bluuebunny/crossref_metadata_2025_split huggingface dataset:
S107 – Management of Noma in Third World Mission Trips
Authors: Pierce Brendan , Sidman James D 
Published: August 2008

ObjectivesWe describe the experiences of the volunteer physicians treating Noma patients in two West African nations. Included is an extensive literature review describing preoperative methods, the pathogenesis of lesions, symptoms of the disease, and surgical repair techniques. Finally, we discuss consequences of the disease, specifically severe trismus secondary to temporomandibular joint ankylosis causing complications related to the delivery of anesthesia.MethodsDescription of 4 Noma patients treated in Liberia or Ghana at distinct stages. 1) Treatment of malnutrition and correction of electrolyte disturbances; 2) Treatment of underlying infections with antibiotics and debridement of lesions; 3) Surgical repair of necrotic areas and closure of the open wounds with appropriate anesthetic management; 4) Observation following surgical repair.ResultsWe discuss in detail 4 illustrative patients who were encountered at varying stages of treatment. We describe extensive reconstruction under local anesthesia and other treatment options available to teams with resources such as micro‐surgical techniques and the use of single‐stage reconstruction. Fiberoptic intubation techniques were unavailable, and thus intubation was not attempted on patients with ankylosis.ConclusionsNoma continues to grotesquely disfigure the poor malnourished children of Africa at an incidence of 4 per 1000, a 10‐fold greater incidence than cleft lip. Untreated, Noma has a mortality rate up to 80%, with proper treatment that can be lowered to 10%. We demonstrate that remarkable results can still be accomplished without intubation with only local anesthesia. We acknowledge these limitations but illustrate the benefit is overwhelming to these patients.
S108 – Close Margin Excision Outcomes in Head and Neck Skin Cancer
Authors: Barnes Martyn Lawrence , Ross Steven , Barnes Alison Jayne , McClymont Leo George 
Published: August 2008

Objectives1) Determine clinical and histological outcomes for patients following close margin excisions of head and neck skin cancer. 2) Guide decisions regarding further intervention and follow‐up.MethodsRetrospective review of Otolaryngology department skin excisions from 1991 to 2008. Pathology reports and casenotes were reviewed to identify lesions excised with less than 1mm margins and determine their further management and outcome. Kaplan‐Meier survival analysis was used to obtain the number needed to follow up for 2 years (NNFU) to detect a recurrence.ResultsOf 1223 skin cancers, 1207 histology reports were obtained‐24% were squamous cell carcinomas, 76% were basal cell carcinomas. 1060 had histological (lateral and deep) margin assessments. Of these, 72.4% were complete, 16.1% close (<1mm) and 11.5% incomplete. 112 closely excised lesions were identified and 107 casenotes were obtained. 2 underwent ‘immediate’ further excision, both demonstrating no residual tumour. Of the remaining 105 subjects, 8 developed clinically suspected recurrence, but 5 were disproved histologically. During follow‐up, 10 subjects had a new lesion diagnosed (9 malignant). 12 patients had new lesions diagnosed beyond follow‐up; 6 were malignant. 104 (97%) of the original closely excised lesions did not require further excision within the study's 4.1 years of observation (mean) following the initial procedure (range 1.5–12.1). The NNFU following close margin excisions was 34 (95% CI 16 to infinity).ConclusionsIn similar cases, close surgical margins will rarely indicate a need for further surgery or follow‐up. Good quality patient advice leaflets and self‐monitoring is advised.
S118 – Study of Pharyngeal Swallowing by High‐resolution Manometry
Authors: Takasaki Kenji , Hiroshi Umeki , Enatsu Kaori , Tanaka Fujinobu , Kumagami Hidetaka , Takahashi Haruo 
Published: August 2008

ObjectivesThis study aimed to demonstrate the feasibility of a novel high‐resolution manometry (HRM) system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus.Methods33 asymptomatic adult Japanese controls were studied. A solid‐state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 ml of water) pressures at velo, meso‐hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distance from the nostril to the above‐mentioned points of pressure were also measured.ResultsThe maximum value of dry and water swallowing pressures at the velopharynx, meso‐hypopharynx and UES, and the distances from the nasal vestibulum to each point were 132.3±61.3 (mmHg, mean ± standard deviation), and 146.5±77.5, 171.6±52.0, and 176.3±74.4, 163.5±70.6, and 239.3±80.1, and 9.8±1.2 (cm), and 9.8±1.3, 13.6±1.6, and 13.7±1.5, 17.0±1.9 and 17.1±1.6, respectively. The maximum value of the resting USE pressure, the length of the part in the cervical esophagus showing the resting USE pressure, and the distance from the nostril to the mid‐point of the length of the resting UES pressure were 66.6±28.1 mmHg, 3.8±0.7 cm, and 18.2±1.6 cm, respectively.ConclusionsThe present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to future clinical and investigative studies.
S121 – Balloons in Management of Epistaxis: In‐Vitro Study
Authors: Sivaji Nagaraj , Basavaraj Sreeshyla , Duvvi Shyam , Sanjeevan N 
Published: August 2008

ObjectivesAim of the study was to access the rate of deflation of 2 commonly used inflatable balloons in management of epistaxis at human body temperature.MethodsThis in‐vitro experimental study was conducted at the department of Otolaryngology in Warrington Hospital, UK. 20 randomly selected Foley's and Brighton balloon catheters each were inflated with 10 mls of air or water and kept at 37 degree centigrade in culture room of the Microbiology department. The rate of deflation at human body temperature in both balloons inflated with air and water at 24 hours & 48 hours in terms of pressure, volume, and diameter were accessed.ResultsFoley's catheters inflated with air deflated completely within the first 24 hours of the study. The rate of deflation in Foley's inflated with water was faster, when compared to same group of Brighton balloon (paired t‐test P<0.05). The pressure in these balloons was much higher than capillary pressure of lining mucosa of post‐nasal space.ConclusionsIf the pressure in post‐nasal balloons has to be maintained for more than 24 hours, it is better to use saline/water for inflation. Brighton balloons maintain both pressure and volume for a much longer period than Foley's at human body temperature.
S125 – Local Anesthetic Method: PE Tube Insertion & TM Perforation
Authors: Craig Catherine A , Richardson Brynn E , Moore Gary 
Published: August 2008

ObjectivesOur hypothesis was that the rates of persistent tympanic membrane (TM) perforation following pressure equalization (PE) tube removal were not higher with topical phenol application. 1) Determine perforation rates using topical phenol. 2) Compare perforation rates using infiltration of lidocaine with epinephrine vs. topical phenol application.MethodsThis was a retrospective review of all patients undergoing insertion of Silverstein tube and microwick placement for dexamethasone infusion. The procedure was completed in an outpatient setting using either infiltration of lidocaine with epinephrine (control) or topical phenol (experimental). Dexamethasone (10mg/ml) drops were administered 3 times a day for 6 weeks, at which time the tube and wick were removed. All subjects were followed for 6 months for evidence of perforation or surgical repair. Fisher's exact test was used for statistical analysis.ResultsA total of 79 patients were identified. 27 underwent lidocaine infiltration and 52 had topical phenol application. At 3 months, the perforation rate for the lidocaine group vs. the phenol group was 11% and 21%, respectively (p=0.21). 5 total perforations were surgically repaired (2 from the lidocaine group and 3 from the phenol group, p=0.27). At 6 months, there was complete resolution of perforations in the lidocaine group and only 4% of the phenol group persisted (p=0.43).ConclusionsTopical phenol appears to be a safe method of local anesthesia for PE tube insertion without significant increased risk of persistent perforation. Phenol also offers a cost‐effective, less painful, and less time‐consuming option in an outpatient setting.
S128 – Diagnosis and Treatment of 703 Patients with Taste Disorder
Authors: Miuchi Shinya , Umemoto Masanori , Negoro Atsushi , Oka Hideki , Nin Tomomi , Sakagami Masafumi 
Published: August 2008

ObjectivesAs life spans increase, the number of patients with taste disorder consulting in our taste clinic has increased. This study prospectively examined patients’ history, causes of taste disorder, and treatment outcomes.MethodsSubjects consisted of 703 patients with taste disorder who consulted our taste clinic at the department of Otolaryngology, Hospital of Hyogo College of Medicine, between 1999 and 2007. There were 284 men and 419 women, and patient ages ranged from 12 years to 88 years with a mean age of 59.7 years. Electrogustometry (EGM) and filter paper disk method (FPD) were used to assess taste function. We also asked each patient to indicate the severity of symptoms using a visual analog scale (VAS). Patients were treated mainly with zinc sulfate (ZnSO4 300 mg/day, or polaprezinc 150 mg/day), and in some cases with iron supplement, herbal medicine, and minor tranquilizers.ResultsIdiopathic taste disorder was the most common cause (271 cases, 38.5%), followed by drug‐induced (131 cases, 18.6%), post‐common cold (83 cases, 11.8%), psychogenic (73 cases, 10.4%), iron‐deficiency (37 cases, 5.3%) and others. Deficiency of serum zinc (less than 70 ?g/dl) was found in 50–70% of cases. The recovery rate was 130/183 (71.0%) in idiopathic, 41/61 (67.2%) in post‐common cold, and 24/29 (82.8%) in iron deficiency. The recovery period in drug‐induced (39.7 weeks) was longer than that in other cases (20.4 weeks). Results of EGM and FPD were not always associated with the severity of symptoms.ConclusionsTreatment with zinc supplement may be useful for taste disorder.
S135 – Head and Neck Paragangliomas and von Hippel‐Lindau Disease
Authors: Boedeker Carsten Christof , Ridder Gerd Jurgen , Maier Wolfgang , Neumann Hartmut Ph 
Published: August 2008

ObjectivesTo review our experience with head and neck paragangliomas (HNPs) in patients with von Hippel‐Lindau disease (VHL). HNPs are rare tumors, 30% of which have been shown to be hereditary neoplasms. Since 2000,4 different paraganglioma syndromes (PGL 1–4) have been described. VHL is characterized by retinal angiomas, haemongioblastomas of the central nervous system, kidney tumors, pancreatic cysts, and pheochromocytomas. Only 4 cases of VHL patients with HNPs have been published in the international medical literature. We systematically reviewed our VHL registry for patients with HNPs.MethodsIn 1983 we founded a registry for VHL patients. Until 2008, 395 index cases could be registered. First‐degree relatives were offered genetic screening as well.ResultsThree VHL patients presented with HNPs. One boy (mutation VHL 505 T>C) developed a metastatic pheochromocytoma at age 7. 8 years after treatment, he presented with a right‐sided carotid body tumor. Another male patient was diagnosed with a tumor of the right carotid body at age 33 (VHL 404 T>A). Interestingly, there have been no other tumors so far. The third patient was diagnosed with a left carotid body tumor at age 33 (VHL 505 T>C). Currently, she has multiple haemangioblastomas of the spinal cord.ConclusionsThe 3 cases presented demonstrate the importance of awareness of HNPs as one of the manifestations in VHL. So far this rare association has found very little attention in international medical literature. We suggest that VHL patients should undergo a thorough otolaryngological examination of the head and neck.
S136 – Recurrent Genetic Changes in Sinonasal Adenocarcinoma
Authors: Llorente‐Pendas Jose‐Luis , Escuredo Jhudit Pérez , Scavo Vincent J , Jorge Garcia‐Martinez , Alvarez‐Marcos Cesar , Nunez Faustino , Llorente Jose L. 
Published: August 2008

ObjectivesIntestinal‐type adenocarcinomas of the nasal cavity (ITAC) are histopathologically similar to colorectal adenocarcinoma. Professional exposure to wood dust is a strong etiological factor, although the mechanism is not understood. Little is known about the genetic changes in sinonasal adenocarcinomas. Our goals were: 1) Identify genome‐wide recurrent DNA copy number changes, and 2) Evaluate their relation to clinico‐pathological characteristics.Methods44 ITAC, 36 of wich related to professional exposure to wood dust, were studied by microarray CGH analysis using a 30,000 oligonucleotide set. In addition, MLPA was applied to identify copy number changes of 60 different tumor‐related genes.ResultsThe most frequent chromosome gains were, in descending order: 5p15,20q13, 8q24, 20q11 and 8q21. Losses occurred most frequently at: 4q31‐qter, 18q12‐22, 8p12‐pter, 5q11‐qter, 10q22‐23 and 17p13. Recurrent high level amplifications were detected at 7p11, 8p11 and 8q24. MLPA confirmed the overall pattern of gains and losses found by array CGH. Frequent gains were found of genes in 8q (PTP4A3, RECQL4, MYC) and 20q (BCL2L1, PTPN1) and deletions of genes in 18q (BCL2, CDH2), 8p (CTSB, N33, MFHAS1) and 17p+q (CRK, TP53, TIMP2). Gains of MYC and PTPN1 were more frequent in the more aggressive solid and mucinous type ITACs. Loss of TIMP2 was associated with advanced tumor stage and worse survival.ConclusionsThis study confirmed a pattern of chromosomal aberrations unique to ITAC and not related to the pattern known in colorectal adenocarcinoma. The results suggest a role for TIMP2, MYC and PTPN1 in ITAC tumor progression.
S138 – Treatment Controversy Incidental Micro‐Medullary Carcinoma
Authors: Swartz Jamie M. , Nowlin Thomas Peyton 
Published: August 2008

Objectives1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature.MethodsThis case is a 33‐year‐old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery.ResultsThe thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease‐free.ConclusionsMedullary thyroid carcinoma is a well‐described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.
S140 – The Fibula Flap for Through and Through Oral Cavity Defects
Authors: Jones Kristin , Gal Thomas J , Valentino Joseph 
Published: August 2008

Objectives1) Understand the complexity of through and through osteocutaneous defects of the oral cavity and face. 2) Appreciate that extensive bone requirements preclude the use of other single flap reconstructive options such as scapula or iliac crest. 3) Understand the use of the fibula osteocutaneous flap in these circumstances.MethodsA retrospective review was performed of patients undergoing fibula osteocutaneous flap reconstruction of through and through oral cavity defects between August 2006 and December 2007 at a tertiary care referral center. Size and type of defects as well as success rates were examined.Results7 patients underwent reconstruction of composite through and through mandibular defects of the oral cavity. There were 4 patients with complications of prior reconstructions, 2 with primary oral cancer, and 1 gunshot wound to the face. All patients had successful restoration of mandibular continuity. Soft tissue defects were successfully closed using the perforator‐based skin paddle with a de‐epithelialized segment to create a double skin paddle. 1 skin paddle from an otherwise viable flap was found to be unusable and was replaced with a pectoralis major(PM) flap. A second flap succumbed to delayed venous congestion but had healed uneventfully prior to postop day 8, and was closed post‐debridement with a PM flap.ConclusionsWhile the usual foibles of the fibula osteocutaneous flap still apply, its versatility in the setting of through and through defects of the oral cavity is underestimated. In the setting of extensive bony defects, it is appropriate to reserve second flaps for salvage reconstruction.
S142 – Circulating Levels of CD105 and VEGF in Oral Cancer
Authors: Chien Chih‐Yen , Huang Chao‐Cheng 
Published: August 2008

ObjectivesTo evaluate the circulating levels of CD105 and VEGF in patients with oral cancer and analyze the correlation between these circulating levels and clinicopathological features.MethodsBetween 2006 January and 2007 December, 28 healthy volunteers and 68 patients with squamous cell carcinoma of oral cavity (OSCC) were enrolled in this study. The serum level of VEGF and plasma level of CD105 were determined by ELISA method, respectively, from the frozen stored blood before treatment. ANOVA analysis was used to evaluate the difference of circulating levels of CD105 and VEGF between normal control group and OSCC group. The difference between nodal status (positive versus negative), tumor stage (T1, T2 versus T3, T4) and TNM stage (stage I, II vs. stage III, IV) were also evaluated.ResultsThe circulating levels of CD105 and VEGF in normal control group were 1.457 ± 0.46 ng/ml and 44.89 ± 20.4 pg/ml, respectively. The circulating levels of CD105 and VEGF in OSCC group were 7.056 ± 3.44 ng/ml and 292.94 ± 117.3 pg/ml, respectively. Both circulating levels of CD105 and VEGF in patients with OSCC were significantly higher than those of normal control group (both p<0.001). In addition, the patients with positive nodal status (p<0.001), advanced tumor stage (T3, T4 versus T1, T2) (p<0.001), and advanced TNM stage (stage III, IV versus stage I, II) (p<0.001) had significantly higher circulating levels of CD105 and VEGF.ConclusionsBoth circulation levels of CD105 and VEGF are useful markers to evaluate the disease progression of OSCC.
S148 – Botulinum Toxin A for the Management of Gustatory Sweating
Authors: Sen Purushotam , Papesch Michael 
Published: August 2008

ObjectivesTo review systematically the evidence currently available on the use of botulinum toxin A in the management of gustatory sweating.MethodsWe conducted a systematic search of databases including PubMed (1950‐December 2007), EMBASE (1966–2007), MEDLINE (1950–2007) and Cochrane library (up to December 2007). The terms used in the search included treatment, Frey's syndrome, gustatory sweating, Botulinum toxin, Botox, Dysport. Data extraction and study evaluation were performed independently by 2 reviewers and results were pooled quantitatively. Data collected included demographic details of patients, aetiology of Frey's syndrome (parotid pathology), duration of symptoms, units of injection, number of injections, commercial types of Botulinum toxin A, rate of recurrence, complications, and length of follow‐up.ResultsThere are 2 prospective studies that compared doses of Botulinum toxin (one randomized and the other non‐randomized) in the management of gustatory sweating (Frey's syndrome). The other studies included prospective and retrospective case series and case reports. Pooled results from these studies on a total of 239 patients showed that the rate of recurrence or incomplete resolution of symptoms were dose‐dependent. Response to treatment did not vary with the size of the affected area or parotid pathology. The demographical details did not differ in the patients with recurrence compared to those patients who were symptom‐free. Complications were also not dose‐related.ConclusionsBotulinum toxin A is a highly effective, minimally invasive, and safe procedure for the treatment of gustatory sweating.
S152 – Injury Predictive Value of Nerve Monitoring in Thyroidectomy
Authors: Cernea Claudio R , Brandão Lenine , Hojaij Flávio , Brandao Neto Jose De Souza , DeCarlucci Dorival , Cavalheiro Beatriz , Sondermann Adriana 
Published: August 2008

Objectives1) To evaluate the efficacy of a nerve monitoring(NM) system in a series of patients submitted to thyroidectomy; 2) To critically analyze the negative‐predictive‐value(NPV) and positive‐predictive‐value(PPV) of the method.MethodsNIM® system efficacy was prospectively analyzed in 447 patients submitted to thyroidectomy between 2001 and 2008(366 female/81 male; 420 Caucasian/47 non‐Caucasian; 11‐ to 82‐years‐old, median: 43 year‐old). There were 421 total thyroidectomies and 21 partial thyroidectomies leading to 868 nerves at risk. The gold standard to evaluate inferior laryngeal nerve function was early postoperative videolaryngoscopy, which was repeated after 4 to 6 months in all patients with abnormal endoscopic findings.ResultsAt the early evaluation, 858 nerves (98.8%) presented normal videolaryngoscopic features postoperatively. 10 paretic/paralyzed nerves (1.2%) were detected (2 unexpected unilateral paresis, 1 unexpected bilateral paresis, 1 unexpected unilateral paralysis, 2 unexpected bilateral paralysis and 1 expected unilateral paralysis). At the late videolaryngoscopy, only 2 permanent nerve paralysis were noted (0.2%), with an ultimate result of 99.8% functioning nerves. NM showed absent or markedly reduced electrical activity at the end of the operations in 25/858 nerves (2.9%), including all 10 endoscopically compromised nerves, with 15 false‐negative nerves. There were no false‐positive nerves. Therefore, NPV was 40.0% and PPV was 100%.ConclusionsIn the present series, NM had a very high PPV, but a low NPV for the detection of recurrent nerve injury.
S157 – A Novel Approach to Managing Nasopharyngeal Stenosis
Authors: Vakharia Kalpesh T , Richmon Jeremy D , Deschler Daniel 
Published: August 2008

ObjectivesNasopharyngeal stenosis is a rare and challenging problem that is difficult to treat successfully. We present a novel solution in a patient with idiopathic inflammatory nasopharyngeal stenosis by using a tracheoesophageal puncture prosthesis.MethodsCase report and review of the literature.ResultsWe present the case of a 51‐year‐old man with an aggressive idiopathic inflammatory process of the nasal cavity resulting in complete nasopharyngeal stenosis. Despite numerous surgical interventions and obturator placement, stenosis recurred. Eventually, a tracheoesophageal voice prosthesis was placed through a controlled puncture in the nasopharyngeal stenosis which has successfully relieved his symptoms. Various treatments within the literature are discussed.ConclusionsThe use of a tracheoesophageal puncture voice prosthesis in treating nasopharyngeal stenosis is a novel solution to a difficult problem and may be considered in recalcitrant cases.