bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Salivary Gland Frozen Section on Surgical Outcomes
Authors: Houlton Jeffrey , Turner Kevin , Fernandez Nella , Sun Gordon H. , Zhai Qihui , Patil Yash J. 
Published: September 2011

ObjectiveDetermine the accuracy of intraoperative salivary gland frozen section (FS) and to evaluate the effects of misdiagnosis on surgical outcomes and postoperative complications.MethodData were retrospectively reviewed for all patients undergoing intraoperative salivary gland FS at a tertiary care center from January 2000 to June 2010. FS was correlated with permanent pathology and categorized as concordant, discordant, or deferred. Patients with discordant/deferred FS were evaluated for appropriateness of surgical intervention and for postoperative complications of inappropriate surgery.ResultsOver 2,000 patients underwent salivary gland surgery in the 10‐year study period. One hundred eighty underwent intra‐operative FS, including 73% (132) concordant, 2% (3) discordant, and 25% (45) deferred (non‐definitive) FS interpretations. One of 3 patients with discordant FS underwent surgery of inappropriate extent resulting in an unnecessary neck dissection and permanent spinal accessory nerve paralysis. 7% (3/45) of patients with deferred/nondefinitive FS underwent suboptimal surgery, resulting in one re‐operation but no other major complications. Overall, 98% (176/180) of patients that underwent salivary gland FS received operations consistent with permanent pathology. Pleomorphic adenoma was the most commonly deferred entity.ConclusionThough deferred and discordant salivary gland FS diagnoses may lead to suboptimal surgical intervention and potential postoperative complications, the use of FS correlates with optimal surgical intervention in the vast majority of cases.
Thimble‐Enhanced Fine Needle Aspiration of the Submandibular Triangle
Authors: Cannon C. Ron 
Published: September 2011

Objective1) Learn a method to enhance the yield in diagnosing masses in the submandibular triangle via Fine Needle Aspiration (FNA). 2) Learn how to enhance the technique of FNA using an inexpensive sewing thimble.MethodIn patients with submandibular triangle masses, a thimble is placed over the surgeons index finger and gloved. The index finger is placed intraorally and the contents of the submandibular triangle are displaced inferiorly and laterally. Using the contralateral hand or a “two‐person” technique, the FNA is then completed.ResultsThis simple refinement has aided in the successful completion of FNA for masses located in the submandibular triangle.ConclusionThe use of an inexpensive sewing thimble is a helpful adjunct in the successful completion of FNA in masses located in the submandibular triangle.
Treatment of Thyroglossal Duct Cyst by OK‐432
Authors: Ota Nobuo , Fukase Shigeru 
Published: September 2011

ObjectiveIntralesional injection therapy with OK‐432 was developed as a therapy for operatively difficult lymphangioma and is currently becoming a first choice treatment of this disease. The aim of this article was to evaluate the outcome and complications of the treatment of patients with thyroglossal duct cysts by OK‐432 therapy.MethodWe tried this therapy in 15 patients with thyroglossal duct cysts between January 2001 and February 2009. We injected OK‐432 solution into the lesion with a 27 gauge needle to prevent the leak of the agent out of the cyst. We performed this treatment on an outpatient basis without hospitalization.ResultsDisappearance and marked reduction of the lesion were observed in all patients who had this therapy, and local scarring and deformity of the auricle did not occur in any patients. As side effects, local pain at the injection site and fever (37 to 38°C) were observed in a few cases of the patients who had this therapy, but such problems resolved within a few days.ConclusionThese results may allow us to speculate that intralesional injection therapy with OK‐432 is simple, easy, safe, effective, and useable as a substitute for surgery in the treatment of thyroglossal duct cysts.
Ultra‐low Velocity Penetrating Neck Trauma: Explore/Extract?
Authors: Page Matthew P. , Panfili Zachary E. , Lasiter J. Clint 
Published: September 2011

Objective1) Describe the injury pattern caused by ultra‐low velocity (ULV) foreign body penetration of the neck in the context of self‐mutilation, and 2) Propose a conservative management strategy for removal of such foreign bodies when the likelihood of serious injury is low.MethodCase series of 8 incidents of self‐inflicted ULV penetrating neck trauma in a single patient who presented to a tertiary care hospital between December 2007 and December 2008. Postoperative morbidity was analyzed according to the presenting signs, symptoms, and radiologic findings and to the extent of surgical intervention.ResultsTen foreign bodies were removed on 8 separate occasions. Concerning physical signs were present on one occasion (bleeding); symptoms on 3 (dyspnea or odynophagia); and radiologic findings on 6. Seven objects were retrieved by targeted dissection, with a mean operative time of 27.7 ± 8.4 min. Three objects were removed in the context of formal neck exploration, each with an operative time of 65 min. No significant injuries were found after foreign body removal. Minor transient incisional pain was the only morbidity observed, and this did not vary with preoperative injury assessment or extent of surgical intervention.ConclusionIn our series of ULV penetrating neck trauma, concerning CT findings were more common than signs/symptoms of serious injury. Morbidity from ULV foreign body penetration and from its surgical treatment was low, whether formal exploration or targeted extraction was performed. Imaging tended to overestimate injury but helped with surgical planning.
Closure of Scalp Defects Using External Tissue Expander
Authors: O’Reilly Ashley , Youse Jeremy , Roenigk Randall , Price Daniel L. , Schmitt William R. 
Published: September 2011

Objective1) Present a novel method of closure of large scalp defects with an external tissue expansion device. 2) Review methods of scalp closure.MethodPatients with large central scalp defects secondary to cutaneous malignancy underwent wound closure with a novel external tissue expansion device. The device applies a constant, measured tension to approximate the wound edges. Data regarding patient clinical factors, defect size, and photographs were collected prospectively.ResultsFour patients had large scalp defects secondary to extirpation of cutaneous malignancies. Two patients with wounds 7.5‐ x 7.5‐cm and 9.5‐ x 5‐cm respectively achieved primary closure after 8 days of expansion. One patient with a 6.5‐ x 7.5‐cm wound had reduction of wound size to 3.5‐ x 2.5‐cm after 14 days. The wound then healed by secondary intention. One patient with a 6‐ x 7‐cm wound achieved closure with the use of bilateral rotation‐advancement flaps after 8 days. This flap ultimately failed and will require free flap reconstruction. There were no other postoperative complications, wound breakdown, or device failures.ConclusionExternal tissue expansion is a safe and alternative technique to close large scalp defects that would otherwise require skin grafting or free flap reconstruction in appropriately selected patients, and can be achieved in a relatively short period of time.
A Novel Transgenic Animal Model for HPV‐Associated Cancer
Authors: Sewell Duane , Dobrosky Christine , Marvel Douglas , Hancock Melyssa , Gendron Kristin B. , Banyard Derek 
Published: September 2011

ObjectiveThe incidence of HPV‐associated tumors is rising at a rapid pace. In order to develop novel therapies with high efficacy but low toxicity, it is crucial to have an animal model in which HPV‐associated oral lesions spontaneously develop. Our objective was to develop such a model.MethodA transgene was created to target expression of E7 to the oral cavity by cloning HPV‐16 E7 downstream of the L2 promoter. Transgenic mice which carry this gene were created on the C57Bl6 background. Then, these mice were backcrossed with a strain of mice heterozygous for p53.ResultsMice were bred to create the desired genotype, E7 +/+, p53 ‐/‐. Because of the short life span and limited breeding potential of mice with a homozygous p53 deletion, breeding was performed with p53 heterozygous mice. In accordance with Mendelian genetics, we found the majority of offspring were heterozygous for p53, and did not form spontaneous tumors. Of the offspring with homozygous p53 deletions, few lived longer than 25 weeks. However, one mouse lived long enough to develop an HPV‐associated oral tumor. E7 transcript was detected in the tumor by RT‐PCR, and E7 protein was detected via Western blot.ConclusionWe report the development of a transgenic mouse which spontaneously expressed an HPV‐associated oral tumor. Additional genetic manipulation may be required to enhance the longevity and stability of this mouse strain. This strain has the potential to serve as a platform to investigate novel therapeutic strategies for HPV‐associated tumors.
A Survival Analysis for Primary and Salvage Ablative Surgery with Microvascular Reconstruction for Squamous Cell Carcinoma of the Upper Aerodigestive Tract
Authors: Boeckmann Jacob O. , Spencer Horace , Vural Emre A. , Suen James Y. , Yuen James C. 
Published: September 2011

ObjectiveProvide prognostic data for the physicians and patients when a decision is made for primary or salvage ablative surgery of the upper aerodigestive tract with the aide of microvascular reconstruction.MethodRetrospective chart review of patients with primary or recurrent upper aerodigestive tract squamous cell carcinoma treated with free flap reconstruction between 1993 and 2009. Prior treatment, recurrence time and site, sex, age, complications, cause of death, stage, and survival rates were analyzed.ResultsA total of 219 patients were identified. Mean age was 59.6 years. A total of 136 patients underwent primary resection with immediate reconstruction, 83 patients underwent salvage treatment. A total of 196 patients had advanced clinical stage oral (n = 129) and oropharyngeal squamous cell carcinomas (n = 51). Median overall survival for all patients was 21.7 months (CI 16.2, 33.1) with median recurrence free survival of 12.6 months (CI 8.8, 16.6). Median overall survival was 31.3 months (CI 18.6, 48.6) for primary resection group and 14.6 months for salvage group (CI 11.4, 21.5). Recurrence free median survival was 16.6 months for the primary resection group and 7.7 months for salvage group (P =. 009).ConclusionThe surgeon and the patient need to be aware of survival rates, when radical resection with free flap reconstruction offered; especially in salvage setting. This may help the patient and the surgeon in choosing the most suitable treatment modality for any given condition.
Adenoid Cystic Carcinoma: Benefit of Surgery Plus Adjuvant Radiation
Authors: Pearce Elizabeth C. , Yu Chang , Alvarez JoAnn , Netterville James L. , Rhode Sarah L. 
Published: September 2011

ObjectiveEvaluate the role of adjuvant radiation compared with surgical resection alone in treatment of adenoid cystic carcinoma of the head and neck. In addition, given the varied course and presentation of the disease, to analyze the impact of perineural invasion, margin status, and AJCC Tumor stage on survival.MethodRetrospective review of 92 patients treated for adenoid cystic carcinoma of the head and neck between 1978 and 2010 at a single tertiary care academic center. Kaplan‐Meier survival curves and Cox Proportional Hazards Model were used to evaluate the impact of treatment modality and clinical and pathological parameters on survival.ResultsThe oropharynx was the most common site (30.4%). Overall 2‐, 5‐, and 10‐year survival rates were 75%, 51%, and 22%. Mean follow‐up was 75.9 months. All but 3 patients were treated with surgery and 60 out of 92 (65.2%) underwent postoperative radiation. Mean time to recurrence was 45.6 months and occurred in 45 out of 90 patients (50%). Significantly more T3/T4 staged patients underwent surgery plus adjuvant radiation than T1/T2 patients (P <. 045).ConclusionDespite being classified with more advanced disease (T3/T4 Stage), patients in the surgery plus radiation group had similar outcomes to patients who received surgery alone. Adjuvant radiation should be considered in all patients with adenoid cystic carcinoma of the head and neck.
An Inexpensive, Reproducible Anatomic Model for Surgical Training of Myringotomy
Authors: Ingram Amy , Malone James P. 
Published: September 2011

ObjectiveDesign an inexpensive, reproducible anatomic model to simulate myringotomy and tympanostomy tube placement in the surgical skills laboratory, which would allow residents to familiarize themselves with the microscope, anatomy, and tools used during a typical procedure.MethodDesign an inexpensive, reproducible anatomic model to simulate myringotomy and tympanostomy tube placement in the surgical skills laboratory, which would allow residents to familiarize themselves with the microscope, anatomy, and tools used during a typical procedure.ResultsThe model was assembled by sawing the styrofoam head in half and making medial and lateral openings. The medial portion of the simulator ear was removed and the ear placed within the external opening of the head. A T‐pin was molded to represent the malleus and secured at the inner edge of a three cm segment of detached bulb syringe tip. Glad Wrap was draped over the “malleus,” and the entire assembly was then placed within the medial opening of the head to line‐up with the external canal. The “tympanic membrane” is the only disposable portion of the model.ConclusionThis model is a practical and reproducible anatomic model for simulation training of a myringotomy. It has been used successfully by multiple residents and can be created by utilizing inexpensive materials. We plan to integrate this into a Verification of Proficiencies (VOP) program to assess surgical skills in otolaryngology residents.
Assessment for Staging of Head and Neck Cancers by FLT PET
Authors: Hoshikawa Hiroshi , Kishino Takehito 
Published: September 2011

ObjectiveInvestigate the feasibility of using FLT PET to detect head and neck squamous cell cancer (HNSCC) and to compare the diagnostic efficacy with that of FDG PET in evaluation of the nodal and distant metastatic staging.MethodPatients with histopathologically proven HNSCC underwent FLT PET and FDG PET performed at 60 min after radiotracer injection. The PET images were evaluated qualitatively for regions of focally increased metabolism and for semiquantitative analysis, the maximum standardized uptake value (SUV) was calculated.ResultsFor depiction of primary tumors, the sensitivity of both approaches was 100%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for lymph node staging on a per‐patient basis were 71, 95, 94, 72, and 81%, respectively, with FLT PET and 79, 89, 90, 77, and 84%, respectively, with FDG PET. One of 2 distant metastases was detected with FLT and FDG PET. Although FLT PET had no false‐positive result for M staging, FDG PET showed three false‐positive results owing to physiological bowel activity and/or inflammation.ConclusionFLT PET was found to have high sensitivity for depiction of primary tumors despite a lower FLT SUV than FDG. FLT PET showed better specificity and positive predictive values for N staging than FDG PET. Further studies are needed to predict and evaluate tumor response to therapy by FLT PET.
Assessment of Autofluorescence for Oral Cancer Screening
Authors: Sweeny Larissa , Clemons Lisa , Dean Nichole , Rosenthal Eben L. , Magnuson J. Scott , Carroll William R. 
Published: September 2011

ObjectiveAlthough FDA approved for clinical use, the utility of hand‐held tissue reflectance and autofluorescence devices for screening head and neck cancer (HNC) patients is poorly defined. There is no published evidence regarding the efficacy of these devices. We investigated the sensitivity and specificity of these modalities compared with standard examination.MethodStudy design: prospective, cross sectional analysis. Included patients previously treated for HNC (n = 89) and patients being evaluated for a new primary (n = 10) between 2009 to 2010. Patients were screened using white light illumination (standard of care) followed by tissue reflectance and autofluorescence illumination. Results were compared with biopsy results or follow‐up screening.ResultsViolet light had a specificity (Sp) of 67% and a sensitivity (Sn) of 79%, which was comparable with standard of care (white light) examinations (67% Sp and 86% Sn). Amber light had poor specificity (0%) and good sensitivity (83%). The positive and negative predictive values for standard white light examination (15% and 96% respectively) were superior to both violet and amber light. For patients presenting with new lesions (n = 10), tissue reflectance (60% Sp, 83% Sn) and autoflourescence (50% Sp, 75% Sn) were inferior to standard white light examination (100% Sp and Sn).ConclusionStandard clinical lighting has a higher sensitivity than tissue reflectance and autoflourescence visualization for detection of disease in new patients or those with a history of HNC. This study does not support the added costs associated with these devices.
Culture of Human Septal Chondrocytes in a Rotary Bioreactor
Authors: Reuther Marsha S. , Briggs Kristen , Schumacher Barbara , Watson Deborah , Masuda Koichi , Sah Robert L. 
Published: September 2011

Objective1) Show that extracellular matrix deposition is possible in 3‐dimensional culture of human septal chondrocytes cultured in a rotary bioreactor as well as in static conditions. 2) Demonstrate that the biomechanical properties of human septal chondrocytes cultured in a bioreactor and static culture amplify with time.MethodHuman septal chondrocytes from 9 donors were expanded in monolayer and seeded in alginate beads. The beads were cultured in a rotary bioreactor for 21 days in media supplemented with growth factors and human serum, using static culture as the control. Biochemical and biomechanical properties of the beads were measured.ResultsGlycosaminoglycan (GAG) accumulation significantly increased during 2 measured time intervals, 0 to 10 days and 10 to 21 days (P <. 01). No significant difference was seen between the static and bioreactor conditions. However, substantial type II collagen production was demonstrated in the beads terminated at day 21 of culture in both conditions. In addition, the biomechanical properties of the beads were enhanced at 21 days in comparison with beads from days 0 and 10.ConclusionHuman septal chondrocytes cultured in alginate beads exhibit significant matrix deposition and improved biomechanical properties after 21 days. Enhanced matrix deposition during bead culture will expectantly lead to formation of neocartilage that is comparable with native tissue. Matrix production in beads is supported by the use of a rotary bioreactor.
Business Case for Pretreatment Swallowing Exercises
Authors: Focht Kendrea Layne , Simpson Kit , Martin‐Harris Bonnie 
Published: September 2011

ObjectiveConstruct a decision analysis model to 1) estimate the incremental cost‐effectiveness ratio (ICER) of pretreatment swallowing exercises to posttreatment swallowing exercises, and 2) propose a clinical decision‐making tool to reduce head and neck cancer treatment‐related morbidity.MethodA transition state model was constructed to estimate the ICER of pretreatment swallowing exercises in 100 hypothetical patients with HNC treated with chemoradiation. Quality of life estimates were obtained through convenient sampling. Costs were estimated from Medicare reimbursement data. Sensitivity analyses evaluated changes in efficacy, utilities, and costs.ResultsPretreatment swallowing exercises were less costly and resulted in a greater gain in quality‐adjusted life‐years (QALYs) when compared with posttreatment swallowing exercises. Compared with standard practice of providing posttreatment swallowing exercises, the pretreatment exercise intervention provides a dominant ICER of $142,972 and 15.88 QALYs per 100 patients. Sensitivity analysis adjusting both costs and utilities had minimal impact on these results as the ICER continued to be dominant, which suggests that pretreatment swallowing exercises are more effective and less expensive than posttreatment swallowing exercises.ConclusionPretreatment swallowing exercises offer a clinical benefit in patients treated with chemoradiotherapy for head and neck cancer with significant cost savings relative to current standard of care. Findings from this analysis result in a useful decision‐making tool for clinicians regarding prophylactic swallowing exercises to reduce treatment‐related morbidity.
Central Neck Compartment Metastases in Tall‐Cell Variant of Papillary Thyroid Cancer
Authors: Roman Benjamin R. , Opher Elana , Har‐El Gady , Carew John 
Published: September 2011

ObjectiveRecent American Thyroid Association (ATA) guidelines suggest a role for prophylactic central neck dissection in patients with papillary thyroid cancer (PTC). No studies directly address this subject in patients with the tall‐cell‐variant (TCV) of PTC. We sought to determine the risk of metastasis to the central compartment in patients with TCV.MethodA retrospective review was performed of all cases of papillary thyroid cancer undergoing primary surgical therapy with central neck dissection (CND) at our institution from 2007‐2010. Charts were reviewed for demographic data, and pathology was reviewed for tumor histology, size, multi‐focality, CND positivity, and extra‐thyroidal extension (ETE).ResultsA total of 63 patients with PTC underwent primary surgical therapy with CND, 10 of whom had TCV. Five of the TCV patients had positive nodes (50%), whereas only 18 of the 53 classical PTC had positive nodes (34%). TCV tumors were significantly larger than PTC tumors (1.8 cm 1.2 cm, P <. 005). In both groups, a larger tumor size correlated with a significantly higher incidence of positive CND (P <. 05 for TCV, and P <. 01 for PTC). In the PTC group, ETE correlated with significantly higher incidence of positive CND (P =. 001). Patients’ age and tumor multi‐focality did not correlate with increased positive CND in either group.ConclusionCentral compartment metastases occurred in 50% of TCV and 34% of classical PTC. This may be due to the fact that TCV tumors presented with a significantly larger size when metastases were already present. The findings of this study support the ATA recommendation for CND in patients with TCV.
Circulating Tumor Cells in Head and Neck Squamous Cell Carcinoma: Evaluation of a Novel Method
Authors: Baker Jeffrey C. , Ducatman Barbara , Rassekh Christopher H. 
Published: September 2011

ObjectiveThe primary objective of this project is to determine if circulating tumor cells (CTCs) are identifiable in peripheral blood from patients with advanced head and neck squamous cell carcinoma using a commercially available semi‐automated technique.MethodPrior to treatment, adult patients with advanced Head and Neck Squmous Cell Carcinoma had whole peripheral blood drawn and analyzed using the CellSearch Epithelial CTC kit. The target molecules of the system include EpCAM and cytokeratins 8, 18, and 19.ResultsThere was a total of 18 patients with additional positive and negative controls. The average age was 65 years and 61% of the population was female. Primary tumor sites were varied with 39% laryngeal, 33% pharyngeal, 22% oral cavity, and 6% cutaneous. The majority of patients, 78%, had stage IV disease at the time of evaluation. The positive control, SCC‐1483, identified over 305 CTCs. There were no CTCs identified in clinical samples.ConclusionHNSCC cells are detectable using the CellSeach system, as evidenced by the positive control. Despite testing a population with advanced disease, the system failed to detect a CTC in a clinical sample. Therefore, the system is not a sensitive technique for identifying CTCs in HNSCC.