bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Regulatory T Cells in Oropharyngeal Cancer
Authors: Boucek Jan , Rihova Blanka , Betka Jaroslav , Eckschlager Tomas , Zabrodsky Michal , Betka Jan 
Published: September 2011

ObjectiveOropharyngeal cancer is the most frequent type of malignancy in the head and neck area. Regulatory T cells (Treg, CD4+CD25+Foxp3+) and Th17 cells were described as critical factors for regulation or inhibition of effective anti‐cancer immune response and, consequently, prognosis and survival.MethodWe examined Treg and Th17 from periphery blood and tumor samples of patients with oropharyngeal cancer before the start of anti‐tumor therapy. We particularly focused on lymphocytes subpopulations (CD3+, CD3‐CD16+CD56+, CD4+, CD8+, CD19+, CD4+CD45RA+, CD3+CD4+CD25+, CD161+CD4+ a CD161+CD8+) and tumor markers (SCC, CEA, AAT, Cyfra 21‐1).ResultsIn comparison with control group (nononcologic surgery), the Treg population in the peripheral blood of the patients with oropharyngeal cancer was 1.6‐fold higher. Infiltration of Treg in specimens from primary tumors and metastatic neck lymph nodes was higher (8.7% and 9.6%) in comparison with oropharyngeal tissue and neck lymph nodes without tumor or metastatic extension (3.12% and 3.3%, both p+CD161+cells and 12.8% CD8+CD161+ cells, and in tumor tissue, 1.66% CD4+CD161+ cells and 3.9% CD8+CD161+ cells. Level of tumor marker CEA correlated with higher T stadium (T3+4, t‐test, P <. 005).ConclusionWe can conclude that regulatory T cells and Th17 generally represent a highly important factor in the progression of many types of malignancies and our data indicated their particular importance for oropharyngeal cancer.
Initial Experience Training Otorhinolaryngology Residents in Transoral Robotic Surgery
Authors: Sperry Steven , O’Malley Bert W. , Weinstein Gregory S. 
Published: September 2011

Objective1) Describe a safe, efficient, and effective pathway for the development of transoral robotic surgical skills in otorhinolaryngology residency training, and 2) Report initial results of resident experience in the training modules.MethodA curriculum for training otorhinolaryngology residents in transoral robotic surgery (TORS) was defined. The training included PGYII‐V residents and progressed through modules, including Didactics, Skills, and Operative. In the skills module, performance measurements in the simulator were recorded. Surveys of PGY‐V residents completing the curriculum assessed the program effectiveness.ResultsDidactics teach the device setup, controls, and surgical approaches, via video and texts. Skills‐training is primarily completed with a robotic surgery simulator. Introduction to the TORS approach is completed on cadaver models. The operative experience includes live case observation, bedside surgical assistant, and finally console surgeon. The surgical experience advances in a stepwise fashion, with the resident progressing after demonstrating proficiency with preceding steps. Proficiency in the robotic simulator with performance of simple tasks was demonstrated by all participants within a 2‐hour initial session. Residents completing the modules expressed satisfaction with their comfort level in performing basic procedures via TORS.ConclusionAn efficient and effective curriculum for training residents in TORS was developed. This formal training is necessary and effective for residents to acquire the knowledge and skills to perform TORS safely. Further evaluation is warranted to improve the training curriculum and increase training experiences during otorhinolaryngology residency.
Longitudinal TEP Size Stability
Authors: Lundy Donna , Landera Mario , Weed Donald T. 
Published: September 2011

ObjectiveTracheoesophageal speech rehabilitation is considered the gold standard after laryngectomy. Changes in size of the prosthesis are common in the early period after initial fitting. Size may be affected by factors over time necessitating continued assessment. This study will determine size stability in laryngectomized patients over a 5‐year period.MethodIndividuals s/p total laryngectomy and TEP with a minimum 5‐year follow‐up will be accrued. Data will be derived from chart review including demographic, surgical, medical, and prosthesis factors by stability of size over time after the first three‐month initial fitting phase.ResultsThirty‐seven patients, 32 males and 5 females, met the criteria and were included in the study. Mean age was 63.7 years (range, 41‐78 years). Medical factors leading to total laryngectomy changed over the follow‐up period with more recent patients only undergoing laryngectomy for either extremely advanced disease or recurrence versus persistent disease after chemo‐radiation therapy. A total of 80% of patients required a change in the length and/or diameter of their prosthesis over the 5‐year follow‐up period regardless of other medical and surgical factors.ConclusionClinicians need to continually reassess prosthesis fit for the life of the patient to prevent inadvertant closure of the posterior fistula tract from a prosthesis that is too short or pistoning resulting in aspiration from a prosthesis that is too long. This contrasts previous reports of stability after initial fitting.
Endoscopic Removal of Subcutaneous Pyogenic Granuloma of the Nasal Radix
Authors: Badran Karam , Gu Mai , Rothholtz Vanessa S. , Wong Brian 
Published: September 2011

ObjectiveThis case report describes the removal of a subcutaneous pyogenic granuloma (lobular capillary hemangioma) on the left nasal bone in a 51‐year‐old woman. A minimally invasive surgical approach using rhinoplasty techniques combined with endoscopes is described, along with indications and contraindications for use.MethodThe nontender nasal mass developed over 5 weeks. It was soft like a lipoma and clearly subcutaneous with no visible puncta or cutaneous irregularity, and was lateral to the nasal bones between radix and rhinion. The patient wanted to avoid a skin incision at all costs.ResultsUnder anesthesia, an intercartilagenous incision was made and sharp dissection over the upper lateral cartilage and nasal bone was performed to approach the mass. Using endoscopes and dissectors, the mass was removed with a cuff of soft tissue. It appeared blue and grossly consistent with a vascular neoplasm. Frozen section evaluation was nondiagnostic. Final histopathology showed the characteristic lobular configuration with a central branching vessel with solid growth pattern of endothelial proliferation. At 12 weeks no contour defect along lateral nasal sidewall was appreciated. The indications and limitations of this minimally invasive approach will be discussed.ConclusionThis presentation of a pyogenic granuloma is rare and unusual. An endonasal rhinoplasty approach utilizing endoscopy instrumentation spared the patient a cutaneous scar. This approach should be considered for patients with similar deep subcutaneous benign neoplasms over the osseous or cartilage nasal framework as it spares a visible incision.
Long‐Term Cosmetic Outcomes of Parotidectomy Reconstruction: AlloDerm versus Free Dermal Fat Graft
Authors: Mitchell Joshua R. , Robinson Jamie , Rangarajan Sanjeet , Netterville James L. , Athavale Sanjay M. , Dhulipala Sravan 
Published: September 2011

ObjectiveParotid neoplasms generally require surgical resection with adequate margins. Cosmetic contour deformities resulting from parotidectomy can cause significant postoperative dissatisfaction. Therefore, we seek to compare the functional and cosmetic success of 2 postparotidectomy reconstructive modalities: autologous free dermal fat grafting (FDFG) and AlloDerm implantation.MethodWe conducted a retrospective review of all patients who underwent a parotidectomy with either AlloDerm or autologous FDFG reconstruction by a single surgeon since January 1997. Complications were identified and patients from both cohorts were contacted by telephone to assess cosmetic satisfaction using a novel analogue scale.ResultsSixty‐five patients who received AlloDerm reconstruction and 35 patients who received FDFG reconstruction were analyzed. The incidence of complications following FDFG was 3% (n = 1) compared with 5% (n = 3) after AlloDerm implantation (P = 1.000). Both cohorts rated their reconstruction on symmetry (1‐worst to 5‐best), degree of change (1‐least to 5‐most), and overall satisfaction (1‐worst to 5‐best). Patients with FDFG reconstruction reported favorable cosmesis with respect to symmetry (4.5 ± 0.7) and overall appearance (4.8 ± 0.4), while indicating mild changes in their appearance over time (2.0 ± 1.2). At the time of this writing, cosmetic assessment of AlloDerm patients was underway but incomplete.ConclusionFDFG and AlloDerm are cosmetically and functionally viable options to reconstruct the post‐ablative parotid bed. Both modalities demonstrated similarly low complication rates (P = 1.000), and an assessment of long‐term patient satisfaction with AlloDerm will determine how it compares to the cosmetically efficacious FDFG.
Methylome Analysis of HPV‐Associated Head and Neck Cancer
Authors: Lechner Matthias Alexander , Feber Andrew , Teschendorff Andrew , Boshoff Chris , Wilson Gareth , Butcher Lee M. , Beck Stephan 
Published: September 2011

ObjectiveA significant proportion of HNSCC is caused by human papillomavirus. Patients diagnosed with this subtype have a significantly better outcome. It is the aim of the UCL Head and Neck Cancer Epigenome Project to generate and analyze comprehensive, genome‐wide profiles of epigenetic aberrations in this specific type of human cancer.MethodWhole‐genome DNA methylation (methylome) analysis of 3 HPV positive and 3 HPV negative frozen HNSCC samples (obtained from the UCL Head and Neck Cancer Tissue Bank as part of a larger discovery set) was conducted using methylated DNA immunoprecipitation coupled with next‐generation sequencing (MeDIP‐Seq).ResultsOn average, each sample in the pilot phase generated 2 x 107 sequencing reads and 70% coverage of all CpG sites within the host genome. HPV type 16 was observed in all HPV positive samples and, interestingly, methylated regions of this virus were identified—most notably at genes E1 and L1 (previously shown to have been methylated in cervical cancer). We also detected multiple methylation changes between HPV positive and HPV negative host’s methylomes, of which a significant proportion mapped to genes previously shown to display down‐regulated expression in transcriptionally active HPV positive oropharyngeal cancer.ConclusionThe observed epigenetic differences between the 2 types might explain the different clinical behavior of HPV‐associated HNSCC. Although preliminary, these pilot data are encouraging with respect to the possibility of identifying potential diagnostic and prognostic markers, as well as putative therapeutic targets in this subtype of HNSCC.
Nodal Disease in Post‐chemoradiotherapy Neck Dissection
Authors: Ahsan Farhan , Junor Elizabeth , Ironside Janet , Vernham Guy A. , Ganly Ian , Keh Siew M. 
Published: September 2011

Objective1) Determine the rate of residual neck node disease in patients with squamous cell carcinoma of the larynx, hypopharynx, and oropharynx undergoing neck dissection post‐chemoradiation; and 2) Determine the impact on outcome.MethodDesign: Retrospective case series. Patients: Thirty‐three consecutive patients with residual neck disease following chemoradiotherapy for advanced stage laryngopharyngeal cancer were identified at a single institution between May 2003 and October 2007. Main outcome measure: Neck node pathological positivity, neck recurrence free survival, and disease specific survival.ResultsThirty‐eight neck dissections were carried out in 33 patients (median ± STD age, 59 ± 7.8 years; 85% male). The oropharynx was the most common primary site (n = 27; 73%). The follow‐up duration ranged from 9 to 61 months. Pathologically, 39.4% (13/33) of patients had viable tumor cells identified in dissection specimen. Three patients (9%) developed primary site recurrence. One patient (3%) died from local/regional disease and 2 patients (6%) died from distant metastasis. There was no statistically significant (P =. 37) increase in neck recurrence rate in the SND group when compared to the MRND and RND groups.ConclusionViable tumor results in poorer outcome even after complete resection by neck dissection.
Oncologic Validity of Cervical Recipient Vessel Preservation
Authors: DeConde Adam , Vira Darshni , Blackwell Keith E. 
Published: September 2011

ObjectiveDetermine whether preservation of cervical recipient vessels affects surgical resection margins in patients who undergo microvascular free flap procedures for defects of reconstruction of the head and neck after the treatment of neoplasms.MethodConsecutive patients with adventitial biopsies of recipient neck vessels were identified over the previous 6‐month period, and pathology was reviewed. Patient clinical information (age, sex, diagnosis, tumor site, tumor stage, prior treatment with surgery, radiation therapy, chemotherapy) was reviewed as potential risk factors for tumor involvement of recipient vessels.ResultsA total of 57 patients with recipient vessel biopsies were identified between June 2010 and January 2011. Tumor sites included oral‐oropharnygeal (n = 38), laryngopharyngeal (n = 8), scalp (n = 7), skull base‐midface (n = 3), and neck (n = 1). Tumor pathology included squamous cell carcinoma (n = 45), osteoradionecrosis with a history of squamous cell carcinoma (n = 4), adenocarcinoma (n = 2), ossifying fibroma (n = 2), as well as a case each of ameloblastma and melanoma. One (1.7%) recipient vessel biopsy was positive for squamous cell carcinoma. This vessel looked grossly abnormal and was sent for frozen section analysis.ConclusionMicrovascular free flap reconstruction uses recipient vessels in the neck, which can potentially adversely affect resection margins by requiring preservation of recipient vessels in proximity to tumors. However, our results show that frozen section biopsy is necessary only when intra‐operative findings are concerning for tumor involvement of the recipient vessels.
Overexpression of CIP2A in Head and Neck Cutaneous SCC
Authors: Koide Jade , Sauer David , Wong Melissa , Gross Neil D. , Clayburgh Daniel 
Published: September 2011

ObjectiveDetermine if 1) Cancerous Inhibitor of Phosphoprotein 2A (CIP2A), which increases c‐myc activity by inhibiting the c‐myc inhibitor Phosphoprotein 2A (PP2A), is overexpressed in cutaneous squamous cell carcinoma of the head and neck (cSCCHN). 2) PP2A expression is altered in cSCCHN.MethodSpecimens of normal skin, early stage cSCCHN, late stage primary cSCCHN, and metastatic cSCCHN were sectioned and subjected to immunofluorescence staining for CIP2A and PP2A. CIP2A and PP2A expression was quantitated using the validated open‐source software CellProfiler. Expression changes were assessed with ANOVA and Bonferroni tests, with p < 0.05 denoting significance.ResultsA total of 38 specimens were examined (5 normal skin, 9 early stage cSCCHN, 12 late stage cSCCHN, and 12 metastatic cSCCHN). CIP2A was significantly overexpressed in early stage cSCCHN relative to normal skin (30.0 vs 17.7% of cells positive for CIP2A, P =. 049), while expression was even higher in late stage primary cSCCHN (46.3% positive) and metastatic cSCCHN (49.4% positive, P =. 004 vs normal, ANOVA among all 4 groups: P =. 002). However, PP2A expression was completely unchanged among all 4 groups (P =. 9754 by ANOVA).ConclusionWhile PP2A expression is unchanged, CIP2A is overexpressed in cSCCHN, and increasing expression of CIP2A is correlated with metastatic progression of cSCCHN. Thus, CIP2A activity may be important to cSCCHN tumorigenesis and serve both as a prognostic marker and as a novel target for new therapeutic agents.
Parathyroid Ectopia‐Development of a Surgical Algorithm
Authors: Gunasekaran Sinnappa P. , Mikl Dan , Wallace Helen C. , England James 
Published: September 2011

ObjectiveStudy the incidence of ectopic parathyroid adenomata from a single surgical series and devise a surgical algorithm from the results to follow when an adenoma cannot initially be located.MethodRetrospective review of a prospectively collected senior author’s (RJAE) database of 357 patients who underwent parathyroidectomy between June 2001 and February 2008. From the database, an ordered surgical protocol has been developed for the location of both ectopic superior and inferior parathyroid adenomata in order of incidence.ResultsParathyroid ectopia occurs in approximately 10% of cases of hyperparathyroidism. It is more common in superior than inferior parathyroid glands. The most common superior location is the left retroesophageal position, and the most common inferior location is within the left thymic remnant.ConclusionProspective data collection and subsequent analysis can lead to the development of a systematic surgical protocol to aid the location of ectopic enlarged parathyroid glands in the surgical management of hyperparathyroidism.
Parotid Gland Tumors: A Survey of UK Management Practice
Authors: Bradley Paula Theresa , Homer Jarrod J. 
Published: September 2011

ObjectiveIdentify if practice variations exist in the management of parotid lesions between otolaryngologists and oral maxillofacial specialists (OMFS). Benign and malignant parotid surgery is undertaken by both otolaryngologists and OMFS. Between the specialties there is debate about the surgical approach to parotid tumors.MethodAn online questionnaire (SurveyMonkey) was sent to members of ENT‐UK via email. The members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) were posted a questionnaire that was either returned by post or completed online.ResultsA total of 108 otolaryngologists and 98 OMFS res‐ponded to the questionnaire, all of whom performed parotid surgery. The majority (75.2%) of otolaryngologists used facial nerve monitors in all/most cases whereas 73.1% OMFS used them never/seldom. In revision surgery 88.3% of otolaryngologists mostly/always used a facial monitor compared to 38% of OMFS with 39.1% never/seldom using one. The choice of surgery for a presumed pleomorphic adenoma showed the most difference between the two groups: 87.6% of otolaryngologists would perform a partial parotidectomy, yet 34.5% of OMFS would remove the tumor by extracapsular dissection of the tumor without a cuff.ConclusionThere are marked differences in the approach to parotid disease between OMFS and otolaryngologists, particularly in the intra‐operative monitoring and the surgical approach.
Feasibility of Endoscopic Intramedullary Fixation of Fractures of the Mandibular Condyle
Authors: Frake Paul C. , Joshi Arjun S. , Goodman Joseph F. 
Published: September 2011

Objective1) Describe a novel technique for internal fixation of mandibular condyle fractures, as well as a new type of implant for the same. 2) Demonstrate surgical feasibility of this technique in a cadaver model.MethodA transoral endoscopic approach was used to access the osteotomized mandibular condyle in 2 human cadavers. Titanium intramedullary implants were placed endoscopically after reaming of the medullary space without the need for transbuccal puncture or facial incisions.ResultsBoth cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg type implant and screwing a threaded implant into the condylar head are possible. The inferior portion of the implant remains exposed and the ramus of the mandible can be manipulated into position on the implant using retraction at the sigmoid notch.ConclusionTrue total endoscopic repair of fractures of the mandibular condyle is possible by utilizing novel intramedullary titanium implants and a transoral endoscopic approach. This is the first description of the technique and implants for endoscopic intramedullary fixation of fractures of the mandibular condyle.
Percutaneous Gastrostomy Complications and the Management of Head and Neck Cancer
Authors: Gal Thomas J. , Sokoya Fiyin , Valentino Joseph 
Published: September 2011

Objective1) Understand the surgical site morbidity of percutaneous gastrostomy (PEG) in the head and neck cancer population. 2) Understand the implications of PEG morbidity on the therapy for head and neck cancer.MethodA retrospective review was performed on patients with head and neck cancer undergoing PEG in a tertiary care center. Patients treated between 1998 and 2008 were eligible for inclusion. Demographic and oncologic data were recorded. Primary outcome measures were surgical complications and complication type arising from the gastrostomy itself.ResultsA total of 153 patients were identified with sufficient data available for review. A total of 61.6% of patients were male. Mean age was 58.1 years. Complications were observed in 28.1% of patients. The most common documented complication was leakage around the gastrostomy site (9.2%). Other observed complications included cellulitis of the abdominal wall (8.5%), abdominal wall abscess (1%), buried or extruded bumper (8%), and non‐patent tubes (2.3%). Major complications were documented in 4 patients (2.6%) and included hemorrhage, perforated viscus, and peritonitis. No association of complications of any type with age, gender, tumor site, stage, or surgical service were observed.ConclusionComplications resulting from PEG in the head and neck cancer population are for the most part minor, self limited, and likely underreported. Major complications are infrequent but can be significant. Management and treatment implications with regards to head and neck cancer are discussed.
Prevention of Complications in Salvage Pharyngolaryngectomy
Authors: Sakai Akihiro , Okami Kenji , Iida Masahiro 
Published: September 2011

ObjectiveSalvage pharyngolaryngeal surgery can often cause severe complications. We applied surgical techniques, including pectoralis major myocutaneous flap (PMMCF) or deltopectoral flap (DPF) and some additional techniques, and could reduce the PCF and severe complications. Herein, we report the usefulness of our surgical techniques in salvage pharyngolaryngeal surgery.MethodThis retrospective study was based on a review between 2001 and 2010. Additional surgical techniques were applied since 2008. Our surgical techniques included covering with PMMC or DP, leakage test, thyroid lobe preserving, and suturing the tracheal cartilage to sternoclavicular joint. The complication rate and PCF rate were analyzed.ResultsSalvage surgeries were undergone in 36 patients between 2001 and 2008. The wound complication rate was 30.5%. The incidence of PCF was 22.2%. In the chemoradiation group, 3 out of the 5 PCF cases suffered severe bleeding. Since 2008 salvage surgery was performed in 18 patients. The wound complication rate was 28% and PCF rate was 5.5%. We had no lethal complication, such as carotid rupture.ConclusionWe could not reduce the complication rate because the complications of flap were increased. However, we could reduce the PCF rate and lethal complications using additional surgical techniques. We must improve the surgical techniques to reduce the risk of complications in salvage pharyngolaryngeal surgery in the era of organ preservation therapy.