bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevertebral Calcific Tendinitis
Authors: Cheng Alex , Zapanta Philip E. 
Published: September 2011

Objective1) Recognize that prevertebral calcific tendinitis of the longus colli is a rare inflammatory noninfectious cause of retropharyngeal fluid. 2) Understand that appropriate treatment of this condition is with anti‐inflammatory medications rather than antibiotics and/or surgical drainage.MethodWe report a rare case of retropharyngeal effusion caused by prevertebral calcific tendinitis of the longus colli muscle. The patient was evaluated and treated in the emergency department of an urban university hospital and was seen one week later in the otolaryngology clinic.ResultsPrevertebral calcific tendinitis of the longus colli is a rare entity that may cause an effusion that can be misdiagnosed as a retropharyngeal abscess. Our patient presented with a 1 day history of worsening neck pain and stiffness, and dysphagia. Absence of fever and a normal white cell count were noted. CT scan revealed a nonrim‐enhancing, nonbulging retropharyngeal fluid collection and calcification of the longus colli tendons near the C2 vertebrae. One dose of intravenous dexamethasone was administered, and the patient’s neck stiffness markedly improved. At 1‐week follow‐up, his symptoms had completely resolved on a steroid taper.ConclusionPrevertebral calcific tendinitis of the longus colli may cause a retropharyngeal effusion mimicking abscess. Prompt diagnosis can be made by recognizing the characteristic CT findings in the context of absent clinical evidence for infection. Anti‐inflammatory medications are the treatment of choice.
Basal Cell Carcinoma and Rhinophyma: A Novel Treatment Option
Authors: Velargo Parker A. , Sebelik Merry E. 
Published: September 2011

ObjectiveResection of basal cell carcinoma (BCCA) from a background of advanced rhinophyma can present a reconstructive challenge, thus a novel surgical treatment option is presented. Report a case of concurrent rhinophyma and BCCA, review the literature, and discuss surgical options available.MethodA review of the literature reveals only 12 reported cases of concurrent BCCA and rhinophyma since 1955, all describing occult discovery of BCCA. This is the first reported case of known BCCA complicated by rhinophyma.ResultsThe traditional repair options after excision of BCCA from the nasal tip include healing by secondary intention, skin grafting, and local flap rotation. In patients with rhinophyma, these options are less than ideal. As a novel alternative, wide local excision of the lesion with intra‐operative frozen section margin control was carried out, followed by single‐stage tangential excision and dermabrasion of the nasal skin involved with rhinophyma. Negative margins were obtained, symmetry and homogeneity of the nasal skin was achieved, and the patient was very pleased with the results. Before and after photo documentation and representative histologic sections will be presented.ConclusionThe reported synchronous presence of known BCCA and rhinophyma is exceedingly rare. This case demonstrates that both cancer cure and an optimal aesthetic result can be achieved by this novel treatment option.
Screening for Lesions with an Oral Mucosal Brush Biopsy
Authors: Seltzer Paul , Gold Daniel R. , Loewenstein Ronald K. , Carroll Deborah J. 
Published: September 2011

ObjectiveEvaluate the use and impact of providing a noninvasive oral brush biopsy to patients presenting on an initial visit with a mildly or nonsuspicious oral lesion. The cytopathologic findings can be used as confirmatory evidence in support of the clinical impression.MethodThe brush biopsy test provided an option to patients presenting nonsuspicious lesions at our office over a 24‐month period. Impressions regarding obtaining a specimen and time required were monitored. When brush biopsy tests were ordered, cytologic evaluation was performed. Doctors were surveyed on their impressions of the test.ResultsThe brush biopsy test was performed on patients with mildly to nonsuspicious lesions. Cytology evaluation was performed, and abnormal or dysplastic cells were reported. Results showed how the brush biopsy cytology confirmed the clinical impressions. Survey of clinicians indicated that tests were relatively easy to perform and could be completed in a reasonable timeframe of less than 10 minutes during the initial visit. Doctors reported benefits of ease of performance, absence of identifiable risks, and complications from the tests.ConclusionOral brush biopsy can be provided to patients as a screening option for oral mucosal lesions that are not highly suspicious. Surveys indicated the test was perceived as an instrument to provide confidence to patients and gather information early with no complications and risk factors during the visit.
The Modified Nasal Trumpet: Revisiting a Novel Technique in Management of the Difficult Airway
Authors: Rodwell David Watson , Saltzman Joel , Thompson Jerome W. 
Published: September 2011

Objective1) Highlight an underutilized method for use of the nasal trumpet in management of the difficult airway. 2) Review the application of this technique in multiple clinical scenarios.MethodReport of technique and application in airway management.ResultsThere are a multitude of techniques and devices available to assist with intubation and ventilation for both the difficult patient and those that do not pose a significant challenge in airway management. The use of a nasal trumpet with an endotracheal tube connector represents an additional means of establishing ventilation and providing inhalational anesthesia. This technique has proven extremely useful to the senior author over many years in the pediatric population in a wide variety of clinical scenarios. We review the technique and clinical application.ConclusionThe use of the modified nasal trumpet has been previously reported in the anesthesiology literature, but represents a critical skill and technique of airway management that should be familiar to all otolaryngologists.
Tick Bites for the Otolaryngologist
Authors: Walton Benjamin , Pine Harold S. 
Published: September 2011

ObjectiveThe human head and neck can provide multiple environments ideal for parasitic invasion. One of the more common parasites encountered is the tick. We report a specific case involving a tick bite involving the external auditory canal. There is a lack of evidence on the proper treatments.Method“Ticks,” “tick bites,” “head and neck,” and “otolaryngology” were searched in PubMed, and relevant articles were selected and reviewed.ResultsTicks and tick‐borne diseases are outlined, and common presentations of head and neck involvement are examined. Ticks appear to be resistant to common anesthetic chemicals used in the ear. Proper removal is important in preventing transmission of disease and local skin infection. Geography and tick species dictate treatment and follow‐up. We recommend antibiotic prophylaxis for certain tick species making proper tick identification important.ConclusionThe otolaryngologist must be aware of the many differing pathogens, their epidemiology, and their treatments. Proper removal and identification of the tick are very important in further follow‐up and treatment. We present an invaluable but simplified tool in the identification, removal, and management of ticks and tick bites.
Transepithelial Monitoring for Reoccurrence of Oral Cavity Cancer
Authors: Seltzer Paul , Loewenstein Ronald K. , Carroll Deborah J. , Buechler R. Bruce 
Published: September 2011

ObjectiveAttempting to minimize additional biopsy and disfigurement in suspicious areas with resection from previous oral cavity cancers, we utilized and evaluated the results provided from a brush biopsy prior to making further treatment decisions.MethodOver the past 2 years, brush biopsies were performed on patients with a past history of oral cancer who, during periodic reevaluation, presented with a suspicious lesion. During the evaluation period, cytopathology results were evaluated in conjunction with provided clinically relevant information and correlated with clinical treatment decisions.ResultsIn a review of 22 cases, evaluation of brush biopsy specimens revealed abnormal or dysplastic cells in 27% of cases; these patients either had surgical biopsy or definitive treatment. In 72% of cases abnormal or dysplastic cells were not identified; these patients were placed on a periodic reevaluation protocol.ConclusionBrush biopsy cytology can provide information useful for monitoring patients with a history of oral cancer who present with suspicious lesions. Findings from brush biopsy can be utilized in some cases to place a patient into definitive treatment or on an observation.
Transoral Robotic Surgery: A Novel Technique to Treat Eagle Syndrome
Authors: Gudis David , Newman Jason G. , Leahy Kevin 
Published: September 2011

Objective1) Report a novel surgical approach to perform a styloidectomy for Eagle syndrome. 2) Propose a new indication for transoral robotic surgery.3) Demonstrate improved exposure and visualization of a skull base region where critical neurovascular structures are at risk.MethodWe report a case from 2010 of a 47‐year‐old woman presenting with unilateral vocal cord dysfunction, neck pain, throat pain, dysphagia, and odynophagia. Her symptoms, beginning after neck trauma, fluctuated with neck positioning. The diagnosis of Eagle syndrome was confirmed by CT, and a transoral robotic styloidectomy was performed.ResultsWhen conservative management failed to improve the patient’s symptoms, a transoral robotic‐assisted tonsillectomy, pharyngoplasty, and styloidectomy of her elongated right styloid process were successfully performed with the da Vinci surgical robot. Postoperatively the patient recovered well and reported significant improvement of her symptoms. To the authors’ knowledge a transoral robotic styloidectomy for Eagle syndrome has never before been described. The improved exposure and magnified visualization achieved with the transoral robotic approach represents a significant advent in a skull base procedure in which several critical neurovascular structures are at risk.ConclusionEagle syndrome is a rare diagnosis of unilateral lower cranial neuropathy (IX, X) secondary to irritation from an elongated styloid process. Traditionally transoral and transcervical styloidectomy procedures are performed. We propose that transoral robotic surgery provides improved visualization and exposure of a surgically high‐risk region of the skull base.
Understanding the Role of PAs in Otolaryngology
Authors: Reilly Brian K. , Zalzal George H. , Shah Rahul K. , Preciado Diego A. 
Published: September 2011

ObjectiveExamine the impact and trends for academic physician assistants (PAs) who have become contributing members of an urban pediatric otolaryngology practice. We will compare these outcomes to regional and national trends among otolaryngology groups.MethodThis will be an electronic survey study. This survey will be through the web‐based service “SurveyMonkey.” There will be complete anonymity among respondents. Survey data will be password protected.ResultsOur study will contribute the following: 1) A better understanding of trends among otolaryngology practices regarding utilization of PAs between different subspecialties within otolaryngology. 2) An analysis of the evolving role of PAs, looking at how they complete their subspecialty training, the length of the shadow period, and the breakdown between the outpatient and inpatient setting. A comparison of PAs’ practice patterns in private versus academic practice. (3) An analysis of patient satisfaction and department and physician productivity measures. (4) A better understanding of trends among otolaryngology practices regarding utilization of PAs versus Nurse Practitioners (NPs).ConclusionPAs have been providing medical care for patients since the 1960s and perform many of the supervised services that physicians offer. PAs are able to consult patients, formulate treatment plans, perform procedures, and prescribe medications. In addition, PAs have been fulfilling a critical need when there is a shortage of doctors.
Virtual Reality Rehabilitation for Vestibular Dysfunction
Authors: Wang Pa‐Chun , Chang Chia‐Huang , Su Mu‐Chun , Yeh Shih‐Ching , Fang Te‐Yung 
Published: September 2011

ObjectivePeople with chronic vestibular dysfunction can be treated with balance rehabilitation. Virtual reality (VR) technology may serve as a useful therapeutic tool to facilitate rehabilitation. The aim of this pilot study was to investigate the clinical applicability of VR technology in treating patients with vestibular dysfunction.MethodFive patients with chronic vestibular dysfunction were recruited for this uncontrolled clinical study. The rehabilitation protocol (modified Cawthorne‐Cooksey exercises, MCCE) was adapted into a VR‐based training system. Patients followed the instructions of MCCE to complete 20 sessions of vestibular rehabilitation within a 4‐week period.ResultsA VR‐based rehabilitation system was developed with various latest technologies, including Kinect Xbox for full‐body interaction, 3D‐ready projector with shutter‐glasses for stereo imaging, Wii Fit pressure pad for tracing the center of gravity, and Unity game engine for leveled‐difficulty design. Five VR tasks were built, and more than 100 training trials were designed. Subjectively, all patients experienced the improvement of balance function performing daily activities and were overall positive to the training protocol. After intervention the fast component of postural sway (P <. 05) was reduced. The follow‐up interview showed decreased disability and increased general health.ConclusionVR has many advantages over traditional rehabilitation techniques in improving the testing or training environment of human performance. This study demonstrates that VR technology offers great promise in the field of vestibular rehabilitation.
Warthin Tumor of Nasolacrimal Duct
Authors: Ahmadi Neda , Grant Nazaneen N. 
Published: September 2011

Objective1) Review anatomy of the nasolacrimal apparatus. 2) Learn about common primary tumors of the nasolacrimal apparatus and their clinical presentation. 3) Present a rare type of nasolacrimal duct tumor. 4) Discuss the utility of combined endoscopic and external techniques for removal of nasolacrimal duct tumors.MethodRetrospective case report and review of literature.ResultsA 67‐year‐old woman presented with cough and post‐nasal drip. Examination revealed a right‐sided nasal cavity mass anterior to the middle turbinate. Upon further questioning, she reported a history of right nasal dorsal pain, but denied epiphora, epistaxis, and ocular symptoms. Imaging revealed a mass originating from the right nasolacrimal duct with extension into the right peri‐orbital soft tissues. The tumor was completely excised via combined endoscopic and external approaches. Histopathologic examination identified the lesion as Warthin tumor. At 1 year postoperatively, the patient is disease‐ and symptom‐free.ConclusionPrimary tumors of the nasolacrimal apparatus are rare. These tumors must be in the differential diagnosis of a patient presenting with nasal obstruction, epiphora, and nasal‐cavity mass. It is important for otolaryngologists to be familiar with the different pathologies that involve the nasolacrimal apparatus and their clinical presentation.
Acellular Dermal Matrix Reconstruction of the Head and Neck: A Versatile Reconstructive Option
Authors: Mitchell Joshua R. , Robinson Jamie , Rangarajan Sanjeet , Dhulipala Sravan , Netterville James L. , Athavale Sanjay M. 
Published: September 2011

ObjectiveAblative procedures of the head and neck often result in significant contour defects. Acellular dermal matrices (ADM) are relatively resistant to infection and accommodate long term facial growth. Our objective is to confirm the benefits of acellular dermal matrix reconstruction in post‐ablative head and neck defects.MethodPatients who underwent ADM reconstruction of the head and neck since 1997 were identified. Of 265 patients identified, 205 met the inclusion criteria. The pathology, surgical location, long term imaging, cosmetic outcome, and complications were analyzed. Postoperative cosmetic results were assessed by a novel patient‐based numerical grading scale.ResultsThe mean age was 60.4 years. One hundred thirty‐two patients were male (77%) and 40 patients were female (23%). ADM were used to correct a variety of defects with the most common location being the parotid gland (n = 65) followed by the neck (n = 60), low neck/thyroid bed (n = 35), and skull base (n = 30). A majority of patients had a diagnosis of benign parotid lesions (n = 40) although numerous pathologies were identified. Only 3 patients had a complication related to their ADM recipient site (4%). The patient postoperative cosmesis survey is still pending.ConclusionWith regard to function and cosmesis, ADM is an excellent head and neck reconstructive option with few complications. Moreover, ADM can be used in a variety of locations and patients tend to be very happy with their final cosmetic outcome.
Bacteriology of Deep Neck Abscesses: A Retrospective Review of 96 Cases
Authors: Lee Yan Q. , Kanagalingam Jeevendra 
Published: September 2011

ObjectiveReview the microbiology of deep neck abscesses and identify the factors that influence their occurrence.MethodRetrospective chart review of 96 patients diagnosed with deep neck abscesses in the Department of ENT at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Logistic regression was applied to analyze and compare the incidence of common organisms in various conditions (age, gender, etiology, and effect of diabetes).ResultsOf the 96 patients recruited, 18 had polymicrobial cultures. The leading pathogens cultured were Klebsiella pneumoniae (27.1%), Streptococcus milleri group (SMG) bacteria (21.9%), anaerobic bacteria ‐ not otherwise specified (NOS) (20.8%). Klebsiella pneumoniae (50.0%) was over‐represented in the diabetic group. SMG bacteria (68.8%) and anaerobic bacteria ‐ NOS (43.8%) were most commonly isolated in patients with odontogenic infections. Klebsiella pneumoniae was found more commonly among the female patients (39.3%). Klebsiella pneumoniae was the most common organism cultured in parapharyngeal space abscesses, while the submandibular space and parotid space most commonly isolated SMG bacteria and Staphylococcus aureus respectively.ConclusionBroad‐spectrum antibiotics are recommended for treating deep neck abscesses. Empirical antibiotic coverage against Klebsiella pneumoniae infection in diabetic patients and SMG and anaerobic bacteria in patients with an odontogenic infection is advocated. Routine antibiotic coverage against gram‐negative bacteria is not paramount.
Classification System for Lateral Pharyngotomy
Authors: Shires Courtney B. , Rodwell David W. , Sebelik Merry E. , Samant Sandeep 
Published: September 2011

Objective1) Propose a classification system of lateral pharyngotomy (LP) used in exposing various sites of the oropharynx, supraglottis, and hypopharynx. 2) Describe the structures visible with each category of lateral pharyngotomy.MethodAn anatomic study on 5 fresh‐frozen human cadavers was carried out at the Medical Education and Research Institute. After exposure of the anterior compartment of the neck and laryngeal framework, progressively more extensive pharyngotomy was performed. The pharyngeal structures exposed with each extension were recorded by video and still photography.ResultsEntry into the pharynx between the hypoglossal nerve cephalically and the superior laryngeal nerve caudally (Type I LP) provided exposure of the epiglottis and ipsilateral tongue. Exposure toward the pyriform apex was facilitated by dividing the superior laryngeal artery (Type II LP). This provided exposure to the postcricoid area, arytenoids, and cervical esophageal inlet. The digastric and stylohyoid muscles were transected (Type III LP) to provide exposure of the entire base of tongue, uvula, and soft palate. Division of the hyoglossus and mylohyoid muscles was classified as Type IV LP, adding visualization of the vallecula and contralateral tonsil.ConclusionAn appropriate class of pharyngotomy may be chosen depending on the structures requiring exposure. This cadaver‐based anatomic study delineated the anatomic structures to be divided to facilitate exposure of pharyngeal subsets. A classification system is proposed that defines the steps in gaining access to the pharynx.
Clinicopathologic Review of Mucoepidermoid Carcinoma
Authors: Ann Byrd Serena , Light Emily , McHugh Jonathan , Bradford Carol R. , Prince Mark E. , Spector Matthew E. , Carey Thomas 
Published: September 2011

Objective1) Describe the epidemiology of mucoepidermoid carcinoma (MEC) in the head and neck treated at a tertiary care hospital. 2) Determine clinical and pathologic predictors of recurrence and survival in patients with mucoepidermoid carcinoma in the head and neck treated at a tertiary care hospital.MethodMedical records of 94 patients (mean age, 50.4 years; M:F, 48:46) who underwent surgical treatment for MEC of the head and neck between 1995 and 2010 were reviewed. Main outcome measures were DFS, DSS, and OS. Clinicopathologic parameters evaluated were age, sex, TNM stage, subsite, adjuvant therapy, tumor grade, and margin status.ResultsOf the 94 patients, 42 parotid, 26 palate, 12 oral, 9 submandibular/sublingual, 4 orbital, and 1 parapharyngeal tumors were identified. All patients underwent surgical resection, 32 patients had postoperative radiation and 3 postoperative chemoradiation. The 5‐year OS and DSS were 79% and 90% with a median follow‐up of 72 months and 45 months, respectively. The 5‐year DFS was 74% with 12 patients developing recurrence. On univariate analysis, age >50 (P =. 01), male sex (P =. 008), positive nodal status (P =. 01) and high‐grade histology (P =. 003) were predictive of poor prognosis. On multivariate analysis, high‐grade histology (P =. 02) and male sex (P =. 04) were predictive of poor prognosis.ConclusionThe epidemiology of MEC is consistent with previous studies. High grade histology continues to be the strongest independent predictor of survival in MEC followed by male sex. Further studies into the molecular biology of MEC that may account for such clinicopathologic features are warranted.