bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary Tracheoesophageal Puncture with Supraclavicular Artery Island Flap after Total Laryngectomy or Laryngopharyngectomy
Authors: Sethi Rosh K. V. , Kozin Elliot D. , Lam Allen C. , Emerick Kevin S. , Deschler Daniel G. 
Published: September 2014

Objectives:(1) Describe our perioperative experience of primary tracheoesophageal puncture (TEP) with intraoperative placement of voice prosthesis for patients undergoing total laryngectomy (TL) or laryngectomy with partial pharyngectomy requiring supraclavicular artery island flap (SCAIF) reconstruction. (2) Assess TEP voice outcomes in this patient group.Methods:Retrospective chart review of all patients undergoing SCAIF reconstruction following TL or laryngectomy with partial pharyngectomy at a single institution between 2011 and 2013 (N = 14). There were no exclusion criteria.Results:We identified 7 patients who underwent primary TEP with intraoperative placement of voice prosthesis (mean age = 64.1, 5M:2F). Six patients had prior chemoradiation for laryngeal squamous cell carcinoma. One patient had a dysfunctional larynx from radiation treatment for tonsillar squamous cell carcinoma. Five patients underwent TL and 2 patients underwent TL with partial pharyngectomy. Indwelling 16 French Blom‐Singer prosthesis was placed intraoperatively prior to SCAIF reconstruction. There were no TEP‐related complications, such as prosthesis displacement or leakage, intraoperatively or in the perioperative period. One patient developed a peristomal pharyngocutaneous fistula. In terms of voice outcomes, 6 patients achieved tracheoesophageal voice production within 10 months after TEP placement, and most occurred earlier (mean time = 2.9 months, SD= 3.1). One patient remained aphonic. Of the 6 patients who achieved successful voice acquisition, 2 required cricopharyngeal segment Botox injections with good response.Conclusions:Similar to free tissue transfer reconstruction, primary TEP with intraoperative placement of the voice prosthesis at the time of SCAIF reconstruction is safe and effective. Six of 7 patients had successful voice acquisition within 10 months.
Prophylactic Tracheal Stenting for the Palliation of Anaplastic Thyroid Carcinoma
Authors: Mathew Rajeev , Varadharajan Kiran , Hay Ashley , Williamson Peter A. , Odutoye Babtunde , Madden Brendan 
Published: September 2014

Objectives:(1) Determine if airway stenting in patients with anaplastic thyroid carcinoma (ATC) is effective in preventing and treating shortness of breath. (2) Analyze whether this procedure affects survival.Methods:Retrospective case note analysis of patients diagnosed with ATC from 2003 to 2013 at a tertiary head and neck unit. Patients diagnosed with ATC were stented with an expandable covered metallic stent, irrespective of airway symptoms, provided they were medically fit and the tumor was >1 cm distal to the vocal cords. Outcome measures were development of dyspnea and survival.Results:Twelve patients were identified. Tracheal stenting was performed successfully in 4 out of 5 patients; the procedure was abandoned in 1 case due to gross airway distortion. Three of the 4 stented patients did not have airway compromise at the time of stenting; of these 3 patients, 1 did not develop airway compromise at all. The other 2 later developed acute dyspnea due to stent migration as a result of tumor in‐growth; these were successfully managed with stent exchange. All nonstented patients died with or from dyspnea. Mean survival postdiagnosis in stented patients was 89 days (n = 4; range, 39‐189 days) and in nonstented patients was 91 days (n = 9; range, 8‐233).Conclusions:Tracheal stenting is safe and effective at treating and preventing distressing airway symptoms in patients with ATC. It does not, however, confer any survival benefit.
Reoperative Parathyroid Surgery: Role of the Overly‐Descended Superior Adenoma in Persistent Disease
Authors: Vernon Hampton , Duke William S. , Terris David J. 
Published: September 2014

Objectives:(1) Recognize that failure to identify an ectopic, overly‐descended superior parathyroid adenoma may contribute to failed parathyroid exploration. (2) Understand the prevalence of an ectopic, overly‐descended superior parathyroid adenoma in both primary and reoperative parathyroid surgery in patients with single‐gland primary hyperparathyroidism. (3) Describe the findings that should lead the clinician to suspect the presence of an ectopic, overly‐descended superior adenoma.Methods:A retrospective review of patients undergoing curative surgery for single‐gland parathyroid adenomas at a single institution was performed. Clinical records, imaging studies, operative reports, and pathology findings were evaluated, and all instances of an ectopic, overly‐descended superior parathyroid adenoma were identified. The prevalence of this entity in both primary and revision surgeries was calculated.Results:There were 270 cases of curative surgery for single‐gland parathyroid adenomas during the study period. There were 251 primary operations and 19 re‐operative procedures referred from outside institutions. An ectopic, overly‐descended superior parathyroid adenoma was present in 9.2% of primary cases and in 21.1% of reoperative cases. While this condition was more common in the reoperative setting (as expected) the incidence in the primary setting was higher than anticipated, and in fact the difference did not reach statistical significance (P =. 1).Conclusions:An overly‐descended superior parathyroid adenoma is common in both the reoperative and primary settings. Recognition and proper treatment of this entity at the initial operation will reduce the need for revision surgery.
The Serratus Anterior Free Tissue Transfer for Total Laryngectomy and Craniofacial Defect Reconstructions
Authors: Khan Mohemmed , Olarte Lucia S. , Giraldez‐Rodriguez Laureano A. , Miles Brett A. 
Published: September 2014

Objectives:(1) Describe the method of harvesting and recognize the versatility of the serratus anterior free flap. (2) Review the use of the serratus anterior free flap for reconstruction after total laryngectomy and for craniofacial defects.Methods:Retrospective case review of 7 cases performed at a single tertiary care institution. PubMed literature review of serratus anterior free flap reconstruction from 1966 to present.Results:In the 4 patients in whom the serratus anterior free flap was used to reconstruct a total laryngectomy defect, no postoperative wound infections or salivary leaks were identified. The serratus free flap proved to be an effective means of reconstructing the skull base in 2 cases as well as covering a large scalp defect in a third case.Conclusions:This case series illustrates the benefit of muscle coverage in head and neck reconstruction in both the isolation of the nasal cavity from the intracranial cavity after craniofacial resection and in patients at risk of fistula formation after total laryngectomy. The serratus anterior flap was selected because of its ease of harvest, relatively low donor site morbidity, and adequate bulk. The patients who underwent total laryngectomy did not have evidence of leak, and adequate carotid artery coverage was achieved. Similarly, the craniofacial resection patients achieved adequate cranio‐nasal separation and effective coverage of a large scalp defect. The use of a serratus anterior free flap proved to be an excellent choice in the reconstruction of the defects in this series with minimal postoperative morbidity related to both the reconstructive and donor sites.
Surgical Outcomes of Primary versus Flap Closure of Postradiation Laryngectomy Defect
Authors: Rubin Samuel J. , Nene Prachi S. , Salama Andrew R. , Grillone Gregory A. , Ezzat Waleed H. , Jalisi Scharukh 
Published: September 2014

Objectives:The authors of the RTOG 91‐11 study recently presented long‐term outcomes for 3 nonsurgical treatment strategies to preserve the larynx in patients with locally advanced laryngeal cancer. They concluded that concomitant chemotherapy and radiation is optimal for laryngeal preservation; however, 16% of the patients still required total laryngectomies (TL). Additionally, the incidence of pharyngocutaneous fistulas was 30% within this cohort receiving total laryngectomy. We therefore conducted a single center retrospective study of 47 patients treated with total laryngectomy at a tertiary care center from July 2004 to May 2013 to assess the percentage of patients that develop pharyngocutaneous fistula. We propose that the rate of pharyngocutaneous fistula in patients that receive TL will be lower using the technique of flap augmentation compared with the patients that receive TL using the technique of primary closure.Methods:Thirty‐two patients received primary closure for TL with a pharyngocutaneous rate of 9.4% (n = 3), and 14 patients received flap augmentation for TL with a pharyngocutaneous rate of 7.1% (n = 1). We also assessed stage of laryngeal cancer; whether the patient received cheomotherapy, radiation therapy, or concomitant radiation and chemotherapy; the muscle used for flap closure; recipient artery and vein; thyroid‐stimulating hormone, hemoglobin, intact parathyroid hormone, and albumin preoperative and postoperative values, when available.Results/Conclusions:The rate of pharyngocutaneous fistula was comparable between the primary closure group and the flap closure group (P = 1). However, because of the low rate of pharyngocutaneous fistulas, it would be necessary to analyze a larger cohort to determine significance and possible confounding factors.
A Method to Quantify the Confounding Effect of the Nasal Cycle on Nasal Airway Obstruction
Authors: Patel Ruchin , Garcia Guilherme J. M. , Frank‐Ito Dennis O. , Kimbell Julia S. , Rhee John S. 
Published: September 2014

Objectives:(1) Develop a methodology to eliminate the confounding effect of the nasal cycle when comparing pre‐ and postsurgery nasal resistance measurements. (2) Illustrate this methodology by reporting nasal resistances derived from computational fluid dynamics (CFD) simulations in a test subject using computational models that span the full range of mucosal engorgement associated with the nasal cycle.Methods:A cohort of 40 nasal airway obstruction patients was reviewed to select the one patient with the greatest reciprocal change in turbinate engorgement between pre‐ and postsurgery computed tomography (CT) scans. Ten 3‐dimensional anatomically accurate nasal cycling CFD models were created based on the pre‐ and postoperative CT scans. The thickness of the inferior turbinate, middle turbinate, and septal swell body was systematically increased/decreased by adding/removing layers of pixels around these structures using medical imaging software.Results:After surgery (septoplasty), without adjusting for the nasal cycle, nasal resistance decreased by 17% on the left side and by 69% on the right side, and total resistance decreased by 53%. However, after adjusting for cycling, the unilateral nasal resistance decreased by 50% and 43% on the left and right sides respectively, while bilateral resistance decreased by 47%.Conclusions:By simulating the nasal cycle using computational models, changes in nasal resistance due to surgery can be distinguished from physiological changes due to the nasal cycle. This ability can lead to more precise objective comparisons of pre‐ and postsurgery nasal resistance measurements and potentially more accurate virtual presurgery planning.
Thyroid Cancer and Hyperthyroidism
Authors: Sharma Sunil D. , Kumar Gaurav , Kaddour Hesham 
Published: September 2014

Objectives:(1) Present a case series of patients with hyperthyroidism and thyroid cancer. (2) Look at the clinical characteristics and outcomes of these patients to determine which patients require further investigation.Methods:Retrospective review of case notes of all patients with a histopathological diagnosis of thyroid cancer and biochemical evidence of hyperthyroidism treated at a thyroid cancer center between January 2006 and October 2013.Results:During the study period, 66 patients were diagnosed with thyroid cancer. Eight patients had biochemical evidence of hyperthyroidism (12.1%). The mean age of these patients was 56.1 years (range, 29‐87 years). All patients were female. Of these patients, 3 patients were diagnosed with Graves’ disease, 1 patient with toxic multinodular goiter, and 4 patients with an autonomously functioning toxic nodule (AFTN). Five patients had suspicious features on their preoperative ultrasound. All patients were diagnosed with papillary thyroid carcinoma. The mean size of the tumor in patients with an AFTN was significantly larger than those with Graves’ disease (38.1 ± 7.9 vs 4.6 ± 1.3 mm, P =. 001). All 3 patients with Graves’ disease had papillary microcarcinoma, while those patients with AFTN had a poorer prognosis, with 2 patients with extracapsular invasion and lymph node metastases, and 1 patient dying from disease.Conclusions:The incidence of hyperthyroidism in thyroid cancer patients is high. In contrast to previous literature, patients with AFTN seem to have more aggressive disease with poorer outcomes when compared to patients with Graves’ disease. Any suspicious nodule associated with hyperthyroidism should be evaluated carefully.
Tissue Reconstruction and Remodeling Using Acellular Bladder Matrix
Authors: Fuller James H. 
Published: September 2014

Objectives:Attendees should be able to (1) learn of an innovative new material for full thickness repair utilizing urinary bladder matrix (UBM); (2) understand the basic mechanism of this procedure; (3) apply this technique and material to daily surgical use.Methods:Over the past 3 years MatriStem (ACell, Inc.) has been used successfully by the author in multiple head and neck reconstructive procedures, including repair of major, full thickness cancer and osteoradionecrosis cases of the scalp, face, and nose, full thickness oral and mandibular bone defects. MatriStem is derived from porcine UBM. Published studies have shown that UBM may recruit progenitor cells to the injury site and stimulate a constructive remodeling response with site‐specific tissue. Clinically, MatriStem has shown cost benefits and better patient outcomes compared to other therapies. Previous surgical techniques employed by the author have used various synthetic materials and tissue‐derived materials—ranging from cadaveric dermis to bovine tendon—as well as split‐ and full‐thickness autologous skin grafts. However, these techniques did not result in regeneration of full‐thickness tissue. These historical results will provide context for the cases to be presented. In this presentation, the author will display many of these clinical experiences.Results:It has even been possible to regenerate partial bone replacement in radiated bone following partial thickness resection. It has been especially useful in repair of head and neck cancer resection defects.Conclusions:The use of MatriStem has offered unprecedented solutions to many challenging and complex cases.
Transoral Surgical Anatomy and Clinical Considerations of Lateral Oropharyngeal Wall and Base of Tongue
Authors: Gun Ramazan , Durmus Kasim , Kucur Cuneyt , Carrau Ricardo L. , Ozer Enver 
Published: September 2014

Objectives:(1) Describe key anatomic structures in lateral oropharyngeal wall and tongue base transorally. (2) Determine surgical landmarks to increase intraoperative safety in transoral robotic surgery.Methods:Transoral dissections were performed endoscopically in 5 vascular silicone‐injected fresh human cadavers. Anatomic structures were also confirmed with lateral neck dissections.Results:Tonsillar bed is largely made by superior pharyngeal constrictor muscle and overlying pharyngobasilar fascia. Palatoglossus and palatopharyngeus muscles limit this tonsillar bed anteriorly and posteriorly, forming tonsillar pillars. Stylopharyngeus and styloglossus muscles and stylohyoid ligament run between superior and middle pharyngeal constrictor muscles contributing to inferior tonsillar fossa. These structures are located just medial to facial, lingual, and internal maxillary arteries in parapharyngeal space. Internal carotid artery lies posterolateral to the branches of external carotid artery. Lingual artery injury might occur during base of tongue or inferior tonsil resections. At its origin, the lingual artery is situated deep to middle pharyngeal constructor muscle between stylohyoid ligament and greater cornu of hyoid bone posteriorly. At the tonsil‐tongue base junction, it courses lateral and deep to styloglossus muscle. Keeping the resection over styloglossus muscle and stylohyoid ligament will prevent lingual artery injury. The glossopharyngeal nerve is positioned between stylohyoid ligament and styloglosus muscle. Its branches travel posteroinferiorly in inferior tonsillar fossa toward the base of tongue. Lingual nerve is vulnerable to injury as it emerges anterior to medial pterygoid muscle.Conclusions:A thorough understanding of transoral anatomy is critical for surgeons to perform transoral robotic surgery safely and efficiently.
Tumor‐Induced Osteomalacia of the Head and Neck Region: A 10‐Year Tertiary‐Care Experience
Authors: Mathews Suma S. , Rupa Vedantam , Job Anand , Mathew John , Manipadam Marie T. , Thomas Nihal J. , Paul Thomas V. 
Published: September 2014

Objectives:Oncogenic osteomalacia (OO) is a paraneoplastic syndrome seen in tumors of mesenchymal origin that secrete “phosphatonins,” like fibroblast growth factor‐23 (FGF‐23). They are characterized by hypophosphatemia and osteomalacia. These patients make remarkable recovery once tumors are localized and excised. The authors’ aim was to study retrospectively the clinical, biochemical profile and follow‐up of subjects who presented with the features of OO of the head and neck region.Methods:Data of all the patients diagnosed to have OO from 2004‐2013 were collected using the computerized database.Results:Among the total 29 presentations of 27 with OO, 12 (44%) were found to have a histopathologically proven identifiable lesion. Nine (75%) of these were found to be in the head and neck region. The most common presenting symptoms in this subgroup were bone pains (78%) and proximal muscle weakness (56%). Rigid nasal endoscopy, blood pool scan, contrast‐enhanced computed tomography, and magnetic resonance imaging of head and neck region picked up 5 out of 6 (83%), 3 out of 7 (43%), 9 out of 9 (100%), and 3 out of 3 (100%) lesions, respectively. All patients underwent surgical excision, of which 56% are in partial and 44% in complete remission. Two patients had a recurrence at the same site after 5 years.Conclusions:The head and neck region was the most common site where tumor was localized in patients with OO. In all hypophosphatemic osteomalacia, where oncogenic osteomalacia is suspected, nasal endoscopy and imaging of the head and neck region should be done. Surgical excision remains the mainstay of treatment. These patients warrant long‐term follow‐up as a recurrence can occur several years after the initial response.
The Use of Botulinum A Toxin in Dysphagia
Authors: Amin Nikul , Fu Bertram , De Zoysa Neil , Lew‐Gor Simione 
Published: September 2014

Objectives:(1) Describe our experience with the use of botulinum A toxin (Botox) in a case series of patients with dysphagia with cricopharyngeal spasm on videofluoroscopy. (2) Systematic review of current literature.Methods:We present a case series of patients with dysphagia refractory to conventional conservative and medical treatment in whom we administered endoscopic injection of 100 mU of Botox into the cricopharyngeus by a single head and neck surgeon using the same technique. Eight patients with refractory dysphagia were treated with 100 mU of Botox injection into the cricopharyngeus. We excluded patients who previously had a surgical intervention to the upper esophagus or pharynx. The change in dysphagia after Botox administration was assessed using the Mayo Dysphagia Questionnaire‐30 before and approximately 2 weeks, 3 months, and 6 months after Botox administration and with pre‐ and post‐administration videofluoroscopies.Results:The Mayo Dysphagia Questionnaire‐30 scores improved significantly at all follow‐up stages postprocedure. This improvement is reflected in the post‐injection videofluoroscopy examinations.Conclusions:Dysphagia is often difficult to treat. It may be associated with upper esophageal sphincter dysfunction, where conventional treatment, including anti‐reflux medication and dilatation, may not be sufficient to provide symptomatic relief. A wide range of surgical interventions with associated morbidity have been described with varying success rates. Our method and experience with endoscopic injection of botulinum A toxin to the cricopharyngeus has shown to be an effective minimally invasive option in those who have been assessed as appropriate for the intervention.
Nasal Fractures in Children and Adolescents: Mechanisms of Injury and Efficacy of Closed Reduction
Authors: Liu Clive , Scott Andrew R. 
Published: September 2014

Objectives:(1) Determine the most common causes of traumatic nasal deformities referred to pediatric otolaryngology. (2) Examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents’ and surgeon's ratings of post‐reduction nasal symmetry.Methods:Case series and chart review within an urban pediatric otolaryngology practice.Results:One hundred cases of traumatic nasal deformity met inclusion criteria over a 3‐year study period. The mean age at presentation was 13 years (4 weeks‐18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports‐related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%), and alcohol‐related (2%). Of these 100 cases, 21% underwent closed reduction within a 14‐day period following injury. All patients achieved symmetry in the operating room immediately following reduction. At the postoperative visit (7‐10 days following surgery), the operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) was satisfied in 81% of cases. Both parent and surgeon were satisfied with postreduction symmetry 33% of the time.Conclusions:The most common source of traumatic nasal deformity in children and adolescents differs from the most frequent mechanisms of nasal trauma in adults. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases; however, a result in which both parent and surgeon agree with successful re‐establishment of symmetry occurs in only 1/3 of cases.