bluuebunny/crossref_metadata_2025_split huggingface dataset:
Success of Multiple, Sequential, Free Tissue Transfers to the Head and Neck
Authors: Varvares Mark A. , Lin Derrick , Hadlock Tessa , Azzizadeh Babak , Gliklich Richard , Rounds Mark , Rocco James , Deschler Daniel G. , Fabian Richard , Cheney Mack L. 
Published: February 2009

AbstractIntroduction: Free tissue transfer has become the primary reconstructive modality for significant ablative defects in the head and neck. The overall success rate is high, approaching 95% in most centers. The success rate of multiple sequential free flaps has been thought to be lower, based on the absence of optimal vessel availability and the presence of significant scar tissue in the previously operated patient. We evaluated a series of patients who underwent multiple free flaps at different time points to determine the overall success rate and to identify pitfalls encountered in this population.Methods: Retrospective review, tertiary care medical center.Results: From 1995 to 2002, 377 free flaps were performed by our reconstructive service. Of this group, 36 underwent multiple free flaps at different time points. Thirty‐two had two flaps, and four had three flaps. Reasons for performing sequential free flap procedures were as follows: recurrent disease/new primary (18), need for further augmentation (10), failed previous flap (6), delayed mandibular reconstruction after plate fracture (2), mandibular osteoradionecrosis (3), and delayed pharyngoesophageal stenosis (1). The overall failure rate on the second and third flap was 2 of 32 and 0 of 4, respectively, with an overall success rate of 94%.Conclusion: Multiple, sequential, free tissue transfer for reconstruction of head and neck defects is a safe and reliable procedure with success rates equal to that in patients undergoing initial free flap reconstruction. Careful preoperative planning can result in optimal outcomes even in this difficult patient population.
Nocturnal Onset and Development of Bell's Palsy
Authors: Kanoh Naoyuki , Nomura Jun , Satomi Fumio 
Published: February 2009

AbstractObjective/Hypothesis: To examine the mechanism and pathophysiology of idiopathic peripheral facial palsy (Bell's palsy), the mode of onset of facial palsy was investigated.Study Design: Retrospective case review.Methods: We identified the point at which patients with facial palsy first noticed their illness using our medical charts for 648 patients and information from 3,580 facial palsy cases who visited an Internet site; we found that the time of a patient's first awareness of his or her illness was mentioned in 258 (204 Bell's palsy) and 53 cases, respectively. These cases were divided into three periods: morning, afternoon, and night.Results: The ratio of morning:afternoon:night in the two groups was 141:30:33 and 50:0:3, respectively. These findings indicate that the majority of patients first noticed their palsy in the morning.Conclusion: Because several hours are required for facial palsy to develop before becoming apparent, this suggests that the onset and development of facial palsy occurred during sleep, when circulatory dynamics are reduced. In humans, ischemia is more likely to occur and produce facial palsy than virus reactivation.
Endoscopic Measurement of Vocal Fold Movement during Adduction and Abduction
Authors: Dailey Seth H. , Kobler James B. , Hillman Robert E. , Tangrom Kittisard , Thananart Ekawudh , Mauri Marcelo , Zeitels Steven M. 
Published: February 2009

AbstractObjectives/Hypothesis: Whereas vibration of the vocal folds has been analyzed and modeled in detail, less attention has been paid to quantifying the slower motions of abduction and adduction. Because these gestures reflect neuromuscular function, cartilage geometry, and joint mobility, objective measurement might improve assessment and treatment of patients with neuromuscular or structural disease.Study Design: Prospective, observational.Methods: Twenty‐one normal adult volunteers performed a repeated “ee‐sniff” task at three rates during flexible endoscopy. Distortion in the images was corrected and frame‐by‐frame analysis of the angle between the true vocal folds (glottic angle) yielded measures of maximum abduction angle (MAA) and mean angular velocities of abduction (MVAB) and adduction (MVAD).Results: Reliability tests indicated interjudge variability of 3.8 degrees (deg). The mean MAA was 51 deg and ranged from 31 to 77 deg across subjects. The mean MVADs were 229, 309, and 475 deg/s for slow, medium, and fast rates, respectively, and the mean MVABs were 330, 388, and 441 deg/s for slow, medium, and fast rates, respectively. Statistical analysis showed greater influence of gesture rate on adduction than on abduction.Conclusions: The glottic angle can be reliably measured from flexible endoscopic images and angular velocities of vocal fold abduction and adduction can be determined from analysis of sequential video frames. Accuracy is significantly enhanced by correction of distortion in the images. This approach holds promise for objective characterization of vocal fold function in patients with a variety of disorders.
Quality of Life Correlates After Surgery for Laryngeal Carcinoma
Authors: Bindewald Julian , Oeken Jens , Wollbrueck Dorit , Wulke Cornelia , Dietz Andreas , Herrmann Esther , Schwarz Reinhold , Singer Susanne 
Published: February 2009

AbstractObjectives: To assess the correlation of operation mode, postoperative radiotherapy, and disease stage factors with the health‐related quality of life (HRQL) measures after surgery for laryngeal carcinoma.Study Design: Reanalysis of data of two multi‐institutional cross‐sectional studies.Patients and Methods: We interviewed 218 laryngectomees and 153 partial laryngectomy patients in and near Leipzig, Germany, in two cross‐sectional studies, using the general and the head‐ and neck‐specific quality of life questionnaires of the European Organization for the Research and Treatment of Cancer (EORTC QLQ‐C30 and EORTC QLQ‐H&N35). Multifactorial univariate and multivariate models were calculated, with laryngectomy vs. partial laryngectomy, radiotherapy (irradiated or not), and disease stage (International Union Against Cancer [UICC] stages I/II vs. III/IV) as influencing factors and the HRQL scales and items as dependent variables. Analyses were adjusted for the patient's age and the time elapsed since the operation.Results: Laryngectomees were more affected in their sense of smell (P ≤ .000). Among irradiated patients, functioning levels and many symptom scales showed worse results (P ≤ .05). Both operation mode and postoperative radiotherapy were independently associated with head‐ and neck‐specific HRQL in multivariate analysis. Differences between disease stage groups, however, were not significant. Patient's age was an influencing factor on HRQL, but time since operation was not.Conclusions: Postoperative radiotherapy seems to have the greatest impact on patients' HRQL independent of other clinical factors following surgery for laryngeal carcinoma. Aftercare of irradiated laryngeal carcinoma patients should focus more on the patient's quality of life.
A “Fenestration Approach” for Arytenoid Adduction Through the Thyroid Ala Combined With Type I Thyroplasty
Authors: Tokashiki Ryoji , Hiramatsu Hiroyuki , Tsukahara Kiyoaki , Kanebayashi Hidenori , Nakamura Mari , Motohashi Rei , Yamada Tetsuya , Suzuki Mamoru 
Published: February 2009

AbstractObjective: To develop and evaluate the voice outcomes of an approach of arytenoid adduction (AA) through a fenestration of the thyroid ala for unilateral vocal cord paralysis.Study Design: Twelve consecutive patients with severe unilateral vocal cord paralysis, whose maximum phonation times (MPTs) were less than or equal to 5 seconds, underwent laryngoplasty using an approach of AA performed through a fenestration of the thyroid ala combined with type I thyroplasty.Method: Two surgical windows were made in the lower part of the thyroid ala. The anterior window was for typical type I thyroplasty, and the posterior window was for AA. AA was performed by pulling the lateral cricoarytenoid muscle (LCA) (5 patients) or muscular process (7 patients) through the posterior fenestration in the contractile direction of the LCA without releasing the cricoarytenoid joint. The operation was performed under local anesthesia with sedation except in two patients who underwent general anesthesia using a laryngeal mask. The vocal cord medialization was confirmed endoscopically during the operation. For all patients, the MPT and mean airflow rate (MFR) were measured before and after the operation. The postoperative voices were analyzed using shimmer and jitter.Result: All patients achieved a MPT of over 12 seconds. The MFR, which ranged from 340 to 1902 mL/second before the operation, improved to less than 200 mL/second, except in one patient whose MFR was 210 mL/second. Shimmer and jitter improved significantly after the operation. Perceptual evaluation using the GRBAS (grade, roughness, breathiness, aesthenia, strain) scale also improved significantly.Conclusion: A fenestration‐based approach simplified the combination of AA and type I thyroplasty because the two treatments could be performed in the same operating field and provided good voice improvement. Pulling the AA braid in the contractile direction of the LCA and endoscopic vocal cord observation during surgery may have contributed to the positive results.
Nonpharmacologic Effects of Botulinum Toxin on the Life Quality of Patients with Spasmodic Dysphonia
Authors: Anari Shahram , Carding Paul N. , Hawthorne Maurice R. , Deakin Jayne , Drinnan Michael J. 
Published: February 2009

AbstractObjective: Botulinum toxin (BT) injection improves objective and subjective voice measurements in spasmodic dysphonia; however, it is not clear whether the results are entirely caused by the neuromuscular blocking effects of BT or whether other factors (e.g., psychological or emotional) play a part. The aim of this study is to investigate whether nonpharmacologic factors contribute to the changes observed in the quality of life (QoL) after BT treatment of spasmodic dysphonia.Study Design: Prospective cohort study.Methods: Thirty‐eight consecutive spasmodic dysphonic patients attending for repeat BT injections were investigated by recording their Voice Handicap Index (VHI) scores at three time points: 1) immediately prior to injection (baseline), 2) 1 day postinjection (when least pharmacologic change is expected), and 3) 2 weeks postinjection (when most pharmacologic change is expected). The changes in the total and domain VHI scores were compared between the two postinjection scores and the baseline value using two‐way analysis of variance and the post hoc Bonferroni test.Results: Most of the change in VHI score occurred between the baseline and first postinjection measurement. For two of the domains (total and emotional), the change was statistically significant. The change between the two postinjection assessments was minimal, and no domain showed statistically significant change.Conclusions: Our data indicate that the early improvements in QoL after BT injection can only in small part be attributed to the neurotoxic effects of the agent. We cannot say whether the reported effects in our study are attributable to a strong placebo response or are a real consequence of the patient's changing emotional state.
Airway Reconstruction With Carrier‐Free Cell Sheets Composed of Autologous Nasal Squamous Epithelium
Authors: Koo Jaseok P. , Kim Chang‐Hoon , Lee Jeung‐Gweon , Kim Kyung‐Su , Yoon Joo‐Heon 
Published: February 2009

AbstractObjectives/Hypothesis: Although skin has been the most effective graft material for reconstructing the airway lumen, the use of squamous epithelium has many problems. If autologous airway squamous epithelium could differentiate into mucociliary epithelium after in vivo grafting, it could be an answer to these problems. In this study, we wanted to examine whether carrier‐free nasal epithelial cell sheets composed of autologous squamous epithelium could be used as a substitute for skin in airway luminal reconstruction in three maxillectomy patients.Study Design: In vitro biochemical experiments with in vivo applications.Methods: We cultured nasal squamous epithelium from three maxillary cancer patients prior to maxillecotmy. These squamous cell sheets were grafted on the forearm free flap, and, after maxillectomy, the surgical defect was reconstructed with a prefabricated myocutaneous radial forearm free flap with the cultured nasal squamous epithelium. At 1 and 3 month intervals after the reconstructive surgery, the cultured cell grafted area was investigated with histologic phenotype, comparing the skin grafted area.Results: The autologous nasal squamous epithelial cell sheet differentiated into mucociliary epithelium without the crust or mucus stagnation that is usually observed in cases in which skin graft is used for airway reconstruction.Conclusions: We suggest that autologous cultured nasal squamous epithelium, which differentiates into mucociliary epithelium after in vivo grafting, can be used as a clinically relevant substitute for skin graft in airway luminal reconstruction.
Organ Preservation Surgery for Advanced Unilateral Glottic and Subglottic Cancer
Authors: Delaere Pierre , Goeleven Ann , Poorten Vincent Vander , Hermans Robert , Hierner Robert , Vranckx Jan 
Published: February 2009

AbstractObjectives: Functional surgery of unilateral T2b to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007.Methods: Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T2b to 3N0. Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4‐cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect.Results: Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow‐up period of 33 (range, 1–66) months or almost 3 years, 23 patients remained free of tumor recurrence.Conclusions: Tracheal autotransplantation can be recommended as a functional treatment for selected T2b to T3 glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function.
Intracapsular vs. Extracapsular Tonsillectomy: A Comparison of Pain
Authors: Cohen Michael S. , Getz Anne E. , Isaacson Glenn , Gaughan John , Szeremeta Wasyl 
Published: February 2009

AbstractObjective: To measure differences in postoperative pain in children undergoing intracapsular tonsillectomy vs. extracapsular tonsillectomy.Study Design: Prospective clinical trial carried out at a tertiary children's hospital over 1 year.Methods: The study included 43 patients age 5 to 19 years with adenotonsillar hypertrophy, 27 undergoing extracapsular tonsillectomy and 16 undergoing intracapsular tonsillectomy. Tonsillectomy was performed in either an intracapsular or extracapsular fashion using bipolar electrosurgical scissors and monopolar suction cautery for hemostasis. Residents under faculty supervision performed all operations. Postoperative pain was assessed using the Wong‐Baker Faces Pain Scale through postoperative day 10. The patients recorded in a standardized diary pain scores and analgesic use. The main outcome measure was postoperative pain as measured by the Wong‐Baker Faces Pain Scale. The quantity of postoperative pain medicine consumed was a secondary outcome measure.Results: Average postoperative pain for extracapsular tonsillectomy was 5.21 on a 10‐point scale versus 2.75 for intracapsular tonsillectomy (P < .0001).Conclusions: Intracapsular tonsillectomy with bipolar scissors results in less postoperative pain than extracapsular tonsillectomy with bipolar scissors in children age 5 to 19 years.
Cadaveric and Engineering Analysis of the Septal L‐Strut
Authors: Mau Ted , Mau Sheng‐taur , Kim David W. 
Published: February 2009

AbstractObjectives: To identify patterns of failure of the L‐strut, to identify elements of the nasal framework that support the L‐strut, and to investigate the effect of altering L‐strut design on its stability.Study Design: Laboratory study with human cadaveric heads and computational modeling.Methods: Directional forces were applied to cadaveric L‐struts and patterns of failure with incremental force were noted. Computational modeling using the finite element method (FEM) was employed to determine quantitatively the effect of various modifications on the stability of the L‐strut.Results: The L‐strut was found to respond to frontal force initially by buckling. This buckling was reversible until the force exceeded a certain threshold when the L‐strut broke at the bony‐cartilaginous junction. The threshold force varied depending on the length of the overlap with the bony vault. Intact mucoperichondrium provided significant stability. Modeling with FEM showed that the preservation of a triangular piece of cartilage at the dorsal anchor of a narrowed L‐strut can offset some of the loss in mechanical stability.Conclusions: Intrinsic elasticity of the septal cartilage, the mucoperichondrial flap, and overlap with the bony vault all contribute to the stability of the L‐strut, which is enhanced by preserving a small segment of cartilage at the bony‐cartilaginous junction of the dorsal L‐strut.
Cerebrospinal Fluid Leak After Anterior Cervical Disc Fusion: An Unusual Cause of Dysphagia and Neck Mass
Authors: Schaberg Madeleine R. , Altman Jason I. , Shapshay Stanley M. , Woo Peak 
Published: February 2009

AbstractObjective: Dysphagia after anterior cervical disc fusion (ACDF) is a common complaint. We present two cases of dysphagia caused by a rare complication after ACDF: cerebrospinal fluid (CSF) leak into the neck.Study Design: A case series of two patients.Methods: Both patients underwent a chart review, comprehensive history, physical examination, flexible nasolaryngoscopy, and radiographic imaging. A literature review of the MEDLINE database (1966–2006), using key words “dysphagia” and “anterior discectomy,” was performed.Results: We present two patients with persistent dysphagia after ACDF surgery caused by CSF leak into the neck. Their clinical presentation, physical and radiographic examination findings, and hospital course will be discussed.Conclusions: CSF collection presenting as dysphagia and neck mass after ACDF must be included in the differential diagnosis because incision and drainage is contraindicated, and fine needle aspiration (FNA) must be performed under sterile conditions. Treatment including lumbar drain or re‐exploration is appropriate.
Coronoidectomy for the Treatment of Trismus in Head and Neck Cancer Patients
Authors: Bhrany Amit D. , Izzard Mark , Wood Andrew J. , Futran Neal D. 
Published: February 2009

AbstractObjectives: Trismus is a common adverse effect of tumor extension or treatment for those with head and neck malignancy. Physical therapy is the mainstay of treatment, but many patients still fail to maintain adequate mouth opening. Coronoidectomy is a treatment option for those with trismus, and the purpose of this study was to evaluate the effectiveness of coronoidectomy in treating trismus refractory to physical therapy.Study Design: Prospective case series.Methods: Eighteen head and neck cancer patients with interincisal distances less than or equal to 20 mm underwent coronoidectomy after failing physical therapy for at least 3 months. All patients had undergone maximal radiation therapy, half after tumor resection.Results: Postcoronoidectomy, mean interincisal distances improved 22.1 mm and 21.8 mm at 6 and 12 months, respectively, with all patients maintaining an interincisal distance greater than or equal to 35 mm. Tumor location, tumor histology, or the addition of surgical resection had no impact on outcome.Conclusion: Coronoidectomy is effective at improving trismus refractory to physical therapy in head and neck cancer patients.
Value of the Promontory Stimulation Test in Predicting Speech Perception After Cochlear Implantation
Authors: Lee Jong Cheol , Yoo Myung Hoon , Ahn Joong Ho , Lee Kwang‐Sun 
Published: February 2009

AbstractBackground and Objectives: To determine the role of the promontory stimulation test (PST) in cochlear implantation (CI), we evaluated the correlations between PST parameters and the results of speech perception tests after CI.Subjects and Method: With use of a retrospective review of the medical records of 58 patients, the GAP50, GAP100, TDL50, and TDL100 parameters of the PST were compared with the results of speech perception tests at fixed time points after CI. Spearman's rank‐order correlation coefficient was used in statistical analyses.Results: GAP100 scores were correlated with all results of speech perception tests at all time points after CI (r = 0.309–0.509, P = .001–0.010), and TDL100 scores were correlated with the results of open set one‐ and two‐syllabic word tests at 1 month after CI (r = 0.288, P = .028); no other significant correlations were found. The GAP100 scores for postlingually deaf patients, especially for gap intervals up to 100 ms, were correlated with all results of speech perception tests after CI. A stepwise multiple regression analysis revealed that the GAP100 score is the only variable that was significantly correlated with the results of speech perception tests. The duration and onset age of deafness did not significantly affect the results.Conclusion: The PST may be a useful tool for predicting the prognosis of CI. The GAP100 score, especially for gap intervals up to 100 ms, might be useful in predicting the results of speech perception tests after CI as well as in determining the optimal site for CI in postlingually deaf patients without residual hearing.