bluuebunny/crossref_metadata_2025_split huggingface dataset:
Olfactory Neuroblastoma: Fate of the Neck—A Long‐term Multicenter Retrospective Study
Authors: Nalavenkata Sunny B. , Adappa Nithin D. , Schlosser Rodney J. , Wang Eric W. , Woodworth Bradford A. , Smee Robert , Harvey Richard J. 
Published: September 2014

Objectives:Determine the incidence and factors influencing neck disease, at presentation and delayed, in patients with olfactory neuroblastoma.Methods:Patients with a histological diagnosis of olfactory neuroblastoma that were treated across 6 tertiary hospitals were included. Treatment modalities to primary site and neck included radiotherapy, surgery, and combinations. The status of cervical lymph node metastases at presentation and at last follow‐up was defined. Disease‐free survival (DFS) was calculated as time taken for patients to develop delayed neck disease following primary treatment of olfactory neuroblastoma. Pearson correlation, regression analysis, and Kaplan Meier plots were performed to identify risk factors for developing cervical neck metastases.Results:A total of 113 patients (46 females, 49.7 ± 13.2 years) with median follow‐up of 41.5 months (interquartile range, 58.2 months) were identified. Of the patients, 7.1% presented with primary neck disease while 8.8% of patients presented with delayed neck disease. Neck disease, both primary and delayed, was present in patients with Hyams grade II (22.2%), III (55.6%), and IV (22.2%) lesions (χ2 2 5.66, P =. 13). Histologic grade was higher in patients with primary neck disease (χ2 2 16.22, P =. 001). Positive surgical margins were associated with a higher risk of delayed neck disease compared with clear surgical margin (17.9% vs 5%, P =. 034). Five‐ and 10‐year disease‐free survival for regional neck disease was 92.4% (SE: 2.8%) and 79.6% (SE: 9.0%), respectively.Conclusions:Neck metastasis is an important clinical consideration for olfactory neuroblastoma both at presentation and in surveillance. Primary treatment of the neck could be considered in select patients.
Oral Cancer's Early Diagnosis: The Contribution of Contact Endoscopy
Authors: Santos Alberto , Galrito Marta , Barona Teresa M. , Fonseca Isabel , Papoila Ana Luísa , Salvado Francisco , Macor Carlos 
Published: September 2014

Objectives:Oral cancer has high incidence and prevalence rates. Despite the fact that the oral cavity might be easily observed, the diagnosis of oral cancer is usually done later than expected. Early diagnosis is the main oral cancer challenge to decrease morbidity and mortality. Contact endoscopy allows the assessment in vivo and in situ of epithelial cells, glandular ostia, and microvascular network (60X, 150X). The authors describe the contribution of contact endoscopy in performing real time histological diagnosis and guide biopsies in an office setting.Methods:The authors carried out a prospective double blind study (July 2012 ‐ February 2014) where diagnosis was made by contact endoscopy and histology (gold‐standard) in a population of 122 patients with oral lesions persisting without involution for 3 weeks, considering a clinical classification: benign (n = 26), premalignant (n = 83), and malignant (n = 13). Sensitivity, specificity, negative and positive predictive values, and likelihood ratios were calculated.Results:Sensitivity and specificity were superior to 95%. By the identification of the cellular and vascular heterogeneous patterns characteristic of a malignant lesion, contact endoscopy allowed the definition of real cellular margins and the detection of suspicious areas without macroscopic disease.Conclusions:In our study, contact endoscopy allowed in an office setting a precise diagnosis with similar effectiveness of histology. This noninvasive technique was revealed to be an important guide for biopsies, an easy way to define real safety surgical margins, and a good way to improve follow‐up efficiency. The authors concluded that contact endoscopy has good potential to improve oral cancer's early diagnosis.
Outcomes and Oncologic Considerations for Elective Neck Dissection in Patients Undergoing Salvage Laryngectomy
Authors: Giese Rachel A. , Vural Emre A. , Moreno Mauricio A. 
Published: September 2014

Objectives:Most patients treated with organ‐preservation schemas for laryngeal cancer have no nodal disease at the time of recurrence. The oncologic benefit of an elective neck dissection (END) in a patient with clinically N0 neck at the time of salvage laryngectomy (SL) is still controversial. We sought to determine the oncologic outcomes for END and identify predictors for pN(+) status.Methods:Retrospective chart review of 180 patients who underwent laryngectomy between 2004 and 2013 was performed. Fifty‐eight patients met inclusion criteria and the cohort was divided into 2 groups depending upon the END status. Demographics, pathology, and oncologic outcomes were compared.Results:The study was comprised of 46 (79.3%) males and 12 (20.7%) females with a mean age of 60.5 years (range, 24‐88 years; SD = 10 years). Nineteen patients (32.8%) were managed conservatively while 39 (67.2%) had END, uni‐ or bilateral. Out of a total of 71 ENDs, 5 necks in 4 patients had positive nodal disease. The only statistically significant predictor for pN(+) status was T‐stage (P =. 017). Contrary to other reports, tumor location (glottis vs. supraglottic) was not a factor. The 5‐year disease‐free survival was 53.8%, and it was significantly lower for patients who underwent an END (P =. 032).Conclusions:We found that 7% of the dissected necks had positive disease, and the only predictor for pN(+) status was tumor T‐stage. END did not improve locoregional control or survival compared to observation. Our findings suggest END is warranted in patients presenting with locally advanced recurrences, while observation might be preferable in other instances.
Outpatient Thyroid Surgery: Safety of an Optimized Protocol in More than 1000 Patients
Authors: Segel Jamie M. , Duke William S. , White Jennifer R. , Terris David J. 
Published: September 2014

Objectives:(1) Understand the principles for safe outpatient thyroid surgery. (2) Review the outcomes of outpatient thyroid surgery in a large patient cohort.Methods:A protocol for outpatient thyroidectomy was conceived and refined over 3 years. A prospective analysis of all thyroidectomies accomplished by a single surgeon using this protocol from May 2008 to November 2013 was then undertaken. Patient demographics, surgical and pathological data, admission status, and complication and readmission rates were recorded.Results:A total of 1311 thyroidectomy procedures were performed during the study period, of which 1018 (77.7 %) were conducted on an outpatient basis. The readmission rate for outpatients was 0.8%, with only 1 readmission in the last 200 procedures. Inpatients were readmitted more often than outpatients (3.9% vs 0.8%, P <. 01). Outpatient management increased steadily throughout the study period (from 59.2% to 92.8%, P <. 01), despite a larger mean nodule size and a higher rate of malignancy over time. There were no changes in the complication rate across the study timeframe except for the incidence of hypocalcemia, which decreased over time (P <. 01).Conclusions:Outpatient thyroid surgery is safe in appropriately selected patients using an optimized and systematic protocol.
Postoperative Use of Vasopressors in Head and Neck Microvascular Reconstruction
Authors: Roche Ansley M. , Sterling Michael , El‐Deiry Mark W. , Wadsworth J. Trad 
Published: September 2014

Objectives:Microvascular free tissue reconstruction is overall successful in the treatment of patients with disfiguring wounds resulting from ablative cancer resection, trauma, and osteo(radio)necrosis. Flap failure can be devastating for patients and health care providers. The use of sympathomimetic drugs (vasopressors) in microvascular surgery is controversial; however, current research fails to demonstrate adverse outcomes when intraoperative vasopressors are used. Conversely, intraoperative fluid administration greater than 7 L has been associated with major postoperative complications. The aims of the study were: (1) determine the efficacy of postoperative vasopressor use in free flap patients; (2) compare length of hospital stay in patients who receive vasopressors postoperatively and those who do not.Methods:In this retrospective pilot study, we investigated the use of a postoperative hypotension treatment protocol at our institution, implemented in June 2013. Thirty‐nine patients underwent free flap reconstruction of the head and neck secondary to malignancy. Outcome measures included flap viability and length of hospital stay.Results:Analysis of this ongoing study reveals that 23% of patients received peripherally‐active vasopressors within the first 3 postoperative days. There were no flap failures in either group. We found no statistically significant difference in the rate of surgical reexploration in patients who received vasopressors postoperatively compared to patients who did not (Fisher's exact test, P value. 12).Conclusions:The length of hospital stay is not statistically significantly different when vasopressors are used postoperatively. The implementation of a formalized hypotension treatment protocol in the postoperative setting does not adversely affect the outcome of free flap survival or length of hospital stay.
Predictive Value of Intraoperative Parathyroid Hormone for Hypocalcemia following Total Thyroidectomy
Authors: Kim David S. H. , Barber Annabel E. , Wang Robert C. 
Published: September 2014

Objectives:Investigate whether intraoperative parathyroid hormone (PTH) can predict postoperative hypocalcemia following total thyroidectomy.Methods:Cohort study with chart review of total or completion thyroidectomy patients in academic and private settings from May 2013 to February 2014. A total of 42 patients who underwent total thyroidectomy with or without central node dissection were enrolled prospectively. PTH were measured at 2 time points: preincision after induction of general anesthesia and postexcision 20 to 30 minutes following total thyroidectomy. Serum calcium was measured at midnight after surgery (6 hours) and the next morning at 6 am (12 hours). Changes in intraoperative PTH were correlated with post‐thyroidectomy serum calcium.Results:Preincision PTH did not show any correlation with 6‐hour calcium. Postexcision PTH values stratified in an interval of 50 were not associated with significantly different calcium levels (PTH 50‐99.9, Ca 8.2; 100‐149.9, 8.4; 150‐199.9, 8.2). Patients with PTH less than 50 had a decreased mean calcium at 7.7; however the reduction was not statistically significant (P =. 143). The reduction from preincision to postexcision PTH between 75% and 99.9% was associated with hypocalcemia (mean Ca 7.5; P =. 041). However, a reduction less than 75% did not yield significant decreases in calcium (percentage reduction 0% to 24.9%, Ca 8.2; 25% to 49.9%, 8.2; 50% to 74.9%, 8.2).Conclusions:Preincision PTH is not a reliable predictor of postoperative hypocalcemia. A decrease of 75% or more in PTH following total thyroidectomy is more likely to result in postoperative hypocalcemia.
Primary Surgical Excision of Venous Malformations of the Head and Neck: Subsequent Management and Outcomes
Authors: Rosenberg Tara L. , Klug Theodore D. , Tullos Amanda B. , Richter Gresham T. 
Published: September 2014

Objectives:(1) Discuss primary surgical excision of head and neck venous malformations (VMs) and possible need for subsequent therapy. (2) Describe outcomes of primary surgical excision of VMs of the head and neck.Methods:We conducted a retrospective chart review of 45 patients (23 females and 22 males) treated with primary surgical excision of head and neck VMs who presented between 2001 and 2012 to a tertiary pediatric academic institution with a multi‐disciplinary vascular anomalies center.Results:Mean age at presentation was 10.2 years, with a higher average age for female patients (11.7 years) than male patients (8.6 years). The most common anatomical subsites were the face/cheek (22.2%), neck (17.8%), and lower lip (11.1%). A majority of patients (73.3%) experienced significant improvement after the initial excision, though 42.2% of patients ultimately required subsequent treatments (either repeat excision, laser therapy, or sclerotherapy) to obtain overall disease control. The majority of patients (57.8%) required only the initial surgical excision for adequate treatment. Few patients experienced postoperative complications. The most common patient complaint was transient postoperative edema. The main outcome measures included need for subsequent treatments after excision, overall improvement (significantly decreased size or resolution of VM and decreased pain) postoperatively, and postoperative complication rate/patient complaints.Conclusions:Venous malformations of the head and neck are uncommon. However, when appropriately selected for surgical excision, most do not require subsequent treatment for disease control. We present a series of 45 patients who were treated with primary surgical excision, 57.8% of whom required no further treatment.
Facial Reanimation Technique for Facial Nerve Paralysis following Cancer Resection
Authors: Kejner Alexandra E. , Rosenthal Eben L. 
Published: September 2014

Objectives:Analyze outcomes after static sling suspension and orthodromic temporalis tendon transfer reanimation for facial nerve paralysis after definitive cancer resection with flap reconstruction.Methods:Prospectively collected case series in which patient data were collected prospectively from 2004 to 2013 for patients undergoing reconstruction and facial reanimation after resection of malignancy which involved facial nerve sacrifice. Thirty patients were selected for 2 cohorts: static sling suspension (n = 18) and orthodromic temporalis tendon transfer (n = 12). Revision rates, length of stay, complications, time to follow‐up, and postoperative symmetry were compared between the 2 groups.Results:Of the 30 patients, 18 underwent static suspension and 12 underwent temporalis tendon transfer. In the static sling group, 6 patients (33%) were advised to undergo revision compared with 2 in the temporalis tendon group (17%; P =. 31). Only 4 patients underwent revision, 3 from the static group and 1 from the temporalis transfer group. Suture size, average number of sutures used to suspend the face, timing of procedure, radiation history, and flap reconstruction played no significant role between patients requiring revision surgery and those that did not. Of the patients requiring revision in the static sling group, 33% had undergone preoperative radiotherapy compared with 0% in the temporalis tendon transfer group (P =. 35). The remaining patients either underwent adjuvant therapy or were observed.Conclusions:There was no significant difference between the reconstruction methods. Static sling was performed more commonly at time of flap reconstruction.
The Role of Modifiable Risk Factors in the Development of Thyroid Cancer
Authors: Stansifer Kyle J. , Guynan John F. , Smith Russell B. 
Published: September 2014

Objectives:Evaluate the role of modifiable patient risk factors including tobacco use, secondhand smoke exposure, alcohol consumption, and body mass index (BMI) in the development of thyroid cancer.Methods:Retrospective study comparing Midwest thyroid cancer patients from our multicenter Thyroid Tumor and Cancer Registry and Midwest controls without personal history of cancer. Descriptive statistics were created from detailed questionnaires, thyroid cancer type, and odds ratios were reported for significant associations.Results:There were 469 cancer patients and 425 controls. The thyroid cancer group included 406 papillary, 47 follicular, 13 medullary, and 3 anaplastic cancers. Comparing all cancer patients with controls, there was no association between smoking and thyroid cancer (P =. 18). Living or working with smokers was associated with increased cancer risk (odds ratio [OR] = 1.36, 95% confidence interval [CI] 1.04‐1.77). Compared with never drinking, current drinking was associated with reduced cancer risk (OR = 0.48, 95% CI 0.31‐0.75) as was consuming 1 to 2 drinks daily compared with drinking <1 drink daily (OR = 0.55, 95% CI 0.36‐0.85). Consuming >2 drinks daily was not associated with cancer risk (P = 0.26, 95% CI 0.47‐1.22). There was no association between BMI and papillary cancer, except in patients older than 45 years with a BMI >30 (OR = 1.87, 95% 1.20‐2.92).Conclusions:Our data suggest that secondhand smoke exposure is a risk factor for developing thyroid cancer and mild alcohol consumption is associated with reduced risk of developing thyroid cancer. BMI over 30 may be associated with thyroid cancer development for individuals over 45 years old.
Safety and Efficacy of Primary Tracheoesophageal Puncture and Prosthesis Fit
Authors: Momin Suhael , Llanes Daniel U. , Kmiecik Joann , Burkey Brian B. 
Published: September 2014

Objectives:Compare the safety and efficacy of primary tracheoesophageal puncture (TEP) and prosthesis fit with traditional methods, such as secondary TEP or primary TEP with catheter stenting (secondary fit).Methods:Retrospective cohort study of patients who underwent total laryngectomy with TEP between 2009 and 2013. Voice outcome was assessed as voice production at the first postoperative appointment and TEP usage at 6 months and 1 year following puncture. Perioperative emergency department visits, pharyngocutaneous fistula (PCF), and stomal breakdown were analyzed.Results:Ninety patients were included. Seventy‐three had primary TEPs, of which 32 were catheter stented and 41 were fitted primarily. The remainder (17) had secondary TEPs, of which 8 were primarily fit. Patients with primary fittings were less likely to come to the emergency department postoperatively (14% vs 39%, P <. 01). PCF rate (9.3% vs 9.7%, P =. 95) and stomal breakdown rate (12.2% vs 9.3%, P =. 7) were similar between primary vs secondary fit. There was no difference in PCF or stomal breakdown rates between primary and secondary punctures. Among patients with primary punctures, primary fit patients trended toward higher initial voice success compared with secondary fit patients (87% vs 78%, P =. 3). At 6 months and 12 months after surgery, primary fit patients also tended toward higher rates of TEP usage (6 m: 83% vs 61%, P =. 1; 12 m: 92% vs 73%, P =. 17).Conclusions:Primary TEP with primary fit represents a safe and effective approach to vocal rehabilitation following total laryngectomy.
Surgical Management of Olfactory Neuroblastoma: Outcomes and Patterns of Failure
Authors: Petruzzelli Guy J. , Origitano Thomas C. , Byrne Richard 
Published: September 2014

Objectives:(1) Analyze survival, complications, and impact of transnasal endoscopic cranial base surgery. (2) Describe time course and patterns of local, regional, and distant failure patients with olfactory neuroblastoma (ONB) of the nasal cavity, ethmoid sinus, and/or anterior skull base.Methods:Review of prospectively collected clinical data of patients treated by a single head and neck surgeon at 2 academic medical centers over 16 years.Results:Thirty‐seven patients were diagnosed with ONB confirmed by immunohistochemistry between 1996 to 2010, and 31 are available for review. There were 10 women and 21 men with a mean age of 50.9 years. Patients were treated with primary resection and no additional therapy (4), radiation therapy (24), or chemotherapy enhanced radiation therapy (3). Primary resections included open medial maxillectomy without craniotomy (n = 2), endoscopic anterior craniofacial resection (CFR) (n = 9), and open CFR (n = 20). Mean and median overall survivals were 95.95 and 80.62 months, respectively (range, 6.53 to 242 months). Operative complications were only observed in patients undergoing open CFR. Recurrences were either limited to the neck (3/11), the neck and a distant site (3/11), or distant sites alone (5/11). Time interval to the development of recurrence ranged from 3 to 186 months, and only patients with isolated recurrences could be salvaged. Intradural tumor extension correlated with recurrence but not necessarily early death.Conclusions:Margin negative resection of ONB should remain the goal of primary treatment. Long‐term follow‐up is necessary to identify patients with isolated recurrences who would benefit from aggressive salvage therapy.
Survival with Spindle Cell Carcinoma Compared to Conventional Squamous Cell Carcinoma
Authors: Bice Tristan C. , Merkley Mark A. , van der Sloot Paul G. , Newlands Shawn D. , Miller Matthew C. 
Published: September 2014

Objectives:(1) Compare survival of patients with spindle cell carcinoma variant (SpCC) to survival of patients with conventional squamous cell carcinoma (SCC). (2) Describe the impact of patient demographics and tumor characteristics on survival with SpCC.Methods:A retrospective cohort study was conducted with 18,416 cases entered into the Surveillance, Epidemiology, and End Results Program database between 2004 and 2009. Variables including age, sex, race, tumor grade, size, stage group, TNM stage, and treatment modality of 18,298 SCC patients and 118 SpCC patients were extracted and combined into oral cavity, oropharynx, and larynx sites. Characteristics and survival of SpCC and SCC patients were compared in total and at each site. The effect of variables on survival with SpCC was assessed.Results:In total, SpCC patients experienced worse survival than conventional SCC patients (P <. 05). Overall, SpCC patient mortality was worse than SCC patients within the first 3 years (P <. 05) but was not different at 5 or 10 years. Of the 3 sites, survival was only significantly worse for SpCC patients within the oropharynx site (P <. 05). Survival of SpCC patients was worse with higher stage group and TNM stage (both P <. 05), but did not differ by sex, race, or tumor grade.Conclusions:SpCC carries a worse prognosis than conventional SCC when located in the oropharynx. Survival with SpCC was associated with stage group and TNM stage, but was unaffected by sex, race, or grade.
A Swallow Preservation Protocol Improves Function for Veterans Receiving Chemoradiation for Head and Neck Cancer
Authors: Peng Kevin A. , Wu Edward C. , Unger Lindsay , Lorentz William , Wang Marilene B. , Long Jennifer L. 
Published: September 2014

Objectives:Determine the efficacy of a swallowing preservation protocol on maintaining swallow function in patients undergoing chemoradiation (CRT) for head and neck squamous cell carcinoma (HNSCC).Methods:Retrospective case‐control study of patients treated with CRT for HNSCC between July 2011 and December 2013 at a Veterans Affairs medical center. The study group comprised patients participating in a swallowing preservation protocol, including swallowing exercises and biweekly follow‐up, during CRT. The control group received no swallowing intervention during CRT. A previously described functional outcomes of swallowing scale (FOSS; 0 = no symptoms and 5 = nonoral feeding for all nutrition) was used to quantify dysphagia prior to, at the completion of, and 2 months following the completion of CRT.Results:Forty‐eight (all male; mean age, 67 years) and 85 patients (all male; mean age, 61 years) were included in the swallowing preservation and control groups, respectively. In the swallowing preservation group, mean pre‐ and posttreatment FOSS scores were 2.2 and 1.9, respectively, while the corresponding scores in the control group were 0.92 and 1.0. This approached statistical significance (Fisher's exact test, P =. 2).Conclusions:Patients enrolled in a swallow preservation protocol had overall poorer swallowing function at the initiation of CRT, but compared to the control group, a higher fraction of patients in the swallowing preservation protocol maintained or improved their swallow at posttreatment follow‐up. This confirms the importance of early evaluation and intervention for dysphagia prior to and during CRT.