bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triamcinolone versus Saline Soaked Spacers Post‐FESS
Authors: Hathorn Iain F. , Habib Al‐Rahim , Manji Jamil , Mohamed Safia , Javer Amin R. 
Published: February 2015

Objective1) To determine the effectiveness of triamcinolone‐soaked middle‐meatal‐spacers (MMS) within a perforated surgical gloved finger on improving healing and reducing inflammation in CRS patients post‐FESS.2) To determine if triamcinolone‐soaked MMS within a perforated surgical gloved finger improves patient reported outcomes post‐FESS.MethodsDouble‐blind randomized controlled trial of 50 CRS patients undergoing FESS. Patients receive MMS in perforated glove fingers bilaterally, impregnated with triamcinolone (experimental arm) or saline (control). Primary outcome measure is the validated Philpott‐Javer endoscopic mucosal inflammation scoring system at postoperative days 14, 28, and 3, 6 months. SNOT‐22 scores were secondary outcomes.ResultsOur interim results, based on 36 participants, are optimistic. Patients in the triamcinolone group show clinically significant improvement in Philpott‐Javer endoscopic scores compared to saline controls at 28 days postoperative examination, however this difference was not currently statistically significant (1.185 vs 2.65; P =. 084). There was no significant difference between SNOT‐22 scores for the 2 groups at postoperative day 28 (P =. 88).ConclusionTriamcinolone‐impregnated MMS may improve postoperative inflammation and healing in CRS patients following FESS.
Attainment of Surgical Competence in Otolaryngology Training
Authors: Reiter Evan R. , Chadwick Keith A. , Dodson Kelley M. 
Published: February 2015

ObjectiveDetermine postgraduate year (PGY) at which competence is achieved in key otolaryngologic procedures as reported by residents and program directors (PDs) and evaluate relationship between resident and PD perceptions.MethodCross‐sectional survey of residents and PDs in US otolaryngology residencies conducted in 2011 using surveymonkey.com, assessing attainment of competence by residents for 32 otolaryngologic procedures. PGYs at which competence is achieved per residents and PDs were determined using linear regression models, and associations were assessed with chi‐square goodness‐of‐fit test.ResultsA total of 277 residents (19.45%) and 39 PDs (37.86%) completed surveys. Compared with PD perceptions, residents felt they achieved subjective competence earlier than expected by PDs for 13 of 32 procedures, later than expected by PDs for 3 of 32, and at the same PGY for 16 of 32 (significance at P <. 05 level by pooled t test). Degrees held, fellowship plans, and size of residency program did not significantly impact PGY at which residents felt competence was achieved for most procedures.ConclusionWe provide baseline data on PGY at which residents achieve competence in key otolaryngologic procedures. These results may guide efforts to establish appropriate milestones for resident training and assessment and better structure resident operative experiences.
Medical Malpractice and Salivary Gland Surgery
Authors: Hong Steven S. , Sniezek Joseph , Woods Roberta , Beh Hazel 
Published: February 2015

ObjectiveTo analyze malpractice litigation trends and to better understand the causes and outcomes of suits involving salivary gland surgeries to prevent future litigation and improve physician education.MethodJury verdict reviews from January 1987 to March 2011 were obtained from a computerized legal database, WESTLAW. Data were compiled on the demographics of the defendant and plaintiff, medical specialty of the defendant, use of otolaryngologists as expert witnesses, nature of injury, legal allegations, verdicts, and judgments.ResultsTwenty‐six cases met inclusion criteria and were selected for review. Specialties that were listed as defendants were otolaryngologists (66%), general surgeons (25%), and oral surgeons (13%). Verdicts for the plaintiffs predominated (54%) and the average sum of plaintiff’s monetary award was $978,466. Sixteen cases (62%) directly involved initial pathology or surgical complication of parotid gland etiology. Six cases (23%) involved injury to the lingual nerve. Five cases (19%) involved complications following surgical intervention for sialolithiasis or sialadenitis. Two of the more common complaints were failure to adequately diagnose and treat (31%) and lack of informed consent (15%).ConclusionIn salivary gland surgeries, risk management goals should include a thorough preoperative assessment of salivary gland masses with appropriate and adequate radiologic and pathologic studies. Additionally, thorough and detailed written informed consent with discussion of alternative treatment options and surgical plans may assist in mitigating risk for potential lawsuits.
Ho:Yag Laser for Sialolithiasis of Wharton’s Duct
Authors: Martellucci Salvatore , Gallo Andrea , Pagliuca Giulio , De Vincentiis Marco , Gallipoli Camilla , Rosato Chiara , Benedetti Ferdinando Nobili 
Published: February 2015

ObjectiveEndoscopic laser lithotripsy can potentially treat most cases of salivary gland stones with minimal complications while preserving a functional salivary gland. Various types of lasers have been tested during sialoendoscopic procedures. This case study describes results obtained using the Ho:YAG‐Laser.MethodSixteen patients with sialolithiasis in Wharton’s duct (diameter of the stones between 5 and 10 mm) underwent to intracorporeal lithotripsy with Ho:Yag laser under sialoendoscopic control. Debris were removed using a wire basket. A sialostent was placed at the end of procedure. After a 6‐month follow‐up radiological tests were rerun.ResultsStone fragmentation was successful in all cases. All 16 patients experienced a regular postoperative course. No complications in terms of nerve damage arose during follow‐up. Postoperative radiological findings showed that all patients but 2 were stone‐free. Complete canalization of the duct was obtained in 15 patients.ConclusionEndoscopic laser lithotripsy is a safe and viable technique in Wharton’s duct lithiasis in clinical practice.
NSQIP in Otolaryngology: Our 4‐Year Experience
Authors: Stachler Robert J. , Ritz Jennifer , Yaremchuk Kathleen L. , Ghanem Tamer A. , Hall Francis T. 
Published: February 2015

ObjectiveTo present a 4‐year experience with the American College of Surgeons (ACS) National Surgical Quality and Improvement Program (NSQIP) in Otolaryngology, Head and Neck Surgery, to highlight successes, and to demonstrate areas that provide opportunities for quality improvement.MethodThe Henry Ford Health System (HFHS) database was utilized to analyze NSQIP outcomes and quality measures obtained for the Department of Otolaryngology–Head and Neck Surgery. This had been an ongoing project in our department over the last 4 years.ResultsOverall mortality (0.34%) continues to be equal to the national average (0.34%). The overall wound infection rate (23.38%) has improved but is still slightly higher than the national average (17.4%). Initially, the wound infection rate was a significant high outlier (16.67%). The incidence of infection has improved to 0.00% (3rd Q, 2011). Individual categorical gains have been made in unplanned intubations, pneumonia rates, and off the ventilator rates within 48 hours. Sepsis and septic shock rates continue to be benchmarked compared to the national average. Patient length of stay with wound infection have improved and resulted in savings for the institution.ConclusionInstitutional participation in NSQIP has resulted in demonstrable improvements in patient care outcomes and key quality measures for patients treated at the Department of Otolaryngology–Head and Neck Surgery.
The Utility of Facial Nerve Monitoring for Parotid Surgery
Authors: Samuelson Christian G. , Friedman Michael , Hamilton Craig S. 
Published: February 2015

ObjectiveTo assess the utility of facial nerve monitoring in preventing transient and permanent facial paralysis in patients undergoing parotid surgery.MethodPubMed, MEDLINE, and Cochrane Trial Registry through December 2011 were searched and combined with manual review of relevant article bibliographies. All studies were assessed by 3 reviewers. Systematic review and random‐effects meta‐analysis were performed of studies comparing the incidence of facial nerve injury in monitored and unmonitored parotid surgery.ResultsFive studies met inclusion criteria and had data suitable for pooling (374 patients). Overall, monitoring provided no benefit in reduction of facial paralysis with an odds ratio (OR) of 0.754 (0.488, 1.165; P =. 203). In addition, sensitivity analysis revealed that neither transient nor permanent facial paralysis is significantly reduced with the use of monitoring. Analysis of publication bias revealed a nonsignificant Egger’s regression intercept; however, a single imputed value representing a “missing” study was found to the left of the calculated OR. Addition of this imputed value in no way altered the significance of our findings.ConclusionFacial nerve monitoring does not significantly reduce the incidence of transient or permanent facial paralysis in parotid surgery. While few “high‐level evidence” studies were available for review, our results were not affected by publication bias. Nerve integrity monitoring should not be considered the standard of care for parotid surgery.
Analysis of PET for Nodal Metastasis following Radiotherapy
Authors: Riggs Sterling B. , Quattlebaum Steven C. , Raju Ryan P. , Anderson Michael , Medina Jesus E. , Vasan Nilesh R. 
Published: February 2015

Objective1) Determine the ability of PET scan to predict pathologically positive nodes in patients with persistent nodal disease following radiation with or without chemotherapy. 2) Evaluate whether performing a single level neck dissection is feasible in patients with persistent nodal disease.MethodStudy design: Retrospective analysis. Setting: Tertiary care center. Patients were evaluated with PET after definitive (chemo) radiation and before neck dissection. The SUV of PET‐positive nodes were recorded and compared to pathology reports of subsequent neck dissections. Data regarding follow‐up, recurrence rates, and survival of these patients was recorded.ResultsWhen compared to pathology reports, post‐radiation PET scans failed to identify positive nodes in 4/11 separate cervical levels (sensitivity of 63.6%, P =. 005). It successfully identified 33/40 negative neck levels (specificity of 82.5%, P =. 005). This data suggest that PET scan alone may be inadequate for predicting pathologically positive nodal levels for persistent neck disease after (chemo) radiation. It was also shown that 6/13 (46.2%) nodal levels with SUV greater than 3 on PET scan were pathologically positive. Conversely, a PET negative nodal level with SUV less than 3 had a 27.3% chance (3/11) of being found positive upon pathologic evaluation.ConclusionWhile the relatively high specificity demonstrated here may help support the case for selective neck dissection when PET shows positive nodes, the low sensitivity makes it difficult to exclude PET negative levels from the planned dissection. Larger prospective studies are needed to confirm these findings.
Are Prophylactic Antibiotics Required in Thyroidectomies?
Authors: Cheung Veronique Wan Fook , Sung Dave , Anderson Donald W. 
Published: February 2015

ObjectiveIn clean surgical wounds, the rate of infection ranges between 0.3% and 5%. Although postoperative prophylactic antibiotics use is not recommended, practice depends on surgeon preference. We wish to report our rate of postsurgical wound infection requiring antibiotic use following thyroidectomies and parathyroidectomies, where no preoperative or postoperative antibiotic prophylaxis was used.MethodA retrospective chart review of thyroidectomies and parathyroidectomies without additional procedures from January 2005 to June 2011 was undertaken. The incidence of mild and significant postsurgical wound infections, use of antibiotics, need for readmission, surgical drainage, length of hospitalization, and potential risk factors for postsurgical wound infections were assessed.ResultsOf 767 charts reviewed, 697 met the inclusion criteria. Six hundred eighteen thyroidectomies and 95 parathyroidectomies were undertaken, 21 requiring postoperative drains. Nine (1.29%) were on antibiotics preoperatively, and 3 (0.43%) were on postoperative prophylactic antibiotics. Nine (1.31% of patients not on antibiotics) were given oral antibiotics for symptoms of mild infection. Two (0.29%) more significant infections required intravenous antibiotic therapy 16 and 20 days postoperatively, 1 necessitating readmission for 4 days and seroma drainage, although a wound drain was placed intraoperatively. Surgical drains (1/11 infections; P =. 29) and obesity (4/11 infections, P =. 28), among others, were not statistically significant risk factors for postsurgical wound infections.ConclusionAlthough prophylactic antibiotics were not used for our thyroidectomies and parathyroidectomies, our rate of postsurgical wound infections (1.6%) was comparative to current literature values (0.3%‐5%). Our results suggest that it might not be beneficial or cost‐effective to use prophylactic antibiotics in such clean procedures; a randomized control trial is planned.
Clinical Significance of BRAF Mutation in Papillary Cancer
Authors: Fernandez Ignacio J. , Piccin Ottavio , Sciascia Silvia , Cavicchi Ottavio , Repaci Andrea , Vicennati Valentina , Fiorentino Michelangelo 
Published: February 2015

ObjectiveBRAF mutation represents the most common oncogenic event in sporadic papillary thyroid cancer (PTC). There are, however, significant discrepancies regarding the overall frequency and its relationship with clinico‐pathological parameters of poor outcome. We analyzed BRAF mutation in a cohort of patients affected by PTCs, to identify its association with clinical variables.MethodWe analyzed retrospectively a series of 304 patients, treated for PTC from 1992 to 2011 at Bologna University Hospital. We searched BRAF mutation by RT‐PCR followed by single‐stranded conformational polymorphism or by PCR and direct sequencing, to correlate the presence of the mutation with clinico‐pathological parameters of the patients.ResultsBRAF mutation was found in 77.4% of classical PTCs, 31.9% of follicular variant, and 72.2% of high tall cell PTC, being significantly associated with recurrence (P. 005), stage (P. 043), and multicentricity (P. 025). Moreover BRAF was significantly associated with the classic variant of PTC (P. 0001). Higher T, but not N nor M stage, resulted to be associated to BRAF mutation. A significant difference of disease free survival time was found between BRAF mutation positive and BRAF mutation negative patients (P. 005) after a mean follow‐up of 60.2 months (range 10‐228).ConclusionOur results indicate that BRAF mutation identifies a subset of PTC with increased risk of recurrence. The presence of BRAF mutation might be a valuable diagnostic and prognostic marker of the disease. In order to confirm the diagnostic usefulness of this marker, further studies should be carried out.
Racial and Ethnic Diversity of US Otolaryngology Residents
Authors: Schwartz Joseph S. , Nguyen Lily H. P. 
Published: February 2015

ObjectiveRacial and ethnic minorities constitute a growing portion of the US population including the medical profession. The purpose of this study was to examine the evolution of racial and ethnic diversity in US otolaryngology residency programs and to compare it to minority representation in other surgical and non‐surgical residency programs.MethodInformation concerning minority representation in US residency programs was obtained from annually published Graduate Medical Education reports by the Journal of the American Medical Association from 1980 to 2010. The diversity of otolaryngology residents was then compared to other medical fields (general surgery, family medicine, and internal medicine).ResultsOverall, minority representation among US medical residents increased dramatically from 1980 to 2010 (20% to 43.9%). However, otolaryngology residents remain a less diverse group with only 29% minority representation in 2010. In contrast to other residency programs compared, African American (AA) and Hispanic (H) representation were consistently underrepresented among otolaryngology residents (AA = 3.1%, H = 4.3%) relative to all residents (AA = 5.7%, H = 6.4%) in recent years.ConclusionDespite rising racial and ethnic diversity among medical residents in general, minority representation in US otolaryngology residency programs is lagging. This finding is in contrast to rising trends of diversity within other residency programs including general surgery.
Endoscopic Endonasal Nasopharyngectomy in Selected Cancers
Authors: Turri‐Zanoni Mario , Battaglia Paolo , Villaret Andrea Bolzoni , Gallo Stefania , Nicolai Piero , Castelnuovo Paolo 
Published: February 2015

Objective1) To describe the different surgical techniques for nasopharyngeal endoscopic resection (NER) and 2) to support the efficacy of the endoscopic endonasal approach in the management of selected primary and locally recurrent nasopharyngeal tumors (NPTs).MethodNER was tailored to the NPT extension and classified as follows: type‐1‐NER, resection of the posterior nasopharyngeal wall; type‐2‐NER, resection superiorly extended to the sphenoid; type‐3‐NER, transpterygoid approach to the postero‐lateral nasopharyx with removal of pterygoid plates and Eustachian tube, under control of parapharyngeal‐petrous‐cavernous segments of the internal carotid artery.ResultsFrom 1997 to 2011, 36 consecutive patients with primary (9 cases) or locally recurrent (27 cases) NPTs underwent an NER with curative intent. The lesions were staged (7th edition AJCC staging system) as follows: stage‐I, 16 (44.4%); stage‐II, 3 (8.3%); stage‐III, 13 (36.1%); and stage‐IVA, 4 (11.1%). Type‐1‐NER was performed in 6 cases, type‐2‐NER in 12, type‐3‐NER in 16, and bilateral extended type‐3‐NER in 2. No perioperative mortality or complications were observed. Postoperatively, 11 patients received intensity‐modulated radiation therapy, with or without chemotherapy. Follow‐up ranged from 2 to 173 months (mean, 38 months). Five years overall, disease‐specific and disease‐free survivals were 75.1 ± 9.13, 80.9 ± 7.79, and 58.1 ± 14.8, respectively.ConclusionNER is a safe, feasible, and minimally invasive surgical approach to manage selected primary and locally recurrent NPTs. Our preliminary outcomes are promising, with local control rates comparable to those of conventional open procedures. Larger case series and longer follow‐up are needed to validate the reproducibility and efficacy of the technique.
Hemorrhage after Transoral Robotic Assisted Surgery
Authors: Asher Scott A. , White Hilliary N. , Kejner Alexandra E. , Rosenthal Eben L. , Carroll William R. , Magnuson J. Scott 
Published: February 2015

ObjectiveAn increasing rate of head and neck surgeons have begun to utilize transoral robotic assisted surgery, as it is technically feasible and has acceptable safety levels. Our objective was to examine the postoperative bleeding complications we have encountered to determine risk factors and to discuss the topic of hemorrhage control.MethodMedical records were reviewed in 147 consecutive patients undergoing transoral robotic assisted surgery for any indication at one tertiary academic medical center between March 2007 and September 2011.ResultsEleven of 147 (7.5%) patients undergoing transoral robotic assisted surgery experienced some degree of postoperative hemorrhage, with 9 patients taken back to the operative room for examination and/or control of bleeding. Bleeding occurred at a mean of 11.1 days after the initial operation. Eight of 11 (72%) patients that bled were on antithrombotic medication (anticoagulants or antiplatelet agents) for other medical comorbidities. Postoperative hemorrhage in patients taking antithrombotic medication (8/48 patients = 17%) was significantly higher than in those not taking antithrombotics (3/99 patients = 3%), P =. 0057. There was no significant difference in patients undergoing primary (8/118 = 6.8%) or salvage (3/29 = 10.3%) surgery.ConclusionPotential for postoperative bleeding in association with antithrombotic medications in patients undergoing transoral robotic assisted surgery should be recognized. Indications for antithrombic medication in this patient population should be highly scrutinized and tightly regulated in the perioperative period.
Vocal Rehabilitation after Radiotherapy for Laryngeal Cancer—Pilot Study
Authors: Tuomi Lisa , Björkner Eva 
Published: February 2015

ObjectiveLearning more about to what extent voice therapy with a speech‐language pathologist is an effective method for improved vocal function for patients with laryngeal cancer. Results from self‐evalutation forms as well as temporal and acoustical measures will be presented. The pilot participants are selected from a larger longitudinal study.MethodTwenty patients were randomized to vocal rehabilitation (VRG) or to a control group (CG). Text reading and sustained vowel production, S‐SECEL (The Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer) and vocal fatigue were recorded pre‐ and post‐voice therapy, 1 and 6 months after radiotherapy.ResultsMaximum phonation time increased for CG and decreased for VRG, but was longer than for CG. Vocal fatigue, assessed on a VA‐scale, as well as mean F0 decreased for both groups. Mean values of the total S‐SECEL score increased for CG and decreased with 16.7% for VRG indicating a better vocal function. For CG shimmer increased with 0.03 dB and decreased for VRG with 0.13 dB, indicating an improved voice quality. Mean harmonic‐to‐noise ratio improved for VRG while it deteriorated for CG.ConclusionOur results correspond with earlier studies on voice rehabilitation, showing an improved self‐evaluated communication (S‐SECEL) for VRG, which is also shown in the acoustic measures of voice quality. However, the expected result, with a more pronounced improvement for VRG in most dimensions is not supported.
sLeX Relationship with Head and Neck Cancer Stem Cells CSC
Authors: Papagerakis Silvana 
Published: February 2015

ObjectiveDisseminated head and neck cancer is still considered incurable, as therapeutic options for advanced metastatic head and neck squamous cell carcinomas (HNSCC) are limited. It is not known if CSCs are the metastatic population, nor how they carry out the metastatic process. Our previous studies indicated that metastatic HNSCC express high levels of an endothelial adhesion molecule, Sialyl‐Lewis‐X (sLeX, the main E‐selectin ligand) with a critical role in the initiation of the metastatic dissemination, and that CSCs are significantly more motile and migratory. This study addresses important unknowns about the sLeX relationship with CSC.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 comparatively with known CSC markers. HNSCC‐derived sLeX‐positive cells were injected in the flank of immunodeficient mice to evaluate their tumorigenic potential. Preparations of the cultured cells, and tumor specimens were immunohistochemically stained for sLeX and CSC markers.ResultsHNSCC originating from oral cavity expressed high sLeX that increased with advanced stage and poorer clinical outcomes. A small subpopulation of the sLeX positive cells was also positive for CCS markers. Flank injections of sLeX‐positive tumor cells developed SCC in immunodeficient mice. sLeX‐positive murine primary and metastatic tumors were also positive for CSC markers.ConclusionThese studies suggest that sLeX could serve as a biomarker for CSC metastatic potential and provide foundation for the design of novel therapeutic approaches, resulting in improvement of HNSCC management and patient outcome.