibility study (n = 15) performed in a tertiary referral center over 18 months. Procedure‐related measures included conversions to open, operative time and the learning curve. Patient‐related measures included biometrics, trans‐axillary dissection area, voice and swallow function, pain, scar cosmesis, and global quality of life using validated assessment tools.ResultsThyroid lobectomy was performed in 15 patients with no conversions to open. The average BMI was 25.6 (range, 19‐35). Mean operative time was 200 minutes. A larger trans‐axillary dissection area increased the total operative time. The average size of the excised nodule was 2.5 cm (range, 1.5‐6.5 cm). All patients were discharged within 24 hours. No permanent complications occurred. There was 1 temporary brachial plexus neuropraxia which resolved within 5 days. The mean follow‐up time was 7 months. The mean scar cosmesis score significantly improved from 56% on day 1 postoperatively to 98% at 12 months (P =. 01).ConclusionRobotic thyroidectomy is feasible for selected patients in the UK. The primary advantage is avoidance of a neck scar. Optimal arm position which minimizes brachial plexus injury is crucial. Validated training methods are necessary for safe adoption. A randomized clinical study will establish the clinical efficacy compared with conventional surgery.
sLeX, Biomarker of Metastatic Head and Neck Carcinomas
Authors: Czerwinski Michael J. , Papagerakis Silvana , Athanassiou‐Papaefthymiou Maria , Shkeir Omar , Knibbs Randal , Lapadatescu Cezar 
Published: February 2015

ObjectiveAmong the clinical challenges of head and neck squamous cell carcinomas (HNSCC), the morbidity and mortality of advanced oral cancer (OC) remains paramount. The molecular mechanism controlling OC progression and metastasis are thus key to the improvement of clinical outcomes. Metastatic dissemination begins with adhesion of circulating tumor cells to the E‐selectin‐expressing endothelium with high levels of the main E‐selectin ligand, sLeX, having been implicated in various carcinomas. Our study represents the first investigation of the sLeX involvement in HNSCC dissemination.MethodA panel of stage‐ and anatomic site‐specific primary and metastatic HNSCC cell lines was examined by flow cytometry to quantify cell‐surface sLeX expression. Secreted sLeX expression was measured by Western‐blot in serum‐free conditioned medium. Quantitative real time PCR (qRT‐PCR) was used to identify the fucosyl‐transferases involved in sLeX neosynthesis in HNSCC. HNSCC invasive and migratory abilities were evaluated by Matrigel assays according with their sLeX expression levels.ResultsHNSCC originating from oral cavity (OC) expressed high sLeX that increased with advanced stage; it was highest in cells from recurrent (HNSCC14B) and metastatic (UMSCC103) tumors with known poor clinical outcomes. The expression of secreted sLeX was also high in OC supernatants. sLeX‐positive tumor cells exhibited higher invasive potential than sLex‐negative HNSCC.ConclusionAmong various sites HNSCC, both cell‐bound and soluble sLeX was predominantly expressed in OC carcinomas and associated with recurrent and metastatic tumors. The mechanism of sLeX involvement in OC progression is under investigation. A better understanding of the HNSCC dissemination will positively impact the clinical management.
Supraglottic Tumor Biopsy in a Patient with Spinal Stenosis
Authors: Bedrosian Jeffrey , Liu Jeffrey C. 
Published: February 2015

Objective1) To discuss the management of head and neck cancer in the setting of spinal stenosis. 2) To demonstrate a novel use of the GlideScope to facility direct laryngoscopy and biopsy in a patient with severe spinal stenosis.MethodIn this case report, we present a 53 year‐old woman with a 1.5‐cm mass rising from the left aryepiglottic fold and severe narrowing of the C5‐C6 spinal canal. Using a GlideScope to obtain indirect visualization, we successfully completed this procedure with the cervical spine in the neutral position.ResultsA survey of the anesthesia literature demonstrates the benefit of the GlideScope for visualization of the larynx while maintaining the cervical spine in the neutral position. This technique allowed successful direct laryngoscopy and biopsy in a patient with moderate to severe spinal stenosis.ConclusionOur novel approach allowed reasonable visualization and biopsy of this supraglottic tumor while maintaining cervical spine stabilization.