bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Tumor Size and Margins due to Specimen Processing
Authors: Mills Jonathan C. , Critchlow William A. , Renner Gregory J. 
Published: February 2015

Objective1) Identify and quantify changes that occur in tumor size and tumor‐free margins between surgical resection and gross pathologic analysis of oral cavity squamous cell carcinoma specimens. 2) Determine the extent to which these changes occur before or after tissue fixation in formalin.MethodPreliminary analysis of this ongoing prospective study is presented. Patients with oral cavity squamous cell carcinoma undergoing surgical resection were included. Mucosal reference points were marked with sutures, representing tumor diameter and 2 separate resection margins. Measurements were recorded immediately before resection, after resection, and after fixation in formalin.ResultsSpecimens from 16 patients were examined. From before resection to after formalin fixation, tumor size decreased by a mean of 3.05 mm (95% CI 0.54‐5.56 mm), an 11.2% reduction, P =. 02. Most of this decrease (mean, 1.94 mm, 95% CI 0.04‐3.84 mm) occurred between the pre‐ and postresection measurements (before formalin fixation), P =. 046. Margins decreased by a mean of 0.84 mm (95% CI 0.12‐1.57 mm) from preresection to postfixation, an 11.2% reduction, P =. 025. All of this decrease occurred prior to formalin fixation.ConclusionPreliminary analysis suggests that mucosal dimensions of both tumor and tumor‐free margins in oral cavity squamous cell carcinoma specimens decrease between surgical resection and gross pathologic analysis. Most of this decrease occurs prior to fixation, especially for margins, and may be due to intrinsic tissue properties rather than formalin effects.
A Comparative Analysis of Immune Infiltrating Lymphocytes in a Murine Model of Oral Cancer
Authors: Judd Nancy P. , Allen Clint T. , Uppaluri Ravindra , Winkler Ashley E. 
Published: February 2015

Objective1) Understand types of infiltrating immune cells that contribute to the tumor microenvironment. 2) Understand the relative difference in immune infiltrates between aggressive and indolent tumor phenotypes in a new syngeneic model of OSCC.MethodThis research is a preclinical scientific study focusing on mouse derived oral cavity squamous cell carcinoma that was conducted over 6 months at Washington University in St Louis. This study analyzed tumor infiltrating immune cells by flow cytometry and identified individual infiltrating populations associated with either aggressive or indolent growth.ResultsIndolent growing mouse oral cancer (MOC) lines were associated with increased expression of increased MHC class I expression and increased CD8+ T‐cell infiltration into the tumor microenvironment. However, aggressive and metastatic MOC lines were associated with decreased class I expression and increased FOXP3+ CD4+ T‐cell infiltration and targeting these regulatory T‐cells delayed tumor growth in vivo.ConclusionThese data validate that key infiltrating immune cells identified here parallel findings in human head and neck cancer, making this newly developed syngeneic model a critical platform for the continued dissection of tumor‐host interactions in head and neck cancer.
Lateral Pterygoid Fracture Can Predict a Mandible Fracture
Authors: Truong Anh Q. , Strong E. Bradley , Dublin Arthur B. 
Published: February 2015

ObjectiveIsolated lateral pterygoid plate fractures on head CT imaging can serendipitously be associated with mandible fractures on subsequent maxillofacial imaging. Our objective is to understand the mechanism and to establish a protocol for the radiographic evaluation for this phenomenon.MethodWe performed a retrospective case series of 7 maxillofacial trauma patients with evidence of isolated lateral pterygoid fractures noted on CT images between 2006 and 2012 at our tertiary care institution. Subsequent maxillofacial CT images with coronal, axial, and sagittal views allowed for complete evaluation of maxillofacial trauma.ResultsSeven patients between 2006 and 2012 who sustained facial trauma were found to have isolated lateral pterygoid plate fractures. Subsequent evaluation via maxillofacial CT showed associated mandible fractures. All the patients were men with an average age of 37 years. Seven patients had an ipsilateral subcondylar fracture, 2 had a symphyseal fracture, 2 had a body fracture, and 1 had a coronoid fracture.ConclusionIsolated lateral pterygoid fractures noted on head CTs are suggestive of associated mandibular fractures. The proposed mechanism is an acute force on the mandible that is traduced through the pterygoid muscles. A dedicated maxillofacial CT may reveal an associated mandibular fracture even in the setting of negative clinical exams.
Distribution of FDG PET and CT Imaging Results after Radiation
Authors: Patel Sapna A. , Mendez Eduardo , Rajendran Joseph , Weiss Noel S. 
Published: February 2015

ObjectiveBoth FDG PET and CT imaging can evaluate for persistent or recurrent malignancy after radiation treatment. Currently, there is a paucity of information about the discrepancy rates with these modalities. We want to determine the distribution of the results of posttreatment FDG PET/CT scans and their level of concordance.MethodWe reviewed the records of 486 patients with head and neck squamous cell carcinoma who underwent a postradiation FDG PET/CT scan between 2000 to 2011. PET and CT positivity were defined as a standardized uptake value (SUV) of ≥ 3.0 and a lymph node size of ≥1 cm, respectively.ResultsSixty‐four patients in whom 80 PET/CT scans were performed were eligible. A total of 62.5% (50) of the scans were both PET and CT negative. Scans that were PET positive and CT negative comprised 16.2% (13), while 11.3% (9) were PET negative and CT positive. The remaining 10.0% (8) had positive PET and CT scans. Among those with a positive CT scan (17), 47% (8) had a positive PET scan, yet among those with a negative CT scan (63), only 20.6% (13) had a positive PET scan. The results of the 2 imaging modalities showed a fair level of agreement (kappa = 0.24).ConclusionThere is a moderate level of concordance between PET and CT imaging modalities in the postradiation setting.
Effects of Ketorolac after Free Tissue Transfer
Authors: Schleiffarth Jack R. , Pagedar Nitin A. , Van Daele Douglas J. , Bayon Rodrigo , Chang Kristi E. 
Published: February 2015

Objective1) Describe the effect on postoperative pain and narcotic requirements in patients receiving ketorolac as an antiplatelet agent after head and neck free tissue transfer. 2) Assess for bleeding complications in patients receiving ketorolac.MethodWe identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2011. A subset of patients received ketorolac as an antiplatelet agent at the discretion of the attending surgeon. Postoperative analgesic use, pain scores, and bleeding complications were compared.ResultsWe identified 88 free tissue transfers, with 25 procedures in the ketorolac cohort. Patients in the nonketorolac group received a higher dose of aspirin (198.7 mg/d vs 26.2 mg/d, P <. 0001). In the first 10 postoperative days, patients in the ketorolac and nonketorolac cohorts received equivalent narcotic doses (morphine equivalents, 49.4 mg/d vs 44.4 mg/d, P =. 45). The ketorolac group reported higher pain scores (2.9 vs 2.1, P =. 002), still significant after correcting for the effect of bone flaps. Ketorolac use was not associated with need for transfusion (P =. 66). Reexploration rates, length of hospitalization, and days with neck drains were not different.ConclusionKetorolac did not demonstrate a significant analgesic effect in this group of patients. However, there also was no evidence to suggest a higher likelihood of bleeding complications or prolonged need for suction drains. Ketorolac may be safely used as an antiplatelet agent, with narcotic requirements unchanged.
Endoscopic Benign Neck Mass Excision without Cervical Scar
Authors: Koh Yoon Woo , Lee Hyoung Shin , Kim Won Shik , Shin Yoo Seob , Hong HyunJun , Choi Hong‐Shik , Choi Eun Chang 
Published: February 2015

ObjectiveConventional transcervical approach leaves a visible scar on the neck, regardless of the size of the incision. The aim of this study was to determine the safety and feasibility of a transaxillary or retroauricular approach for the excision of benign neck masses by comparing it to the conventional open approach.MethodWe prospectively compared the outcomes of endoscopic removal of benign neck lesions with the outcomes of conventional open surgery. Transaxillary approach was chosen for lesions mainly located in level III to V and the perithyroidal area and retroauricular approach was chosen for those located in level I or II area.ResultsOperation was successful in all patients in endo group without any significant intraoperative complications or conversion to open surgery. The operating time in the endo group was longer than in the conventional group (P =. 010). The total amount (P =. 689) and duration (P =. 325) of drain between the 2 groups showed no significant difference. The mean duration of hospital stay was also comparable between the groups (P =.129). No significant difference was observed in the overall perioperative complications between the 2 groups. Cosmetic satisfaction evaluated with the graded scale showed much better results in the endo group (P =. 000).ConclusionEndoscopic resection via the transaxillary or retroauricular approach is safe and feasible for various benign cervical lesions with excellent cosmetic results.
Do Residency Applicant Measures Predict Future Performance?
Authors: Shonka David C. , Christophel John J. , Kesser Bradley W. 
Published: February 2015

ObjectiveTo determine if residency applicant measures are predictive of resident performance.MethodA retrospective review of the residents graduating from 2006‐2012 was performed. Residency applicant measures including board scores, medical school grades, and applicant rank were recorded. These were compared to measures of resident performance including otolaryngology training exam (OTE) scores and composite 360° evaluation scores obtained during the final year of residency.ResultsData was available on 20 residents. Residency applicant board scores were minimally predictive of resident OTE scores during the final year of residency (r2 = 0.377). There was no significant correlation between board scores and performance on evaluations (r2 = 0.10). Grade received during the surgical clerkship had an inverse correlation with performance on the OTE (r2 = 0.13). The surgical clerkship grade also had no correlation with evaluation score (r2 = 0.04). Most notably, applicant rank had minimal correlation with final resident performance as measured by composite evaluation score (r2 = 0.06).ConclusionCommonly used measures of applicant quality are minimally predictive of ultimate resident performance. Further studies are indicated to identify better predictors of resident performance.
Effects of a Reward System on Resident Academic Productivity
Authors: Mills Jonathan C. , Chang C. W. David 
Published: February 2015

Objective1) Implement a reward system that positively promotes academic productivity amongst otolaryngology residents. 2) Evaluate outcomes of the reward system with regards to resident academic output.MethodResidents earn points for completing various steps of a research project. Points may be redeemed for academic endeavors, including books, equipment, and travel expenses. Resident publications submitted between 7/1/1997 and 6/30/2011 were reviewed. This timeframe included equal periods before and after implementation of the reward system, which occurred in 2004.ResultsThe reward system was well‐utilized, with median annual points earned per resident of 850 (range 0‐3670). Forty‐nine resident authors on 40 unique publications were identified. Mean resident publications per year increased from 1.67 prior to the reward system to 5.57 after implementation of the reward system, P =. 01. After implementation of the reward system, a significantly higher percentage of resident publications were of the case report type (10% before and 85% after, P <. 001).ConclusionThe reward system is well‐utilized by otolaryngology residents at our institution. One measure of academic achievement—number of publications—increased after implementing the reward system. These data suggest that this system may be effectively encouraging resident research, but may have the unintended effect of skewing publication output toward case reports.
Are Those Who Seek Rhinoplasty Really More Depressed?
Authors: Naraghi Mohsen 
Published: February 2015

Objective1) To study whether the prevalence of depression in rhinoplasty candidates is more than the patients of non‐cosmetic surgeries. 2) To define the importance of depression screening as a factor in rhinoplasty patient selection.MethodThe Beck depression inventory has been used to screen the state of depression in both patients seeking rhinoplasty and those who were supposed to undertake routine non‐cosmetic otorhinolaryngologic surgeries in the same hospital. 45 patients in each group were evaluated, and the results were analyzed through chi‐square and Student t tests.ResultsOverall 54.4% of patients were female and 45.6% were male, among which 62% of females were in the rhinoplasty group (p:0.02). The mean age in the rhinoplasty group was at least 1 decade younger than the patients undertaking non‐cosmetic surgeries (24.89 vs 36.27). Six rhinoplasty patients and 3 non‐cosmetic surgery patients were categorized in the mild depression group (P: 0.39). None of the patients seeking rhinoplasty were scored as having moderate and severe depression, while 2 patients of noncosmetic surgeries were categorized in these groups.ConclusionDespite the existing social image of a large prevalence of depressive symptoms in rhinoplasty seekers, which would lead to the terms of concern about the operation result, patients undertaking rhinoplasty, both males and females, seem to be as depressed as other patients of the same socioeconomic status.
Systemic Chemotherapy with Loco‐regional Radiotherapy
Authors: Chen Ming‐Yuan 
Published: February 2015

ObjectiveSystemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma at diagnosis (mNPC), but radiotherapy for primary tumor and its regional lymph nodes (loco‐regional radiotherapy, LR‐RT) is not routinely advocated. In current study, we evaluate the impact of LR‐RT on survival of patients with mNPC.MethodA retrospective review of 385 mNPC patients at diagnosis recorded at San Yat‐Sen University Cancer Center between 2001 and 2009. We compared mortality risks between patients who underwent different anticancer treatments including systemic chemotherapy, LR‐RT, and local treatment of metastasis, alone or in combination, adjusted these risks for prognostic factors.ResultsHowever, it presented a 50% reduced risk of death compared to those without any anticancer treatment (HR, 0.5; 95% CI, 0.2 to 1.0; P =. 044) and 140% increase of death risk compared with those who underwent combination treatment of systemic chemotherapy and LR‐RT (HR, 2.4; 95% CI, 1.3 to 4.5; P =. 004). With analysis in the subgroup of patients who received combination treatment (n = 176), induction chemotherapy and LR‐RT with high dose (≥66Gy) showed significant lower risk of death compared to concurrent and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.3 to 0.7; P =. 001) and low‐dose radiation (<66Gy) (HR, 0.6; 95% CI, 0.3 to 1.0; P =. 033).ConclusionLR‐RT, particularly combined with systemic chemotherapy, improves survival of patients with mNPC at diagnosis. High dose LR‐RT combined with induction chemotherapy is advocated based on current data. However, well‐designed prospective studies are expected to further evaluate the impact of LR‐RT.
The Esophageal Branches of the Recurrent Laryngeal Nerve
Authors: Espinel Alexandra G. , Sadeghi Nader , Goodman Joseph F. 
Published: February 2015

Objective1) To identify and define the cervical esophageal branches (CEB) of the recurrent laryngeal nerve (RLN), in vivo. 2) To study the feasibility of positively identifying the nonlaryngeal, distinct cervical esophageal branches of the RLN during thyroid surgery.MethodProspective and in vivo study of the CEB of the RLN, in a tertiary academic center. Inraoperative RLN monitoring was used. RLN and its cervical esophageal branches were identified visually. Nerve stimulation coupled with monitoring of the action potentials from the RLN, and direct observation of the cervical esophageal contractions were used for nerve confirmation.ResultsFifty‐one RLNs (25 right and 26 left) were dissected in 31 patients undergoing thyroidectomy. In 17/25 (68%) right RLNs and 20/26 (77%) left RLNs, 1 or more distinct branches of the RLN to the cervical esophagus was identified and confirmed by nerve stimulation. These branches were distinct from the laryngeal branches of the RLN confirmed by direct visualization of esophageal contractions and laryngeal action potentials produced by nerve stimulation at different positions of the RLN and CEB. Overall, in 73% of all RLNs examined, functional esophageal branches could be identified.ConclusionAlthough the cervical esophageal branches of the RLN are well described in the basic anatomic literature, it is not referenced in thyroid surgery literature. It is important for the thyroid surgeon to be aware of these branches and preserve them, as they likely play an important role in swallowing.
The Expression of Activin Receptor‐like Kinase 1 in HNSCC
Authors: Chien Chih‐Yen 
Published: February 2015

ObjectiveWe investigated the expression and clinical significance of activin receptor‐like kinase 1 (ACVRL1) in patients with head and neck squamous cell carcinoma (HNSCC).MethodPatients diagnosed with HNSCC (n = 169) underwent surgical resection followed by radiotherapy and/or chemotherapy for aggressive tumors between November 2000 and March 2004. ACVRL1 expression was assessed using quantitative reverse‐transcription polymerase chain reaction and immunohistochemistry approaches by tissue microarray.ResultsHigh levels of ACVRL1 expression were significantly correlated with advanced T classification, positive N classification, advanced TNM stage, lymphovascular invasion, and extracapsular spread of lymph node. A poor 5‐year overall survival rate was associated with high ACVRL1 expression (P =. 0001), advanced T classification (P =. 0075), positive N classification (P =. 0024), advanced TNM stage (P =. 0077), and extracapsular spread of lymph node (P =. 0002), but a multivariate analysis using Cox’s regression model revealed that the only independent prognostic factors for survival were ACVRL1 expression (P =. 002) and ECS (P =. 007).ConclusionACVRL1 is not only an important prognostic factor but also contributes to the development of new therapeutic strategies in HNSCC patients.
Ultrasound for Localization in Primary Hyperparathyroidism
Authors: Smith Russell B. , Zitsch Robert P. , Evasovich Maria , Pagedar Nitin A. , Girod Douglas A. , Jorgensen Jeffrey B. 
Published: February 2015

ObjectiveMinimally invasive surgery for primary hyperparathyroidism has gained significant popularity. Preoperative localization is required, with ultrasonography and sestamibi imaging being most commonly utilized. When both are obtained, frequently the same site is localized. It is unclear that 2 localization techniques are required in patients with hyperparathyroidism.MethodProspectively collected data from the Midwest Head and Neck Cancer Consortium’s parathyroid protocol was retrospectively reviewed. The study included patients that had preoperative localization and subsequently underwent surgery. The localization studies were correlated to surgical findings.ResultsOf the 96 patients, preoperative US, sestamibi, or both studies were obtained in 77, 88, and 71, respectively. Preoperative US and sestamibi localized an abnormality in 69% and 80%, respectively. In patients with localizing US, surgical findings were exactly as predicted in 75% and localized to the correct side in 84%. The accuracy of localization was similar for sestamibi imaging. In 8 patients with inaccurate US localization, the sestamibi detected an abnormal gland in only 50%. In patients with a nonlocalizing US, sestamibi was able to detect disease in 75%, with 2 being in the mediastinum.ConclusionGiven the lower cost of ultrasonography, it is an acceptable initial localization study for patients with primary hyperparathyroidism. In patients with nonlocalizing ultrasound, sestamibi imaging should be obtained. Frequently potential sites of disease will be identified, still allowing for a minimally invasive surgical approach.
Vanderbilt’s Experience with 201 Carotid Body Tumors
Authors: Netterville James L. , Kuwada Clinton A. , Schmalbach Cecelia E. , Zender Chad A. , Van Deusen Mark B. , Athavale Sanjay , Sinard Robert J. 
Published: February 2015

ObjectiveTo discuss the evolving treatment considerations of carotid body tumors (CBT) based on a large cohort.MethodA retrospective review of 149 patients with 201 CBT treated at Vanderbilt University’s Dept. of Otolaryngology over a 25‐year period (1986‐2011). Patients were analyzed for preoperative deficits, familial involvement, progression under observation, operative details, and postoperative sequelae.ResultsBilateral CBTs were identified in 44%, associated vagal paragangliomas in 26%, and jugular tumors in 22% of patients. Familial inheritance was noted in 35%. A total of 163 tumors were resected from 139 patients. Preoperative embolization was utilized in 33% of tumors. Internal carotid resection‐reconstruction was performed in 13%. No postoperative strokes occurred. Postoperative cranial nerve dysfunction was rare. Of patients who underwent staged resection of bilateral CBTs, 73% experienced baroreflex failure. Although transient mild first bite syndrome was common, only 30% of patients had ongoing significant symptoms. No recurrence has been noted from the CBTs resected at Vanderbilt.ConclusionManagement of CBTs requires consideration of familial inheritance and potential for multiple paraganglioma. We believe the primary treatment of CBT should remain surgical resection, which can be performed with curative intent with minimal morbidity. Slow growth patterns in paragangliomas makes temporary or long‐term observation a treatment option in selected patients.