bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of Narrow‐Band Imaging in Detection of Nasopharyngeal Carcinoma
Authors: Thong Jiun Fong , Ranjini Karumathil Sivasankarannair , Loke David , Hwei Mok Paul Kan 
Published: September 2011

ObjectiveCompare narrow‐band images of nasopharyngeal carcinoma (NPC) with normal nasopharyngeal mucosa and adenoidal tissue.MethodProspective study on patients attending the Ear, Nose and Throat (ENT) clinic. Nasoendoscopic evaluation using both conventional white light (WLI) and narrow band light (NBI) were performed. Biopsies of the nasopharynx were performed for histological confirmation. Epstein‐Barr virus (EBV) serology was tested in all patients.ResultsThirty patients were recruited. Of these, 21 patients had no evidence of malignancy on both histological and serological testing. Seven patients had NPC and 1 patient had nasopharyngeal papillary adenocarcinoma. NBI features identified in normal nasopharyngeal mucosa and adenoids, are: 1) regularly arranged follicular pattern, whereby 2) “follicles” are composed of pale centers with dark peripheries. In comparison, NBI appearances of NPC are noted to show 1 or more of the following features: 1) absence of surface patterns, 2) dark brown, irregular wave‐like surface patterns, and/or 3) irregular follicular patterns with dark brown centers and pale peripheries.ConclusionWith NBI, features on the surface of nasopharyngeal mucosa, adenoidal tissue and NPC are clearly demonstrated and consistently show characteristics as described. NBI may therefore be a useful adjunct in differentiating normal mucosa and tissue from malignancy. Further studies are needed to evaluate its diagnostic accuracy.
Use of Parotid Pressure Bandage for Drainless Parotidectomies: A Modification of an Old Technique
Authors: Chua Dennis Yu Kim , Ho Rachel , Goh Christopher 
Published: September 2011

ObjectiveThe use of fibrin glue has been described in parotidectomies to obviate the need for drains. However, the seroma rate postoperatively can be high. We have modified this technique so as to achieve the same successes without the seroma.MethodA prospective, randomized, case‐control study on 54 patients undergoing superficial parotidectomies. All patients had fibrin glue sprayed on the parotid bed intraoperatively. In group A, a pressure bandage was applied over the parotid area for 12 hours postoperatively. In group B, no pressure bandage was used.ResultsGroup A patients stayed an average of 1.1 days postoperatively while Group B patients stayed 1.6 days. The cost savings in terms of hospitalization was $150 for group A patients. The seroma rate detected postoperatively was 10% for Group A patients but 53% in Group B patients. Among all patients with seromas, the average volume of parotid tissue removed was significantly higher at 71 cm3 compared with patients without seroma, whose average volume of parotid tissue removed was 44 cm3.ConclusionThis paper has shown that it is safer and cheaper to perform parotid surgery with fibrin glue and a parotid bandage. The rate of seroma is related to the volume of parotid tissue removed.
Venous Coupler Dopplers as Microvascular Free Flap Monitors
Authors: Quintanilla‐Dieck Lourdes , Schneider Daniel S. , Wax Mark K. 
Published: September 2011

ObjectiveThe use of implantable Dopplers for microvascular free flap monitoring has been widely described as an efficient method for supervising flaps postoperatively. Recently a Doppler incorporated into the venous coupling device has been made available. This allows the use of a single apparatus. We report our experience with this device.MethodThis is a preliminary report of an ongoing prospective study of 19 microvascular free flaps mostly in the head and neck, completed from March 2010 to February 2011, where a venous coupled Doppler was used for postoperative monitoring.ResultsNineteen free flaps are reported. Ten Dopplers (52.6%) maintained continuous positive signal throughout, 6 (31.6%) became position‐dependent and three (15.8%) became nonfunctional at some point. Two flaps required reoperation for flap and pedicle revision one day after surgery. The first, which developed a hematoma secondary to an arterial bleed from the vascular pedicle, maintained a positive Doppler signal. The second, which presented clinical evidence of impending flap failure, had an intermittent position‐dependent Doppler signal at the time of take back.ConclusionThis study examines the efficacy of the venous coupled Doppler. Our preliminary results show positional variability in many patients. The venous Doppler coupler appears to be as effective in monitoring flaps postoperatively.
Wound Complication in Post‐chemoradiotherapy Neck Dissection
Authors: Ahsan Farhan , Junor Elizabeth , Ironside Janet , Vernham Guy A. , Ganly Ian , Keh Siew M. 
Published: September 2011

ObjectiveReport the incidence and type of postoperative complications following neck dissection in patients with advanced stage squamous cell cancer of the laryngopharynx treated with chemoradiotherapy (CRT) and to identify factors predictive of these complications.MethodDesign: Retrospective review of case series. Setting: Single institution. Patients: Thirty‐three patients with advanced laryngopharyngeal cancer who underwent postchemoradiation neck dissection between 2003 and 2007 were identified. Intervention: Neck dissection, with or without resection of the primary site, in patients following chemoradiotherapy. Main outcome measure: postoperative complications.ResultsThirty‐eight neck dissections were carried out in 33 patients (median ± SD age, 59 ± 7.8 years; 85% male). Local wound complications were recorded in 6 (18%) of 33 patients with one mortality from carotid rupture. Complications were seen in 1 (17%) of 6 patients with N1 disease, 5 (23%) of 22 patients with N2, and 0 of 5 patients with N3 neck disease. There was no association between type of neck dissection, medical comorbidities, smoking, time interval between completion of chemoradiotherapy and neck dissection, and rate of complications (P >. 05). There were no recorded systemic complications following salvage surgery.ConclusionThe incidence of wound complications after neck dissection in patients treated with chemoradiation in our cohort is 18%. This compares favorably to reported literature. Nutritional issues and patients’ co‐morbidities should be addressed to minimize wound complications risk.
Age‐Related Changes of Deglutitive Pharyngeal Clearance Evaluated by Quantitative Measurement
Authors: Umezaki Toshiro , Adachi Kazuo , Komune Shizuo 
Published: September 2011

ObjectiveTo know swallowing ability, one of the most important subjects is to evaluate pharyngeal clearance of swallowing. Until today, age‐related change of it has not been well known. We evaluate it in every age group using our newly developed quantitative measuring system in the videofluoroscopic (VF) swallowing study.MethodThe subjects were 65 healthy adults (31 male and 34 female) without dysphagia. All subjects were instructed to swallow 10 mL of 100% barium and the clearance was measured in %. Images of VF were captured, and volumes of contrast media were estimated by calculating thickness as a function of brightness.ResultsPharyngeal clearance (%) could be measured in all subjects by this system. The mean pharyngeal clearance of them was 93.5%. We divided an age group into under 60 years old (younger group) and 60 years or older (elder group), and we compared the clearance between these 2 groups. The pharyngeal clearance in the younger group was more than 90% (mean: 95.1%), while in the elder group the mean of the pharyngeal clearance was 91.87%. Although these 2 showed a significant difference in pharyngeal clearance (P =. 0021), there was no pathological decrease without aspiration in the elderly.ConclusionWe successfully delineated the age‐related change of the pharyngeal clearance of swallowing quantitatively in swallowing VF. Even in the elder group, however, the pharyngeal function of them should be better maintained than we expected. In the elderly, merely aging will not but other pathological factors lead to dysphagic condition.
Endoscopic Management of Supraglottic Stenosis
Authors: Vira Darshni , DeConde Adam , Chhetri Dinesh 
Published: September 2011

Objective1) Understand traditional techniques for the management of supraglottic stenosis. 2) Learn minimally invasive endoscopic technique using CO2 laser pharyngoplasty, balloon dilation, and Mitomycin‐C application in the management of supraglottic stenosis.MethodCase series in a tertiary academic medical center of patients with isolated symptomatic supraglottic stenosis who underwent endoscopic management.ResultsFour patients with symptomatic supraglottic stenosis were initially managed with CO2 laser endoscopic pharyngoplasty, balloon dilation, and topical Mitomycin‐C application under general anesthesia. Subsequent management in 3 patients included office‐based balloon dilations. Voice, swallowing, and airway outcomes are reviewed with minimum twelve month follow‐up. Results were satisfactory in all patients and all were decannulated.ConclusionSupraglottic stenosis is a rare entity that has been traditionally managed with supraglottic laryngectomy. However, using minimally invasive endoscopic techniques, long‐term success with minimal morbidity can be achieved and should be considered as a first‐line management option for this condition.
Hands‐Free Speech in Glottic Stenosis Patients
Authors: Young Nwanmegha Osita , Acton Lynn , Lee Esther S. 
Published: September 2011

ObjectiveGlottic stenosis remains a difficult disease entity to treat. Many remain tracheostomy dependent and unable to tolerate traditional speaking valves despite intervention. The inability to communicate while gesturing and using both hands is extremely limiting. We demonstrate a novel way of achieving hands free speech in this population.MethodFour patients with glottic stenosis who were tracheostomy dependent and unable to tolerate speaking valves were identified. A special tracheostomy tube was designed to fit a hands‐free laryngectomy speaking valve. After being fitted each patient was given at least 2 hours of instruction on how to use the valve.ResultsAll patients were able to develop proficiency using the valve. Three of the patients continued using the valve greater then 3 months after developing proficiency. There were no complications.ConclusionHands‐free communication greatly enhances the quality of life of tracheostomy dependent patients. Using a tracheostomy tube specially designed to fit a laryngectomy valve. We demonstrate 4 patients with glottic stenosis able to achieve hands‐free speech.
Multidisciplinary Approach to an Arteriovenous Malformation
Authors: Wang Soo‐Geun , Kim Jeong Tae , Nam Soo Bong , Lee Yoon Se , Lim Yun Sung 
Published: September 2011

ObjectiveArteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries and draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach.MethodWe report a complicated case of a huge AVM with a fistula and massive bleeding in the head and neck region to share our treatment experience, together with a literature review.ResultsThe patient underwent wide excision with free flap reconstruction after embolization of the bilateral ECA the day before surgery. We used a subtemporal‐infratemporal fossa approach. The dura was exposed after the middle fossa approach and the masticator space before removing the mass. The mass measured 15x15 cm, and the external jugular vein was dilated. The defect was reconstructed using a latissimus dorsi musculocutaneous free flap, measuring 25x15cm in size and 15 mm thick. No flap or wound complication was observed on CT.ConclusionThe treatment of complicated AVMs in the head and neck region is challenging and a multidisciplinary approach is needed to eradicate the AVM completely without recurrence or complications. This consists of preoperative embolization of vessels, meticulous resection without injuring the feeding vessels, and a reconstruction with well‐vascularized free flap.
Incidence of Recurrent Respiratory Papillomatosis (RRP)
Authors: Omland Turid Brokke , Akre Harriet , Brondbo Kjell , Vårdal Mari 
Published: September 2011

Objective1) Estimate the incidence‐rate of juvenile‐RRP (JoRRP) and adult‐RRP (AoRRP) for each year between 1987 to 2009 in a Norwegian subpopulation. 2) The incidence of HPV‐induced genital‐HPV infections and oropharyngeal cancer in Western countries is increasing. This study was conducted to investigate whether there are similar trends in RRP.MethodPopulation‐based epidemiological survey. Two Norwegian subpopulations, with 2.5 million and 1.1 million inhabitants, were investigated for JoRRP and AoRRP respectively. RRP‐patients in all ENT‐departments located in the 2 areas were identified. The estimates are based on data from the Norwegian Census Bureau during the time‐period.ResultsMedian age at onset was 34 years (interquartile range, 15) for AoRRP and 4 years (interquartile range, 5) for JoRRP. Concerning age at onset there was neither significant differences between genders, nor significant changes during the time‐period. The overall incidence‐rates in juveniles and adults were 0.17 (95% CI = 0.44‐0.65) and 0.54 (95%CI=0.10‐0.25) per 100 000 respectively. We could show a male preponderance in both groups. (P =. 000 for AoRRP and P =. 038 for JoRRP) There was no significant change of the incidence‐rate during the time period neither for AoRRP nor JoRRP or when stratified for gender in each group.ConclusionThis study does not support our hypothesis of an increasing incidence neither for JoRRP nor for AoRRP. The estimated incidence‐rates in the Norwegian subpopulations are consistent with former population based epidemiological surveys. Male preponderance in JoRRP was an unexpected finding. Further surveys are warranted.
Management of Dysphonia among General Otolarygologists
Authors: Cohen Seth , Courey Mark , Pitman Michael , Noordzij Pieter 
Published: September 2011

ObjectiveInvestigate common treatment approaches of general otolaryngologists for adult patients with dysphonia, particularly for patients without obvious laryngeal anatomic abnormalities.MethodOne thousand randomly chosen AAOHNS general otolaryngologists were mailed a survey. The response rate was 27.8%. Mean years in practice were 19.5 years.ResultsThe most common treatments for adult dysphonic patients were anti‐reflux treatment, voice therapy, and allergy treatment. For patients with mobile vocal folds without lesions on laryngoscopy, 52% refer to speech‐language pathologists, 57.9% obtain stroboscopy, and 58.6% start proton pump inhibitors (PPI). Muscle tension dysphonia, vocal fold nodules, and dysphonia of uncertain etiology were the most common reasons for voice therapy referral. Response to once daily PPI, laryngeal signs, and throat symptoms were the most common determinants for LPR. When patients failed initial treatment, 46.9% obtain stroboscopy, 37.4% refer for voice therapy, and 33.3% extend or increase duration of PPI treatment.ConclusionVaried treatment approaches to adult dysphonic patients were identified. How practice patterns vary from best practice guidelines, impact patient outcome, and influence health care costs needs examination.
Mechanical Modulation of Cuff Pressure Reduces Airway Injury
Authors: Osborn Alexander , Luginbuehl Igor , Fisher Joe , Forte Vito 
Published: September 2011

ObjectiveTest a valve‐based mechanical means of modulating endotracheal tube cuff pressure and its efficacy in reducing airway injury.MethodWe developed a mechanical valve‐based device that modulates endotracheal tube cuff pressure with the respiratory cycle. We tested this device in a previously validated porcine model of accelerated airway injury. Laryngeal specimens from animals intubated with a modulated cuff pressure were compared to those intubated with a constant cuff pressure.ResultsWe have demonstrated that the valve‐based device adequately maintains ventilation. Furthermore, there was a significant reduction in the amount of histologically evident injury to the subglottic and tracheal areas of the airway in those animals that were maintained with a modulated cuff pressure. There was no difference between the 2 animal groups in the degree of supraglottic or glottic injury.ConclusionThis valve‐based system is inexpensive, reliable, and effective in reducing airway injury. Validation of this device in the clinical setting would allow its widespread application and potentially result in a significant reduction in airway injury from prolonged intubation.
Proposal for Improved Efficiency through Taped Patient Encounter
Authors: McRackan Theodore R. , Labadie Robert F. 
Published: September 2011

ObjectiveAn extensive amount of time goes into each patient encounter that is unrelated to providing clinical care. This study introduces a new concept that integrates billing/coding, transcription, and patient education through digitally recorded patient encounters.MethodIn the taped clinical encounter, the history of present illness, past medical history, physical examination, and assessment and plan are recorded. Between each section the clinician provides a summary of the pertinent data collected. The video is then reviewed by a coding expert for billing purposes.ResultsIn carrying out the above in a standardized patient, we successfully eliminated all paperwork and dictation that would be done after leaving a patient’s examination room. A typed transcription of the pertinent patient summary dictated to the camera was entered into the patient’s electronic medical record. A digital record of the encounter was also made available through the electronic medical record that the patient could access from home. This allows the patient to review the diagnosis and treatment plan to improve compliance. Both records were also available to the referring physician to review.ConclusionThrough the digital recording of patient encounters, we hope to improve clinical efficiency, coding accuracy, patient compliance, and referring physician gratification.
Nerve Fibers in Laryngeal Muscle Following Injury on Nerve
Authors: Toya Yutaka , Yumoto Eiji , Minoda Ryosei , Kumai Yoshihiko 
Published: September 2011

ObjectiveCompare the modulation of nerve fibers, 1) between recurrent laryngeal nerve (RLN) and vagus nerve (VN) in the thryroarytenoid (TA) muscle, 2) between RLN in TA and peroneal nerve (PN) in tibialis anterior (TbA) muscle following nerve section and immediate anastomosis using rat model.MethodRats were sacrificed at 5 occasions after nerve section followed by anastomosis. Axons, myelin sheaths, Schwann cells, nerve terminals, and acetylcholine receptors in TA and TbA were quantified by immunohistochemistry. Data were expressed as the ratio between treated and untreated sides (T/U ratio).ResultsEighteen weeks posttreatment, the mean T/U ratios for axon expression were RLN: 68.5%, VN: 0.0% and PN: 99.2%; the ratios for myelin sheath were RLN: 0.0%, VN: 0.0%, PN: 97.6%; the ratios for Schwann cells were RLN: 53.7%, VN: 0.0%, and PN: 93.6%; the ratios for nerve terminals were RLN: 61.0%, VN: 0.0%, and PN:96.4%; and the ratios for acetylcholine receptors were almost 100% for RLN and PN and 67.2% for VN. For all measurements there was a significant difference between RLN and PN at the 18 weeks time point (P <. 001).ConclusionThese results show that, at 18 weeks, regeneration did not occur in VN. On the other hand, regeneration occurred in both RLN and PN, moreover, nerve fibers were more matured in PN compared to RLN.
Recalcitrant Airway Stenosis in Patients with Abnormal Scars
Authors: Pacheco Paulette , Garcia Evamariely , Gonzalez‐Aquino Carlos 
Published: September 2011

Objective1) Identify factors that lead to failures in laryngotracheal reconstruction. 2) Substantiate the clinical suspicion that patients with aberrant wound healing are more likely to fail initial reconstruction surgery, requiring multiple procedures. 3) Consider this population for research in the genetics of subglottic and tracheal stenosis.MethodA retrospective chart review of patients who failed initial laryngotracheal reconstruction surgery and required additional procedures. The main outcome measure was decannulation. We evaluated demographic data, cause of stenosis, Cotton‐Myer grade, surgical techniques, medications employed, and whether patients presented evidence of aberrant wound healing in other anatomic sites.ResultsSix records were identified. Five of these (83%) demonstrated hypertrophic scarring on physical examination. The cause of stenosis in every patient was mechanical ventilation ranging from 5 to 20 days. All patients presented with Cotton grades 3 or 4. Although surgical technique did not vary among patients, all underwent a minimum of three interventions over a 2‐year period, despite the regular use of steroids and anti‐reflux medications. Mitomycin C was used in only 1 patient and she is currently tolerating capping. Two patients have been deccanulated, but continue to exhibit dyspnea on exertion. Three are still tracheotomy dependant.ConclusionWe have observed a high incidence of scarring in patients failing initial laryngotracheal reconstruction. Although multiple causes for failure have been identified in the literature, this correlation has not been reviewed. Our results suggest there may be a genetic predisposition to develop airway stenosis in this group of patients.
Recurrent Laryngeal Papillomatosis, Juvenile and Adult: 1990‐2010
Authors: Zamalloa Shirley Paola Gutierrez , Lorenzo Ana Isabel , Hidalgo Camelo Santidrián 
Published: September 2011

ObjectiveLaryngeal papillomatosis is a rare disease, benign, recurrent, with potential for malignancy according to viral type and aggravating factors. Its high recurrence raises different therapeutic modalities. Here we review our experience in 20 years on behavior and type of performed treatment.MethodA descriptive study of a cohort of patients of the University Complex Hospital to Vigo (CHUVI) from January 1990 to December 2010 with papilloma and recurrent respiratory papillomatosis.ResultsWe found 37 cases, 4.35 incidence rate per million population per year, average age 49 years, 81.1% males, 71% history of smoking, 51.4% had symptoms years before the first consultation, 33.3% settled on right vocal cord, 64.9% treated with CO2 laser, 51.5% histology compatible with human papilloma virus, 6 cases became viral typing, 4 positive and 100% HPV type 11. A total of 47.2% relapsed, the average number of interventions was 5 times per patient, 18.9% malignant and none of them had HPV study, 13.8% laryngectomy was performed, until the time of study 43.3% cured and 10% in remission.ConclusionIn our area, laryngeal papillomatosis is a rare disease, more common in middle‐aged men with malignant potential and frequent relapses. It is important to study HPV monitored closely and cessation of toxic habits after surgery. It is necessary to seek alternative therapies.