bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Usefulness of Harmonic Scalpel in Free Flap
Authors: Baek Chung‐Hawn , Byun Hayoung , Ki Chung Man , Park JuYeon , Son Young‐lk 
Published: September 2011

ObjectiveAssess the efficacy and safety of ultrasound‐powered shears (Harmonic Scalpel) in free flap elevation for head and neck defects.MethodFrom January to August 2010, there were 15 patients enrolled, who underwent reconstructive surgery with free flap in our institution. Donor sites were radial forearm in 10, anterolateral thigh in 5, and fibula in 2. HS was used in harvesting the perforators and the vascular pedicles.ResultsAll the free flaps were successfully harvested within 50 to 70 min (from skin incision to pedicle ligation). Bleeding was minimal even without tourniquet application. All vascular pedicle dissections were performed without mechanical or thermal damages, and they were anastomosized to proper, recipient vessels.ConclusionBased on our experiences, HS is a safe and efficient instrument in harvesting the free flaps, especially because of no increased risk of thermal damage to vascular pedicle.
Collateral Tissue Destruction with the Harmonic Scalpel vs the Coblator Wand: How Does This Affect Tumor Resection Margins?
Authors: Siva Thiru , Gurr Paul A. , MacKeith Samuel A. 
Published: September 2011

ObjectiveOncological surgical technological innovation has produced alternative hemostatic dissection techniques. Collateral tissue destruction and impact upon assessment of tumor resection margins from Harmonic and Coblation dissectors remains unknown. This study uses an ex‐vivo animal model to quantify the collateral tissue destruction caused by the harmonic scalpel vs coblator wand dissection.MethodIncisions through cow tongue were made between defined parallel lines with each dissection technique. The residual tissue width was measured with vernier calipers and subtracted from the width of original tissue. A scalpel blade was used as a control.ResultsThe mean width of collateral tissue destruction for each modality was as follows: harmonic cutting 3.0 mm, harmonic coagulating 4.1 mm, coblation cutting 3.5 mm, harmonic cutting under tissue tension 1.2 mm.ConclusionThis study demonstrates that tissue destruction produced when using the harmonic scalpel and coblation is significant when compared to cold steel dissection. The findings of this study should be borne in mind when using the harmonic scalpel and coblation in oncological surgery and making decisions regarding postoperative adjuvant therapy.
Complication Rates for Radiologically Inserted Gastrostomy in Head and Neck Cancer Inpatients
Authors: Kulendra Kevin , Butler Colin , Sherman Jennifer , Clarke Peter 
Published: September 2011

ObjectiveIdentify complications of Radiologically Inserted Gastrostomy (RIG) insertion and factors contributing to complication rates, including the grade of radiologist, forms of treatment, and time from RIG insertion to onset of complications.MethodA retrospective audit was performed on head and neck cancer inpatients undergoing RIG insertion between 2007 and 2008. A case note review analyzed the type and timing of complications. A change in clinical practice was introduced by delaying RIG suture removal from 3 to 7 days. Complication rates were re‐audited from 2009 to 2010.ResultsA total of 63 RIG insertions were performed on 56 inpatients (13 surgical and 50 oncological). Major and minor complication rates were 7.9% (n = 5) and 63.4% (n = 40), respectively. Minor complications in surgical patients were significantly higher (P =. 02) than oncological cases (92.3% vs 56%). Average time onset for major complications was 2 ±1 days (±SD) and for minor complications was 27 ±35 days. There were no deaths. Tube dislodgement was the most common minor complication, and preliminary data from re‐audit demonstrates improved rates following the change in timing of suture removal.ConclusionWe report no differences in major complications. High rates of minor complications were noted. This may be due to the tube type or size utilized. Subgroup differences may be accounted for by timings in RIG placement. The rates of tube dislodgement were reduced by leaving stay sutures in for longer.
ENT Service Compliance to United Kingdom Targets for Suspected Cancers
Authors: Chan John , Rashid Mamun 
Published: September 2011

ObjectiveThe NHS Cancer Plan sets out a 2‐week maximum wait for out‐patient appointments for suspected cancers. The NHS Improvement Plan sets an 18‐week limit from referral to treatment for noncancer cases. Research on evaluation of adherence to these targets is lacking, and we therefore present data to address this issue.MethodAn audit was performed at a local GP practice over a 4‐month period. EMIS database was used to retrieve correspondence with commissioned ENT services. Date of referral, clinic attendance, type of investigations, and date of first definitive treatment were observed. Standards for the 2‐week and 18‐week target are both 100%.Resultsn = 31.97% (30/31) were compliant with the “2‐week rule.” Only 42% (13/31) were compliant with the 18‐week pathway. Of the cases that breached the 18‐week pathway, 56% (10/18) were pending clinic, 33% (6/18) investigations and 11% (2/18) treatment.ConclusionDespite extensive frameworks formulated by the Department of Health for tackling waiting times, our data suggest that the local ENT services are not in compliance with the 2‐week or 18‐week standards. There is need for wider debate and national review.
Adapting Quality Assurance Principles to Open Structure Rhinoplasty
Authors: El‐Guindy Ahmed S. 
Published: September 2011

ObjectiveEvaluate the methodology and outcome of open structure rhinoplasty after adapting Quality Assurance (QA) principles during planning, surgery and follow‐up. Quality assurance broadly means conforming to standards, meeting customer expectations and fulfilling consumer satisfaction.MethodRetrospective study was conducted on 82 patients who underwent open structure rhinoplasty. Patient expectation was measured by comparing preoperative virtual image with the postoperative real one. Patient satisfaction was measured by validated procedure‐specific Quality‐of‐Life questionnaires. Conforming to standards was evaluated through assessing aesthetic measures and functional parameters.ResultsA total of 91.4% of the surgeries met patient expectations while 93.3% fulfilled patient satisfaction. A total of 85.4% of cases conformed to aesthetic nasal measures while 92.7% to functional clinical parameters.ConclusionAdapting QA principles to rhinoplasty allowed standardization of methodology and assessment of results in precise and accurate manner. It enhances education through defining norms, analyzing variants, addressing deviations, and better planning through proper selection of techniques and customized sequencing of steps. It allowed achievement of preoperative goals effectively and efficiently.
Prognostic Factors of Limited T1‐2N0‐1 Oropharyngeal Cancers
Authors: Psychogios Georgios , Waldfahrer Frank , Mantsopoulos Konstantinos , Iro Heinrich , Zenk Johannes , Koch Michael 
Published: September 2011

ObjectiveNonsurgical therapies, which utilize combinations of chemotherapy and radiotherapy, have become popular treatments for early oropharyngeal carcinomas (OPC). The aim of this study is to analyze the outcome of primary definitive surgical management of patients with limited OPC and assess the influence of various prognostic factors in survival.MethodA retrospective study was conducted between 1980 and 2007. A total of 266 surgically treated patients were included. The endpoints for the analysis were disease‐specific survival (DSS) and local control (LC), with respect to T‐ and N‐classification, status of margins, tumor depth, and type of treatment. Major complications were documented.ResultsOverall 5‐year DSS was 89.9% and LC 93.3%. The univariate analysis showed a significant difference in DSS between pT1 and pT2 OPC (DSS 94.0% vs 81.2%, P =. 008) and patients with tumor depth greater than 5 mm (DSS 94.5% vs 78.9%, P =. 031). No difference could be found according to N‐stage, marginal status, HPV status, type of treatment, and adjuvant radiotherapy. Multivariate analysis showed that T‐stage (HR = 2.49, 95% CI = 1.243‐4.974, P =. 01) and tumor depth (HR = 2.88, 95% CI = 1.055‐7.865, P =. 039) were independently associated with DSS. Incidence of major complications was 8% and mortality rate 0.7%.ConclusionPrimary surgical treatment is a very effective therapy against limited OPC independent to the surgical technique used. A low complication and mortality rate was documented. Patients with tumor depth of more than 5 mm have a significant worse survival and should be considered for adjuvant radiotherapy.
Role of Lymphocytic Thyroiditis in Metastasis of Papillary Thyroid Carcinoma
Authors: Paulson Lorien M. , Shindo Maisie L. , Schuff Kathryn 
Published: September 2011

ObjectiveThe role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) is unclear. Studies have failed to demonstrate correlation of CLT with lymph node metastases (LNM) in part due to lack of standardized central lymph node dissection (CND). We investigate the incidence of LNM in specimens with CLT.MethodAll OHSU patients who underwent total thyroidectomy with comprehensive ipsilateral CND for PTC between 2005 and 2010 were included. All specimens underwent genomic mutation analysis using a panel of known mutations. Reports were reviewed for tumor type, presence of lymphocytic thyroiditis, extracapsular extension, angiolymphatic invasion, and nodal metastasis.ResultsA total of 139 patients met the selection criteria for this study. The overall rate of chronic lymphocytic infiltrate was 43.8%. The overall rate of central node positivity was 63%. There was a significantly higher proportion of central node positivity in the non‐CLT patients (74% vs 49%, P =. 003). There was also a higher rate of angiolymphatic invasion in the non‐CLT patients (31% vs 15% P <. 05). There was no significant difference in mean age, tumor size, and extracapsular extension. Molecular genotyping did not reveal a significant difference in the types of mutations found in both groups.ConclusionOur data indicates a lower incidence of LNM in those with CLT (P =. 003), suggesting a potential protective role in tumor spread. The equal distribution of mutations in tumors with and without CLT argues against mutation‐specific inflammation. Further research is needed to characterize the role of autoimmunity in thyroid cancer.
Selective Neck Dissection in Node Positive Squamous Cell Carcinoma of Head and Neck
Authors: Givi Babak , Linkov Gary , Shah Jatin P. , Wong Richard J. , Kraus Dennis H. , Singh Bhuvanesh , Linkov Gary , Shaha Ashok R. 
Published: September 2011

ObjectiveOptimal type of neck dissection in head and neck squamous cell carcinoma HN(SCC) with clinically positive neck nodes has not been determined. The following study was performed to determine the rate of regional control with selective neck dissection (SND) in these patients.MethodHNSCC patients with cervical lymph node metastases who were treated with SND in a single institution from 2000 to 2010 were selected. Demographics, tumor characteristics, extent of neck dissection, prior and adjuvant treatments, locoregional control and survival were recorded. Recurrence in the neck and disease‐specific survival (DSS) were primary and secondary endpoints.ResultsA total of 130 patients underwent SND. A total of 84 (65%) were male. Median age was 62 years (range, 20‐89 years). Most common primary site was oral cavity (64%). Twenty‐one patients (16%) had prior treatments, 107 (82.3%) received adjuvant treatment. Median follow‐up was 21 months. Fifteen patients (11.5%) had recurrence in dissected neck. Five‐year neck recurrence‐free survival (NRFS) was 82.5%. N2C disease patients had shorter NRFS (5‐year: 64%). At the end of study 75 (58%) patients had NED and 32 (25%) had died of disease. Five‐year DSS was 70%. Number of positive nodes, positive surgical margins, and perineural invasion were predictors of shorter DSS.ConclusionSelective neck dissection in patients with cervical lymph node metastases from head and neck SCCs is effective in controlling the disease in the neck, when performed in the setting of multi‐modality treatment including post operative radiotherapy.
Sentinel Lymph Node Biopsy for Desmoplastic Melanoma: Not a Given
Authors: Eppsteiner Robert W. , Swick Brian , Milhem Mohammed , Pagedar Nitin A. 
Published: September 2011

Objective1) Determine the frequency of positive sentinel lymph node biopsy (SLNB) and characteristics predictive of positivity in a population of patients with desmoplastic melanoma of the head and neck. 2) Assess the utility of SLNB by determining the survival benefit and negative predictive value (NPV) of SLNB.MethodUsing the Surveillance, Epidemiology, and End Results (SEER) database, 467 patients with cutaneous desmoplastic melanoma of the head and neck were identified between 2003 and 2007 (years with reliable SLNB data). Frequency of nodal positivity, survival, and NPV of SLNB were determined.ResultsA total of 467 cases of desmoplastic melanoma were identified, of which most were locally advanced (mean Breslow depth 3.5 mm, 96% Clark level 4 or deeper). Few had regional lymph node metastases (3.4%) or distant spread (3.2%). A total of 165 patients had SLNB of which 4.8% had positive regional lymph nodes (NPV 98.5%). Breslow depth, ulceration, age, and sex were not predictive of positive SLNB. Patients who had SLNB did not have different disease‐specific survival from those who did not undergo SLNB.ConclusionDespite the high accuracy of SLNB, this procedure should be undertaken with caution in patients with cutaneous desmoplastic melanoma of the head and neck, given the low propensity for lymphatic spread (3.4%), possibility of complications, and questionable disease‐specific survival benefit.
Sialendoscopy in the Treatment of over 900 Sialoliths
Authors: Zenk Johannes , Klintworth Nils , Bozzato Alessandro , Iro Heinrich , Koch Michael 
Published: September 2011

ObjectiveMinimally invasive techniques have an increasing relevance for the treatment of sialolithiasis of the parotid and submandibular glands. Sialendoscopy can be used as both a diagnostic and therapeutic tool.MethodRetrospective data analysis for patients with a sialolithiasis of the parotid and submandibular glands who were treated between 2002 and 2008.ResultsA total of 206 patients were treated because of sialolithiasis of the parotid gland, 98 (48%) by interventional endoscopy alone, and 108 (52%) by combined procedures. Patients with submandibular disease (736) were treated endoscopically alone in 7.5% (55); 92.5% (681) received a combined treatment together with sialendoscopy. The follow‐up showed that 93% of the patients treated with endoscopy alone were free of symptoms. In the combined group 90% and 79% of the patients with sialolithiasis of the submandibular glands and parotid glands respectively were free of symptoms.ConclusionSialendoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis. It can be effectively used therapeutically as a single treatment option, and it improves the combined techniques. As a single treatment it plays a very important role in parotid gland stones.
SLNB and Outcomes in Cutaneous Melanoma of the Head and Neck
Authors: Smith Valerie Alison , Lentsch Eric J. , Cunningham Joan E. 
Published: September 2011

ObjectiveAmong patients with cutaneous melanoma of the head and neck (CMHN) and ≥1 positive sentinel lymph node (SLN): 1) Determine if completion regional lymphadenectomy (RL) is associated with improved survival.2) Determine if survival differs between patients with 1 and >1 positive SLN.MethodUsing the Surveillance Epidemiology and End Results (SEER) database, years 1998 to 2007, we identified 5,399 patients with primary CHNM who underwent excisional surgery and examination of ≥1 lymph node with follow‐up >12 months. Clinicopathologic and outcomes data were examined using chi‐square tests.ResultsIn preliminary analysis, 495 patients had 1 positive node and 387 had >1 positive node. Disease‐specific survival (DSS) was statistically different between these 2 groups (64% and 47%), respectively, chi‐square p1 node were involved (P =. 112 and. 891 respectively).ConclusionIn this simple preliminary analysis, CHNM patients with >1 positive lymph node had poorer survival compared with patients with a single positive lymph node. Among patients with SLN‐positive CHNM, regional lymphadenectomy did not improve survival compared with patients who underwent SLNB alone. Formal survival analyses results will be presented.
Snail Drives Erlotinib Resistance in Head and Neck Squamous Cell Carcinoma Cells
Authors: Dennis Miranda S. , Wang Guanyu , Luo Jie , Dubinett Steven , Sidell Douglas R. , Abemayor Elliot , St. John Maie 
Published: September 2011

ObjectiveSnail positivity is predictive of poorly differentiated, invasive, and regionally metastatic HNSCC tumors. We have demonstrated the role of Snail in the inflammation‐induced promotion of EMT. Here, we investigate the capacity of Snail to drive EMT in human oral epithelial cell lines, and its ability to confer drug resistance.MethodSnail was overexpressed in HOK and OKF oral epithelial cell lines. AIG assays, wound healing assays, invasion and migration assays, spheroid modeling, and drug resistance assays were performed. Differential gene expression between Snail‐overexpressing and control epithelial and tumor cell lines was evaluated using gene expression microarray analysis.ResultsThe overexpression of Snail in human oral epithelial cell lines (HOK, OKF) drives EMT. OKF‐Snail and HOK‐Snail lines demonstrate growth in anchorage‐independent growth assays; a decreased capacity to form tight spheroids; increased resistance to erlotinib; and a highly invasive and migratory nature. Gene expression analysis also revealed Snail‐associated differential gene expression with the potential to affect inflammatory cytokine regulation, migration, invasion, and diverse aspects of HNSCC progression.ConclusionSnail controls the mesenchymal phenotype and drives erlotinib resistance in HNSCC cells. Snail may prove to be a useful marker in predicting EGFR inhibitor responsiveness.
Anthropometric Study of the Caucasian Nose in the City of Curitiba: Importance of Population Assessment
Authors: Ballin Annelyse C. , Carvalho Bettina , Sarraff‐Berger Cezar A. , Mocellin Marcos , Becker Renata V. 
Published: September 2011

Objective1) Evaluate the aesthetic parameters of Caucasian noses of Curitiba, Brazil, and compare them with standard aesthetic ideals from the literature.MethodProspective cohort study through assessment of anthropometric measurements (intercanthal width [IW], alar width [AW], length, nasofrontal angle [NFA], nasolabial angle [NLA], nasal tip projection) of the Caucasian noses from photographs and comparison with the ideal of literature, with statistical analysis.ResultsA total of 100 volunteers were evaluated, including students and employees connected to the Health Department of HC/UFPR. Met IW0 (sd:8), NLA range 105,430 (sd:10,5) and nasal tip projection 0.63 (GoodeMethod) and 2.1:1 (Baum Method). The naso‐frontal angle showed statistical significance between genders (p = 0.0008).ConclusionCaucasian noses of Curitiba are shorter, with a wider base, and less projected than the aesthetic ideal, showing possible miscegenation of the population and the importance of population studies for evaluation, preoperative counseling, and surgical planning.
Survival Based on Smoking Status in Head and Neck Cancer
Authors: Emerick Kevin S. , Diephuis Bradford , Michaelson James , Busse Paul , Jara Sebastian , Deschler Daniel G. , Clark John 
Published: September 2011

Objective1) Assess the impact of smoking status on disease‐specific and overall survival in head and neck cancer. 2) Identify subsite specific differences in survival related to smoking status.MethodRetrospective analysis of a single institution database from 1980 through 2008. Patients were categorized by site of primary tumor and smoking status. Kaplan Meier analysis was used to calculate survival, and log rank and chi square analysis were used to identify significant differences.ResultsSignificant overall and disease‐specific survival differences were observed between current, previous, and non‐smokers. Current smokers had a lower survival in all subsites except for oral cavity. The biggest differences were observed in the oropharynx subsite. 5‐year disease‐specific survival for oropharyngeal cancer was: current smokers 57.0%, non‐smokers 86.9%, and previous smokers 81.8% (P <. 05). Similar overall survival differences were observed. Smoking status did not impact on overall or disease‐specific survival in oral cavity cancer.ConclusionWhile a significant focus in head and neck cancer has been on HPV and tumor biomarkers, it is important to recognize smoking as an important factor in survival outcome for head and neck cancer. Both nonsmokers and previous smokers have a survival advantage over current smokers.
Targeted Endoscopic Nasopharyngectomy for Recurrent NPC
Authors: Ho Allen S. , Sunwoo John B. , Kaplan Michael J. , Yao Mike , Hwang Peter H. , Fee Willard E. 
Published: September 2011

ObjectiveEvaluate targeted endoscopic nasopharyngectomy as a viable oncologic alternative to open nasopharyngectomy or radiation for recurrent nasopharyngeal carcinoma (NPC).MethodA retrospective analysis at an academic medical center was performed for 13 patients who underwent endoscopic nasopharyngectomy for recurrent NPC (August 2005 to August 2010). Three patients had neck metastases for which a neck dissection was concurrently planned. Outcomes measured included 2‐year disease‐free survival, 2‐year overall survival, and complication rates.ResultsIncluding resections for subsequent recurrences, 19 endoscopic procedures were performed. Average age was 55.7 years, with mean follow‐up period 24.2 months. Mean OR time was 278 minutes, mean estimated blood loss was 197 ml, and mean hospitalization was 1.0 day. Negative margins were obtained in 78.9%: positive margins involved the parapharyngeal space, oropharynx, fossa of Rosenmuller, and infratemporal fossa. Four patients required repeat endoscopic nasopharyngectomy for re‐recurrence, despite having margins cleared or controlled with adjuvant treatment. Two‐year local disease‐free and overall survival rates were 69.2% and 100.0%, respectively. The complication rate was 52.6%, with no major complications.ConclusionTargeted endoscopic nasopharyngectomy is beneficial in recurrent NPC, with favorable morbidity and complication rates. Endoscopic surveillance facilitates identification of re‐recurrences, which often may be treated with additional directed resection. Stereotactic radiation may serve as an appropriate adjunct modality for disease control at positive margins.