bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tracheal Perforation from Primary Thyroid Lymphoma
Authors: Chen Cynthia , Tibbetts Kathleen , Schiff Bradley 
Published: February 2015

ObjectiveTo describe a rare case of tracheal perforation due to invasive primary thyroid lymphoma and suggest that expectant management with temporary airway protection is an option to invasive interventions such as tracheotomy and tracheal stent placement.MethodWe report a case of primary B‐cell thyroid lymphoma causing acute airway obstruction in an elderly female who required emergency endotracheal intubation for airway protection.ResultsAfter receiving one cycle of chemotherapy with rapid response in terms of tumor size reduction, she was found to have extensive anterior tracheal wall necrosis and perforation on both radiologic imaging and direct bronchoscopic examination. She was able to be quickly extubated and survived without intervention.ConclusionThere is currently no standard of care in terms of management of invasive thyroid lymphoma causing airway obstruction due to its rare incidence. We propose that expectant management with temporary airway protection is an option to procedures such as tracheotomy or tracheal stenting, even in the scenario of airway perforation.
Treatment of Laryngeal Cancer at the Brooklyn VA
Authors: Fraser Marika A. , Floyd Elizabeth , Rosenfeld Richard M. , Sundaram Krishnamurthi , Weiss Michael 
Published: February 2015

Objective1) To compare survival outcomes in patients treated with advanced laryngeal cancer. 2)To illustrate the prevalence of tracheotomy and percutaneous endoscopic gastrostomy (PEG) placement in the organ preservation group and its implication for counseling patients.MethodA retrospective chart review was performed from January 1999 to December 2009 of patients with larynx cancer AJCC stages III and IV at the Brooklyn VA Hospital. The endpoints examined were 2‐year overall survival and disease‐free survival. The secondary endpoints were the rate of salvage laryngectomy, tracheotomy, and PEG in each cohort.ResultsKaplan‐Meier survival for the surgery/RT group at 2 years was 75.6% (95% CI; 54.9% to 96.3%) and the survival for the chemo/RT group at 2 years was 62.2% (95% CI; 43.6% to 80.8%). There was no statistically significant difference in overall survival between the surgery/RT vs chemo/RT group. The laryngeal preservation rate was 19 out of 28 (68%) which was lower than the RTOG 91‐11 (84%), and over half these patients required a tracheostomy (52%) or a PEG (68%).ConclusionOur study has not shown a significant survival difference between surgery and radiation vs chemoradiation protocols. However, chemoradiation as an organ‐sparing technique does not ensure normal laryngeal function, particularly with frequent need for tracheostomy and gastrostomy. We hope our study will highlight the potential for problematic functional outcomes in these patients.
Treatment of Laryngeal Cancer: Rationale and Outcomes
Authors: Clayburgh Daniel , Schindler Joshua S. 
Published: February 2015

Objective1) Evaluate the rationale for choice of treatment modality in patients with laryngeal cancer. 2) Compare outcomes among various treatment modalities for patients with laryngeal cancer.MethodA retrospective review was conducted of patients treated for laryngeal cancer between 2006 and 2011. Data were recorded on treatment modality and rationale (radiation therapy (RT), transoral laser microsurgery (TLM), open partial laryngectomy (PL), or total laryngectomy (TL)), and oncologic/functional outcomes. Statistics included chi‐square and bonferroni tests.ResultsSeventy‐nine patients were identified (18 RT, 19 TLM, 20 PL, and 22 TL). TLM was primarily used for early‐stage disease, RT and PL for all disease stages, and TL for advanced disease. RT and TL were usually chosen due to tumor extension or patient health precluding conservation surgery. No surgical patients, but 28% of RT patients required permanent tracheostomy. Voice quality was similar for RT and TLM patients, while PL was significantly worse. All TLM patients resumed a normal diet; a small percentage of RT (17%), PL (10%), and TL (18%) patients required permanent feeding tube use.ConclusionMultiple treatment modalities for laryngeal cancer exist, and treatment decisions are usually driven by a combination of tumor characteristics, patient health, and patient preferences. Future research may better define the relative merits of the various treatment strategies available.
Unusually Aggressive Squamous Cell Carcinoma of the Scalp
Authors: Chung Victor , Lee Arnold 
Published: February 2015

ObjectiveTo report a series of unusually aggressive squamous cell carcinoma of the scalp and to discuss the current strategies for the diagnosis and management of this disease state.MethodPatients with well‐differentiated scalp squamous cell carcinoma, presenting with locally invasive disease and aggressive features were identified. We performed a chart review for each patient in this series. The literature is reviewed as it pertains to prior reports and diagnostic strategies for identifying these uncharacteristically aggressive lesions.ResultsWe present a series of 5 patients with well‐differentiated squamous cell carcinoma of the scalp that behaved in an unusually aggressive pattern for its level of differentiation. This included local invasion of calvarium, recurrence, and satellite lesions. We did not identify in this case series any correlation between the degree of differentiation and the aggressiveness of the cancer. We did not elucidate any risk factors or histologic identifiers to explain this phenomenon, which has not been previously described in the head and neck literature.ConclusionAggressive squamous cell carcinomas of the scalp may progress to the point of metastasis and death despite appropriate initial therapy. The clinician should be aware that these aggressive features, typically associated with poorly differentiated squamous cell carcinomas, may exist with any level of differentiation when found on the scalp.
Urinary Tract Infections after Head and Neck Cancer Surgery
Authors: Chan Jason Y. , Gourin Christine G. , Semenov Yevgeniy R. 
Published: February 2015

ObjectiveCatheter‐associated urinary tract infections (UTI) have been identified as a preventable “never event” by the Centers for Medicare and Medicaid Services (CMS). We sought to determine the relationship between UTI and in‐ hospital mortality, postoperative complications, length of stay, and costs in head and neck cancer (HNCA) surgery.MethodDischarge data from the Nationwide Inpatient Sample for 93,663 patients who underwent an ablative procedure for a malignant oral cavity, laryngeal, hypopharyngeal or oropharyngeal neoplasm in 2003 through 2008 were analyzed using cross‐tabulations and multivariate regression modeling.ResultsUTI was diagnosed in 2% of patients. Patients with UTI were more likely to be over 80 years of age (OR = 3.3, P =. 008), female (OR = 1.9, P <. 001), have advanced comorbidity (OR = 1.8, P <. 012), undergo major surgical procedures (OR = 1.7, P =. 001), have predisposing bladder and prostate conditions (OR = 3.8, P <. 001), experience surgical complications (OR = 2.3, P <. 001), and have acute medical complications (OR = 3.1, P <. 001). UTI was associated with significantly increased length of hospitalization and hospital‐related costs, after controlling for all other variables.ConclusionUTI is unusual in HNCA surgical patients but is more common with extent of surgery and age and is significantly associated with postoperative complications, length of hospitalization, and hospital‐related costs. HNCA patients are a high‐risk group for this “never event,” particularly as the population ages.
Vessel Sealing System Thyroidectomy
Authors: Hirunwiwatkul Prakobkiat 
Published: February 2015

ObjectiveTo compare efficacy and adverse effects between vessel sealing system thyroid lobectomy (VSSL) and conventional thyroid lobectomy (CTL).MethodStudy design: Randomized, controlled study. Research methodology: Eighteen subjects with solitary thyroid nodule planned for thyroid lobectomy were enrolled consecutively. Intervention was randomized by mixed‐block randomization into 2 groups. Measured outcomes: Primary outcome was operative time. Secondary outcomes were intraoperative blood loss, postoperative blood loss and postoperative recurrent laryngeal nerve injury.ResultsThere was clinically significant less operative time in VSSL group compared with CTL group (VSSL/CTL = 59.78 ± 11.83/85.22 ± 19.25 minutes, P =. 004). There was no significant difference of intraoperative blood loss (VSSL/CTL = 39.49 ± 23.24/57.56 ± 18.94 mL, P =. 089) and postoperative blood loss (VSSL/CTL = 49.44 ± 23.78/60.56 ± 41.57 mL, P =. 496) between both groups. There was no case of postoperative recurrent laryngeal nerve injury in both groups.ConclusionThyroid lobectomy using vessel sealing system was clinically significantly better than conventional technique in terms of operative time. Intraoperative blood loss in VSSL group also had a tendency to be less than CTL group. Postoperative blood loss and recurrent laryngeal nerve injury were not significantly different between both techniques.
Anterior Cervical Discectomy and Fusion Is Not a Benign Procedure
Authors: White Zrria , Karakla Daniel W. , Sinacori John 
Published: February 2015

Objective1) Present 5 cases of esophageal injury following anterior cervical discectomy and fusion. 2) Discuss the existing literature on mechanism of injury, presentation, and treatment.MethodThis study is a retrospective case series conducted between 2009 and 2011, reviewing the presentation, and treatment of 5 cases of esophageal injury following anterior cervical discectomy and fusion.ResultsAll 5 patients in the series presented with dysphagia. The esophageal injuries in 3 out of 5 cases were identified on barium swallow. In 2 of the 5 patients esophageal injury was not identified until direct laryngoscopy was performed. Four out of 5 of the patients presented in the case series were repaired with sternocleidomastoid flaps and one with endoscopic diverticulotomy alone. All patients had improvement in their symptoms and 3 of the 5 patients completely recovered esophageal function.ConclusionWith the increased number of anterior cervical disk fusion cases being performed, there are more complications that otolaryngologists must be aware of. Esophageal perforation is a very serious complication and early recognition and treatment are necessary to prevent serious morbidity and mortality. As imaging does not easily identify esophageal perforation, endoscopy is recommended to optimize identification. Management of perforation is best conducted with sternocledoimastoid flaps, which are ideal for esophageal reinforcement because of their excellent blood supply and low donor site morbidity.
Brain Activity in Patients with Adductor Spasmodic Dysphonia
Authors: Kiyuna Asanori , Maeda Hiroyuki , Higa Asano , Uehara Takayuki , Shingaki Kouta , Suzuki Mikio 
Published: February 2015

ObjectiveSpasmodic dysphonia (SD) is clinically characterized by irregular hyperadduction of vocal folds leading to a strained/strangled, hoarse, and effortful voice with break in pitch and phonation. The aim of the present study is to evaluate the cerebral activity in patients with adductor SD in response to phonation.MethodSix patients with adductor spasmodic dysphonia and 29 healthy subjects participated. Brain activity was evaluated using functional magnetic resonance imaging (fMRI). The experimental task consisted of alternate phonation conditions: vocalization (a prolonged vowel, |i:|) and no vocalization. The cues of both conditions were randomly presented to subjects.ResultsActivation areas in SD, compared with controls, were in right inferior frontal gyrus, right supramarginal gyrus, right middle temporal gyrus, and right superior temporal gyrus. On the contrary, decreased brain activity in SD group was observed in bilateral primary sensory area, right inferior parietal cortex, bilateral precentral gyrus, bilateral rolandic operculum, bilateral SMA, left anterior cingulate cortex, bilateral middle cingulate gyrus, right temporal pole, right superior pole, bilateral cerebellum, left inferior frontal gyrus, right insula lobe, bilateral thalamus, and right basal ganglia.ConclusionThe present fMRI study demonstrated that brain activity during phonation in SD resembled those in other local dystonia diseases, especially in sensorimotor area, supplementary motor area, basal ganglia, thalamus, and cerebellum. Although sample size was quite limited, it is likely that spasmodic dysphonia is one aspect of local dystonia.
Diffusion of Aniline Blue Injected into Thyroarytenoid Muscle
Authors: Hachiya Adriana , Alonso Valéria M. O. , Rui Imamura , Braga Natasha M. , Tsuji Domingos H. , Sennes Luis U. 
Published: February 2015

ObjectiveIntralaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for the treatment of laryngeal focal dystonia. The side effects and the modification of the laryngeal configuration are probably due to the diffusion of the botulin toxin to nearby structures. Aim: Analyze the diffusion of aniline blue (liquid substance) injected into the TA to the adjacent intrinsic laryngeal muscles.MethodStudy Design: Experimental. Eighteen excised cadaveric larynges were analyzed after injection of aniline blue (0.2 mL) into the TA, using the intralaryngeal technique. After fixation by formaldehyde and decalcification using nitric acid, the larynges were sectioned in the coronal plane in 4 slices and the intrinsic muscles analyzed.ResultsThe aniline blue spread to the lateral cricoarytenoid muscle, the cricothyroid muscle and the posterior cricoarytenoid muscle 94.3%, 42.9%, and 8.6%, respectively. Gender, height, and width of the TA had no effect on the likelihood of diffusion to any of the muscles.ConclusionThe present study showed that, based on the methodology proposed, the diffusion of a solution injected into the TA occurs in almost all cases toward the CAL muscle. The CT muscle was affected in half of the cases. Although rarely, it can also achieve the PCA muscle.
Experimental Laryngeal Granuloma in Rats with GERD
Authors: Shimazu Rintaro , Kuratomi Yuichiro , Inokuchi Akira 
Published: February 2015

ObjectiveAcid reflux and mucosal injury of the larynx may be involved in the development of laryngeal granuloma. This study developed an experimental laryngeal granuloma by mechanical injury to the vocal cord mucosa in rats with chronic acid refluesophagitis to clarify the pathological mechanism of laryngeal granuloma.MethodAn experimental rat model of chronic acid reflux esophagitis was surgically created. A plastic bar was inserted into the trachea of the model rat to mechanically injure the vocal cord mucosa. The pharynx, larynx, and esophagus of these rats were observed histologically every 2 weeks after the operation.ResultsA granuloma was observed in the vocal cord mucosa of the rat after 2 weeks of the surgery, and this presented the same pathological structure as human laryngeal granuloma. In contrast, only mucosal abrasions and blister formations of the vocal cord mucosa were observed in the control rats without surgery.ConclusionThe current results showed both mechanical injury and acid refluwas involved in the development of a laryngeal granuloma.
Incidence of All‐Cause Chronic Laryngitis
Authors: Stein Daniel J. , Noordzij Jacob P. 
Published: February 2015

Objective1) Appreciate the most common causes of chronic laryngitis. 2) Understand the incidence of chronic laryngitis in a primary care population. 3) Describe the demographic profile of patients who present to care for treatment of chronic laryngitis.MethodA review identified patients diagnosed with chronic laryngitis among an urban academic medical center primary care population from 2009 to 2010. One hundred subjects with chronic laryngitis were selected, and symptoms, first‐visit treatment, smoking, and demographics were recorded. Incidence was calculated by comparison to an existing database of all cases of idiopathic chronic laryngitis.ResultsYearly incidence of chronic laryngitis was 19.5 per 1000 people. The 100 subjects consisted of 62 women and 38 men. Race was recorded as black (46), Hispanic (25), white (17), other (12). Age ranged from 20 to 75 years, with a mean of 52.6 years (standard deviation, 12.6 years). Therapies included a proton‐pump inhibitor (77%), voice therapy (21%), nasal steroid (15%), anti‐histamine (6%), amitriptyline (4%), and no treatment (10%). The most common symptoms reported were cough hoarseness (59%), cough (37%), pain/soreness (37%), globus (36%), excessive throat clearing (31%), subjective dysphagia (26%), and throat irritation (19%). 92% were seen by an otolaryngologist.ConclusionWe found a yearly chronic laryngitis incidence of 19.5 per 1000 people. In an academic setting, most of these will present to otolaryngologists. The majority was treated using proton pump inhibitors. Hoarseness, cough, and pain were the most common symptoms. Population surveys could better define who presents to care.
Incipient Vocal Nodules in Singers without Voice Complaints
Authors: Hachiya Adriana , Baravieira Paula B. , Pimenta Regina A. , Dajer Maria E. , Montagnoli Arlindo N. , Tsuji Domingos H. 
Published: February 2015

ObjectiveTo investigate if the presence of incipient nodular lesions, ie, the presence of turbulence of secretion where the vocal fold preferably contacts during phonation, in patients without voice complaint can affect voice quality and vocal cord vibratory parameters.MethodTwenty female professional voice users (singers) without voice complaints were included in the study. Twelve women had no vocal lesions on a previous videolaryngostroboscopy examination and 8 women showed incipient nodular lesions. The voices were recorded and submitted to auditory perceptual analysis (GRBASH) by 3 different evaluators. The examinations were recorded with a high speed imaging videolaryngoscope equipment (HS Endocam 5560, Richard Wolf GmbH, Knittlingen, Germany), running at 4000 fps. The following parameters were studied: F0, open quotient, speed quotient, time peridiocity index, and the amplitude periodicity index. The data were analyzed by X‐CAD software, and t tests were performed to compare the 2 groups.ResultsThe auditory perceptual analysis of the voices of the 2 groups shows that both the control group and the study group have normal variability of voice quality in all vocal samples. There was no statistically significant difference in the studied vibratory parameters.ConclusionThe presence of turbulence secretion in the transition of the anterior and middle third vocal fold named in the clinical practice as incipient nodules or prenodular lesions does not reflect in changes in voice quality or vocal fold vibratory parameters on high‐speed imaging in female singers without voice complaints.
Intubation‐Related Vocal Cord Palsy
Authors: Hsu Yu‐Ting , Hao Sheng‐Po 
Published: February 2015

Objective1) To review the incidence of intubation‐related vocal cord palsy. 2) To analyze the risk factors of intubation‐related vocal cord palsy and review literature.MethodProspective study of patients who received general anesthesia by intubation from January 2010 to August 2011 in otolaryngology department. Patients who complained of hoarseness after operation will undergo flexible laryngoscopy to look for vocal palsy and will be included in this study.ResultsA total of 2511 patients received general anesthesia by intubation in otolaryngology department. Six patients developed post‐operative vocal palsy, including 5 men and 1 woman ages 47 to 67 years old. Time of endotracheal cuff inflation varies from 45 minutes to 1675 minutes. These 6 patients had neck hyperextension during operation. Recovery time of vocal palsy in each patient was less than 10 weeks. The incidence of intubation‐related vocal palsy is around 0.2% in otolaryngology department, considerably higher than the literature reports. Prolonged endotracheal cuff inflation time and neck hyperextension could be the reasons for the higher incidence.ConclusionThe incidence of intubation‐related vocal palsy in otolaryngology department is 0.2%. Risk factors are the same as the literature, including prolonged endotracheal cuff inflation time, and neck hyperextension position.
Long‐term Follow‐up of Laryngeal Amyloidosis
Authors: Robb Philip , Tulunay‐Ugur Ozlem E. , Suen James Y. 
Published: February 2015

Objective1) Laryngeal amyloidosis is a rare disease and most of the knowledge is from single case reports. In this paper, we aim to present one of the larger series of primary laryngeal amyloidosis reported in the English written literature. 2) To understand the disease course and be able to describe long term outcomes in these patients.MethodRetrospective review of six patients with laryngeal amyloidosis followed at a tertiary university voice center. The patient charts were reviewed for initial presentation, workup, and surgeries or other treatments performed. Serial laryngoscopic examinations were reviewed. Voice handicap index was used to evaluate voice outcomes.ResultsMajority of the patients required multiple surgeries to control the disease. Endoscopic approach with CO2 laser excision was the preferred technique. Attention was given to preserve the function of the larynx. During follow‐up, patients who had an adequate vocal quality preferred observation only with no further surgeries or treatment. Long‐term follow‐up shows an indolent course of the disease.ConclusionThe extended follow‐up allows us to provide recommendations on treatment options and surgical technique. Since this is a slowly progressing disease, the main objective should be to preserve laryngeal function as long as possible.
Novel Repair Technique of Transmural Tracheal Lacerations
Authors: Cervantes Sergio S. , Matthaeus Jamie L. , Lott David G. , Landry April M. , Jaroszewski Dawn E. 
Published: February 2015

Objective1) Demonstrate a novel method to repair a full thickness tracheal wall laceration. 2) Discuss the relationship of this new technique in regard to current accepted methods of treatment reported in the literature. 3) Learn that full thickness tracheal tears, although rare, are possible following routine tracheal balloon dilation.MethodWe review a patient’s case of symptomatic idiopathic subglottic stenosis. One year after initial dilation, balloon dilation was performed and an 8‐cm full‐thickness tracheal laceration occurred. We report successful repair with a covered tracheobronchial stent and review the literature relating our repair to other accepted techniques.ResultsFollowing tracheal balloon dilation, staying within recommended limits, a complete tear was identified. Using flexible endoscopy and fluoroscopic guidance the tear was measured to be 8 cm. An 80 × 20 mm covered tracheobronchial stent was deployed into position to overlie the area of tracheal disruption. Intraoperative computed tomography demonstrated minimal air extravasation, thus the patient was extubated. The patient’s course was uncomplicated and discharged three days later. Review of current literature demonstrates a variety of repair techniques including soft tissue reconstruction. Our technique is advantageous because it can be done at the time of surgery with excellent outcomes and less morbidity.ConclusionEndotracheal balloon dilation is an established and safe method to restore airway volume; however full thickness lacerations can occur. This case demonstrates that deployment of an appropriate tracheobronchial stent at the time of surgery is a viable treatment option with low comorbidity. Close postoperative monitoring is vital to successful outcome.