bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictive Value of Laryngeal Cartilage Sclerosis on CT‐Scan
Authors: Poirier Jackie Bibeau , Nguyen Félix , Bélair Manon , Moubayed Sami P. , Ayad Tareck 
Published: September 2011

ObjectiveThe value of laryngeal sclerosis as a sign of neoplastic invasion on CT‐scan is controversial. We investigated the value of laryngeal cartilage sclerosis on CT‐scan as a predictor of locoregional control, success of organ preservation, and survival for patients treated with radiation therapy for laryngeal carcinoma.MethodRetrospective chart review on patients treated for laryngeal carcinoma with radiation therapy at the CHUM between 2002 and 2007. A head and neck radiologist revised each patient’s pretreatment CT‐scan to determine the presence of laryngeal cartilage sclerosis. This variable was correlated with locoregional control, laryngectomy, and survival rates.ResultsOf the 111 patients, 76% were male and 24% female. Their mean age was 61 years. Forty‐eight had supraglottic tumors and 63 had glottic tumors. Seven percent had thyroid cartilage sclerosis, 5% cricoid cartilage sclerosis, 55% arytenoid cartilage sclerosis, and 16% arytenoid cartilage sclerosis with adjacent tumor. There was no significant correlation demonstrated between cartilage sclerosis and locoregional control rate, laryngectomy rate and global and disease‐free survival.ConclusionCartilage sclerosis on CT‐scan cannot be identified as a powerful predictor of treatment failure for patients with laryngeal carcinoma treated with radiation, which confirms our therapeutic attitude.
Preoperative Testing for Radial Forearm Free Flaps
Authors: Wood John , Chen Karen , Philips Sharon , Burkey Brian B. 
Published: September 2011

ObjectiveDetermine whether Doppler ultrasound (DUS) is a necessary preoperative test for all patients undergoing radial forearm free flaps (RFFF) or if it can safely be omitted in patients with a normal clinical Allen test (CAT).MethodRetrospective analysis of 143 consecutive patients who underwent RFFF at Vanderbilt University Medical Center between 1992 and 2006. Charts were reviewed for the Allen test, Doppler ultrasound, intraoperative vascular findings, and clinical outcomes. Data were recorded in a Redcap Database and statistical analysis performed by the Vanderbilt Department of Biostatistics.ResultsNinety percent of DUS and 92% of CAT were normal. The relationship between DUS and CAT was statistically significant. For patients with sufficient flow on CAT, 98% were in agreement with the SAT. Of the 3 patients with insufficient flow intraoperatively, 2 had documented normal CAT and DUS. Two patients developed hand ischemia. Both had normal CAT and no preoperative DUS. One hundred percent of abnormal DUS were abnormal by CAT.ConclusionPostoperative RFFF hand ischemia is an extremely rare condition, but it does cause significant postoperative morbidity. DUS testing highly correlates with the findings of CAT and does not appear to be superior in predicting intraoperative findings or postoperative complications. DUS should be limited to patients who have an abnormal CAT.
Qualitative Analysis of the Experience of Oral Tongue Cancer Survivors
Authors: Sperry Steven , Philiponis Genevieve , Chalian Ara A. , Malloy Kelly M. , Kagan Sarah H. 
Published: September 2011

ObjectivePatient experience of oral tongue cancer and life as a survivor is poorly understood and not well described in the literature. This qualitative analysis of interviews with oral malignancy survivors aims to: 1) Describe the common experiences of patients, and 2) Identify surprising findings previously under‐recognized in this patient population.MethodOral tongue cancer survivors from a single surgical practice at a tertiary‐care center participated in open‐ended interviews discussing their experience. The interviews were transcribed and analyzed using constant comparative technique. Open and axial coding identified common themes that are discussed in this descriptive analysis.ResultsSixteen patients, aged 30 to 80 years with stage II to IV disease, participated; all but one patient underwent surgery as primary treatment. Interviews were conducted 3 months to 12 years after treatment. Patients described variable levels of physical pain throughout their experience, but particularly during radiotherapy, when it was severe. Patients’ emotional distress was most pronounced at the time of diagnosis; few described sustained emotional distress. Concerns about altered speech, taste, swallowing, and dry mouth persisted, while changed appearance and social isolation were rarely reported. Interestingly, the majority of patients focused on pervasive dry mouth sensation, regardless of radiotherapy treatment.ConclusionOur findings describe significant variation in physical and emotional pain during disease diagnosis and treatment, with persistent concerns regarding disrupted speech, taste, and swallowing function. Troubling dry mouth sensation is pervasive, independent of adjuvant radiation treatment. Further research should focus more specifically on these experiences and their causal relationships.
Radiation Deteriorates Functional Outcome after Glossectomy
Authors: Shin Yoo Seob , Kim Won Sik , Lee Hyoung‐Shin , Hong Hyun Jun , Kim Se‐Heon , Koh Yoon Woo , Choi Eun‐Chang 
Published: September 2011

ObjectiveQuality of life could be deteriorated by surgical treatment of tongue cancer. Adjuvant therapy may also affect the functional outcome. Therefore, we intend to evaluate the influence of radiotherapy on the postoperative functional outcome after partial glossectomy with free flap reconstruction in early tongue cancer patients.MethodWe measured the functional outcome and reviewed the charts of 31 oral tongue cancer patients. We evaluated speech integrity with Diadochokinetic test (DDK). Mobility of tongue was checked with measurement of upward, protrusion, and lateral deviation distance. We also evaluated swallowing capacity with the M.D. Anderson Dysphagia Inventory.ResultsDDK rates of the surgery‐only group and the postoperative radiotherapy group were 27.8 and 23.9, respectively, which was statistically different. Swallowing capacity was significantly superior in the surgery only group. Tongue mobility was not statistically different between the groups.ConclusionThe functional outcome regarding speech and swallowing is negatively influenced by postoperative radiotherapy.
Relation between PGS Invasion and LN Metastasis in SCPL
Authors: Nam Inn Chul , Joo Young Hoon , Park Jun Ook , Cho Kwang‐Jae , Kim Min Sik 
Published: September 2011

ObjectiveTransglottic cancer invading PGS is characteristically known to show a high incidence of laryngeal skeleton invasion and cervical metastasis. The objective was to determine the role of paraglottic space (PGS) invasion in lymph node metastasis in patients undergoing supracricoid partial laryngectomy (SCPL).MethodWe retrospectively reviewed the clinical and pathological data of 98 patients who were diagnosed with glottis laryngeal carcinoma and underwent SCPL. We examined the relationship between PGS invasion and clinicopathological factors such as age, gender, tumor stage, vocal cord mobility, anterior commissure invasion, thyroid cartilage invasion, and subglottic extension.ResultsThe PGS invasion rate was 60.2% (59/98). Significant correlations were found between PGS invasion and cervical lymph node metastasis (P =. 022). Fifteen of the 59 patients (25.4 %) with the PGS invasion had cervical lymph node metastasis, whereas only 3 of the 39 patients (7.7%) without any evidence of PGS invasion had lymph node metastasis. There was also a significant correlation of PGS invasion with T stage (P =. 008), vocal cord mobility (P =. 001), and subglottic extension (P =. 014). Patients with no evidence of PGS invasion may have a survival benefit even without statistical significance (P =. 118).ConclusionPGS invasion was found to be significantly related to the presence of cervical lymph node metastasis, which suggests that could be used to predict the presence of lymph node metastasis and to determine operative extent and prognosis in patients undergoing SCPL.
Residual Lymph Node Metastasis in Planned Neck Dissection
Authors: Agena Shinya , Maeda Hiroyuki , Hasegawa Masahiro , Suzuki Mikio 
Published: September 2011

ObjectiveClarify the effectiveness of planned neck dissection (PND) after concurrent chemoradiotherapy (CCRT), we investigated residual lymph node metastasis; imaging tests such as positron emission tomography (PET), computed tomography (CT), and ultrasonography at pre‐ and post‐CCRT; and the adverse effects of PND.MethodCCRT combined with PND was performed on 13 patients with oropharyngeal carcinoma, 4 with hypopharyngeal carcinoma, and 2 with laryngeal carcinoma. All primary lesions showed complete response to CCRT. Histopathologic examination of neck specimens and imaging tests were employed to evaluate the effect of CCRT.ResultsEight of 19 patients (47%) had viable carcinoma in their lymph nodes. Patients with poorly differentiated carcinoma in the primary lesion tended to have residual lymph nodes. Most of the residual neck specimens belonged to the level III or level IV lymph node group. Major complications of PND were prolonged laryngeal edema, dysphasia, and disturbance of shoulder movement. Tracheotomies were performed in 42% of all cases. Positive and negative predictive values of PET examination before PND were 50% and 73%, respectively. None of the patients with PND experienced local or lymph node recurrence.ConclusionResidual lymph nodes were frequently observed in head and neck carcinomas. Of the imaging tests, PET was sufficient for detecting residual regions. Although PND is a useful tool, related complications were frequently observed. A more accurate detection system is needed to reduce unnecessary neck dissections.
Screening for Head and Neck Cancer in Childhood Irradiation
Authors: Chu Eugenia , Davidson Bruce J. , Blau Jenny E. 
Published: September 2011

ObjectiveExcept for thyroid disease, no guidelines exist for screening the various sites at risk after a history of childhood irradiation. We sought to develop a formal screening algorithm used to target these high risk patients.MethodFour patients who each demonstrated 3 or more potentially radiation induced tumors of the head and neck are described. Evidence from the literature describing the relationship between these tumors and childhood irradiation provided the basis for screening recommendations.ResultsFour patients, ages 63 to 76 years, who received childhood irradiation are reported. Three patients had salivary tumors and developed hyperparathyroidism secondary to adenoma. Other tumors included papillary thyroid cancer, benign thyroid nodules, basal cell carcinoma, and ear canal osteoma. We propose an algorithm in evaluating these patients. Initially, patients receive a head and neck physical, baseline laboratories and thyroid ultrasound. Suspicious thyroid lesions or ones greater than 8 mm undergo FNA. An audiogram is recommended and potentially MRI if clinical suspicion exists for acoustic neuroma. If pathology is absent on screening, patients merit follow‐up with examination and labs every 1 to 3 years.ConclusionPatients with a history of childhood irradiation present a risk for a multitude of head and neck neoplasms and need thorough screening and evaluation. The proposed algorithm provides a comprehensive tool for head and neck cancer screening in this population emphasizing the diversity of manifestations that may present.
Temporoparietal Fascia Flap Reconstruction for Lateral Skull Base Tumors
Authors: Patel Rusha J. , Hunt Jason P. , Buchmann Luke 
Published: September 2011

Objective1) Determine the efficacy of the temporoparietal fascia flap (TPFF) in preventing cerebrospinal fluid (CSF) leaks during skull base reconstruction for lateral skull base tumors. 2) Learn which factors lead to success of the TPFF.MethodA retrospective chart review was conduced of lateral skull base resections from 2005 to 2010 at a tertiary academic hospital. Patients were divided into TPFF versus non‐TPFF groups. Data on tumor size, intradural extension, and presence of postoperative CSF leak were recorded and compared between groups.ResultsA total of 62 patients underwent lateral skull base resection and were available for review. Sixteen patients had a TPFF reconstruction and 46 patients had other forms of reconstruction. The rates of CSF leak in TPFF versus non‐TPFF groups were 6% and 11%, respectively. Patients with TPFF reconstruction were more likely to have large tumors (25% vs 9%) and to undergo intradural surgical dissection (25% versus 13%). The TPFF group had a higher number of paragangliomas (93% vs 32%) and the non‐TPFF group had a higher rate of squamous cell carcinoma and meningioma (19% and 10%, versus 0%).ConclusionTPFF reconstruction of lateral skull base defects is effective in preventing postoperative CSF leaks. Since the procedure has low morbidity, it should be considered in all lateral skull base defects at risk for CSF leaks, especially for patients with large tumors or intradural involvement.
The Feasibility of 18‐FLT PET for the Detection of Metastatic Lymph Node of Head and Neck Cancer
Authors: Kishino Takehito , Hoshikawa Hiroshi 
Published: September 2011

ObjectiveInvestigate the diagnostic efficacy of FLT PET for evaluating the nodal metastatic lymph nodes in head and neck cancers.MethodThe diagnosis of metastatic lymph nodes was based on CT findings. The sensitivity, specificity, positive predictive value, and negative predictive value with FLT PET were determined based on CT findings. Ten patients underwent surgical treatment, and those cases were all evaluated histopathologically.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value with FLT PET were 90%, 91%, 96%, and 80%, respectively. While the accuracy was 98% in the lymph nodes with a minimum diameter greater than 10 mm, the accuracy decreased to 80% in lymph nodes with a minimum diameter less than 10mm. A histopathological examination of 191 lymph nodes from 10 patients revealed that FLT PET had a sensitivity, specificity, positive predictive value, and negative predictive value for lymph node of 61%, 99%, 90%, and 93%, respectively.ConclusionFLT PET was found to have a high sensitivity for detecting metastatic lymph nodes with a minimum diameter greater than 10 mm. However, it was difficult to detect the occult metastatic lymph nodes which could not be detected with CT imaging.
The Learning Curve of Video‐Assisted Thyroidectomy
Authors: Kania Romain E. , Verillaud Benjamin , Tran Hugo , Bon Mardion Nicolas , Sauveget Elisabeth , Ba‐Huy Patrice Tran , Herman Philippe 
Published: September 2011

ObjectiveMinimally invasive video‐assisted thyroidectomy (MIVAT) has been demonstrated to be a safe procedure for the removal of small thyroid nodules in order to improve cosmetic results and reduce pain. The aim of this study was to evaluate the learning curve of this procedure.MethodThirty‐four patients were consecutively operated by MIVAT and were arbitrarily split in 2 groups: group 1 (n = 17) for the first 17 patients who underwent MIVAT and group 2 (n = 17) for the following 17 patients. MIVAT was performed through a unique cervical incision of 2 cm length.ResultsTwenty‐one lobectomies and 13 total thyroidectomies were performed. The mean operative time was significantly shorter in group 2 (59 ± 22 min) than in group 1 (81 ± 33 min) (P =. 03). There was neither significant difference between groups for the occurrence of postoperative complications nor for the other outcome measurements: scar length was 2.1 ± 0.2 cm and 1.85 ± 0.4 cm in group 1 and 2 respectively, postoperative pain was 2.7 ± 1.5 and 2.2 ± 1.8 in group 1 and 2 respectively, and the mean time of hospital stay was 2.8 ± 1.0 days.ConclusionMIVAT requires a learning curve. This study showed that the surgical time was significantly shortened with experience. Recommendations should define the number of lobectomies and the training program to be performed for the surgeon and assistants in order to lower mean operative time and reduce complications for MIVAT.
The Utility of Frozen Section Margin Analysis in Transoral Robotic Surgery
Authors: Martin Eliot J. , Moore Eric J. , Olsen Kerry D. , Olsen Steven 
Published: September 2011

ObjectiveDetermine the benefit of frozen section margin analysis on oncologic specimens resected via Transoral Robotic Surgery (TORS).MethodA retrospective, single institution chart review of 150 consecutive patients with upper aerodigestive tract malignancies who underwent Transoral Robotic Surgery with intraoperative frozen section margin analysis between April 2007 and November 2010.ResultsA total of 105 of the 150 cases were found to have negative tumor margins on initial tumor extripation. None of these patients were found to have delayed positive margins on permanent section analysis. Forty‐five patients were found to have 1 or more positive margins on frozen section analysis following initial tumor, and/or tumor margin resection. These positive margins were all re‐resected until frozen section pathology was consistent with tumor free margins (no evidence of CIS or invasive carcinoma). Of the 45 patients who underwent re‐resection of initial tumor involved margins, 2 were found to have positive margin disease on permanent section pathology.ConclusionFrozen section margin analysis is a critical intraoperative tool in Transoral Robotic Surgery that accurately accesses margin free tumor resection. This technique allows for a single operative encounter consisting of initial tumor biopsy with rapid diagnosis, followed by immediate complete primary tumor resection with synchronous neck dissection when oncologically indicated.
Traditional vs Advanced Thyroidectomy: Patient Preference
Authors: Snissarenko Eugene P. , Bradford Benjamin , Simental Alfred 
Published: September 2011

ObjectiveSeveral thyroidectomy techniques are available today, both traditional and advanced. However, little data is available regarding patients’ preference and understanding of their options. The purpose of this study is to 1) evaluate patents’ choice prior to thyroid surgery; and 2) examine factors that influence it.MethodThis study was conducted at the tertiary medical center between October 2010 and February 2011. Patients visiting the surgery clinic for evaluation of thyroid pathology were given a 2‐part questionnaire regarding their knowledge of different thyroidectomy techniques and factors which influence their choice.ResultsThe majority of patients had no prior knowledge of thyroidectomy techniques (82.3%) and did not conduct research on their own prior to surgical consultation (70.6%). Patients who reported research spent less then 6 hours, used various sources, and traveled less then 30 miles to the clinic. No patients claimed knowledge of different advanced thyroidectomy techniques. More females than males reported cosmesis as an important concern (64% vs 11%), while both groups cited safety as the most important factor. Patients showed preference of neck scar to axillary/sternal scar (56% vs 21%). 90% of patients said that the visit changed their knowledge.ConclusionWhile patients are interested in different thyroidectomy techniques, their preference is driven primarily by concern for safety. Cosmesis is more important for females than males, although both genders prefer cervical scar. Despite the availability of information, patients conduct little research and most of them rely on their surgeon for education.
Transoral Resection of the Pharyngeal and Laryngeal Cancers
Authors: Okami Kenji , Sakai Akihiro , Maki Daisuke , Ebisumoto Kouji , Iida Masahiro 
Published: September 2011

ObjectiveEvaluate the efficacy and safety of the transoral en bloc resection of superficial pharyngeal and laryngeal cancers. Transoral tumor resection is one option of minimally invasive surgery.MethodFrom 2008 to 2010, 34 lesions (from 31 patients) were resected transorally under microscope with monopolar cautery.ResultsTwenty‐four hypopharyngeal, 4 oropharyngeal, and 6 laryngeal cancers were operated on using this method. Operation field was widely exposed with wide caliber scope or extending laryngoscope. Bimanual procedure under microscope enabled us to achieve en bloc resection. Radical neck dissection was done simultaneously in one case. Local control rate was 97%. No postoperative dyspnea or dysphagia was observed. Two‐thirds of the patients had no symptoms, which were detected by screening of the esophageal cancer patients. Narrow Band Imaging (NBI) system was very useful for detection of the superficial lesions.ConclusionTransoral robotic surgery is now applied for minimally invasive surgery, which is not applicable yet in Japan. Our technique of en bloc resection can be easily introduced and was effective in maintaining the quality of life after treatment.
Management of Severe Asian Septal Deformity Using Polydiaxonone Foil
Authors: Lo Stephen 
Published: September 2011

ObjectiveThe aim of this study is to determine the functional and aesthetic outcome of reconstruction of severely deformed nasal septum in septorhinoplasty using polydiaxonone (PDS) foil in Asian patients.MethodA prospective case series of all consecutive patients who underwent septorhinoplasty using PDS foil for complex septal deformity in our institution over a 1‐year period has been reported.ResultsA total of 16 patients were included (13 men, 3 women, mean age 25 years). Eleven had a history of nasal trauma and 2 were revision cases from elsewhere. All required an open approach and underwent extra‐corporeal septoplasty with PDS foil. Tip sculpture was performed in 15, and osteotomies in 10 patients. The septum required spreader graft in only 2 patients. Ten patients presented with preoperative saddle, 8 required augmentation with autologous grafts, and 2 were corrected by septoplasty. Median follow‐up period was 12 months. Satisfaction was achieved in most; one required tip revision. Two cases developed columellar retraction.ConclusionThe results of the current series in Asians are comparable with previous case series published by the senior author on white patients. In many cases, donor site morbidity secondary to autologous cartilage harvest can be avoided using the technique described here.
Use of GlideScope for NIM EMG Endotracheal Intubation during Recurrent Laryngeal Nerve Monitoring
Authors: Kanotra Sohit P. , Lesser Jonathan , Kuriloff Daniel B. 
Published: September 2011

ObjectiveThe proper positioning of the NIM EMG endotracheal tube during recurrent laryngeal nerve monitoring is of paramount importance. In this article we describe our experience with the GlideScope and how it facilitates the accurate placement of the NIM EMG endotracheal tube.MethodNIM EMG endotracheal intubation was performed in 50 consecutive thyroidectomies using the GlideScope video laryngoscope (Verathon Medical, Bothell, Washington). The correct positioning of the tube was determined by impedance values of less than 5 kX and impedance imbalance of less than 1 kX.ResultsSuccessful intubation was achieved in all the cases using the GlideScope. The GlideScope helped in the correct placement of the NIM endotracheal tube in the majority of the cases.ConclusionUse of the GlideScope is an excellent method to ensure the correct positioning of the NIM tube allowing both the surgeon and the anesthesiologist to participate in the intubation process and confirm correct placement of the tube while also allowing a gentle intubation with improved visibility.