bluuebunny/crossref_metadata_2025_split huggingface dataset:
Submucosal Dissection for Superficial Pharyngeal Cancer
Authors: Tateya Ichiro , Ki Muto Man , Kitamura Morimasa , Kada Shinpei , Morita Shuko , Ito Juichi , Hirano Shigeru 
Published: September 2011

ObjectiveWe have previously reported that narrow band imaging (NBI) combined with magnifying endoscopy is useful in detecting early superficial pharyngeal cancers, which are difficult to detect with a standard endoscopy. In this study, we investigated the usefulness of submucosal dissection for such superficial lesions of pharyngeal cancer retrospectively.MethodFifty patients with superficial pharyngeal cancer were treated since September 2007. Under general anesthesia, a curved laryngoscope was inserted trans‐orally, the extent of the lesion was determined by the NBI endoscope, and the lesion was dissected with an orally inserted curved electric knife.ResultsTracheostomy was performed in 5 cases, which had synchronous multiple lesions in the hypopharynx. Regarding adverse effects, postoperative bleeding occurred in one case, which needed emergency tracheostomy. With a median follow‐up period of 20 months, metachronous multiple laryngo‐pharyngeal cancer occurred in 4 cases and recurrence occurred in 2 cases. All the metachronous cancer cases and the recurrent case were controlled with additional endoscopic submucosal dissection. The cause‐specific survival rates at 2 years were 100%. All the patients retained their pharynx and their speaking, breathing, and swallowing functions.ConclusionEndoscopic submucosal dissection for early pharyngeal cancer allows excellent survival and preservation of swallowing and voice functions. Early detection of superficial pharyngeal cancer with narrow band imaging technology and treatment with endoscopic submucosal dissection can be a new treatment strategy for head and neck cancer.
Survey of Post‐thyroidectomy Parathyroid Hormone (PTH) Assay Use by American vs European Thyroid Surgeons
Authors: Stein Daniel , Calo Piergiorgio , Kepchar Jessica J. , McLeod Ian K. , Noordzij Jacob P. , Brietzke Scott E. 
Published: September 2011

Objective1) Identify differences in PTH assay usage by European vs American physicians. 2) Analyze factors that correlate with these differences.MethodAnonymous surveys of physicians regarding their use of post‐thyroidectomy PTH assay were collected in 2009 from members of the American Academies of Otolaryngology and Endocrine Surgery and compared with 2010 survey data from members of the European, Italian, French, Spanish, and British Societies of Endocrine Surgery.ResultsEuropean respondents returned 61 surveys that were compared with 356 received from American physicians (11% vs 3% response rate). A total of 40.1% of the European physicians used the PTH assay vs 29.8% of the American physicians (chi‐square P =. 083). A total of 63% of US respondents were otolaryngologists, compared with 7% of the Europeans, but usage among US physicians was not significantly correlated with specialty. Fewer American physicians were fellowship trained (26.6% vs 44.3% (chi‐square P =. 003)). Using Mann‐Whitney testing, estimates of the rate of temporary hypocalcemia were similar, median 10% to 20% (P =. 708), but American respondents provided a lower estimated rate of permanent hypocalcemia (P =. 007).ConclusionWe found a trend suggesting that more European physicians obtain PTH levels than US physicians and report higher rates of permanent hypocalcemia among thyroidectomy patients, perhaps accounting for their more frequent use of PTH assays.
Survival Differences in American Indians with Head and Neck Cancer
Authors: Dwojak Sunshine M. , Sequist Thomas , Deschler Daniel G. , Emerick Kevin S. 
Published: September 2011

ObjectiveAmerican Indians and Alaska Natives (AI/AN) experience poor overall survival. The specific aim of this study was to analyze disparities in survival between AI/AN and white patients with squamous cell carcinoma of the head and neck.MethodWe identified all incident cases of oropharyngeal, oral cavity, and hypopharyngeal/laryngeal squamous cell carcinoma among AI/AN and white patients from 1996 to 2007 using the SEER database. Univariate, multivariate, and sequential Cox proportional hazard models were fit to analyze racial differences in sex, age, stage, treatment patterns, and overall survival.ResultsFor cancer of the oropharynx, AI/AN experienced decreased overall survival after adjusting for age, sex, stage, and type of treatment (hazard ratio (HR) = 1.4, P =. 008). For cancer of the oral cavity, AI/AN experienced decreased survival after adjusting for patient age and sex (HR =1.3, P =. 05). This difference was eliminated after adjusting for type of treatment (HR=1.2, P =. 17). AI/AN were significantly less likely to receive surgery (odds ratio=0.57, P =. 02). For hypopharyngeal/laryngeal cancer, AI/AN experienced decreased survival after adjusting for patient age and sex (HR = 1.6, P =. 04). Adjusting for stage at diagnosis eliminated the disparity (HR =1.4, P =. 12).ConclusionSignificant disparities in survival exist among AI/AN patients with head and neck cancer. These disparities are variably related to stage at presentation and differential treatment patterns. Future research is needed to understand how to implement programs to reduce these differences in care and outcomes.
Temporalis Myofascial Flap for Maxillofacial and Oral Defect
Authors: Tananuvat Rak , Ruenmarkkaew Donyarat , Sittitrai Pichit , Srivanitchapoom Chronticha 
Published: September 2011

ObjectiveTemporalis myofascial flap is a good option for the reconstruction of maxillofacial, oral cavity, and parotid defect.MethodA total of 28 patients with postoperative defects located in the lower two thirds of the face and oral cavity in Chiang Mai University Hospital were included in this study.ResultsSixteen patients had nasal cavity and maxillary sinus cancer, 6 patients had oral cavity and oropharyngeal cancer, 3 patients had parotid cancer, 1 patient had cementifying fibroma, 1 patient had facial palsy, and 1 patient had osteoradionecrosis of the mandible. Temporalis muscle flap provided profuse well‐vascularized tissue for the obliteration of orbital exenteration and totalor partial maxillectomy cavities and coverage of the surface of sinonasal and oropharyngeal defects.ConclusionOral and nasal spaces were separated successfully in all patients. Temporalis muscle flap is a very reliable technique with low complication rates and few donor site problems. This safe and technically simple flap can be preferred for the reconstruction of maxilla‐facial defects after ablative tumor surgery, especially in older and debilitated patients.
Management of Salivary Bypass Tube and Stent Migration in Pharyngoesophageal Microvascular Reconstruction
Authors: Skoner Judith Marie , Bowman Seth , Banks Caroline A. 
Published: September 2011

ObjectivePost‐chemoradiation salvage surgery with pharyngoesophageal reconstruction may be associated with postop fistula, even with free tissue transfer. Salivary bypass tubes and stents have thus been used to minimize this complication, but migration is a real risk. We present our series of bypass tube and esophageal stent distal migrations and management.MethodA retrospective chart review at a tertiary academic medical center identified those patients undergoing pharyngoesophageal salvage resection, simultaneous complex pharyngoesophageal reconstruction, and salivary bypass tube or esophageal stent placement. Demographics, surgical details and postop management of tube or stent migration distally into the GI tract were investigated.ResultsDistal migration of the salivary bypass tube was identified in 2 patients, and migration of the esophageal stent was identified in 1 patient. All cases were in the setting of complex pharyngoesophageal flap reconstruction after salvage surgical resection. Dates of migration discovery ranged from weeks to months postop. All patients were asymptomatic and without fistula formation, but with the tubes/stent radiographically confirmed in the GI tract. Management was via a team approach with our GI colleagues, and all salivary‐channeling devices were successfully retrieved endoscopically, without complication.ConclusionPharyngoesophageal reconstruction after salvage surgery carries the risk of fistula even in the setting of micro‐vascular tissue transfer. To minimize this dreaded complication, salivary bypass tubes/stents may be used, but migration is a well‐recognized risk. Our series presents successful management of such via a team approach.
The Method of Establishing a Xenograft Animal Model
Authors: Hou Fang , Saad Ali , Dai Yuemeng , Richter Gresham , Suen James Y. , Buckmiller Lisa M. , Fan Chun‐Yang 
Published: September 2011

Objective1) Establish a xenograft animal model of arteriovenous malformation (AVM), an uncommon and often incurable vascular anomaly. 2) Observe the morphological alterations and histological characteristics of xenograft AVM.MethodAVM specimens harvested from 4 patients were sectioned (5x5x5mm) and implanted in the subcutaneous dorsum of 5‐Athymic Nude‐Foxn1nu mice. 4 implants per animal were placed (N = 20). Specimens were harvested monthly and stained for hematoxylin and eosin (H&E). Immunohistochemistry for anti‐human nuclear antigen and Ki‐67 was performed. Histologic observations were recorded by 2‐blinded pathologists.ResultsClinical characteristics and pathologic diagnosis of AVM was confirmed in each donor patient. A total of 85% (n = 17) of AVM xenografts survived the xenograft implantation. Survival was unrelated to date of harvest. The majority of implants slightly decreased in size by date of harvest (1‐2mm). Pathologic diagnosis of a vascular anomaly was confirmed in each implant and demonstrated numerous small and medium‐size vessels. A total of 76.5% (n = 13) of implants of surviving xenografts were positive for Ki‐67 and anti‐human nuclear antigen, confirming survival of the human derived tissue.ConclusionWe herein describe an animal model for AVM that may provide the first step for examining the pathophysiology and potential treatment of these difficult to treat lesions in vivo.
Tongue Base Resection in Workup of Unknown Primary Head and Neck Cancer
Authors: Wolford Brent , Lee Steve , Simental Alfred , Stewart Charles , Kim Paul 
Published: September 2011

ObjectiveOften, extensive workup (H&P, CT/MRI/FDG‐PET, tonsillectomy and biopsies) is undertaken to detect the primary tumor of a cervical metastasis, in order to reduce morbidity of treatment. We report on transoral resection of the base of tongue (at the time of panendoscopy) in the diagnostic management of unknown primary HN cancers.MethodIn this retrospective study, we reviewed findings from workups of Loma Linda University patients with unknown primary HN cancer in the past 4 years (when base of tongue resection was instituted) and noted the number of primary unknowns detected by base of tongue resection vs traditional diagnostic modalities.ResultsIn the past 4 years, 17 patients underwent panendoscopy for the diagnosis of an unknown primary cancer after careful outpatient workup, including CT/PET studies, failed to reveal a source. Of this group, a primary source was found in eight by tonsillectomy and directed biopsies. In the remaining 9, transoral laser resection of the ipsilateral base of tongue was performed, and a base of tongue source was found in 4. In all of these, no lesion was visualized or palpable, there were no procedure complications, patients returned to adequate PO intake immediately and operative time increased by forty minutes on average.ConclusionWe conclude that transoral laser resection of the base of tongue in the workup of unknown primary HN cancers is safe, is well‐tolerated, and provides valuable information for therapeutic planning as a supplement to other traditional diagnostic modalities, when no primary source has been previously identified.
TP53 Mutations in Head and Neck Squamous Cell Carcinoma
Authors: Tokumaru Yutaka , Fuji Masato 
Published: September 2011

ObjectiveThe TP53 plays a critical role in a key pathway involving apoptosis and cell cycle control. The mutation of TP53 is one of the most common genetic alterations in cancer cells. We evaluated TP53 mutations and prognosis in patients with squamous cell carcinoma of the head and neck.MethodA total of 60 patients with newly diagnosed squamous cell carcinoma of the head and neck in our hospital from 2005 through 2009 were enrolled in this study. TP53 mutations were analyzed using direct sequencing methods for exon 2 to 11. TP53 mutational status was compared with clinical outcome.ResultsMutations were classified into 2 groups, disruptive and nondisruptive, according to the degree of disturbance of protein structure predicted from the crystal structure. Of the 60 tumors, 38 (63.3%) harbored a TP53 mutation including 17 (28.3%) disruptive mutations. While 75.0% of cases with wild type are alive without recurrence, only 25.0% of disruptive mutation cases are with no recurrence. In addition, the presence of disruptive TP53 mutation was associated with poor prognosis as compared with wild type TP53.ConclusionDisruptive TP53 mutations in tumor DNA are associated with poor prognosis and TP53 mutational status is considered to be useful as a molecular biomarker for personalized treatment in squamous cell carcinoma of the head and neck.
Transoral Robotic Surgery for Hypopharyngeal Carcinoma
Authors: Kim Se‐Heon , Lee Sei‐Young , Choi Eun‐Chang 
Published: September 2011

ObjectiveConventional surgical approaches for hypopharyngeal carcinomas have a great risk for developing treatment‐related morbidity. To minimize this morbidity, hypopharyngectomy by transoral robotic surgery (TORS) was performed, and the efficacy and feasibility of this procedure were evaluated.MethodTORS was performed using Surgical Robot in 18 patients with T1 or T2 pyriform sinus cancer. Pyriform sinus was totally resected. Laterally, the inner perichondrium of the thyroid cartilage was peeled off to make sure of the safe margin. We evaluated the surgical margins, swallowing, decannulation, and surgery related complications.ResultsTransoral robotic hypopharyngectomy was performed successfully in all eighteen patients. The mean robotic operation time was 62.4 minutes, and an average of 17.5 minutes was required for the setting of the robotic system. There was no significant perioperative complication in the cases. Swallowing function returned to all patients within 8.3 days average. Decannulation was carried out within an average of 6.3 days after surgery. We can confirm the negative margins by frozen section. Average surgical margins are 7.5mm circumferentially.ConclusionTransoral robotic hypopharyngectomy is a feasible and oncologically safe technique for the treatment of early hypopharyngeal cancer.
Treatment of 183 Sinonasal Tumors: Updating Our Experience
Authors: Guilemany Jose M. , Montero Cristobal Langdon , Blanch Josep Lluis , Alobid Isam 
Published: September 2011

ObjectiveThe current study updated our previous study involving the outcomes and prognostic factors of sinonasal cancer patients treated at our institution.MethodA total of 183 sinonasal cancer patients who were treated between 1974 and 2008 with a minimum follow‐up of 2 years were retrospectively reviewed and restaged using the seventh edition of the AJCC staging manual.ResultsThe mean age was 60.89 years (+14.99 years SD), 70.4% males. Tumor stage distribution was: T1:72patients; T2:48p; T3:39p; T4:24p. Ninety‐six patients received surgery as primary treatment, 51 received surgery plus radiotherapy, 7 received surgery plus radiotherapy with/without chemotherapy, and 22 received radiotherapy with/without chemotherapy palliative treatment. The 1‐, 5‐, 10‐year disease free survival rate was 82.3%, 49%, and 34.9%, respectively. There was no significant survival difference between surgery alone and surgery plus radiotherapy. The parameters with statistical prognostic significance were tumor stage, tumor histology, and locoregional failure.ConclusionAlthough there is a significant advance in survival rates, the failure at the primary site is still the main problem. As a prognostic value of survival, therefore, we should put all our effort to improve the control of the locoregional failure.
Trends and Outcomes in the Management of Upper Esophageal Disorders
Authors: Gullung Jessica L. , Gibbs Kevin , Gillespie Marion B. 
Published: September 2011

Objective1) Compare the outcomes of 2 surgical modalities used to treat hypopharyngeal diverticulum and esophageal stenosis at the Medical University of South Carolina (MUSC) and analyze the economic efficiency of each. 2) Compare the MUSC experience with statewide treatment in South Carolina (SC) Medicare patients.MethodRetrospective analysis was conducted of 50 patients treated at MUSC. The 2 approaches utilized were endoscopic laser diverticulotomy and transcervical open diverticulectomy with cricopharyngeal myotomy. SC Medicare data was collected for patients undergoing these procedures. Primary outcomes investigated were intraoperative complications, operative charge, hospital stay, and postoperative complications.ResultsStatistically significant differences between the 2 operative groups at MUSC were observed in length of stay (1.08 days endoscopic group and 4.75 days transcervical open group; P >. 0001) and operative charge (US $ 2842 endoscopic and US$ 3425 transcervical; P >. 0001). The perioperative complication and readmission rates were similar. The rate of reoperation was the same between the 2 groups; however, most of the patients who underwent transcervical open diverticulectomy were initially planned as endoscopic approaches. The Medicare data group differed significantly in length of hospital stay and patient charges compared to MUSC group.ConclusionThe comparison of techniques reveals that long‐term outcomes are similar, but the immediate postoperative sequelae of prolonged hospital stay and increased operative charge with transcervical open diverticulotomy is evident. Although further cost analysis is indicated, endoscopic laser diverticulotomy is a safe, cost effective alternative to transcervical open diverticulectomy.
Ultrasound‐Guided FNA of Base of Tongue: A Cadaver Study
Authors: Meacham Ryan K. , Sebelik Merry E. , Boughter John D. 
Published: September 2011

Objective1) Determine the utility of ultrasound imaging to visualize the anatomy of the tongue base. 2) Demonstrate that ultrasound imaging can guide transcervical needle placement in the tongue base and thus serve as a surrogate for needle biopsy in the patient with a tongue base lesion.MethodDesign and subjects: Feasibility study of ultrasound‐guided needle placement in the tongue base in 37 adult cadavers. Interventions: Ultrasound imaging of tongue base anatomy and guidance of dye injection into the intrinsic muscles. Outcome Measurements: Tongue base anatomy visualization on ultrasound and placement accuracy of dye injection.ResultsOf 37 cadaver heads, 32 were noted to have excellent and identifiable anatomy of the geniohyoid, genioglossus, and intrinsic muscles of the tongue base. The intrinsic muscles were well visualized during methylene blue dye injection on most specimens, with confirmation of the needle tip location and “bloom” of the injection on real‐time ultrasound images. After bisection, 25 of 32 (78%) evaluable specimens were found to have accurate placement of dye within the posterior genioglossus and intrinsic tongue base muscles. Neck circumference was similar between those with accurate (mean 37.9 cm) and inaccurate (mean, 37.4 cm) dye placement (P =. 75).ConclusionThis study utilizes a cadaver model to establish that ultrasound visualization of the tongue base provides excellent anatomic detail and demonstrates feasibility of transcervical ultrasound localization of the tongue base for image‐guided FNA. This technique has potential applicability to the clinical setting.
U‐shaped Skin Incision for Parotidectomy
Authors: Furuta Yasushi , Matsumar Michiya , Tsubuku Takashi 
Published: September 2011

ObjectiveThe facelift incision (FLI) has been reported to be a more cosmetic approach than the traditional Blair incision for parotidectomy. However, a long skin incision and a wide skin‐flap elevation are required for the FLI. To overcome the disadvantages of the FLI, we have employed a U‐shaped skin incision (UI).MethodFrom July 2007, 79 parotidectomies were performed for benign parotid tumors. A Blair incision was used in 41 patients and an FLI in 25 patients. In the remaining 13 patients, a UI, which consists of pre‐ and postauricular incisions and curved incision around the lobe of the ear, was employed.ResultsIn all patients with a UI, the tumors were located in the superficial lobe of the parotid gland. By contrast, 10 of the 25 (40%) patients with an FLI had a tumor in the deep lobe. The size of the tumor was significantly smaller and the time of surgery was significantly shorter in patients with a UI than in those with an FLI. The incidence of hematoma was higher in FLI than in UI (12% vs 0%). The incidence of temporal facial paralysis and salivary leak was comparable in both groups.ConclusionThe UI is a safe alternative approach to parotidectomy for small benign tumors within the superficial lobe of the parotid gland.
Utility of Abdominal Computed Tomography in Head and Neck Cancer Patients
Authors: Kamdar Dev Prakash , Robinette Natasha , Yoo George H. , Kim Harold , Lin Ho‐Sheng , Lemonnier Lori A. , Pereira Lucio M. 
Published: September 2011

ObjectiveAssess the role of abdominal computed tomography (CT) imaging in the staging and surveillance of patients with head and neck squamous cell cancer (HNSCC) for distant metastatic disease (DMD) and second primary tumors (SPT).MethodRetrospective review of 172 HNSCC patients treated at an academic center who underwent abdominal CT imaging from 2003 to 2007. These scans were categorized as suspicious, positive, or negative for DMD or SPT. Charts of patients with suspicious or positive results were reviewed to determine resultant work‐up and outcomes.ResultsAfter consideration of exclusion criteria, 165 patients were included in this retrospective study. Normal abdominal CT scans were seen in 139 patients while the remaining 27 patients had abnormal abdominal CT findings. Of these 27, 16 patients (9.7%) were determined to have malignancy. Twelve patients had DMD, and 4 were diagnosed with SPT.ConclusionAbdominal CT imaging identified DMD or SPT in 9.7% of patients resulting in significant alteration in their comprehensive oncologic care. This rate is not inconsequential and might justify the use of abdominal CT in managing HNSCC patients. Prospective trials might help determine the impact of abdominal CT findings on survival.