bluuebunny/crossref_metadata_2025_split huggingface dataset:
Observation versus neck dissection for positron‐emission tomography–negative lymphadenopathy after chemoradiotherapy
Authors: Khodayari Behnood , Daly Megan E. , Bobinski Matthew , Farwell D. Gregory , Shelton David K. , Chen Allen M. 
Published: October 2013

Objectives/HypothesisTo analyze outcomes among patients with residual positron‐emission tomography (PET)‐negative lymphadenopathy after chemoradiotherapy for head and neck cancer based on whether or not they underwent neck dissection.Study DesignRetrospective review.MethodsFifty‐five patients with stage III/IV squamous cell carcinoma of the head and neck were identified with residual PET‐negative lymphadenopathy based on standardized uptake value of <3. All patients had been treated with chemoradiotherapy to a median dose of 70 Gy (range, 60–4 Gy).ResultsWith a median follow‐up of 30 months (range, 6–67 months), the 3‐year overall survival (85% vs. 81%, P = .57), progression‐free survival (88% vs. 88%, P = .42), and local‐regional control (96% vs. 100%, P = .68), did not differ between patients treated by neck dissection or observation.ConclusionsOmission of neck dissection appears to be reasonable for patients with residual lymphadenopathy but negative PET after chemoradiotherapy for head and neck cancer.Level of Evidence4. Laryngoscope, 124:902–906, 2014
Restoration of scarred vocal folds using 5 amino acid‐deleted type hepatocyte growth factor
Authors: Mizuta Masanobu , Hirano Shigeru , Ohno Satoshi , Kanemaru Shin‐ichi , Nakamura Tatsuo , Ito Juichi 
Published: October 2013

Objectives/HypothesisOur previous studies demonstrated a regenerative effect of recombinant human hepatocyte growth factor (HGF) on vocal fold scarring using full‐length HGF. However, clinical application has not yet been achieved because of the lack of a good manufacturing practice (GMP) for full‐length HGF. Another natural form of human HGF, 5 amino acid‐deleted type HGF (dHGF), has been newly produced under a GMP procedure. In the current study, we investigated the effect of dHGF in comparison with full‐length HGF for the treatment of vocal fold scars using a canine model.Study DesignProspective animal experiment.MethodsThe vocal folds of nine beagles were unilaterally injured. Four weeks after injury, the vocal folds were treated with an intracordal injection of full‐length HGF (full HGF group), dHGF (dHGF group), or phosphate‐buffered saline (sham group). Vibratory and histological examinations were performed for each group 6 months after injury.ResultsVibratory examinations demonstrated significantly lower phonation threshold pressure and a higher ratio of normalized mucosal wave amplitude in both the full HGF and dHGF groups as compared to the sham group. Histological examination showed restoration of hyaluronic acid in both the full HGF and dHGF groups as compared to the sham group. No significant differences were observed for each parameter between the full HGF group and the dHGF group.ConclusionsdHGF showed the same potential for regenerative effects on vocal fold scars as full‐length HGF. dHGF should be applicable for human clinical trials in patients with vocal fold scars.Level of EvidenceNA Laryngoscope, 124:E81–E86, 2014
Organ preservation surgery for low‐ and intermediate‐grade laryngeal chondrosarcomas: Analysis of 16 cases
Authors: Piazza Cesare , Del Bon Francesca , Grazioli Paola , Mangili Stefano , Barbieri Diego , Nicolai Piero , Peretti Giorgio 
Published: October 2013

Objectives/HypothesisTo demonstrate that endoscopic resection (ER), open partial laryngectomies, and cricotracheal resection and anastomosis (CTRA) achieve a good balance between oncologic radicality and organ preservation for laryngeal low‐grade chondrosarcoma (LCS) and intermediate‐grade chondrosarcoma (ICS).Study DesignRetrospective series in an academic institution.MethodsBetween 2001 and 2013, we treated 13 cricoid, two thyroid, and one arytenoid LCS and ICS. Two cricoid and the only arytenoid LCS were managed by ER. Two thyroid ala LCS were submitted to laminectomy. Five ICS and six LCS of the cricoid received CTRA.ResultsNine patients only required tracheotomy, removed after a maximum of 14 days. Three patients required a nasogastric feeding tube, removed after a maximum of 8 days. Immediate complications included one bleeding, one cervical emphysema, and one partial anastomotic dehiscence. The only late complication was anastomotic stenosis that was resolved by laser resection. All patients regained regular oral feeding and a voice ranging from normal to moderate dysphonia. At the last follow‐up, two patients died of unrelated causes, seven are alive with asymptomatic and radiologically stable residual disease, and seven are alive without evidence of persistent disease. One patient received total laryngectomy 11 years after CTRA for recurrent symptomatic disease.ConclusionsOrgan preservation surgery for laryngeal LCS and ICS represents a treatment option with low morbidity, good quality of life, and fair possibility to obtain oncologic radicality.Level of Evidence4. Laryngoscope, 124:907–912, 2014
Incidence and management of rhinosinusitis after complex orbitofacial reconstruction
Authors: Parkes William J. , Nyquist Gurston G. , Rizzi Christopher , Zhang Sarah , Evans James J. , Heffelfinger Ryan N. , Rosen Marc R. , Curry Joseph M. 
Published: October 2013

Objectives/HypothesisTo examine the sinus‐related sequelae of free flap reconstruction for complex orbitofacial defects.Study DesignRetrospective chart review.MethodsDemographic, clinical, and radiographic data on a series of 55 patients who had undergone free tissue transfer for orbitofacial reconstruction was retrospectively reviewed. Follow‐up of ≥ 3 months was available for 49 patients.Outcome measures studied included clinical or radiographic evidence of sinusitis and the need for sinus surgery.ResultsThe most commonly involved sinuses were the ethmoid (n = 40) and maxillary (n = 38) sinuses, and the anterolateral thigh was the most common flap used (n = 41). Clinical and/or radiographic sinusitis was evident in 21 patients (43%), and 10 patients (20%) required sinus surgery at some point during follow‐up. Involvement of multiple sinuses in the initial orbitofacial surgery was associated with a significantly increased need for subsequent sinus surgery (P = 0.009). Adjuvant radiotherapy and adjuvant chemoradiotherapy were associated with a significantly increased risk for the development of rhinosinusitis (P = 0.045 and 0.016, respectively).ConclusionRhinosinusitis and the need for operative management of sinus obstruction are common in patients having undergone complex orbitofacial reconstruction. Careful management of the paranasal sinuses is an important component of the multidisciplinary treatment of such patients.Level of Evidence4. Laryngoscope, 124:1059–1065, 2014
Protective effect of dexmedetomidine on noise‐induced hearing loss
Authors: Wen Jian , Xiao Ying , Bai Yan‐Xia , Xu Min 
Published: October 2013

Objectives/HypothesisNoise generated by instruments, such as mastoid or craniotomy drills, may cause hearing damage by reducing the cochlear blood flow (CoBF). This study investigated whether dexmedetomidine can lessen noise‐induced hearing loss (NIHL) in a guinea pig model.Study DesignAnimal study using noise stimulation and measurement of hearing and CoBF in guinea pigs.MethodsGuinea pigs (n = 8 animals/group) were treated by saline vehicle (control group), dexmedetomidine (1, 3, and 10 μg/kg dex groups), saline and noise (noise group), or 3 μg/kg dexmedetomidine and noise (dex+noise group). For noise exposure, octave band noise at 124 dB sound pressure level was administered to animals for 2 hours. Blood pressure (BP) and CoBF were monitored continuously. Auditory function was measured by the auditory brain‐stem response (ABR) before and 1 hour, 3 hours, 8 hours, and 10 days after noise exposure. Plasma norepinephrine (NE) was measured at baseline and 30, 60, 90, and 120 minutes after noise exposure by high‐performance liquid chromatography (HPLC).ResultsNoise exposure caused temporary and permanent hearing damage. Dexmedetomidine concentrations of 1 μg/kg and 3 μg/kg dose dependently improved CoBF. Administration of 10 μg/kg dexmedetomidine drastically reduced BP and CoBF. Pretreatment with 3 μg/kg dexmedetomidine alleviated the noise‐induced reduction in CoBF and improved hearing function by decreasing the permanent and temporary threshold shifts.ConclusionDexmedetomidine displayed protective effects against NIHL in this animal model, suppressing activation of the sympathetic nervous system and improving CoBF. These findings could have clinical relevance and deserve further investigation.Level of EvidenceN/A. Laryngoscope, 124:E188–E193, 2014
External laryngotracheal trauma
Authors: Randall Derrick R. , Rudmik Luke R. , Ball Chad G. , Bosch J. Douglas 
Published: October 2013

Objectives/HypothesisLaryngotracheal trauma encompasses a subset of relatively uncommon yet life‐threatening injuries requiring prompt intervention to prevent short‐ and long‐term aerodigestive tract sequelae. Minimal literature exists regarding laryngotracheal injuries on a population level, particularly among Canadian centers.Study DesignCase series.MethodsRegional health databases containing in‐patient admissions, emergency department visits, and trauma service activations using International Classification of Diseases (ICD) diagnostic codes were queried to identify all laryngotracheal injuries diagnosed from April 1, 1995, to December 31, 2011. Health records and diagnostic imaging were evaluated for mechanism, injuries, airway management, and long‐term aerodigestive function.ResultsEighty‐nine patients met inclusion criteria, equating to 1/1042 admissions and 1/2478 emergency presentations. Nineteen percent of injuries were severe (Schaefer‐Fuhrman score ≥ 4). Airway intervention was performed at presentation in 65% of patients, with 13.5% necessitating emergent surgical airway; 52% underwent investigative or interventional airway surgery. Nine patients (16%) had long‐term moderate or severe dysphonia; 14.5% had dysphagia. Odds ratio for death and long‐term dysphonia among severe compared to minor laryngotracheal injuries were 7.1 (95% CI = 1.4–35.4) and 17.2 (95% CI = 3.3–91.1), respectively. Several factors were identified that predicted airway management and outcomes.ConclusionTraumatic laryngotracheal injuries are more common than previously reported, due to increased recognition. Many can be managed nonoperatively; however, cases require individual evaluation with judicious airway management and intervention to minimize aerodigestive sequelae. Severe injuries are associated with death and dysphonia but not with dysphagia.Level of Evidence4. Laryngoscope, 124:E123–E133, 2014
Central skull base osteomyelitis
Authors: Johnson Andrew K. , Batra Pete S. 
Published: October 2013

Objectives/HypothesisSkull base osteomyelitis (SBO) most commonly results as a complication of otitis externa in diabetic patients. Central or atypical presentations, unrelated to aural pathology, have been documented, though restricted to small patient series or case reports. The current study systematically analyzed the literature to construct the clinical profile of this rare entity.Study DesignSystematic review of case series.MethodsThe MEDLINE database was searched for all published cases of central SBO. Four additional cases were included from the University of Texas Southwestern Medical Center. Statistical analysis was performed to identify trends affecting overall outcomes or differences in treatment.ResultsA total of 42 cases were included with mean age of 52 years and male:female ratio of 2.2:1. The most common presenting symptoms were headaches and cranial nerve palsies, including VI (31%), IX (29%), and X (29%). Staphylococcus aureus (21%) and Pseudomonas aeruginosa (19%) were the two most common causative pathogens. The mean duration of antimicrobial therapy was 21 weeks, with 55% requiring intravenous antibiotics for a mean duration of 6.9 weeks. Twenty of 42 patients (48%) received surgical biopsy for diagnosis, whereas 18 patients (43%) required adjunct surgical debridement. Women were more likely than men to require multiple courses of therapy (46% vs. 7%, P = .01). The overall mortality was 9.5%, with an additional 31% experiencing residual neurological dysfunction.ConclusionsOsteomyelitis of the central skull base poses significant challenges for timely and accurate diagnosis. Aggressive management with antimicrobials, coupled with surgical debridement in select cases, may avoid serious neurologic morbidity and mortality.Level of EvidenceNA Laryngoscope, 124:1083–1087, 2014
Adjuvant stereotactic body radiotherapy ± cetuximab following salvage surgery in previously irradiated head and neck cancer
Authors: Vargo John A. , Kubicek Gregory J. , Ferris Robert L. , Duvvuri Umamaheswar , Johnson Jonas T. , Ohr James , Clump David A. , Burton Steven , Heron Dwight E. 
Published: October 2013

Objectives/HypothesisLocoregional recurrence remains the primary failure pattern following salvage surgery for previously irradiated head and neck cancer; randomized trials have suggested a complimentary role for adjuvant chemotherapy and conventional reirradiation at the expense of significant increases in toxicity. We aimed to identify if stereotactic body radiotherapy (SBRT) ± cetuximab improves tumor control while reducing treatment‐related toxicity following salvage surgery.Study DesignRetrospective review (2005–2011) of 28 patients with high‐risk features (positive surgical margins or extranodal extension) following macroscopic complete (R0/R1) salvage surgery treated with adjuvant SBRT ± cetuximab.MethodsSBRT consisted of 40 to 44 Gy in five fractions over 1 to 2 weeks with concurrent cetuximab (n = 7) administered at 400 mg/m2 day −7 + 250 mg/m2 days 0 and +8. Toxicity was physician recorded, and University of Washington Quality of Life Revised surveys were prospectively collected.ResultsAll patients received prior radiotherapy (median, 70 Gy; range, 54–99 Gy) with a median reirradiation interval of 25 months (range, 6–156 months). At a median follow‐up of 14 months (range, 2–69 months), the 1‐year locoregional control, distant control, disease‐free survival, and overall survival were 51%, 90%, 49%, and 64%, respectively. Rates of acute and late severe (≥grade 3) toxicity were low at 0% and 8%, respectively. At a median follow‐up survey time of 6 months, 56% of patients reported improved/stable overall quality‐of‐life scores.ConclusionsAdjuvant SBRT ± cetuximab following salvage surgery is well tolerated with acceptable oncologic outcomes and little toxicity. Future prospective trials should evaluate adjuvant SBRT ± cetuximab versus a wait‐and‐see approach for recurrent head and neck cancers with high‐risk features following salvage surgery.Level of Evidence4 Laryngoscope, 124:1579–1584, 2014
Robotic microlaryngeal surgery
Authors: Lalich Ian J. , Olsen Steven M. , Ekbom Dale C. 
Published: October 2013

Objectives/HypothesisRobotic surgery is increasingly used for a variety of head and neck surgical procedures but has yet to be adapted for routine robotic microlaryngeal surgery (RMLS). Current retractor technology is limited by the following: poor tongue retraction, poor oral commissure retraction, poor larynx visualization, and laryngeal blades that do not take advantage of the robot's ability to operate without line‐of‐site exposure. Additionally, adequate instrumentation for RMLS is lacking.Study DesignFeasibility study.MethodsWe performed a feasibility study of RMLS using a newly designed robotic retractor in a cadaver model with the goal of routinely exposing the glottis. Microlaryngeal instrumentation was also adapted for the da Vinci Surgical Robot effector arms.ResultsRMLS surgery was successfully performed including microflap elevation, anterior commissure surgery, false cordectomy, true cordotomy/cordectomy, and arytenoidectomy. Photographic and video documentation was obtained demonstrating feasibility.ConclusionsWe present a newly designed laryngeal robotic retractor and novel microlaryngeal instrumentation in a cadaveric model. This allows for glottic and anterior commissure exposure, effector arm access to the glottis, and performance of delicate endolaryngeal procedures with the robot. The overall efficacy of our retractor will need to be examined in an in vivo human model.Level of EvidenceNA Laryngoscope, 124:1624–1630, 2014
Truncus bicaroticus: An underestimated anatomic variation
Authors: Becker Christoph , Csatari Zoltan , Pfeiffer Jens 
Published: October 2013

Objectives/HypothesisTo illustrate that a truncus bicaroticus and an elongated truncus brachiocephalicus are underestimated anatomic variations; and to highlight the risk of injury of these vessel anomalies during routine surgical interventions.Data SourceReport of a woman with long‐term ventilation who was planned for conventional surgical tracheostomy. Due to a strong pulsatile vessel crossing the cricoid cartilage, the procedure was stopped. Further diagnostics revealed anomalies of the supraaortic vessels, including a truncus bicaroticus.ConclusionAnomalies of supraaortic vessels are not rare and injuries may cause severe bleeding; therefore, we recommend performing a preoperative ultrasound, particularly before starting dilatative tracheostomy. Laryngoscope, 124:1141–1142, 2014
Preventing pharyngo‐cutaneous fistula in total laryngectomy: A systematic review and meta‐analysis
Authors: Sayles Mark , Grant David G. 
Published: October 2013

Objectives/HypothesisConcurrent chemoradiotherapy is the gold‐standard nonsurgical organ‐preservation treatment for advanced laryngeal carcinoma. Total laryngectomy (TL) is increasingly reserved for surgical salvage. Salvage surgery is associated with more complications than primary surgery. A systematic review and meta‐analysis was undertaken to establish the impact of organ preservation protocols on pharyngo‐cutaneous fistula incidence following TL, and to synthesize evidence on the role of “onlay” prophylactic tissue flaps in reducing this complication in salvage TL.Data SourcesThe English language literature (January 1, 2000, to September 1, 2013) was searched, using PUBMED and EMBASE databases, for the terms “laryngectomy” and “fistula.” Of 522 studies identified from database searches, 33 were included in the quantitative synthesis.Review MethodsStudies reporting fistula incidence following primary TL (PTL), salvage TL (STL), and STL with “onlay” flap‐reinforced pharyngeal closure were included. Data were extracted by the first author (M.S.). Meta‐analysis of fistula incidence was performed.ResultsPTL fistula incidence is 14.3% (95% CI 11.7–17.0), STL 27.6% (23.4–31.8), and STL with flap‐reinforced closure 10.3% (4.6–15.9). Chemoradiotherapy is associated with a pooled fistula incidence of 34.1% (22.6–45.6), compared to 22.8% (18.3–27.4) for radiotherapy alone. Relative risk of fistula is 0.566 (0.374–0.856, P = 0.001) for STL with flap‐reinforced closure compared to STL alone. The number needed to treat (NNT) to prevent one fistula is 6.05.ConclusionProphylactic flaps used in an “onlay” technique reduce fistula incidence in STL. Chemoradiotherapy increases fistula incidence more than radiotherapy alone. Prophylactic flaps should be offered in salvage cases after failed chemoradiation protocols.Level of Evidence3A.Laryngoscope, 124:1150–1163, 2014
Clival keloid after nasopharyngeal radium irradiation masquerading as skull base malignancy
Authors: Kanumuri Vivek V. , Raikundalia Milap D. , Khan Mohemmed N. , Husain Qasim , Vasquez Alejandro , Eloy Jean Anderson 
Published: October 2013

Objectives/HypothesisNonchordomatous lesions of the clivus are rare entities. Nasopharyngeal radium irradiation (NRI) treatment consists of application of radium to the posterior nasopharynx near the orifice of the Eustachian tubes, an area adjacent to the clivus. Here we present a unique case of a patient with a history of NRI 70 years prior to presentation with a space‐occupying clival lesion suspicion for a skull‐based malignancy. This lesion was resected using an endoscopic endonasal approach. Histopathological analysis revealed a clival keloid, an entity not previously reported in the literature. Laryngoscope, 124:1767–1770, 2014
Codeine‐related adverse drug reactions in children following tonsillectomy: A prospective study
Authors: Prows Cynthia A. , Zhang Xue , Huth Myra M. , Zhang Kejian , Saldaña Shannon N. , Daraiseh Nancy M. , Esslinger Hope R. , Freeman Edita , Greinwald John H. , Martin Lisa J. , Sadhasivam Senthilkumar 
Published: October 2013

Objectives/HypothesisTo prospectively determine factors associated with codeine's adverse drug reactions (ADRs) at home in a large homogenous population of children undergoing outpatient tonsillectomy.Study DesignProspective, genotype blinded, observational study with a single group and repeated ADR measures documented by parents at home.MethodsA total of 249 children 6 to 15 years of age scheduled for tonsillectomy were enrolled. The primary outcome was number of daily codeine‐related ADRs. We examined the number and type of ADR by race and by days and further modeled factors potentially associated with ADR risk in a subcohort of white children. Sedation following a dose of codeine was a secondary outcome measure. Parents recorded their children's daily ADRs and sedation scores during postoperative days (POD) 0 to 3 at home.ResultsDiaries were returned for 134 children, who were given codeine. A total of 106 (79%) reported at least one ADR. The most common ADRs were nausea, lightheadedness/dizziness for white children and nausea, and vomiting for African American children. In a subcohort of white children ≤ 45 kg, increased ADR risk was associated with the presence of one or more full function CYP2D6 alleles (P < 0.001), POD (P < 0.001), and sex (P = 0.027). Increased pain intensity (P = 0.009) and PODs 0 and 1 (P = 0.001) contributed to a higher sedation risk. Neither obstructive apnea nor predicted CYP2D6 phenotype were associated with sedation risk.ConclusionsOur results provide evidence that multiple factors are associated with codeine‐related ADRs and support the FDA recommendation to avoid codeine's routine use following tonsillectomy in children.Level of Evidence4. Laryngoscope, 124:1242–1250, 2014
Effects of botulinum toxin A on patient‐specific keloid fibroblasts in vitro
Authors: Haubner Frank , Leyh Michaela , Ohmann Elisabeth , Sadick Haneen , Gassner Holger G. 
Published: October 2013

Objectives/HypothesisTo test whether therapeutic effects of botulinum toxin A on patient‐ specific keloid tissue can be reproduced on the cellular level. Specifically, effects on cell proliferation and expression of growth factors and cytokines relevant for wound healing were to be tested.Study DesignExperimental study including patient specific cell cultures of keloids.MethodsPatient‐specific keloid tissue was tested in a cell culture model for effects of botulinum toxin incubation on cell proliferation and expression of the following cytokines and growth factors: IL‐6 (interleukin‐6), VEGF (vascular endothelial growth factor), TGF‐β (transforming growth factor‐β).ResultsNone of the tested parameters of human keloid tissue were affected by botulinum toxin A incubation.ConclusionThe present study does not add evidence to suggest a significant therapeutic role of botulinum toxin injections for the treatment of keloids.Level of EvidenceN/A. Laryngoscope, 124:1344–1351, 2014