bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor Functional Performance following Bidirectional Dilatation of Severe Postradiation Esophageal Stricture
Authors: Gavriel Haim , Chowdhury Aqiq T. , Duong Cuong , Spillane John , Sizeland Andrew 
Published: September 2014

Objectives:Assess the efficacy of bidirectional esophageal dilatation in the severely strictured esophagus induced by radiation therapy following the treatment of head and neck malignancies.Methods:Retrospective analysis of 5 patients who underwent bidirectional esophageal dilatation for esophageal stricture secondary to radiation therapy for head and neck malignancies over a 5‐year period. The parameters of the primary tumor, evaluation of preoperative and postoperative esophageal dysfunction, and complications of the procedure were evaluated to assess its efficacy.Results:There were 9 episodes of bidirectional dilatation among 5 patients, 3 males and 2 females with a mean age of 63 years. Complete obstruction was demonstrated in 4 patients and severe obstruction was found in one patient during preoperative evaluation. The procedure was uneventful in all but 1 who was found to have postoperative mediastinitis due to microperforations, and healed completely. Four patients had persistent dysphagic symptoms despite post‐dilatation video fluoroscopy failing to reveal any significant narrowing of the esophageal lumen.Conclusions:Combined anterograde and retrograde dilatation of severe chemoradiation‐induced esophageal strictures is efficacious in improving luminal patency but ineffective in relieving functional dysphagia.
Predictors of Nondiagnostic Cytology in Surgeon‐Performed Fine‐Needle Aspiration Biopsy of Thyroid Nodules
Authors: Isaac Andre , Jeffery Caroline C. , Al‐Marzouki Hani , Harris Jeffrey R. , Seikaly Hadi , O'Connell Daniel A. 
Published: September 2014

Objectives:(1) List the factors that are predictive of non‐diagnostic cytology in surgeon‐performed ultrasound‐guided fine‐needle aspiration (FNA) of thyroid nodules. (2) Describe a patient cohort that may benefit from early referral to other clinicians.Methods:Retrospective chart review. Patients included all adults who underwent thyroid nodule FNA by a staff, fellow, or resident otolaryngologist at our center between January 2011 and June 2013. Cytology was interpreted by a staff cytopathologist according to the Bethesda classification system. The predictive factors analyzed were patient age, sex, body mass index (BMI), thyroid gland size, thyroid function, presence of multinodular goiter, presence of Graves’ disease or thyroiditis, nodule size, location, vascularity, echogenicity, calcifications, cystic component, level of performer training, and level of FNA experience. Results were analyzed using chi‐squared, Fisher exact test, or unpaired t test.Results:A total of 190 patients were reviewed, for a total of 301 nodules. The average age was 53 years, with an 88% female predominance. The overall nondiagnostic rate was 23%. Nodules with a predominant cystic component and those less than 1 cm were more likely to yield nondiagnostic cytology (P =. 04, P =. 05, respectively). FNA performed by a trainee with experience of less than 50 FNA were also more likely to yield nondiagnostic cytology (P =. 04). No other factors significantly influenced the nondiagnostic rate.Conclusions:Cystic nodules and nodules less than 1 cm are more likely to yield non‐diagnostic cytology in surgeon‐performed thyroid FNA. Caution should be used in trainee‐performed FNA for which the nondiagnostic risk is high. These patients may benefit from early referral to other clinicians.
Primary Placement of a 16 French Voice Prosthesis at the Time of Tracheoesophageal Voice Restoration
Authors: Naunheim Matthew R. , Remenschneider Aaron K. , Bunting Glenn W. , Deschler Daniel G. 
Published: September 2014

Objectives:Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and secondary prosthesis placement. Successful primary prosthesis placement at the time of primary or secondary puncture using a 20 French prosthesis has been previously described. We now wish to evaluate whether 16 French prostheses can be used safely and effectively.Methods:All cases of primary 16 French tracheoesophageal voice prosthesis (TEVP) placements at a large academic medical center were retrospectively reviewed from January 2011 through December 2013. Perioperative complications attributable to device placement were recorded. These included inability to place prosthesis during procedure, intraoperative issues with primary placement, postoperative infection, prosthesis dislodgement, leakage around/through the prosthesis, or inability to obtain voice.Results:Twenty‐two patients received primary placement of a 16 French TEVP. All prostheses were successfully placed, and there were no intraoperative complications. Approximately 18% of patients had a postoperative complication, including leakage through the prosthesis (3 of 22) and prosthesis displacement (1 of 22). These were addressed with prosthesis change and replacement, respectively.Conclusions:Placement of 16 French TEVPs is effective and safe, with a low rate of complication directly attributable to the prosthesis itself. Therefore, a smaller prosthesis may be primarily placed at the time of TEVR and is preferred over the previously described 20 French prosthesis.
Prognostic Factors Associated with Survival in Recurrent Oral Cavity Squamous Cell Carcinoma
Authors: Ali Syed A. , Schuller David E. , Ozer Enver , Carrau Ricardo L. , Agrawal Amit , Teknos Theodoros N. , Old Matthew O. 
Published: September 2014

Objectives:(1) Analyze the prognostic factors implicated in survival of patients with recurrent oral cavity squamous cell carcinoma (SCC). (2) Highlight the poor salvage and overall survival rates in this patient population.Methods:Between 1997 and 2006, 235 patients with oral cavity SCC were identified, of which 85 experienced recurrences. Overall survival and prognostic factors were analyzed, including epidemiologic, tumor‐specific factors, and surgical outcomes.Results:Eighty‐five of 235 patients experienced recurrence of their primary oral cavity SCC. Only 8 (9.4%) patients have survived, with follow‐up ranging from 8 to 14 years. Six of the surviving patients had tongue primaries, while the other 2 had buccal mucosa and hard palate primaries. All 8 surviving patients were staged T1 (1) or T2 (7) and were N0 (6), N1 (1), or N2b (1). Among deceased patients, 9 (11.7%) were staged T3 and 16 (20.1%) T4. Tumor volume (cm3) also varied greatly between surviving (3.97) and deceased (22.14) patients.Conclusions:Salvage surgery in oral cavity patients remains a difficult clinical problem and our long‐term analysis of these patients reveals that most do not survive. Those who survive have lower initial tumor stage, less nodal disease, and smaller tumor volume than the deceased patient group. This data highlights the poor prognosis of these patients and the dire need of different strategies to improve outcomes.
Immediate Endosseous Dental Implant Placement in Osteocutaneous Radial Forearm Free Flap
Authors: Moneta Lauren B. , Peck Jessica J. , Eftekhari Siavash , Petrisor Daniel , Wax Mark K. 
Published: September 2014

Objectives:(1) Analyze the advantages and disadvantages of immediate endosseous dental reconstruction using osteocutaneous radial forearm free flap (OCRFFF). (2) Describe the “double barrel” technique for dental reconstruction following OCRFFF.Methods:A 61‐year‐old man with previous hard palate squamous cell carcinoma (SCC) and fibula flap reconstruction complicated by osteoradionecrosis then underwent OCRFFF for secondary reconstruction of the maxilla using the “double barrel” technique. The Straumann system was used to immediately place 3 endosseus implants in the radial bone graft and one in the previously bone‐grafted site. The purpose of this case report is to evaluate the methodology and outcome of immediate dental reconstruction with endosseous implants into an OCRFFF, which is traditionally thought to be an unsuitable graft for dental implants because of inadequate bone thickness. Outcome measures include hardware stability, aesthetics, and function. Aesthetics and function were subjectively measured through patient and surgeon satisfaction. Additionally, hardware stability was measured through follow‐up imaging studies and functionality.Results:Both patients and physicians concluded positive functional and aesthetic outcomes using this reconstruction technique.Conclusions:Use of a double‐barrel technique harvest of an OCRFFF provides adequate bone for immediate endosseus dental implants with improved aesthetic and functional outcomes over other reconstructive techniques.
Prognostic Implications of Intraoperative Radiography of Thyroidectomy Specimens
Authors: Frank Robert , Fitzgerald Ryan , Bodenner Donald L. , Stack Brendan C. 
Published: September 2014

Objectives:(1) Analyze radiographic findings of thyroidectomy specimens. (2) Correlate intraoperative radiography to preoperative ultrasound and its guided fine‐needle aspiration biopsy, intraoperative impression, and final pathology. (3) Describe a new intraoperative tool to help identify malignant characteristics of thyroid tissue.Methods:Prospective study comprised of consecutive patients undergoing hemi‐ or total thyroidectomy in a tertiary referral center. This is an ongoing study of patients treated from the months of November 2013 to June 2014. After obtaining ultrasound‐guided fine needle aspiration biopsies that were indeterminate or confirmed malignancy, all patients received either a hemi‐ or total thyroidectomy. Prior to pathologic processing, the specimens were passed off the field and underwent intraoperative specimen radiography (IOSR) by the Faxitron Biovision (Tucson, Arizona), generating a plain radiograph. Radiographic characteristics were analyzed by a surgeon and radiologist and correlated with final pathologic diagnosis. Sensitivity, specificity, positive and negative predictive value, and accuracy of IOSR with regard to final pathology will be reported.Results:Adequacy of resection of tumors and the presence of microcalcifications are features assessed by IOSR which, when compared with a pathology gold standard, may allow for a intraoperative decision regarding surgery. This technology may reliably detect multifocal microcarcinomas, another indication for total thyroidectomy. This approach may reduce the number of diagnostic hemi‐thyroidectomies that require a later completion thyroidectomy.Conclusions:Intraoperative plain film radiography may be an effective tool in the risk stratification of thyroid specimens and could be used as an adjunctive measure to reduce the need of delayed completion thyroidectomy, depending upon permanent pathology.
Surgical Technique for Preservation of Inferior Parathyroid Gland
Authors: Park Young Min , Shin Sung Chan , Lee Won Yong , Lee Jin‐Choon , Wang Soo‐Geun , Lee Byung‐Joo 
Published: September 2014

Objectives:The inferior parathyroid glands receive blood supply from the inferior thyroid artery. The anatomic relationship of the inferior thyroid artery and recurrent laryngeal nerve (RLN) can be described in 3 different patterns. We reconsidered the anatomic relationship of these structures and mentioned the method to maintain vascular supply of inferior parathyroid gland during central neck dissection (CND) according to their anatomical relationship.Methods:For removal of fibrofatty tissue in central neck compartment, dissection proceeds along RLN. During the process, surgeons should be careful not to injure the inferior parathyroid gland.Results:To preserve the inferior parathyroid gland, dissection should proceed along RLN in the medial side of inferior parathyroid gland, if inferior parathyroid gland usually receives blood supply from posterolateral vascular pedicle. In cases in which inferior thyroid artery travels deep to right RLN and right parathyroid gland receives blood supply from posteromedial vascular pedicle, CND should be carefully performed along the lateral side of inferior parathyroid gland to preserve posteromedial vascular pedicle.Conclusions:To preserve the function of inferior parathyroid gland, the anatomical relationship between inferior thyroid artery and RLN should be understood. The direction of dissection along the RLN should be changed according to their anatomical pattern.
Therapeutic Decision Making of the Unilateral Vocal Cord Palsy after Thyroidectomy Using Thyroidectomy‐Related Voice Questionnaire
Authors: Chun Byung‐Joon , Park Jun‐Ook , Nam Inn‐Chul , Kim Chung‐Soo , Cho Kwang‐Jae , Park Young‐Hak , Sun Dong‐Il 
Published: September 2014

Objectives:Investigate the efficacy of early management of post‐thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy‐related voice questionnaire (TVQ) when planning UVCP treatment.Methods:The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre‐thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post‐thyroidectomy. Twenty‐five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure.Results:The average total TVQ scores 2 weeks afterthyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (P <. 01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post‐intervention (P <. 01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cutoff distinguishing the 2 groups was 45 (68.0% sensitivity, 78.3% specificity).Conclusions:Early management following timely diagnosis of post‐thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.
Use of Mohs Technique and Immediate Reconstruction for Advanced Head and Neck Cutaneous Squamous Cell Carcinoma
Authors: Sumiyoshi Mika , Cruz Raul M. , Iaquinta Salvatore 
Published: September 2014

Objectives:(1) Report the outcome of patients with cutaneous squamous cell carcinoma (SCCs) of the head and neck treated with Mohs micrographic surgery in the operating room. (2) Describe the method and benefits of a single operation for extirpation of cutaneous SCC and reconstruction in the operating room with the use of intraoperative Mohs margins.Methods:A total of 104 patients with cutaneous SCCs of the head and neck were retrospectively reviewed in a single‐center retrospective study, considering recurrence, metastasis, and death between January 2002 and December 2008. The secondary aim was to describe the demographic and tumor characteristics, type of closure of defect, adjuvant therapies, immunocompromised status, bony or perineural invasion, and regional and local recurrence of SCC cases.Results:Twenty‐one (20%) of the lesions were recurrent SCC. Ten (10%) patients had bony or perineural invasion. Additional extirpative procedures performed by the head and neck surgeons included 8 bone excisions (8%), 2 parotidectomies and neck dissections (2%). Eleven percent had local and 13% had regional recurrences. Nine percent of the total patient population died of disease. Disease‐specific survival was 88%.Conclusions:Mohs micrographic surgery in the operating room for high‐risk cutaneous SCC is effective. Using Mohs technique in the operating room permits a combined extirpation and reconstruction as a single procedure. This approach combines Mohs’ proven superior ability to produce clear margins with immediate reconstruction offered by the same surgeon. This offers patients many benefits, and extirpation with forethought of reconstruction offers potential superior outcomes, reduced hospitalizations and anesthetic exposures, and patient convenience.
Usefulness of Endoscopic Screening for Synchronous Cancer in HNSCC as Initial Baseline Study
Authors: Baek Seung Jae , Suh Michelle J. , Bong Jeong Pyo 
Published: September 2014

Objectives:Determine the usefulness of endoscopic screening methods for detecting synchronous malignancies in patients with head and neck carcinoma.Methods:We retrospectively reviewed the medical records of patients who were diagnosed with head and neck mucosal squamous cell carcinoma (oral cavity, oropharynx, nasopharynx, larynx, hypopharynx) between January 2003 and July 2013 in the Department of Otorhinolaryngology, Head and Neck Surgery, Yonsei University Wonju Christian Hospital.Results:Among 285 patients who underwent esophagogastroduodenoscopy and bronchoscopy as initial baseline study, 23 synchronous cancers were diagnosed. Esophageal cancer and lung cancer were diagnosed as the most synchronous cancers (10 lesions each), followed by gastric cancer (2 lesions), and colon cancer (1 lesion). Among these 23 patients, positron emission tomography (PET) or PET/computed tomography (CT) was performed in 14 patients. Of these 14 patients, PET or PET/CT detected 7 of the synchronous cancers.Conclusions:As to their ability in detecting synchronous cancer in head and neck carcinoma, PET or PET/CT showed unsatisfactory detection rate. PET and PET/CT have limitations in the detection of superficial lesions. As initial baseline modality, PET or PET/CT needs supplementary endoscopic studies for the detection of superficial lesions.
Voice and Swallowing Outcome following Radiotherapy for Head and Neck Squamous Carcinoma of Unknown Primary
Authors: Oozeer Nashreen B. , Harrison Anna , James Allan 
Published: September 2014

Objectives:Patients with head and neck squamous cell carcinoma (HNSCC) of unknown primary present without voice or swallowing symptoms. This study aims to analyze the impact of radiotherapy on the voice and swallowing function in this subgroup of HNSCC patients.Methods:This was an original cross‐sectional study. All patients with treated HNSCC of unknown primary identified from the head and neck cancer database in August 2012 in Greater Glasgow and Clyde had their voice assessed using the Voice Symptoms Scale (VoiSS) and their swallowing function assessed using the MD Anderson Dysphagia Inventory (MDADI).Results:Questionnaires were sent to 30 patients. A 67% response rate was obtained. There were 5 females and 15 males with a mean age of 61 years (range, 49‐81 years). Six patients had no surgical intervention and oncological treatment alone. All patients were free of disease at the time of the study. The mean VoiSS score was 29.45 (range, 4‐62) and mean MDADI score was 63.94 (range, 26‐100). One patient did not complete the MDADI form so was excluded from this analysis. There was no statistically significant change in patient voice and swallowing function. There was a trend for improved function with longer duration since treatment.Conclusions:Functional assessment should form an integral part of the assessment of HNSCC patients. This cohort of patients did not have a significant voice and swallowing functional impact secondary to their treatment.
Acquired Choanal and Subglottic Stenosis Associated with MYHRE‐LAPS Syndrome: A Case Report and Literature Review
Authors: Oldenburg Michael , Frisch Christopher D. , Kirmani Salmann , Kasperbauer Jan L. , O'Brien Erin K. 
Published: September 2014

Objectives:MYHRE‐LAPS syndrome (MLS) is a recently recognized disease caused by a mutation in the SMAD4 gene that alters the transforming growth factor (TGF)–beta pathway. This results in a wide range of pathology including laryngotracheal stenosis, arthropathy, prognathism and short stature, or LAPS syndrome. We present a unique case of MLS associated with both acquired choanal stenosis (CS) as well as subglottic stenosis (SGS) and perform a systematic review of all MLS associated airway pathology.Methods:Single case reviewed via the medical record. Literature review.Results:MLS was reported in 32 patients, and 5 had clinical airway symptoms. We added the case of a 43F who presented with 9 months of progressive nasal obstruction and was found to have bilateral CS and SGS on endoscopic examination. The patient had no recent airway instrumentation but had two prior operations requiring intubation. Genetic testing revealed SMAD4 mutation consistent with MLS and Losartan was initiated to inhibit TGF‐beta signaling. Most patients with MLS develop airway symptoms as a late sequela of disease with a median onset of 22 years old. Attempts to surgically address airway stenosis invariably results in recurrence secondary to robust scar formation. All patients who have undergone surgical management of airway stenosis were tracheostomy dependent (4/4).Conclusions:MLS is a newly recognized disorder characterized by progressive systemic fibrosis. Airway management is complicated by prognathism, trismus, and limited neck extension as well as invariable restenosis of the airway after instrumentation. Caution should be exercised when surgical intervention is entertained in these patients.
Characterizing the Vocal Fold Epithelial Response to Recovery following Phonation‐Induced Trauma at the Transcriptional Level
Authors: Valenzuela Carla V. , Kojima Tsuyoshi , Greene Scott M. , Dharamsi Latif M. , Novaleski Carolyn K. , Garrett C. Gaelyn , Rousseau Bernard 
Published: September 2014

Objectives:It is unknown how acute episodes of phonotrauma affect the recovery of the vocal fold epithelial barrier. The epithelial barrier is characterized by specialized adhesive structures. Our objective was to evaluate the gene expression of junctional complex proteins and inflammatory mediators following phonation‐induced trauma in an in vivo rabbit model.Methods:Sixty‐five New Zealand white breeder rabbits were randomized to normal (n = 5), modal intensity (n = 30), or raised intensity (n = 30) phonation for 120 minutes. Larynges were harvested at 0 hours, 4 hours, 8 hours, 1 day, 3 days, or 7 days following phonation and compared with normal. Real‐time polymerase chain reaction was used to evaluate mRNA expression of occludin, zonula occluden‐1 (ZO‐1), E‐cadherin, β‐catenin, interleukin 1β (IL‐1β), cyclooxygenase‐2 (COX‐2), and transforming growth factor β‐1 (TGFβ1).Results:Both phonation groups demonstrated a down‐regulation of occludin between 8 hours and 1 day (P <. 016), and ZO‐1 levels at 3 days (P =. 08). β‐catenin and E‐cadherin demonstrated an inverse relationship at 8 hours in the modal phonation group (P =. 08). IL‐1β, COX‐2, and TGFβ1 levels peaked at 8 hours in the modal intensity group (P =. 08), with TGFβ1 peaking at day 1 in the raised intensity group (P =. 08).Conclusions:Results revealed a critical time point at 8 hours and 1 day in which most junctional complex and inflammatory markers decreased or peaked. Given the mechanical stresses that the vocal folds must withstand on a regular basis, time‐dependent changes in barrier and inflammatory gene regulation are critical to understanding vocal fold homeostasis and tissue recovery.