bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distal Facial Nerve Exposure: A Key to Partial Parotidectomy
Authors: Wang Robert C , Barber Annabel E , Vantine Paul , Ditmyer Marcia 
Published: August 2008

Objective1) Learn techniques and outcomes of distal facial nerve identification compared with antegrade exposure in partial parotidectomy. 2) Be able to incorporate other modifications of parotidectomy facilitated by distal facial n. isolation including preservation of the greater auricular nerve, superficial musculo‐aponeurotic system (SMAS), and parotid duct.Methods29 parotidectomies done using antegrade facial nerve trunk exposure (Group 1) and 13 consecutive partial parotidectomies done with distal facial nerve branch dissection (Group 2) for benign neoplasms and intraparotid lymph nodes were reviewed from 2001 to 2008. The greater auricular nerve and SMAS were preserved when possible. Branches draining to the main parotid duct from the lesion were incised rather than the main parotid duct whenever feasible. Outcomes examined include postoperative facial nerve function, cutaneous sensation, SMAS preservation, sialocele or salivary fistula. Logistic Regression was used to determine if select variables (age; antegrade vs. retrograde nerve exposure; and size of tumor) significantly affected outcomes. A series of univariate analysis of variance with Bonferroni post hoc tests were subsequently used to confirm findings of the logistic regression.ResultsNo difference in facial nerve function was found between the groups. Group 2 had better cutaneous sensation and SMAS preservation. More salivary fistulas and parotid swelling were associated with parotid duct transection in Group 1. There were no tumor recurrences.ConclusionsPartial parotidectomy utilizing distal facial nerve exposure can reduce the extent of surgical dissection, facilitate preservation of the parotid duct and greater auricular nerve, improve contour with primary SMAS closure, and allow greater flexibility in skin incisions.
FAS and FASL Polymorphisms in Oral / Oropharyngeal Cancer
Authors: Lehn Carlos Neutzling , Beserra Ivo Marquis , Carvalho Paulo , Silva Adriana , Carvalho Marcos , Santos Viviane 
Published: August 2008

ObjectiveExamine the hypothesis if genetic polymorphisms in FAS and FASL genes, alone or in combination, are associated with oral and oropharyngeal squamous‐cell carcinoma.MethodsProspective study based on 225 pacients with oral and oropharyngeal squamous‐cell carcinoma and 215 controls, analyzed with PCR‐RFLP.ResultsWe observed a statistically significantly increased risk of oral and oropharyngeal squamous‐cell carcinoma associated with the FASL ‐844 CT genotype (p=0,031). An increased risk of oral and oropharyngeal squamous‐cell carcinoma was also associated with the FASL −844 T allele (p=0,04). Gene‐gene interactions of FAS and FASL polymorphisms increased the risk of oral and oropharyngeal squamous‐cell carcinoma in a multiplicative manner (p=0,04).ConclusionsThe results suggest that the presence of the allele T of FASL and its combination with G allele potentially increase the risk of cancer development.
Female Gender: A Post‐Thyroidectomy Hypocalcemia Risk Factor
Authors: Sands Noah Benjamin , Cote Valerie , Tamilia Michael , Hier Michael P , Black Martin J , Payne Richard J 
Published: August 2008

Objective1) To evaluate the role of patient gender as a potential risk factor for post‐thyroidectomy hypocalcemia. 2)To elucidate, from previous studies, potential physiologic mechanisms underlying any identified gender disparity. 3)To help better predict post‐thyroidectomy hypocalcemia and ultimately limit its incidence with prophylactic/early calcium supplementation.MethodsA retrospective review of 270 consecutive total thyroidectomy patients (October 2004‐December 2006) was conducted, consisting of 219 females and 51 males. Postoperative hypocalcemia was defined as any one of the following: total serum calcium of less than or equal to 1.90 mmol/L up to 1 month following surgery or symptoms of hypocalcemia. The following were evaluated as potential confounding factors in the study: age, menopause, pre‐operative calcium and parathyroid hormone levels, magnesium and phosphate levels, pathology and number of parathyroid glands preserved in situ. Chisquared testing was used to evaluate for statistical significance.ResultsFemale patients experienced transient postoperative hypocalcemia in 24.7% (54/219) of cases, which was significantly greater than the 11.8% (6/51) incidence detected in males (p less than 0.05). This represents a female:male relative risk ratio of 2.1 (C.I. 1.0–4.6). There was no significant difference in rates of hypocalcemia between pre‐menopausal (age less than 50) and post‐menopausal women (22.7% vs. 26.6%).ConclusionsThese findings suggest that being female is a significant risk factor for transient post‐thyroidectomy hypocalcemia. Furthermore, females appear to experience this postoperative complication more than twice as frequently as males. Additional research is needed in order to ascertain the physiologic mechanisms underlying this identified gender difference.
Fine Needle Aspiration Analysis of B‐RAF in Thyroid Nodules
Authors: Bentz Brandon G , Miller Brian Thomas , Holden Joseph , Rowe Leslie R , Bentz Joel 
Published: August 2008

ObjectiveFine needle aspiration (FNA) represents the most useful initial diagnostic tool with which to analyze thyroid nodules for carcinoma. A mutation of the B‐type RAF kinase (BRAF) represents the most common genetic alteration in sporadic papillary thyroid cancer (PTC), and may signify a more aggressive biological behavior within PTCs. Our objective was to determine if BRAF analysis of FNA cytology may provide clinically useful information in the analysis of thyroid nodules.MethodsAn IRB‐approved retrospective chart review of clinically relevant data for classic PTCs (CPTC), follicular‐variant of PTC (FV‐PTC), or non‐malignant goiter was performed following a blinded pathologic re‐review. Both pathologic and cytology samples were analyzed by fluorescent melting curve analysis (FMCA) for the V600E mutation of BRAF, and mutational status was compared with clinical information.ResultsA 100% concordance was found for BRAF mutation determination between the cytologic and final pathologic malignant and benign tissue samples studied. BRAF mutation was found to be significantly higher in papillary carcinomas when compared to follicular‐variant of papillary thyroid carcinomas (55.6% vs. 14.3%, p=0.05), and correlated with cytologic interpretation (p=0.025) and histologic diagnosis (p=0.03).ConclusionsFMCA of thyroid nodule FNAs can accurately determine the mutational status of the BRAF gene. Since the presence of BRAF mutation can predict a more aggressive biological behavior, an analysis of BRAF mutational status of initial FNAs may add useful information to the list of risk stratification criteria for PTCs.
Incidence and Management of Siaolocele Post‐Parotidectomy
Authors: Witt Robert L 
Published: August 2008

Objective(1)To determine if a post‐parotidectomy sialocele occurs at a higher incidence with a partial superficial parotidectomy compared to a near complete parotidectomy; both with facial nerve dissection. (2)To determine if needle aspiration vs. observation yields more persistant sialoceles beyond 4 weeks.MethodsRetrospective, single surgeon, single institution study comparing 100 consecutive partial superficial parotidectomy procedures and 20 consecutive near‐total parotidectomy procedures for formation of post‐operative sialocele. Study period 2004–2007. The first 18 sialoceles were treated with one or more needle aspirations. The last 21 sialoceles were treated with observation and no needle aspiration. Antibiotics were not used beyond the first week of surgery in either group. Chi Square analysis was performed.ResultsThere were 39 sialoceles in the partial superficial parotidecotomy group (39/100–39%) and none in the near‐total parotidectomy group (0/20–0%). (p<0.05). All sialoceles resolved by the end of the fourth post‐operative week whether aspirated or not aspirated.ConclusionsSialoceles are common post‐partial superficial parotidectomy and did not occur after near‐total parotidectomy. Patients should be advised in the pre‐operative counseling period of this possible event after partial superficial parotidectomy. Sialoceles after parotidectomy can generally be treated by observation. Needle aspiration and antibiotics are optional.
Incidence of Micropapillary Carcinoma in Total Thyroidectomy
Authors: Pakdaman Michael Navid , Hier Michael P , Tamilia Michael , Black Martin J , Payne Richard J 
Published: August 2008

Objective(1) Compare prognostic factors in thyroid micropapillary carcinoma (MPC) <5 mm versus >=5 mm. (2) To compare MPC characteristics in patients with pre‐existing thyroid carcinoma to patients with no other thyroid carcinoma.MethodsPathology results were reviewed for consecutive total thyroidectomy patients between 2002 and 2007 (n=835). Hemithyroidectomies and completion thyroidectomies were excluded. Statistical significance of the difference in incidences was calculated using Fisher's exact test and chi‐squared analysis.ResultsMPC was found in 50.2% of total cases. Where the size was <5mm (64%), 9.3% extended beyond the thyroid capsule, 51.7% were multifocal, and 27.5% were bilateral. In MPCs >=5 mm (36%), the data showed 25.2%, 70.9%, 51%, respectively (p‐value always < 0.05). In the 314 patients with no other thyroid malignancy, MPC was found in 47.1% of cases. 14.9% had capsular extension; 50% were multifocal, of which 56.8% were bilateral. In the 521 patients with malignant disease, the data showed 52.1%, 15.1%, 63.2%, and 63.3%, respectively, with p‐values via Fisher's exact test. 22,. 112,. 003, and. 07.ConclusionsIn this study, MPC was found in 50.2% of patients. MPCs >=5 mm carried an increased risk for extracapsular spread, multifocality, and bilaterality. While patients with malignancies of the thyroid (aside from MPC) more commonly have multifocal MPCs, there was no significant difference in bilaterality, size, or extracapsular spread in MPCs in the presence of malignant vs. benign disease.
Increased Survival in HPV Positive Oropharyngeal SCCa
Authors: Nichols Anthony C. , Faquin William , Begum Shanaz , Westra William H , Clark John , Rocco James W 
Published: August 2008

ObjectiveTo determine if HPV16 infection is associated with improved survival in advanced oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiation.MethodsA retrospective chart review was performed in 44 patients with stage III and IV OPSCC who were treated with curative intent using chemoradiation. Tumor specimens were evaluated for the presence of HPV16 DNA with the in‐situ hybridization‐catalyzed signal amplification method applied to pre‐treatment archival tumor specimens. Tumors were scored as HPV positive if a signal specific to tumor nuclei was detected. Progression‐free survival was estimated by Kaplan‐Meier analysis. Outcome analyses were performed in the subsets of those with documented local, regional or distant relapse, and in disease‐free patients, with a minimum of 2 years for follow‐up.ResultsThe incidence of HPV16 positive tumors in this patient population was 59%. Overall progression‐free survival independent of HPV status was 62%, while survival for patients with HPV16 positive tumors was 78%. Survival of patients with HPV negative tumors was considerably less at 40%. Only HPV status was associated with response to chemoradiation (p=0.006). Patient age, performance status, and tumor stage were not predictive of response. Patients with a history of smoking and heavy alcohol use had an inverse association with HPV status and lower survival in response to chemoradiation (p=.00015).ConclusionsPatients with OPSCC tumors resulting from HPV16 infection are more likely to respond to platinum‐based concurrent chemoradiation, than HPV negative patients with traditional risk factors for oropharyngeal head and neck cancer.
Medial Wall Orbital Decompression in Graves’ Orbitopathy
Authors: Sellari‐Franceschini Stefano 
Published: August 2008

Objective1) To delineate useful criteria when choosing between different techniques for orbital decompression. 2) To discuss indications and limits of the medial wall only approach.MethodsA retrospective analysis was made of the medical charts of 256 patients operated on by a single surgeon from 1998 to 2006. 228 patients were operated on using a balanced technique, 17 by an inferomedial decompression, 11 by a medial decompression. Patients operated on by the medial wall removal had a mild to moderate proptosis, and a slight involvement of the extraocular muscles in the disease.ResultsMean proptosis reduction was 4 mm with the inferomedial approach, 5.5 mm with the balanced procedure, and 2.6 mm with the medial wall removal. Postoperative deterioration or new onset of diplopia was 29% after inferomedial orbital decompression, 17.1% after balanced decompression, and 9% after medial wall removal.ConclusionsWhen a proptosis reduction of less than 3 mm is needed, the medial wall approach is suggested. When a greater proptosis reduction is needed, a balanced decompression is advisable, since the inferomedial approach carries with it a higher risk of postoperative diplopia.
Natural History of Arteriovenous Malformations
Authors: Suen James Y , Buckmiller Lisa M , Fan Chun‐Yang , Shafirstein Gal , Glade Robert 
Published: August 2008

Objective1) To demonstrate the natural history of arteriovenous malformation (AVMs) when left untreated or inadequately managed. 2) To demonstrate the need for major treatment to patients, families, healthcare providers, and insurance companies.MethodsRecords from 10 of 50 representative patients treated at University of Arkansas for Medical Sciences (UAMS) for advanced AVMs were reviewed for age at presentation, gender, presenting symptoms, previous treatment, disease course, and post‐presentation management. Patients were asked if quality of life had improved after treatment at UAMS Facial photos from childhood were obtained and compared with photos taken at time of presentation.Results10 patients (7 male, 3 female, range 21–46 years) received treatment. All patients presented with bleeding, pain and/or facial destruction. 6 of 10 patients received previous embolization. No patients had undergone previous surgical resection. All were informed by a previous physician that the disease was incurable or treatment options had been exhausted. All patients experienced subsequent worsening of symptoMS All patients were treated at UAMS with preoperative embolization followed by surgical resection and required multiple surgeries to remove persistent AVM. All patients indicated quality of life improved after embolization/surgical resection. Comparison of photos revealed progression of disease in all cases marked by facial destruction and deformity.ConclusionsAVMs display a progressive and destructive nature when left untreated or inadequately managed. Natural history can be used to demonstrate to patients, families, and healthcare providers the seriousness of disease and convince insurance companies that radical treatment is typically necessary to obtain control or cure.
p53 Protein Overexpression in Oral Squamous Cell Carcinomas
Authors: Awan Sohail M. , Syed Adnan , Ghaffar Shehzad 
Published: August 2008

Objective1. To determine whether p53 protein expression is prognostic indicator of patient survival. 2. Learn its correlation with habits and histological variables of the tumor in Pakistani patients.MethodsA retrospective case series of 140 patients with primary oral squamous cell carcinoma at a tertiary care setting during the period of January 1991 to Dec 2004. p53 protein overexpression was investigated by means of immunohistochemistry. Results of p53 overexpression were evaluated in relation to different clinicopathological parameters and survival. Overall survival and disease‐free survival were measured. Event time distributions for these end points were estimated by use of the method of Kaplan and Meier and compared by use of the log‐rank statistic. Factors associated with p53 status were selected on cross‐tabulations and logistic regression. Cross‐tabulations were analyzed by use of the chi‐square test or Fisher's exact test, where appropriate. Results were summarized as odds ratio (OR) with corresponding 95% Confidence Interval.ResultsOverexpression of p53 protein was observed in 75 patients (54%). Patients with p53 negative tumors had improved overall survival (OS) when compared with patients with p53 positive tumors (p=0.036). The p53 overexpression did not correlate with disease‐free survival (DFS) (p=0.126), histological differentiation (p=0.611) and patients’ habits (p=0.894) In univariate analysis, AJCC stage, nodal status, tumor size and histological grade were significantly associated with shortened OS and DFS.ConclusionsOur study supports that patients with p53 overexpression had a significantly poor overall survival compared to p53 negative patients. However, p53 overexpression was not associated with patients disease‐free survival.
Patterns of Neck Metastasis in Recurrent/Persistent PTC
Authors: Farrag Tarik Y. , Michelli Shien , Tufano Ralph P 
Published: August 2008

ObjectiveTo determine the patterns of cervical LN disease recurrence in the lateral and central neck in patients with recurrent/persistent papillary thyroid cancer undergoing reoperative surgery. Recommendation of level dissection.MethodsWe reviewed the charts of 45 consecutive patients (February 2002‐November 2007) with PTC who underwent first‐time reoperative surgery by the senior author (R.P.T) for recurrent/persistent PTC.Results43 had PTC, and 2 had PTC with tall cell variant on final pathology. 38 underwent unilateral neck dissection; 7 had bilateral neck dissection, with a total of 52 lateral neck dissections. 48/52(92%) were + for metastasis. Level II was dissected in 46/52(88%) and was + in 30/46(65%) times. Level III was dissected in 46/52(88%) and was + in 30/ 46(65%) times. Level IV was dissected in 50/52(97%) and was + in 38/50(76%) times. Level V was dissected in 25/52(48%) and was + in 14/25(56%) times. Size of largest LN ranged from (0.5 to 3) cm. 18/46(39%) had extra‐nodal spread. 25/ 45(55%) had reoperative bed surgery and all had + metastasis; where 22/25(88%) had also + lateral LN, while 3/25(12%) had ‐ lateral LN.ConclusionsPatients undergoing lateral neck dissection for persistent/recurrent PTC are likely to harbor metastatic disease in levels 2–5 with a high incidence of extra‐nodal spread. Those that are undergoing reoperative thyroid bed surgery for nodal disease in the central neck are very likely to harbor concomitant gross nodal disease in the lateral neck. We encourage a level 2–5 lateral neck dissection or removal of all previously undissected levels when possible for this patient population.
Randomized Trial Tissue Adhesive/Staples in Thyroidectomy
Authors: Amin Mohamed , Glynn Fergal , Timon Conrad A 
Published: August 2008

ObjectiveClosure of thyroidectomy skin incision with tissue adhesive was compared to staples for the cosmetic appearance 3 months postoperatively, and proportion of wound infection as well as patient pain score.MethodsA prospective randomized control trial, study conducted over 8 months. Disease/condition studied – Skin closure in thyroidectomy surgery. 43 patients undergoing thyroid surgery. The setting in which subjects were studied is a tertiary referral centre. Intervention – tissue adhesive and staples. Outcome measurements – cosmetic appearance 3 months postoperatively, using the Manchester Scar Assessment Tool, pain levels and wound infection. Statistical methods were Fisher exact test/paired t‐test.Results43 patients ranging in age between 16 to 72 years were included, of whom 34 (79%) were female and 9 (21%) were male; none developed wound infection. Pain level ranged between 0 and 6 on the 1st and 10th postoperative day with no significant different between the 2 modalities. Assessment using Manchester tool showed no statistically significant difference (P greater than 0.05). There was a statistically significant difference in patient satisfaction regarding ability to shower on the same day with dermabond compared to staples (p less than 0.05). Pain on removal of staples was reported by 91% of patients. There was no difference in patient rating of wound cosmesis.ConclusionsTissue adhesive is an acceptable method of skin incision closure in thyroid surgery, with the added advantage of ability to shower on the same day and avoidance of pain associated with staples removal.
Role of 18F‐FDG PET in Management of Sinonasal Neoplasms
Authors: Lamarre Eric D. , Scharpf Joseph , Batra Pete S , Lorenz Robert R , Citardi Martin J , Adelstein David J , Saxton Jerrold 
Published: August 2008

ObjectivePET/CT in sinonasal malignancies is largely undefined. The objective of this study was to evaluate PET/CT in the initial staging and oncologic surveillance of paranasal sinus carcinomas.MethodsRetrospective review was performed of patients undergoing PET/CT for sinonasal neoplasms from 2001–2006 at tertiary care referral center. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of PET/CT were calculated. The gold standard was histology and clinical course when histology was not available. Any uptake in PET was considered a positive study.Results78 PET/CT scans were reviewed from 32 patients. Most common histopathologies included esthesioneuroblastoma (28.1%), sinonasal undifferentiated carcinoma (18.8%), sinonasal melanoma (18.8%), squamous cell carcinoma (18.8%), and adenosquamous carcinoma (9%). Overall sensitivity and specificity of PET/CT was 89% and 90% with PPV of 67% and NPV of 98%. PPV at the primary site, neck, and distant sites was 81%, 47% and 69%; NPV was 94%, 100%, and 98% respectively. For initial staging, 9.5% of patients were accurately upstaged at the neck or distant sites. During restaging, 29.6% of patients were accurately upstaged at the neck or distant sites.ConclusionsPET/CT serves as a useful adjunct to conventional imaging in initial staging and restaging of sinonasal malignancies. Negative studies are effective in predicting the absence of disease as seen in the consistently higher NPV. Positive studies need to be examined with caution, given the high rate of false positive studies. When viewed along with clinical exam and focused biopsies, they may effectively result in upstaging patients as noted in our series.
Spinal Accessory Nerve Neuropathies Followng Neck Dissection
Authors: Lehn Carlos Neutzling , Lima Luciana Pereira , Amar Ali 
Published: August 2008

ObjectiveTo evaluate through electromyography (EMG) the injury to the 11th cranial nerve following neck dissection.MethodsProspective study with 60 patients submitted to neck dissection as part of treatment of head and neck tumors. All the cases underwent physiotherapic evaluation of shoulder dysfunction. Nerve integrity was evaluated pre‐ and postoperatively through surface EMG registering the electric activity of descendent fibers of trapezius muscle during maximal isometric voluntary contraction. The patients were grouped according the type of neck dissection, presence of shoulder pain, impairment during abduction movement, and hypotrophy or atrophy of trapezius muscle.ResultsThe action potential had mean and standard deviation of 61,7±31,6mcV in preoperative evaluation and 15,6±12,4mcV in postoperative evaluation (p<0.001). According to the neck dissection extension, there were mean values of 18,8±14,2mcV after dissection includiog level IIb and 18,8±14,2 mcV after dissection including levels IIb and V (p<0.002).ConclusionsSurface EMG is a sensitive and painless for 11th cranial nerve disfunction evaluation. In all cases, the superior fibers of trapezius muscle were affected with presence of pain and impairment abduction movement of the arm. The results suggest the benefit of trapezius muscle EMG to confirm the diagnosis and early physiotherapic intervention in neuropathies of the 11th cranial nerve.