bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Supraglottic Squeeze in Adductor Spasmodic Dysphonia: A New Technique
Authors: Young Nwanmegha , Blitzer Andrew 
Published: February 2009

AbstractObjectives: Spasmodic dysphonia is a disabling disorder of the voice characterized primarily by involuntary disruptions of phonation. Botulinum toxin injections of the thyroarytenoid muscles have been the treatment of choice for adductor spasmodic dysphonia (ADSD). We describe a new technique to address the problem of compensatory or supraglottic hyperadduction in some of these patients.Study Design: Case series.Methods: Four patients with ADSD with sphincteric supraglottic contraction were seen for evaluation of botulinum toxin injection. On fiberoptic exam, it was noted that they had type I hyperadduction of the true vocal cords with a significant type III, and/or type IV hyperadduction of the supraglottis. After standard management of the thyroarytenoid muscles, the strained/strangled voice continued. On fiberoptic exam it was noted that the vocal folds were weakened, but the supraglottic hyperfunction persisted. The patients were treated by speech therapists to unload their supraglottis without success. All patients then had their oblique portion of the lateral cricoarytenoid muscles injected with botulinum toxin A through a thyrohyoid approach. This was done in the office under electromyographic control.Results: On follow‐up, all patients demonstrated improvement in the quality of their voices (as compared to thyroarytenoid injections alone).Conclusions: We describe a new technique for injection of the supraglottic portion of the lateral cricoarytenoid muscles. We demonstrate this can be done safely and successfully in an office setting with electromyography control.
Minimally Invasive Endoscope‐Assisted Parotidectomy: A New Approach
Authors: Chen Mu‐Kuan , Chang Cheng‐Chuan 
Published: February 2009

AbstractObjective: To evaluate the benefits of a new approach, endoscopic parotidectomy through a postauricular skin incision by using an ultrasonically activated scalpel.Study Design: An investigation of the outcome of endoscopic parotidectomy at a tertiary referral medical center.Methods: Fourteen operations for selected patients presenting with benign parotid tail disease were performed via minimally invasive endoscopic resection by a single surgeon (MK Chen).Results: All 14 operations were successfully performed endoscopically, and no conversions to conventional open resection were necessary. The procedures lasted 60 to 160 minutes. Two patients had transient grade II facial paresis. The scars were almost invisible due to their concealed location behind the ear.Conclusions: Minimally invasive endoscope‐assisted parotidectomy is a feasible method for treatment of benign lesions located in the parotid tail. The main advantage of this procedure is that the small operative scar is concealed in the postauricular area resulting in improved cosmetic results.
Lingual Thyroid Carcinoma With Nodal Metastasis
Authors: Kennedy Thomas L. , Riefkohl Waldemar L. 
Published: February 2009

AbstractObjectives: To discuss treatment options and surgical management of lingual thyroid carcinoma with cervical metastasis.Study Design: Lingual thyroid is relatively uncommon, and carcinoma of the lingual thyroid is extremely rare, with only 40 cases reported. We report a new case of a young female who presented with a cervical neck mass found to represent metastatic papillary thyroid carcinoma. Further workup revealed the patient's only thyroid tissue was located at the tongue base and was the site of the primary tumor. Management of lingual thyroid carcinoma and review of the literature is discussed.Methods: A case report and review of the literature of lingual thyroid carcinoma.Results: A young female presented with a left neck mass diagnosed as metastatic papillary thyroid carcinoma. Review of the computed tomography scan of the neck revealed a tongue base mass, absence of an othotopic thyroid gland and bilateral cervical lymphandenopathy. Bilateral selective neck dissections with removal of the tongue base lesion confirmed the diagnosis of lingual thyroid carcinoma with multiple left cervical nodal metastases.Conclusions: A case of lingual papillary thyroid carcinoma with cervical metastasis is reported. Treatment is best managed with surgical excision of all thyroid tissue followed by radioactive iodine ablation. Surgical approaches to the tongue base need to be considered based on the size of the lingual primary tumor and the need to address lymph node metastases gland. This is the first reported case in the literature of lingual papillary thyroid carcinoma presenting with cervical nodal metastasis in a female with absence of an orthotopic thyroid gland. This is also the first report to show that papillary and not follicular cell carcinoma is the predominating histopathology in lingual thyroid carcinoma.
Etiology of Late Free Flap Failures Occurring After Hospital Discharge
Authors: Wax Mark K. , Rosenthal Eben 
Published: February 2009

AbstractObjectives: Vascular compromise of free flaps most commonly occurs in the immediate postoperative period in association with failure of the microvascular anastomosis. Rarely do flaps fail in the late postoperative period. It is not well understood why free flaps can fail after 7 postoperative days. We undertook a case review series to assess possible causes of late free flap failure.Study Design: Retrospective review at two tertiary referral centers: Oregon Health Sciences University and University of Alabama at Birmingham.Methods: A review of 1,530 flaps performed in 1,592 patients between 1998 and 2006 were evaluated to identify late flap failure. Late flap failure was defined as failure occurring after postoperative day 7 or on follow‐up visits after hospital discharge. A prospective database with the following variables was examined: age, medical comorbidities, postreconstructive complications (fistula or infection), hematoma, seroma, previous surgery, radiation therapy, intraoperative findings at the time of debridement, nutrition, and, possibly, etiologies.Results: A total of 13 patients with late graft failure were identified in this study population of 1,530 (less than 1%) flaps; 6 radial forearm fasciocutaneous flaps, 2 rectus abdominis myocutaneous flaps, 4 fibular flaps, and 1 latissimus dorsi myocutaneous flap underwent late failure. The time to necrosis was a median of 21 (range, 7–90) days. Etiology was believed to possibly be pressure on the pedicle in the postoperative period in four patients (no sign of local wound issues at the pedicle), infection (abscess formation) in three patients, and regrowth of residual tumor in six patients. Loss occurring within 1 month was more common in radial forearm flaps and was presented in the context of a normal appearing wound at the anastomotic site, as opposed to loss occurring after 1 month, which happened more commonly in fibula flaps secondary to recurrence.Conclusion: Although late free flap failure is rare, local factors such as infection and possibly pressure on the pedicle can be contributing factors. Patients presenting with late flap failure should be evaluated for residual tumor growth.
Gold Laser Versus Curettage Adenoidectomy: Incidence of Complications and Otorrhea After Concurrent Pressure‐Equalization Tube Placement
Authors: Worley N Knight , Abdalkhani Arman , Hagmann Michael A. , Belafsky Peter C. , Amedee Ronald G. 
Published: February 2009

AbstractObjectives: To measure the incidence of postoperative complications and otorrhea in patients undergoing Gold laser or curettage adenoidectomy with pressure‐equalization (PE) tube placement.Study Design: A prospective study of 100 patients, ages 8 to 48 months, undergoing Gold laser (n = 50) or curettage adenoidectomy (n = 50) and PE tube placement in a pediatric outpatient setting.Methods: Pediatric patients with chronic otitis media with effusion and adenoid hypertrophy after failure of medical management were included in the study. Adenoid size and middle ear status were recorded at surgery. The total adenoidectomy procedure time was recorded. All patients were evaluated at 1 week, 1 month, and 4 months postoperatively. The incidence of nasal complications and otorrhea was recorded.Results: There was no statistical difference in age, race, sex, adenoid size, or middle ear status between groups. The laser group had a shorter procedure time (P = .001) and a lower incidence of otorrhea (P = .024). There was no difference in nasal complications between groups.Conclusions: The Gold laser adenoidectomy technique can be safely performed with PE tube placement and may offer advantages over the traditional curettage adenoidectomy technique.
Cochlear Implant Outcomes and Quality of Life in Adults with Prelingual Deafness
Authors: Klop W Martin C. , Briaire Jeroen J. , Stiggelbout Anne M. , Frijns Johan H. M. 
Published: February 2009

AbstractObjectives: To evaluate sound and speech perception and quality of life in prelingually deafened adults implanted with state of the art devices. To investigate which patient factors influence postoperative performance.Study Design: Prospective intervention study.Methods: Eight prelingually deafened subjects (with onset of severe hearing impairment before the age of 4 years and functioning in an oral‐aural setting) participated in this study. Subjects were implanted at a mean age of 36 (range, 21–55) years with a CII or 90 K cochlear implant (Advanced Bionics Corp.). All subjects completed standard speech perception tests as well as quality of life measures (Health Utility Index Mark‐II, Nijmegen Cochlear Implant Questionnaire, visual analogue scale for subject's hearing and health) at different points in time. Postoperative scores were compared with each other and with the baseline preoperative scores. The relationship between nine patient variables and the postoperative consonant‐vowel‐consonant (CVC) phoneme score was also investigated.Results: Significant improvement was measured for CVC word and phoneme scores and several quality of life measures. Postoperative speech perception correlated with a new and promising factor named quality of a patient's own speech production (QoSP).Conclusion: With state of the art implants, speech perception and quality of life do improve in prelingually deafened adults. More importantly, the prognostic value of QoSP should be investigated further.
Conservative Therapy of Esophageal Perforation With Neck Abscess in a Child
Authors: Miller Matthew C. , Schmidt Richard J. , Keller Marc S. , Murphy Stephen G. , Reilly James S. 
Published: February 2009

AbstractConservative management of complicated esophageal perforations has gained favor in recent years. However, there are limited data concerning the applicability of this approach in the pediatric population. We describe the care and outcome of a 14‐year‐old girl who sustained an esophageal perforation after accidental ingestion of a shard of glass. The patient was treated using ultrasound‐guided drainage catheter placement with simultaneous esophagoscopy and postoperative antibiotics. She was discharged within 1 week of presentation and enjoyed an uncomplicated recovery. We believe that selected cases of pediatric esophageal perforation may be safely and effectively treated using a conservative approach.
Branchial Sinus of the Piriform Fossa: Reappraisal of Third and Fourth Branchial Anomalies
Authors: James Adrian , Stewart Craig , Warrick Paul , Tzifa Constance , Forte Vito 
Published: February 2009

AbstractObjective: The objective of this study was to review clinical and embryologic aspects of third and fourth branchial anomalies.Study Design: Retrospective study.Methods: We reviewed the institutional and departmental databases at our institution to identify all cases of third and fourth branchial anomalies encountered from 1992 to 2006. All patient records were examined with respect to demographics, clinical history, and radiologic and pathologic reports.Results: We identified 17 cases of third and fourth branchial anomalies, the largest series of its kind reported to date. The lesions were predominantly left sided, all presenting with neck infection. Fistula formation was iatrogenic, secondary to incision and drainage. Preoperative direct laryngoscopy always revealed a pit within the apex of the piriform fossa. Surgical excision involved ipsilateral thyroidectomy as the lesion passed through the thyroid gland. No lesions following the classical course of a either a third or fourth branchial anomaly were identified.Conclusions: The clinical presentation of branchial sinuses arising from the piriform fossa is more in keeping with derivation from the thymopharyngeal duct (of the third pouch) than the hypothetical course of third and fourth branchial fistulae.
Chronic Ear Surgery in Patients With Syndromes and Multiple Congenital Malformations
Authors: O'Malley Matthew R. , Kaylie David M. , Van Himbergen Daniel J. , Bennett Marc L. , Jackson C Gary 
Published: February 2009

AbstractObjectives/Hypothesis: The propensity for the development of chronic ear disease in patients with certain congenital syndromes is well described. Little is known about the efficacy of surgery in the management of such patients. This paper will review an institutional experience with the surgical management of chronic ear disease in patients with congenital syndromes or multiple major malformations associated with high rates of ear disease.Study Design: Retrospective chart review.Methods: Charts were reviewed to identify patients diagnosed with either a congenital syndrome or multiple major malformations with a known association with the development of chronic ear disease who underwent ear surgery for chronic ear disease (excluding tympanostomy tube placement). Syndromes encountered, surgeries performed, operative outcomes, complications, and the efficacy of ossicular chain reconstruction is reported.Results: Forty‐three patients with 14 different syndromes or malformations were identified. These patients underwent 66 surgical procedures on 56 ears. Seventy‐nine percent of patients had undergone an ear procedure prior to presentation. Disease eradication was achieved in 64% of ears with a single procedure, and 89% of ears were controlled with two surgeries or less. Thirty‐two percent of surgeries involved a canal wall down procedure, a rate similar to that seen for all patients in our practice over the past decade. When used, ossicular chain reconstruction significantly reduced the air‐bone gap, resulting in hearing improvement. Results for patients with Down syndrome, Turner syndrome, and conotruncal cardiac abnormalities are discussed. Only minor complications were encountered.Conclusions: Syndromic patients and those with a major congenital malformation may present with significant chronic ear disease. Appropriate surgical management can yield successful eradication of disease with low complication rates.
Classification and Management of Tracheoesophageal and Tracheopharyngeal Fistulas After Laryngectomy
Authors: Gehrking Eckard , Raap Michael , Sommer Konrad D. 
Published: February 2009

AbstractObjectives: Tracheoesophageal fistulas (TEF) and tracheopharyngeal fistulas (TPF) are intentionally created for prosthetic or surgical voice restoration after laryngectomy or can develop after radiotherapy or surgical interventions. If the fistula does not shrink or close spontaneously or does not respond to conservative measures, surgical closure of the fistula is indicated.Study Design: Retrospective study of 177 patients.Methods: Data of 168 laryngectomy patients who needed a voice prosthesis (VP) replacement were obtained. Our experiences with nine severe TEF/TPF were analyzed, and a classification of these fistulas depending on the anatomic and clinical appearance was developed.Results: TEF/TPF can be divided into five types: high TEF with leakage through the VP (type Ia), high TEF with leakage around the VP (type Ib), enlarged high TEF (type II), deep TEF (type III), TPF (type IV), and TPF associated with pharynx stenosis (type V). Persisting TEF/TPF after unsuccessful attempts at surgical closure in four patients and the surgical solutions and procedures in these rare cases are discussed in detail.Conclusions: Leakage of TEF in prosthetic voice restoration usually responds well to conservative measures. If these measures fail, and in all cases of TPF, surgical intervention is necessary for transtracheostomal or transcervical closure with multilayer sutures of the esophagus and trachea. Persisting TEF/TPF after unsuccessful surgical attempts at revision surgery remain challenging. Our experiences show that tracheostoma transposition for dissociation of the cranial end of the trachea and the hypopharynx and esophagus is essential for effective closure. In rare cases of TPF combined with pharyngoesophageal stricture formation, a resection and immediate reconstruction of the stenotic pharyngoesophageal segment with a tube‐shaped fasciocutaneous radial forearm flap must be considered.
Injection Versus Medialization Laryngoplasty for the Treatment of Unilateral Vocal Fold Paralysis
Authors: Morgan Justin E. , Zraick Richard I. , Griffin Allison W. , Bowen Travis L. , Johnson Felicia L. 
Published: February 2009

AbstractObjective/Hypothesis: To determine whether injection laryngoplasty or medialization laryngoplasty is more effective in the treatment of unilateral vocal fold paralysis.Study Design: A retrospective study of patients with unilateral vocal fold paralysis who underwent either injection or medialization laryngoplasty at the University of Arkansas for Medical Sciences between July 29, 2003 and March 8, 2005.Methods: The data analyzed included patient characteristics and type of intervention, along with the pretreatment and posttreatment voice parameters of videostrobolaryngoscopy, perceptual analysis, and patients' subjective voice assessment.Results: Nineteen patients were evaluated. The average time from intervention to posttreatment evaluation was 3 (range, 1–9) months. Improvements were demonstrated in all three voice parameters in both the injection and the medialization groups. No significant differences were found in the degree of improvement between the two groups. Videostrobolaryngoscopy and the perceptual analysis, both rated by the authors, correlated well with each other, but they both correlated poorly with the patients' subjective voice analysis.Conclusions: Injection and medialization laryngoplasty were comparable in their improvement of subjective and objective voice outcomes. Both treatment modalities should be included in the otolaryngologist's armamentarium for managing unilateral vocal fold paralysis.
Injection of Embryonic Stem Cells Into Scarred Rabbit Vocal Folds Enhances Healing and Improves Viscoelasticity: Short‐Term Results
Authors: Cedervall Jessica , Ährlund‐Richter Lars , Svensson Bengt , Forsgren Kristina , Maurer Franz H. J. , Vidovska Daniela , Hertegård Stellan 
Published: February 2009

AbstractObjectives: Scarring caused by trauma, postcancer treatment, or inflammation in the vocal folds is associated with stiffness of the lamina propria and results in severe voice problems. Currently there is no effective treatment. Human embryonic stem cells (hESC) have been recognized as providing a potential resource for cell transplantations, but in the undifferentiated state, they are generally not considered for therapeutic use due to risk of inadvertent development. This study assesses the functional potential of hESC to prevent or diminish scarring and improve viscoelasticity following grafting into scarred rabbit vocal folds.Study Design: hESC were injected into 22 scarred vocal folds of New Zealand rabbits. After 1 month, the vocal folds were dissected and analyzed for persistence of hESC by fluorescence in situ hybridization using a human specific probe, and for differentiation by evaluation in hematoxylin‐eosin‐stained tissues. Parallel‐plate rheometry was used to evaluate the functional effects, i.e., viscoelastic properties, after treatment with hESC.Results: The results revealed significantly improved viscoelasticity in the hESC‐treated vs. non‐treated vocal folds. An average of 5.1% engraftment of human cells was found 1 month after hESC injection. In the hESC‐injected folds, development compatible with cartilage, muscle and epithelia in close proximity or inter‐mixed with the appropriate native rabbit tissue was detected in combination with less scarring and improved viscoelasticity.Conclusions: The histology and location of the surviving hESC‐derived cells strongly indicate that the functional improvement was caused by the injected cells, which were regenerating scarred tissue. The findings point toward a strong impact from the host microenvironment, resulting in a regional specific in vivo hESC differentiation and regeneration of three types of tissue in scarred vocal folds of adult rabbits.
Correlation of Intraoperative Parathyroid Hormone Levels With Parathyroid Gland Size
Authors: Moretz William H. , Watts Tammara L. , Virgin Frank W. , Chin Edward , Gourin Christine G. , Terris David J. 
Published: February 2009

AbstractObjectives: To study the relationship of intraoperative intact parathyroid hormone levels (iPTH) with parathyroid adenoma weight and volume in patients with primary hyperparathyroidism.Methods: Retrospective evaluation of consecutive patients undergoing minimally invasive parathyroidectomy with iPTH measurement. Data collected include preoperative serum calcium, ionized calcium, and serum parathyroid hormone (PTH) levels, iPTH levels at baseline, 5 minutes, and 10 minutes, and parathyroid adenoma weight. Adenoma volume was calculated using an equation for the volume of a spheroid object.Results: Thirty patients underwent minimally invasive parathyroidectomy with iPTH measurement for a single parathyroid adenoma between March 2004 and January 2006. There were 8 men and 22 women, with a mean age of 59.3 (range 26–92) years. A significant correlation between preoperative serum calcium and ionized calcium levels and parathyroid adenoma weight was identified (P = .0008 and P = .03, respectively). A significant correlation was also shown between baseline iPTH measurements and parathyroid adenoma volume (P = .03). There was no correlation between baseline iPTH levels and parathyroid adenoma weight. There was a significant correlation between parathyroid adenoma weight and percentage decrease of iPTH levels at 10 minutes compared to baseline (P = .04).Conclusion: Preoperative serum calcium and baseline iPTH levels may be useful in predicting parathyroid adenoma weight and volume, respectively. Adenoma weight may relate to the percentage decrease of iPTH levels at the 10‐minute postparathyroidectomy interval.