bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modern Management of Laryngotracheal Stenosis
Authors: Herrington Heather C. , Weber Stephen M. , Andersen Peter E. 
Published: September 2006

AbstractObjectives: Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma,or autoimmune disease. Management options include dilation or airway reconstruction including laryngotracheoplasty (LTP), cricotracheal resection (CTR), and tracheal resection (TR). We describe our experience with management of this difficult problem.Study Design: Retrospective chart review of patients treated for laryngotracheal stenosis between January 1995 and July 2005 at an academic, tertiary referral center.Methods: A total of 127 patients were treated during the study period. Patients were followed, and hospital records were reviewed.Results: There were 38 male and 89 female patients with an average age of 55.5 years treated for laryngotracheal stenosis resulting from intubation (64), idiopathic (25) or autoimmune disease (18), radiation (9), trauma (5), prior surgery (4), and relapsing polychondritis (2). Thirty‐three percent were treated for grade I stenosis, 44% grade II, 19% grade III, and 4% grade IV. Seventy percent of patients undergoing initial dilation required a subsequent procedure. LTP, CTR, or TR was performed in 43%, 48%, 71%, and 100% of patients with grade I through IV stenosis, respectively. Among 76 patients undergoing LTP, CTR, or TR, 24 (32%) required a subsequent intervention. Among 36 patients treated with primary LTP, CTR, or TR, only 10 (28%) required further therapy. Twenty‐two of 35 (63%) tracheostomy‐dependent patients were ultimately decannulated. Three patients died in the immediate postoperative period.Conclusions: Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.
Methacholine Challenge Testing in the Diagnosis of Paradoxical Vocal Fold Motion
Authors: Guss Joel , Mirza Natasha 
Published: September 2006

AbstractObjective: The purpose of this study was to determine whether methacholine challenge testing (MCT) combined with serial laryngoscopy could elicit and visualize paradoxical vocal fold motion (PVFM) during asymptomatic periods and suggest laryngeal dysfunction as an etiology of episodic dyspnea.Study Design: A retrospective study of seven adult patients.Methods: Medical records of seven adult patients who were referred to an otolaryngology clinic with recurrent episodes of dyspnea or choking and underwent bronchoprovocation testing were reviewed. After initial fiberoptic laryngoscopy and pulmonary function testing (PFT), bronchoprovocation was performed using aerosolized methacholine at increasing concentrations. Each administration was followed by repeated laryngoscopy and PFT. A positive endoscopic test was marked by the visualization of paradoxical adduction of the true vocal folds during inspiration. A positive bronchoprovocation test was marked by a 20% or greater decline in the forced expiratory volume.Results: All seven patients demonstrated normal upper airway anatomy and function on initial laryngoscopy. In three patients, a positive endoscopic examination demonstrating PVFM was elicited during MCT. In three, the bronchoprovocation test was positive, and asthma was diagnosed. In one patient, both tests were negative. PVFM was seen in all patients whose chief complaint was choking (n = 2) but in only one of five patients whose chief complaint was dyspnea.Conclusions: PVFM may be elicited and observed during MCT coupled with serial laryngoscopy. This test holds promise in differentiating vocal cord dysfunction from asthma during asymptomatic periods in patients who present with recurrent episodes of refractory dyspnea.
Repair of Motor Nerve Gaps With Sensory Nerve Inhibits Regeneration in Rats
Authors: Brenner Michael J. , Hess Jason R. , Myckatyn Terence M. , Hayashi Ayato , Hunter Daniel A. , Mackinnon Susan E. 
Published: September 2006

AbstractObjective: Sensory nerve grafts are often used to reconstruct injured motor nerves, but the consequences of such motor/sensory mismatches are not well studied. Sensory nerves have more diverse fiber distributions than motor nerves and may possess phenotypically distinct Schwann cells. Putative differences in Schwann cell characteristics and pathway architecture may negatively affect the regeneration of motor neurons down sensory pathways. We hypothesized that sensory grafts impair motor target reinnervation, thereby contributing to suboptimal outcomes. This study investigated the effect of motor versus sensory grafts on nerve regeneration and functional recovery.Study Design: The authors conducted a prospective, randomized, controlled animal study.Methods: Fifty‐six Lewis rats were randomized to seven groups of eight animals each. Five‐millimeter tibial nerve defects were reconstructed with motor or sensory nerve grafts comprised of single, double, triple, or quadruple cables. Tibial nerve autografts served as positive controls. Three weeks after reconstruction, nerves were harvested for histologic examination and quantitative histomorphometric analysis. Wet muscle masses provided an index of functional recovery.Results: Nerve regeneration was significantly greater across motor versus sensory nerve grafts independent of graft cross‐sectional area or cable number. Motor grafts demonstrated increased nerve density, percent nerve, and total fiber number (P < .05). Normalized wet muscle masses trended toward improved recovery in motor versus sensory groups.Conclusions: Reconstruction of tibial nerve defects with nerve grafts of motor versus sensory origin enhanced nerve regeneration independent of cable number in a rodent model. Preferential nerve regeneration through motor nerve grafts may also promote functional recovery with potential implications for clinical nerve reconstruction.
Radiographic and Histologic Analysis of the Bone Underlying Inverted Papillomas
Authors: Chiu Alexander G. , Jackman Alexis H. , Antunes Marcelo B. , Feldman Michael D. , Palmer James N. 
Published: September 2006

AbstractIntroduction: Inverted papilloma (IP) is a benign but locally aggressive sinonasal tumor. Those localized to the maxillary sinus or medial maxillary wall have classically been removed through an external approach. In recent years, endoscopic removal has been advocated as an effective, minimally invasive approach. Successful endoscopic management is based on accurate intraoperative identification and complete resection of the tumor. The surgical management of the bone underlying the surface of an IP is less clearcut. Controversy exists as to whether the bony undersurface of an IP should be removed. In this article, histopathologic specimens and preoperative radiologic studies are prospectively examined to better understand the involvement of the bone underlying an inverted papilloma.Materials and Methods: A prospective study of patients with maxillary sinus IP treated with endoscopic or endoscopic‐assisted resection over a 12‐month period was conducted. Intraoperatively, the site of tumor attachment was identified, and a 1‐ to 2‐cm wedge of bone with overlying tumor was removed en bloc and analyzed under light microscopy. Preoperative radiographic studies were analyzed with respect to bony changes in the area of the tumor pedicle.Results: On histopathologic analysis, the bony surf/ce underlying the IP was irregular with multiple bony crevices in all nine cases. In two cases (22% of specimens), an isolated rest of normal‐appearingsalivary gland and/or mucosal tissue was seen embedded in the underlying bone. Radiographic osteitic bony changes were seen at site of tumor attachment in 100% of cases.Conclusion: The irregularity of the bony surface may hinder complete tumor removal because microscopic rests of mucosa can be hidden within the bony crevices. Intraoperative removal of the bony surface at the site of tumor attachment may ensure a more complete removal.
The Impact of Endoscopic Cultures on Care in Rhinosinusitis
Authors: Cincik Hakan , Ferguson Berrylin J. 
Published: September 2006

AbstractObjectives: The objectives of this retrospective, observational study were primarily to analyze endoscopically guided culture results (EGCRs) from an office setting in patients with subclassifications of chronic rhinosinusitis (CRS) and to determine the frequency EGCR‐altered patient management; and secondarily to determine whether purulent secretions are more likely to be positive for a bacterial pathogen.Methods: Consecutive symptomatic patients with nasal secretions not currently on antibiotics were cultured endoscopically. Patients were classified as chronic rhinosinusitis (CRS; n = 41) or acute exacerbation of chronic rhinosinusitis (AECRS; n = 27). Initial therapy was individualized and 32 of 68 (47%) had an antibiotic initiated before availability of the EGCR. Patients were reassessed 2 to 4 days later, and therapy was continued or altered based on clinical course and EGCR.Results: EGCRs were positive in 41 of 68 (60.2%) of all patients. Incidence of positive cultures was not statistically different between CRS (21 of 41 [51%]) and AECRS (20 of 27 [74%]) patients. Initial therapy was changed in 45 of 68 (66%) patients. In 35 of 68 (51.4%), the change was directed by EGCR; in 11 of 77 (14.2%), the change was unsubstantiated by EGCR, and in no cases was an antibiotic initiated inappropriate to EGCR. The frequency of pathogens in the subgroups of CRS and AECRS, respectively, were Staphylococcus aureus (9 of 41 [22%]; 9 of 27 [33%]), acute pathogens (6 of 41 [14.6%], 7 of 27 [25.9%]), and Pseudomonas aeruginosa (5 of 41 [12%], 5 of 27 [18.5%]) and were not statistically different between subgroups. Purulent cultures were not significantly more likely to be Gram stain‐positive than nonpurulent cultures (12 of 34 [35%] compared with 6 of 34 [17.6%], respectively; P = .1). Purulent cultures were more likely to be culture‐positive (25 of 34 [73.5%]) compared with nonpurulent secretions (17 of 34 [50%]; P < .05). AECRS was significantly more likely to be purulent (21 of 27 cases) compared with CRS (13 of 41 cases, P < .001).Conclusion: EGCR directed a change in therapy in 35 of 68 (51.4%) patients with CRS. The pathogens isolated from CRS and AECRS were similar and predominately S. aureus, acute pathogens, and P. aeruginosa. Purulent secretions are more frequently bacteriologically positive than nonpurulent secretions and more common in AECRS than CRS.
Diagnosis and Management of Skull Base Osteoradionecrosis After Radiotherapy for Nasopharyngeal Carcinoma
Authors: Huang Xiao‐Ming , Zheng Yi‐Qing , Zhang Xiang‐Min , Mai Hai‐Qiang , Zeng Liang , Liu Xiang , Liu Wei , Zou Hua , Xu Geng 
Published: September 2006

AbstractObjective: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC).Methods: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC.Results: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years.Conclusions: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.
General and Rhinosinusitis‐Related Quality of Life in Patients With Wegener's Granulomatosis
Authors: Srouji I A. , Andrews P , Edwards C , Lund V J. 
Published: September 2006

AbstractObjectives: The objectives of this cross‐sectional study were to outline the pattern of sinonasal morbidity and determine its effects on the quality of life (QOL) of patients with Wegener's granulomatosis (WG).Methods: The authors conducted a survey of 199 patients with WG, including two validated (QOL) instruments to assess general (SF‐36) and rhinosinusitis‐specific quality of life (Sinonasal Outcome Test [SNOT‐22]).Results: Patients with WG who have sinonasal involvement reported significantly lower general QOL scores than their unaffected counterparts (P = .000006–0.04) for all SF‐36 subsets except for emotional role. WG‐related sinonasal morbidity was comparable to the high levels previously demonstrated in the general rhinosinusitis population. A total of 38.2% of all patients with WG reported a nasal symptom as their most troublesome from a list of nasal and constitutional symptoms. Twenty‐three percent of all patients with WG rated nasal crusting and 17% rated epistaxis as one of their top three most troublesome symptoms even in the setting of multisystem disease. The inclusion of crusting, bleeding, and nasal deformity in the SNOT scoring significantly increased average scores of patients with WG (P = .024, paired t test).Conclusions: Sinonasal involvement impacts significantly on the general QOL of patients with WG and is at least as significant as that of the general rhinosinusitis population. Nasal symptoms that are of particular relevance to this patient group include nasal crusting and epistaxis.
Continuous Intraoperative Facial Nerve Monitoring in Predicting Postoperative Injury During Parotidectomy
Authors: Meier Jason D. , Wenig Barry L. , Manders Ernest C. , Nenonene Emmanuel K. 
Published: September 2006

AbstractObjectives/Hypothesis: To assess whether the use of continuous intraoperative f/cial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy.Study Design: A retrospective analysis.Methods: Forty‐five consecutive parotidectomies were performed using an electromyograph (EMG)‐based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice.Results: The overall incidence of facial paralysis (House‐Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (χ2, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (χ2 and Fisher's, P < .05).Conclusions: The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.
Transnasal Endoscopic Surgery of the Pituitary: Modifications and Results Over 10 Years
Authors: Kelley Richard T. , Smith Joseph L. , Rodzewicz Gerald M. 
Published: September 2006

AbstractObjective: A 10‐year retrospective review of three endoscopic approaches used by the authors for pituitary gland surgery is presented. We review our results and complications and outline the advantages and disadvantages of each. The variations in nasal anatomy that factor in the endoscopic approach are tabulated and discussed.Methods: A chart review and examination of computed tomography and magnetic resonance imaging scans of patients who have had endoscopic pituitary surgery by the authors was performed. We gathered specific details of the operative approach, nasal‐sinus anatomy, tumor location, required ancillary nasal procedures, and postoperative complications.Results: Ninety patients had endoscopic pituitary surgery. Operative reports and review of radiographic studies were possible for 75 patients. The surgical approach progressed over 10 years from endoscopic transseptal (42) to bilateral transostial (13) to unilateral transostial (20). Adequate exposure for the degree of resection was achieved in all patients. Complications included hemorrhage requiring return to the operating room (1), transient visual field loss (2), and transient diabetes insipidus (7). Four patients subsequently had craniotomy to resect suprasellar tumor extension. The average follow‐up was 6 years. One patient required revision endoscopic resection 3 years later for tumor recurrence. Anatomic findings included nasal septal deflections in 36 (48%) of the patients, abnormalities of the turbinates in 42 (56%), and variances of the sphenoid sinus septum in 59 (79%) of the patients. In the unilateral transostial approach, the operative side was often determined by anatomic factors.Conclusion: The authors have exclusively used endoscopic surgery of pituitary gland tumors for over 10 years. Modifications to the approach have occurred as a result of increased surgeon experience and improved technology. The unilateral transostial approach is safe, effective, and recommended.
Is Lack of Placement of Drains After Thyroidectomy With Central Neck Dissection Safe? A Prospective, Randomized Study
Authors: Lee Seung Won , Choi Eun Chang , Lee Yong Man , Lee Jae Yong , Kim Shi Chan , Koh Yoon Woo 
Published: September 2006

AbstractObjective: Selective use of drains after thyroidectomy has been suggested in the literature. Although the safety of thyroidectomy without drains has been reviewed, there is little specific data available to identify the safety of thyroidectomy combined with central neck dissection (CND) without drains. This study aims to determine the feasibility and safety of thyroidectomy without drains, especially in cases of combined CND.Study Design: Prospective, randomized study.Materials and Methods: One hundred ninety‐eight consecutive thyroidectomized patients were enrolled in this study. Drain group (n = 101) consisted of 41 hemithyroidectomies (HT), 28 total thyroidectomies (TT), and 32 total TT with CND. No‐drain group (n = 97) consisted of 42 HT, 18 TT, and 37 TT with CND. The following variables were examined: perioperative complications (hemorrhage, hematoma, seroma), intraoperative bleeding, operation time, volume of resected thyroid gland, time of hospital discharge after operation, duration of drain placement, and total amount of drainage (drain group).Results: There were no significant differences in age, sex, volume of resected thyroid gland, types of operation, operation time, and histopathlologic diagnosis between two groups. In the drain group, overall perioperative complications occurred in seven (7/101, 6.9%) patients. In the no‐drain group, overall perioperative complications occurred in nine (10/97, 10.3%) patients. There was no significant difference in overall perioperative complications between the drain and no‐drain groups, even in cases of performing CND. Time of hospital discharge after operation was significantly shorter in the no‐drain group than the drain group (P < .05).Conclusions: We conclude that thyroidectomy without drains is safe and effective even in combination with CND and appears to confer several advantages over the routine drainage method. In addition, we achieved significant reduction of hospital stay, which led to a reduction in costs for the patients.
Does Induction Chemotherapy Still Have a Role in Larynx Preservation Strategies? The Experience of Institut Catala d'Oncologia in Stage III Larynx Carcinoma
Authors: Majem Margarita , Mesia Ricard , Mañós Manel , Gomez Joaquin , Galiana Ramon , Cardenal Felipe , Juan Amparo , Montes Ana , Perez Francisco Javier , Nogues Julio , Llluch Josep Ramon Germa 
Published: September 2006

AbstractBackground: Radiotherapy with concurrent cisplatin is the standard alternative to total laryngectomy for patients with locally advanced laryngeal cancer. The value of induction chemotherapy in larynx‐preservation therapies remains unknown. Hyperfractionation radiotherapy might improve disease‐free survival.Methods: From August 1993 to August 2004, 71 patients with T3N0–1 larynx tumors and eligible for total laryngectomy received induction chemotherapy with three cycles of cisplatin plus fluorouracil. Clinical tumor response was assessed by indirect laryngoscopy and computed tomography scan. Patients with complete response received hyperfractionation radiotherapy, whereas those without complete response were proposed for total laryngectomy.Results: A total of 71 consecutive patients were included. Thirty‐three patients achieved complete response to induction chemotherapy (46.5%), four of them presented a tumor relapse, and all underwent salvage surgery. Seventy‐six percent of surviving patients preserved a functional larynx. Despite not achieving complete response, 15 patients refused total laryngectomy and received hyperfractionation radiotherapy. Seven patients presented a tumor relapse and salvage surgery was performed in three of them. Fifty percent of surviving patients preserved a functional larynx. Twenty‐two patients without complete response underwent total laryngectomy; three of them presented a tumor relapse but none could be rescued. With a median follow up of 68 months, 5 five‐year overall survival, 5‐year disease‐free survival, and 5‐year larynx function preservation survival rates were 68% (confidence interval [CI], 57–80), 75% (CI, 64–87), and 42% (CI, 29–54), respectively. No differences in overall survival were observed between groups. Five‐year disease‐free survival of patients without complete response who received hyperfractionation radiotherapy was significantly lower than that of the other two groups (P < .02). Ten patients with larynx preservation and no tumor relapse had chronic toxicity that caused the loss of larynx function: seven patients required permanent tracheotomy, two died from pneumonia, and one patient died as a result of a laryngeal necrosis.Conclusions: Patients with complete response to induction chemotherapy in laryngeal carcinoma have a high probability of cure after hyperfractionation radiotherapy. However, hyperfractionation radiotherapy induces a high degree of toxicity that reduces the laryngeal function preservation rate and may jeopardize overall survival.