bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results after U‐shaped Pectoralis Major Myocutaneous Flap Reconstruction of Circumferential Pharyngeal Defects
Authors: Malard Olivier , Ferron Christophe , Durand Nicolas , De Montreuil Claude B. , Cassagnau Elisabeth , Espitalier Florent 
Published: August 2013

Objectives:Evaluate surgical, functional, carcinologic results after circumferential pharyngolaryngectomy and reconstruction with U‐shaped pectoralis major myocutaneous flap.Methods:Forty‐one patients in a retrospective case series spanning a 6‐year period.Results:General and local complications occurred in 10% and 22% of patients respectively, without early death. Swallowing and vocal functions were satisfactory for 82% and 43% of patients respectively, despite 39% of neopharynx stricture and 22% of pharyngocutaneous fistula. With a 20‐month mean follow‐up, cancer recurrence was present in 58% of patients. The overall survival rate was 29% at 3 years.Conclusions:This flap is simple, reliable, and allows adequate reconstruction of the hypopharynx. However, the neopharynx stricture rate is high and the quality of voice rehabilitation is poor when compared with free flaps. This procedure, which is an option for the reconstruction of circumferential pharyngeal defects, must be considered in selected cases.
Salvage Surgery for Locally Recurrent Pharyngeal Squamous Cell Carcinoma after Definitive Radiotherapy or Chemoradiotherapy
Authors: Omura Go , Kobayashi Kenya , Saito Yuki , Ebihara Yasuhiro , Ando Mizuo , Asakage Takahiro , Yamasoba Tatsuya 
Published: August 2013

Objectives:A local recurrence of pharyngeal carcinoma (PC) after definitive radiotherapy (RT) or chemoradiotherapy (CRT) is correlated to a poor prognosis. Therefore, the objective of the current study was to analyze the efficacy of salvage surgery for patients with locally recurrent PC after RT or CRT.Methods:We retrospectively reviewed the clinical charts of patients with PC treated between 2001 and 2011 at the University of Tokyo Hospital and enrolled 222 patients, including 106 with oropharyngeal carcinoma (OPC) and hypopharyngeal carcinoma (HPC) who received definitive RT or CRT. Local recurrence developed in 63 patients (26 OPC and 37 HPC), of whom 44 (18 OPC and 26 HPC) underwent salvage surgery. Initial treatments were radiotherapy, radiotherapy with induction chemotherapy, and concurrent chemoradiotherapy in 13, 11, and 20 patients, respectively. The median radiation dose was 70 Gy.Results:Resection of the local recurrence was combined with free or pedicle flap reconstruction in 38 patients and was performed without reconstruction in 8. Twenty‐eight patients simultaneously underwent laryngectomy and resection. The median overall survival (OS) and median disease‐free survival (DFS) after salvage surgery was 16 and 10 months, respectively. The DFS of HPC patients (median, 15 months; 2‐year OS rate, 43%) was significantly longer than that of OPC patients (median, 7 months; 2‐year OS rate, 12%; P = 0.01).Conclusion:The prognosis of locally recurrent PC remains poor despite the technical feasibility of salvage surgery, with the prognosis for HPC being significantly better than that for OPC.
Secondary TEP Placement in Office
Authors: Britt Christopher J. , Lippert Dylan C. , Hartig Gregory K. 
Published: August 2013

Objectives:Evaluate the use and outcomes of in‐office secondary tracheoesophageal puncture (TEP) technique using trans‐nasal esophagoscopy (TNE) and the Seldinger technique for placement, in a large series of patients having undergone laryngectomy and laryngopharyngectomy.Methods:A retrospective chart review at a single institution was performed on 83 subjects who underwent in‐office secondary TEP procedure. Variables that were examined included disease site, staging, histology, extent of resection and reconstruction, chemoradiation, functional voice status (as assessed by speech pathologist in most recent note), and complications directly related to the procedure.Results:83 individuals from our institution met our criteria for in‐office secondary TEP placement from 2006 to 2012. The overall complication rate was 2.4% (2/83). Complications included one patient with bleeding from the puncture site, and another who had closure of puncture site before initial TEP placement. At the time of most recent follow‐up, voicing was achieved in 91% of all patients with a TEP (74/81) with 75.3% (61/81) having a fully functional voice as defined as regular use of their TEP for conversational speech.Conclusions:These results justify the regular use of in‐office TEP performed using TNE and the Seldinger technique. This technique avoids the need for a general anesthetic and has results which compare favorably with other methods of placement.
Sialendoscopy for Dysfunction of Salivary Gland after Radioactive Iodine Therapy
Authors: Choi Jeong‐Seok , Lim Jae‐Yol , Kim Young‐Mo 
Published: August 2013

Objectives:Ablation of the thyroid remnants using radioactive iodine (RI) after total thyroidectomy of well differentiated thyroid cancer could induce dysfunction of salivary gland. The purpose of this study is to review our experience with sialendoscopy for dysfunction of salivary gland after RI therapy.Methods:We reviewed medical charts of all patients treated with sialendoscopy due to RI induced salivary dysfunction. The study included 30 patients who underwent sialendoscopy for the treatment of RI induced salivary dysfunction after failing conservative management.Results:30 patients (23 women, 7 men) with a mean age of 45.2 years (range, 25~71) underwent sialendoscopy for the treatment of RI‐induced salivary dysfunction that is unresponsive to conservative management. Symptoms arising from the parotid gland were seen in 26 (87%) of patients, whereas symptoms arising from the submandibular gland were seen in 4 (13%). Fifteen patients (50%) presented symptoms in bilateral parotid or submandibular glands. The mean dose of RI was 203.5 mCi (range, 150 ~ 500) received as a single dose. The mean duration from RI ablation therapy to sialendoscopy was 13.2 months (range, 0.5 ~ 32). Sialendoscopy was possible in all patients. Ductal stenosis and mucous plugs and debris were the most common types of ductal pathology. Sialendoscopy improved the symptoms in 80% (24/30) of patients, with no serious complications reported in mean follow‐up of 12 months(range, 1 ~ 24).Conclusions:Sialendoscopy is an effective tool for improving symptoms due to RI‐induced salivary dysfunction in patients who are unresponsive to conservative managements.
Six‐Year Experience with Video‐Assisted Thyroidectomy: Outcomes and Safety Profile
Authors: White Jennifer R. , Singer Michael C. , Duke William S. , Chin Edward , Terris David J. 
Published: August 2013

Objectives:1) Review complication profiles among various thyroidectomy techniques, including conventional, minimally invasive non‐endoscopic, minimally invasive video‐assisted (MIVAT), and robotic approaches. 2) Analyze factors contributing to the safety profile of MIVAT. 3) Describe potential steps to implement MIVAT in a surgical practice.Methods:The largest single series of MIVAT in North America was reviewed to explore its safety profile. An institutional review board (IRB)‐approved prospectively maintained database was queried for all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011. Demographic information, surgical and pathologic data, and post‐operative outcomes were analyzed.Results:A total of 1,132 consecutive thyroidectomies were identified. MIVAT was incorporated beginning in 2005. There were 249 MIVATs (164 hemi, 85 total), 399 minimally invasive non‐endoscopic thyroidectomies, 441 conventional thyroidectomies, and 43 robotic thyroidectomies. Two hundred twenty‐eight MIVATs were accomplished on an outpatient basis. MIVAT patients were predominantly young (46.8 ± 14.8 years old) and female (89%). The mean incision length was 2.3 ± 0.4 cm. No cases of permanent hypoparathyroidism or permanent true vocal fold paralysis occurred. Observed complications included transient vocal fold dysfunction (n = 10; 4.0%), cellulitis (n = 1, 0.4%), and temporary hypocalcemia (n = 5; 2.0%). The overall complication rate for MIVAT was lower than the combined overall complication rate for minimally invasive non‐endoscopic, conventional, and robotic thyroidectomy (6.8% vs. 14.8%; P = 0.001).Conclusions:MIVAT can be performed safely with a low complication profile in a high‐volume practice. The safety of MIVAT represented by this experience may support expanded implementation.
Swallowing Outcomes for T1‐T4 Oropharyngeal Cancers Treated with TORS: Preliminary Experience
Authors: Ghanem Tamer A.H. , Fei Naomi , Simmerman Erin , Lindholm Jamie M. 
Published: August 2013

Objectives:1) Assess swallowing function longitudinally using standardized questionnaires in a cohort of oropharyngeal cancer patients treated with transoral robotic surgery (TORS). 2) Compare the effect of tumor T‐stage on swallowing outcomes.Methods:A prospective, institutional review board (IRB)‐approved database of all patients undergoing TORS for oropharyngeal cancer at a tertiary‐care academic institution was queried from November 2010‐October 2012. Demographic data as well as longitudinal assessment of swallowing outcomes were collected. Standardized questionnaires included: University of Washington Quality of Life question 5 (UW‐QOLq5), MD Anderson Dysphagia Inventory (MDADI), and Functional Oral Intake Scale (FOIS). Two‐sided Wilcoxon signed‐rank tests were used to compare baseline values with corresponding 1, 3, 6, and 12 months post‐surgery. Two‐sided Wilcoxon rank‐sum tests were used to test for differences between T‐stages.Results:Thirty‐nine patients were studied with a mean age of 60.7 (42‐92). T‐stages included: T1 n = 14, T2 n = 15, T3 n = 6, T4 n = 4. No significant differences were detected at any time between patients with T1‐T2 and T3‐T4 stage disease on UW‐QOLq5, MDADI, or FOIS. Compared to baseline, UW‐QOLq5 measures were significantly lower at 1 month (P = 0.0156), but not at 3 or 6 months. MDADI overall scores were significantly lower than baseline at 1 month (P = 0.0134), but not at 3, 6, or 12 months. Compared to baseline, FOIS measures were significantly lower at 1 month (P <.0001), and remained significantly lower at 3 (P <.0001), 6 (P <.0001), and 12 months (P = 0.0039).Conclusions:Results suggests that while swallowing status declines immediately after TORS, it can be expected to approach baseline within 3 months post‐surgery.
T4 Oropharyngeal Squamous Cell Carcinoma: Primary Management Outcomes
Authors: Van Abel Kathryn M. , Moore Eric J. , Price Daniel L. , Oldenburg Michael , Kasperbauer Jan L. , Olsen Kerry D. 
Published: August 2013

Objectives:1) Describe T4a and T4b oropharyngeal squamous cell carcinoma (OPSCC) and its management. 2) Analyze morbidity, functional and oncologic outcomes, and survival associated with four major treatment strategies.Methods:We retrospectively reviewed functional, clinical, and oncologic outcomes for patients diagnosed with T4 OPSCC at a tertiary institution from 1990‐2010. Patients underwent primary 1) surgery + chemoradiation (Group 1), 2) surgery + radiation (Group 2), 3) chemoradiation (Group 3), or 4) chemoradiation + neck dissection (Group 4). Preliminary analysis of ongoing study (N = 120).Results:47 patients were included (32% female, 68% male; mean age 58.8 years, range 43‐82). Groups 3 and 4 had a higher preoperative nodal stage (P = 0.02). Complications and PEG placement/dependence were similar across groups. Groups 2 and 4 had higher rates of surgical airway dependence at last follow up (P =0.05). Average follow up was 43 months (median 26, range 2‐167). Two/five year overall survival was 83%/54% for Group 1, 60%/40% for Group 2, 64%/32% for Group 3, and 80%/30% for Group 4 (P =0.82). Disease specific survival at two/five/ten years was 83%/63%/31% for Group 1, 70%/58%/44% for Group 2, 68%/60%/48% for Group 3, and 80%/40 %/40% for Group 4 (P =0.97). Progression free survival at two/five years was 80%/80% for Group 1, 57%/57% for Group 2, 68%/58% for Group 3, and 40%/40% for Group 4.Conclusions:For a disease in which improved survival and oncologic outcomes are measured in months, primary surgery followed by chemoradiation may achieve this goal without sacrificing morbidity or functional outcomes.
Transoral Robotic Surgery and the Unknown Primary: A Highly Effective Technique for Identifying the Tumor
Authors: Byrd James K. , Albergotti William G. , Davis Kara , Kim Seungwon , Ferris Robert L. , Johnson Jonas T. , Duvvuri Umamaheswar 
Published: August 2013

Objectives:1) Describe the use of transoral robotic surgery (TORS) in the management of patients with unknown primary carcinoma of the head and neck. 2) Report the efficacy of TORS for patients with unknown primaries in our updated series, the largest reported series of such patients.Methods:A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with non‐diagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Tumor identification rate and characteristics were analyzed.Results:206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. Of these, 11 had bilateral base of tongue resection, 3 had unilateral base of tongue resection, and the remainder had a combination of base of tongue procedures and tonsillectomy. The primary tumor was located in 19/22 (86.4%) patients. Mean tumor size was 1.03 cm +/‐ 0.66 cm and 9/22 (40.9%) patients had negative resection margins after the primary procedure.Conclusions:TORS is an effective procedure to locate the primary tumor in patients with cervical lymph node metastases and no obvious source. Bilateral base of tongue resection should be considered as part of the exam under anesthesia for these patients, particularly if the palatine tonsils have already been removed.
Using Sentinel Lymph Node Biopsy for Thick (>4 mm) Head and Neck Melanoma
Authors: Pattisapu Prasanth , Monroe Marcus M. , Myers Jeffrey N. , Kupferman Michael E. 
Published: August 2013

Objectives:Sentinel lymph node biopsy (SLNB) has become standard practice for intermediate‐thickness head and neck melanoma (HNM) but remains controversial for melanomas >4 mm thick. The objectives of this study were to evaluate the diagnostic accuracy and the prognostic value of SLNB in patients with thick HNM.Methods:Retrospective cohort study of patients undergoing SLNB for thick HNM at a large cancer center between June 2000 and December 2012. Univariate and multivariate analysis of prognostic factors was performed. False negative SLNB was defined as recurrence within a previously identified negative nodal basin.Results:A total of 107 patients with thick HNMs were identified, of which 77 met inclusion criteria. Population characteristics included a mean patient age of 62.9 (range 4‐87) with a male predominance (82%). Mean Breslow thickness was 6.04 mm (range 4‐21 mm). Of the 77 patients undergoing attempted SLNB, 7 had no identifiable SLN (9%). For the remaining 91% with identifiable SLN(s), the mean number of nodes identified was 3.3 (range 1‐13). The SLN positivity rate was 24%. A false‐negative SLNB occurred in two patients (3.8%). With a median follow‐up of 36 months, the estimated 5‐year disease‐free, disease‐specific and overall survival rates were 47%, 80%, and 71%, respectively. A positive SLN was significantly linked to shortened DFS (35% v. 51%, P = 0.028) and DSS (65% v. 85%, P = 0.04) and trended towards significance for OS (59% v. 76%, P = 0.09).Conclusions:SLNB provides accurate staging of the regional node basin and important prognostic information for patients with thick HNM.
What Is the Learning Curve of Sialoendoscopy?
Authors: Steck Jose H. , Bertelli Hallan D. , Hoeppner Catarine A. , Volpi Erivelto , Vasconcelos Evandro C. 
Published: August 2013

Objectives:Sialoendoscopy is becoming the gold standard method for diagnosis and treatment of Salivary gland inflammatory diseases (SGID). Our objectives are:1) Analyze our initial experience with sialoendoscopy. 2) Measure the learning curve to implement this technique.Methods:We reviewed the data from 113 consecutive sialoendoscopies from September 2010 to January 2013. These procedures were performed for diagnosisor intervention in 82 patients (62% female), with mean age 46.4 (4 to 83). They were divided into 2 groups: A, with the first 60 exams, and B, with the last 53 exams. We compared the following outcomes in the 2 groups: failure in papilla catheterization, failure to complete the exam, complication rates and need to repeat exams in the same patient. The most common diagnoses were lithiasis, stenosis, scars, radiodine sialoadenitis, Sjogren Disease.Results:In Group A, failure to catheterize papilla were 18.3%, versus 3.7% in Group B (95% CI, 3.58 to 25.62), P = 0.016 (statistically significant‐SS). Failure to complete the examination was 21.6% in Group A versus 7.5% in Group B (95% CI 1.52 to 26.68), P = 0.036 (SS), and need to repeat exams was 23.3% in Group A versus 3.7% in Group B (95% CI 7.78 to 31.42), P = 0.0027 (SS). The overall complication rate was 11.2%, 15% in Group A, 7.5% in Group B, P = 0,23 (not SS).Conclusions:Sialoendoscopy is a challenging procedure. In our experience we found statistically better outcomes for the exam after 60 procedures. The complication rate was statistically the same.
Acute Contained Ruptured Aortic Aneurysm Presenting as Left Vocal Cord Paralysis
Authors: Gnagi Sharon H. , Howard Brittany E. , Lott David G. 
Published: August 2013

Objectives:Recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal cord paralysis.Methods:Case report and review of the literature.Results:An 85‐year‐old female with prior history of an aortic aneurysm status post‐endovascular repair presented to a tertiary care laryngology clinic with a history of sudden onset hoarseness that began two months prior with no subsequent improvement. On laryngoscopy, the left vocal cord was seen in the midline position. A computed tomography (CT) scan obtained that day revealed a new, large acute 4.6 cm hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was subsequently referred to the Emergency Department for further evaluation and treatment by the vascular surgery team. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal cord paralysis was subsequently treated via office‐based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow‐up CT scan at 8 months after diagnosis demonstrated a slight decrease in the size of the hematoma and the development of a pseudoaneurysm within it. The left vocal cord remains immobile to date.Conclusions:Ortner's syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition, and while typically presenting gradually, may also present with acute symptomatology.
Adult Supraglottic Rhabdomyoma with Extralaryngeal Extension: Surgical Excision and Reconstruction with Aortic Homograft
Authors: Gnagi Sharon H. , Cain Rachel B. , Lott David G. 
Published: August 2013

Objectives:1) Review the presentation, pathology, and treatment of rhabdomyomas. 2) Recognize the potential need for open resection with reconstruction as a treatment of benign laryngeal lesions in rare cases.Methods:A 67‐year‐old female presented with dyspnea and hoarseness. On examination she had a soft, mobile, centrally‐located neck mass. Fiberoptic laryngoscopy revealed a large, submucosal supraglottic mass. Computed tomography (CT) showed a 3‐cm supraglottic tumor with extralaryngeal extension. Needle aspiration suggested rhabdomyoma, confirmed by direct laryngoscopy with biopsy. She subsequently underwent awake tracheostomy, hemilaryngectomy, and reconstruction with aortic homograft. Pathology showed adult rhabdomyoma with representative large, polygonal cells with abundant cytoplasm, focal cross‐striations, and occasional “strap” cells. Three weeks postoperatively she was decannulated and found to have a functional voice and swallow. After six months of follow‐up she is without evidence of recurrence.Conclusions:Laryngeal rhabdomyoma is a rare benign clinical entity, which may present with airway distress and extralaryngeal extent. Treatment is complete surgical excision, possibly requiring open surgery with reconstruction. Aortic homograft reconstruction is safe, is technically straight‐forward, and has good postoperative results.
Chronic Pepsin Exposure Increases Cell Proliferation and Promotes Tumor Growth of Hypopharyngeal Cells
Authors: Kelly Elizabeth A. , Samuels Tina L. , Johnston Nikki 
Published: August 2013

Objectives:1) Investigate the role of reflux, specifically pepsin, in laryngopharyngeal carcinogenesis. 2) Evaluate effects of chronic pepsin exposure on cell proliferation, apoptosis, and colony forming ability in hypopharyngeal cells.Methods:Human hypopharyngeal squamous cell carcinoma FaDu cells were chronically exposed to nonacidic porcine pepsin (exposed for 24 hours, 4 times over 2 weeks at the following concentrations: 0.01mg/ml, 0.1 mg/ml, and 1mg/ml). Precise wounds were created in confluent cell plates. Rates of cell invasion into wounds were quantified. Separately, cell viability of chronic pepsin exposed FaDu cells acutely treated with paclitaxel was measured. Finally, a clonogenic assay was performed on these cells to measure effects of chronic pepsin exposure on colony forming ability.Results:In the invasion assay, an increased rate of relative wound density was observed in pepsin treated (0.01mg/ml, 0.1mg/ml) cells compared to control (P = 0.003, P < 0.001), suggesting greater rates of cell proliferation. Pepsin treated (0.1 mg/ml) cells had a greater cell viability compared to control after exposure to paclitaxel (P < 0.03) demonstrating greater apoptosis resistance. Chronic pepsin exposure (0.1mg/ml, 1mg/ml) was associated with dose dependent increase in colony forming ability relative to control (P < 0.001), supporting the role of pepsin as a tumor promoter.Conclusions:Hypopharyngeal cells chronically exposed to pepsin demonstrated an enhanced rate of cell proliferation and increased resistance to apoptosis and colony forming ability relative to control cells. These experiments indicate that chronic pepsin exposure acts as a tumor promoter in cellular transformation of airway epithelium, suggesting a role for pepsin in laryngopharyngeal carcinogenesis attributed to gastric reflux.