bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Novel Preliminary Step in Orbital Exenteration
Authors: Manickavasagam Jaiganesh , Leeman Hayley , Durham Luke , Yousefpour Afshin 
Published: February 2015

ObjectiveAn external approach of orbital exenteration involves retracting the orbital contents within a nonexpandable bony orbit. Orbital pressure would be more raised for patients with orbital tumors where retraction of the orbital contents may be difficult. We describe a simple preliminary step, which may be used to facilitate orbital retraction.MethodCase reports at a university teaching hospital for nasal tumors with orbital involvement. For the literature research, MEDLINE search from 1950 to Jan 2012.ResultsPrior to orbital exenteration, the cornea of the affected eye is aspirated with a 21‐gauge needle. Approximately 3 to 4 mL of clear fluid can be aspirated. This subsequently causes depression of the bulbar conjunctiva and globe, which reduces the intraocular pressure. This allows orbital contents to be easily retracted and facilitates easy division of the orbital muscles as well as aiding the control of bleeding from the orbital apex, under direct vision. This technique has not previously been reported in the literature. We have used this technique in 18 cases of orbital exenteration for maxillary tumors with orbital involvement.ConclusionWe have used this technique without any subsequent complications and found it to be extremely useful particularly as it enhances visualization of the orbital apearea. This preliminary step explained above can be an adjunct to all methods of orbital exenteration.
Accuracy of FDG PET and CT Imaging for Nodal Metastasis
Authors: Patell Sapna A. , Mendez Eduardo , Rajendran Joseph , Weiss Noel S. 
Published: February 2015

ObjectiveAfter radiation treatment, head and neck cancer patients often undergo FDG PET and CT imaging to survey for nodal metastasis. Inconsistencies among these make it difficult to decide if surgery is necessary. Our goal is to determine the accuracy of these modalities using histopathology, both overall and among discrepant results.MethodWe reviewed the records of 486 head and neck squamous cell carcinoma patients who underwent a postradiation FDG PET/CT scan between 2000 and 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.ResultsOf the 64 patients with postradiation PET/CT scans, 16 underwent a neck dissection after imaging. When either PET or CT was positive, all 9 cases of malignancy were identified (sensitivity 100%), and the positive predictive value was 69.2% (9/13). Of the 7 with benign pathology, 3 were negative for both modalities (specificity 42.8%). In this setting, the negative predictive value was 100% (3/3). Eight cases had discrepant results between PET and CT imaging. For these, the positive and negative predictive values with PET imaging alone were 33% and 20%, while with only CT imaging, they were 80% and 66%, respectively.ConclusionCorroborating with prior studies, our study observed a high negative predictive value when using the combination of PET/CT in the management of neck disease in postradiated patients. When PET and CT results conflicted, CT imaging had a higher predictive accuracy compared to PET scans.
An Invention on Operative Scar of the Parotid Gland Tumor
Authors: Maeda Hiroyuki , Hasegawa Masahiro , Yamashita Yukashi , Agena Shinya , Kiyuna Asanori , Suzuki Mikio 
Published: February 2015

ObjectiveA parotid gland tumor is an important disease for otolaryngologists to be able to treat through surgical technique in Japan. It is necessary to preserve facial nerves completely and to not make a prominent postoperative incisional scar of the skin, particularly in the case of benign tumors.MethodWe experienced 42 cases of parotid gland tumors in 2011. We tried to diagnose by CT scan, MRI imaging, and fine needle aspiration at preoperation.ResultsBenign tumors made up 37 cases, with the rest malignant tumors. We could identify a benign tumor in almost all cases at preoperation. In case of benign tumor, permanent facial nerve palsy was not found, except the schwwanoma in facial nerve at postoperation. Moreover, when we removed the tumor, the following steps were taken: 1) A skin incision was established with minimum length. 2) Incising the preauricular area, we drew a cutting line on the external auditory canal inside a tragus. 3) The sigmoid curve in the postauricular area was designed as gently as possible. The cervical incision line was drawn along the digastic muscle.ConclusionIt is clear that during operations for the facial nerves, complete extraction of the tumors and minimum skin incision in the parotid gland tumor yield compatible results.
Biofilms on Patients with Skull Base Osteoradionecrosis
Authors: Tsai Yiih‐Jeng , Chiu Bo‐Han , Hao Sheng‐Po 
Published: February 2015

ObjectiveTo study if there are biofilm formations in the nasopharyngeal tissues from NPC patients who were diagnosed as having skull base osteoradionecrosis (ORN).MethodWe conducted a prospective study to evaluate the presence of biofilm formations in NPC patients with and without ORN between 1980 to 2011. The specimens obtained were processed and analyzed with FilmTracer LIVE_DEAD Biofilm Viability Kit and fluorescent microscope. The investigator examining the sample was blinded to the disease state.ResultsEleven of 15 (73%) NPC with ORN patients demonstrated biofilm formations in their nasopharynbiopsied specimens. Five of them yielded positive cultured results which made the culture rate 45%. Among the culture results, 4 patients showed MRSA infections and 1 patient showed streptococcus viridins. Two patients with MRSA infections had concomitant Escherichia coli and candida infections, respectively. The other 4 NPC with ORN patients without biofilms detected showed negative in culture. In NPC patients without ORN, 1 of the 12 (8%) patients presented the biofilm formation. The culture results were all negative.ConclusionAlthough the role of biofilm in skull base ORN of NPC remains unclear, this article presents further evidence of their existence in this condition. Their presence not only implicate them in the pathogenesis of ORN, but might partly explain its chronicity and its resistance to antibiotic treatment.
Black Thyroid Secondary to Minocycline Use
Authors: Smucker Joanne , Goyal Neerav , Goldenberg David 
Published: February 2015

ObjectiveTo present 3 cases of black thyroid syndrome discovered intraoperatively in association with prior and current minocycline use.MethodThis is a case series of 3 cases between 2009 and 2012 at a tertiary care referral center where a darkly pigmented (black) thyroid was identified intraoperatively. Retrospective chart review was performed for each of these cases to review pathology, intraoperative findings, and patient history.ResultsFrom other studies conducted, black thyroid has been found to be highly associated with the use of the drug minocycline. In reviewing our cases of black thyroid, it was discovered that each patient had taken or was currently taking minocycline. All cases were found incidentally intraoperatively. One case was associated with thyroid carcinoma, while the others did not have pathology consistent with neoplasm. The first case was noted during a total thyroidectomy for papillary thyroid carcinoma, the second case during a parathyroidectomy for primary hyperparathyroidism, and the last case during a partial left thyroidectomy for thyroid goiter.ConclusionWhile other causes of black thyroid have been suggested, the most common cause of black thyroid, minocycline use, held true in the 3 cases presented. There have been recent reports of a linked association with black thyroid and carcinoma which warrants further investigation.
Body Weight for Outcome of Uvulopalatopharyngoplasty
Authors: Chao Chun Chih , Wu Jiunn‐Liang , Chang Yu‐Tuan , Lin Cheng‐Yu 
Published: February 2015

ObjectiveUvulopalatopharyngoplasty (UPPP) is the commonly performed surgical procedure for the treatment of obstructive sleep apnea syndrome (OSAS). The efficacy of this procedure has not been clearly established. Our aim was to assess long‐term effects of UPPP for OSAS and the impact of body weight for outcome of UPPP.MethodWe report the results of routine pre‐/postoperative OSA‐related assessments in patients undergoing UPPP from January 1, 2003 to June 30, 2011. All participants received overnight polysomnography (PSG) and questionnaires regarding daytime sleepiness, snoring severity, and sleep quality before and after the treatment.ResultsFifty patients completed the study. Forty‐two (80%) were male subjects. The average age was 30.7 years. The success of UPPP was defined as AHI reduction more than 50% and post‐op AHI <20. The success rate for UPPP was decreased with time (<0.5 year: 81.8%; 0.5‐1 year: 44.4%; 1‐2 years: 33.3%; 2‐3 years: 33.3%; 3‐5 years: 42.9%; >5 years: 40.0%). There were 27 patients with body weight reduction after UPPP. In the group of patients with body weight increase after UPPP, snoring index was increasing (P =. 0080), AHI was increasing (P =. 0512), and ESS was increasing (P =. 0182) with longer follow‐up period.ConclusionSleep apnea could be resolved for most patients in 6 months after UPPP but recurred with longer post‐op period. Body weight change may be an important factor for recurrence. For OSA patients with body weight increase after UPPP, the recurrence rate was higher than patients with body weight reduction.
Boron Neutron Capture Therapy for Squamous Cell Carcinoma of the Skull Base
Authors: Inui Takaki , Haginomori Shin‐Ichi , Ichihara Takahiro , Takamaki Atsuko , Kawata Ryo 
Published: February 2015

Objective1) Describe the first case of inoperative squamous cell carcinoma (SCC) in the skull base recurring after surgery, conventional radiotherapy, and chemotherapy, which was treated using 2‐stage boron neutron capture therapy (BNCT). 2) Determine the effectiveness of BNCT for head and neck cancer.MethodWe present a case of inoperative recurrent SCC in the right temporal bone involving the occipital condyle. The patient underwent BNCT twice in 1 month in 2007 at Research Reactor No. 4 of the Japan Atomic Energy Research Institute to ensure neutron capture in the deep lesion.ResultsAn epithermal neutron beam was used as the neutron source. The total estimated radiation dose of the BNCT to the tumor beneath the skin, at the deepest point of the tumor, and in the skin around the right auricle was 41.8, 36.9, and 15.8 Gy‐Eq, respectively. After the BNCT, the tumor became necrotic and shrank immediately and disappeared 6 months after the first BNCT. Radiological studies performed 5 years after the first BNCT showed no evidence of residual or recurrent tumors.ConclusionTotal resection of SCC deeply invading the skull base is difficult. Surgical complications can leave patients in critical condition. Two‐stage BNCT might be an effective treatment for patients with SCC deep in the skull base.
Caution: Carotid Artery Aneurysm May Disguise as Neck Tumor
Authors: Pacheco Paulette C. , Almodovar Gustavo J. 
Published: February 2015

Objective1) To present a case where a right common carotid aneurysm was clinically undistinguishable from tumor. 2) Stress the importance of contrast‐enhanced imaging in the workup of a neck mass. 3) Review of literature.MethodA 64‐year‐old male smoker with hypertension presented with hoarseness, dysphagia, and an enlarging right neck mass. Physical examination revealed 6‐cm neck mass, nonfluctuant, nonpulsatile. F/L: Right parapharyngeal mass impinging right hemilarynx, causing partial airway obstruction. Noncontrast computed tomography (CT) scan was suggestive of neoplasia versus abscess formation. Contrast‐enhanced CT revealed an aneurysm of the right carotid bifurcation. PubMed literature was reviewed.ResultsExtracranial carotid aneurysms are rare (1‐4%), with atherosclerosis being the most common etiology. They arise in the internal carotid (67%), bifurcation (32%), and the external carotid artery (1%). Airway obstruction and dysphagia has been reported in very few cases. In our patient this led to the clinical diagnosis of tumor. Contrast‐enhanced imaging is essential in the workup of a neck mass. Management options include interposition bypass grafting, resection with patch angioplasty, or carotid ligation, as well as endovascular interventions with stenting or occlusion.ConclusionLarge carotid artery aneurysms may resemble a tumor and they must be considered in the differential diagnosis of a neck mass. The importance of contrast‐enhanced imaging before attempting invasive procedures cannot be overemphasized.
Cervicofacial and Cervicothoracic Rotation Flaps: An Update
Authors: Van Deusen Mark B. , Athavale Sanjay , Dang Jennifer , Netterville James L. 
Published: February 2015

Objective1) Understand the indications for use of the cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 2) Learn the surgical technique for constructing cervicofacial and cervicothoracic advancement flaps in head and neck reconstruction. 3) Describe the varying defects that can be reconstructed with cervicofacial and cervicothoracic advancement flaps.MethodRetrospective review of medical records at a university‐based head and neck cancer center. Patients were operated on between 2001 and 2012. Patients had varying lesions that were amenable to cervicofacial and/or cervicothroacic advancement flaps. After a thorough description of indications and defect locations, complications and flap viability were evaluated.ResultsSixty‐nine patients were identified, with a mean age of 66 years. Primary or recurrent skin neoplasms made up the most common surgical indication, followed by primary parotid tumors and cervical metastases from aerodigestive tract malignancies. Defects of the cheek, orbit, periauricular region, and neck were reconstructed with cervicofacial or cervicothoracic flaps. Larger wounds required extension of the incision onto the chest wall. Other reconstructive modalities were used in 38 cases to increase tissue bulk or provide internal lining. Minor wound complications occurred in 15 patients. There was no statistically significant association between wound complications and smoking or previous radiation therapy.ConclusionCompound cervicofacial and cervicothoracic rotation flaps provide a straightforward, reliable, and efficient means to reconstruct compledefects of the face, lateral skull.
Clinical Efficacy of FDG‐PET/CT in Head and Neck Adenoid Cystic Carcinomas
Authors: Smith Tukisa D. , Varvares Mark A. 
Published: February 2015

ObjectivePositron emission tomography/computed tomography (PET/CT) with fluorine‐18‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG) of salivary malignancies is variable, thus unreliable for staging/surveillance. For adenoid cystic carcinomas (ACC), data is limited regarding FDG uptake. The objective is to characterize PET/CT and its ability to detect primary disease/tumor recurrence in patients with head and neck ACCs (HNACCs).MethodTen‐year retrospective study of 25 patients diagnosed with HNACCs. Eleven patients (8 women; age 33‐65 years at time of diagnosis) were referred for whole‐body FDG‐PET/CT. Secondary imaging modalities were also acquired. Fifteen tumor sites (primary and metastatic foci) were evaluated. Histological disease was confirmed by biopsy and surgical pathology.ResultsOf those referred for PET/CT, 81.8% (9/11) had primary disease foci detected and 22.2% (2/9) had distant metastasis. In one patient with metastatic disease, cavernous sinus disease was detected on MRI and not appreciated on PET/CT but was consistent with MRI in detecting disease foci of the nasal dorsum and lung. In one patient with base of the tongue ACC, PET/CT accurately detected cervical lymph nodes suspicious for malignancy not detected on CT scan. On MRI, another patient treated for nasal cavity ACC had what appeared to be disease recurrence, not appreciated on PET/CT and was confirmed as a pyogenic granuloma.ConclusionIn HNACCs, FDG‐PET/CT is useful for preoperative evaluation of initial/recurrent disease foci and disease staging for treatment strategy; thus it shouldn’t be excluded as a method of patient evaluation.
CRP as an Inflammatory Marker in Oral Rinses
Authors: Pierce Brendan H. G. , Ondrey Frank 
Published: February 2015

Objective1) Learn if CRP stimulates production of IL‐6 in human leukoplakia cells (MSK‐Leuk1). 2) Learn if pioglitazone attenuates CRP stimulation of IL‐6 in leukoplakia cells. 3) Establish an oral rinse CRP reference range in controls that can be used in an ongoing trial of leukoplakia patients treated with pioglitazone.MethodELISA will be used to measure IL‐6 release from MSK‐Leuk1 treated with varying concentrations of CRP and pioglitazone. ELISA will be used to measure CRP in oral rinses of control patients. Two‐sided t test and ANOVA are used for analysis of results with significance level of 5%.ResultsWhen treated with CRP (0.001‐10 ug/mL), MSK‐Leuk1 cells increased IL‐6 release in a dose‐dependent manner (P <. 05). When treated with CRP (0.01‐10 ug/mL) and with pioglitazone (10 uM) MSK‐Leuk1 cells released a statistically significantly decrease in IL‐6 as compared to CRP treatment (P <. 05) Oral rinses were easily collected and CRP was measured by ELISA to establish controls for an ongoing study of pioglitazone treatment of leukoplakia and CRP as an affective inflammatory marker.ConclusionCRP is now shown to play an active roll in increasing the inflammatory cascade in leukoplakia cells, and pioglitazone attenuates this stimulation as measured by IL‐6. The next step is to test CRP in already collected oral rinses of leukoplakia patients before and after treatment with pioglitazone.
Dental Health of Patients Receiving Intensity Modulated Radiation Therapy vs Conventional Radiation Therapy
Authors: Duarte Victor M. , Tajima Tracey , Nabili Vishad , Wang Marilene B. 
Published: February 2015

ObjectiveTo analyze the dental health of head and neck cancer patients who received comprehensive dental care before and after radiation.MethodRetrospective study of 282 head and neck cancer patients at a single VA hospital who were treated with radiation between 2000 and 2010 were identified. All patients received conventional radiation therapy (RT) or intensity‐modulated radiation therapy (IMRT).ResultsA complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The treatment plan was formulated to eliminate current and potential dental disease, as well as prepare for future dental rehabilitation. The rates of dental extractions, infections, and caries were analyzed and comparison made between patients treated with IMRT and those treated with conventional RT. The number of posttreatment extractions has been reduced with advent of IMRT, and more so with a complete dental evaluation prior to treatment. The rate of caries was found to be less in patients treated with IMRT.ConclusionHead and neck cancer patients who had IMRT had significantly less radiation caries and more salivary flow and less requisite post‐treatment extractions compared to those patients with conventional RT.
Effect of Aging on Tracheoesophageal Speech Rehabilitation
Authors: Lundy Donna , Weed Donald T. , Landera Mario A. , Bremekamp Jocelyn 
Published: February 2015

Objective1) To determine whether tracheoesophageal puncture usage changes as a function of age. 2) To determine whether age is associated with voice deteroriation, need for repuncture, or dependence in stomal care.MethodRetrospective chart review on individuals following total laryngectomy and tracheoesophageal puncture (TEP) and minimum 1‐year follow‐up data after prosthesis placement. Data reviewed included demographic variables and medical/surgical factors related to laryngectomy. Outcome measures of voice deterioration, TEP use, repuncture, and change in dependent prosthesis management were compared with age.ResultsSixty‐nine individuals were identified that met criteria; 58 men and 11 women. Mean age was 65 years (range, 43‐88 years). Nine individuals, mean age of 70.0 years, did not use their prosthesis for speech purposes; 2 chose never to use it and the remainder became unable to speak due to further medical issues. Deterioration in speech was further noted in five individuals, mean age of 79.4 years. Seven individuals, mean age of 58.6 years, required a re‐puncture due to extrusion. Six individuals with a mean age of 76.3 years became dependent over time for daily stoma management.ConclusionAge was significantly associated with deterioration in alaryngeal voice quality and need for dependence in stoma care for older individuals while repunctures were associated with a younger age. These results support careful selection criteria and counseling when considering a tracheoesophageal puncture in an older aged individual.
Endoscopic Transnasal Craniectomy for Sinonasal Malignancies
Authors: Villaret Andrea Bolzoni , Nicolai Piero , Bottazzoli Marco , Bignami Maurizio , Turri‐Zanoni Mario , Battaglia Paolo 
Published: February 2015

ObjectiveThis study reviewed the surgical technique of endoscopic resection with transnasal craniectomy (ERTC), its indications, and morbidity in the management of selected sinonasal malignancies.MethodFrom April 1996 to December 2010, 265 patients affected by sinonasal malignant tumors were treated by endoscopic resection at 2 referral university hospitals. From 2004, 126 patients underwent ERTC. Duraplasty was carried out using iliotibial tract and fat tissue. Overall (O), disease‐specific (DS), and recurrence‐free (RF) survival were calculated.ResultsThe most frequent histologies were adenocarcinoma (57%) and olfactory neuroblastoma (16%). Eighty‐seven (69%) patients were previously untreated. The overall complication rate was 10.6%. Cerebrospinal fluid leak was observed in 9 (7%) cases. The mean hospitalization time was 10.5 days (range, 5‐32 days). Overall, 75 (60%) patients received adjuvant treatment. After a mean follow‐up of 52.7 months (range, 12‐169 months), 100 (79.3%) patients had no evidence of disease, with 5‐year OS, DSS, and RFS of 82.6%, 85.7%, and 77.9% respectively.ConclusionERTC is a safe procedure with an acceptable complication rate, allowing the ability to perform a wide resection of the dura with a correct assessment of its involvement. Only a few cases of malignancies extending intracranially require combining with an external subfrontal craniotomy.