bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Multilevel (Tongue and Palate) Radiofrequency Tissue Ablation for Patients with Obstructive Sleep Apnea Syndrome
Authors: Steward David L. 
Published: November 2004

AbstractObjectives: The primary objective is to determine the effectiveness of multilevel (tongue base and palate) temperature controlled radiofrequency tissue ablation (TCRFTA) for patients with obstructive sleep apnea syndrome (OSAS). The secondary objective is to compare multilevel TCRFTA to nasal continuous positive airway pressure (CPAP).Study Design and Methods: The study is a controlled case series of one investigator's experience with multilevel TCRFTA for patients with OSAS. Twenty‐two subjects with mild to severe OSAS, without tonsil hypertrophy, completed multilevel TCRFTA (mean 4.8 tongue base and 1.8 palate treatment sessions) and had both pre‐ and posttreatment polysomnography. Primary outcomes included change from baseline in apnea/hypopnea index (AHI), daytime somnolence, and reaction time testing measured 2 to 3 months after TCRFTA. Secondary outcomes included change in other respiratory parameters, OSAS related quality of life, and upper airway size. Comparison of 18 patients treated with TCRFTA for mild to moderate OSAS (AHI > 5 and ≤ 40) is made with 11 matched patients treated with nasal CPAP for mild to moderate OSAS.Results: Multilevel TCRFTA significantly improved AHI (P = .001), apnea index (P = .02), as well as respiratory and total arousal indices (P = .0002 and P = .01). Significant improvement with moderate or large treatment effect sizes were noted for OSAS related quality of life (P = .01) and daytime somnolence (P = .0001), with a trend toward significant improvement in reaction time testing (P = .06), with mean posttreatment normalization of all three outcome measures. Fifty‐nine percent of subjects demonstrated at least a 50% reduction in AHI to less than 20. The targeted upper airway, measured in the supine position, demonstrated a trend toward significant improvement in mean cross sectional area (P = .05) and volume (P = .10). Side effects of TCRFTA were infrequent, mild, and self‐limited. No significant correlation between pretreatment parameters and outcome improvement was noted. Nasal CPAP resulted in significant improvement in AHI (P = .0004) to near normal levels, with an associated improvement in OSAS related quality of life (P = .02) and a trend toward significant improvement in daytime somnolence (P = .06). Reaction time testing demonstrated no significant improvement (P = .75). No significant differences were seen for change in AHI, OSAS related quality of life, daytime somnolence, or reaction time testing between multilevel TCRFTA and CPAP.Conclusion: Multilevel (tongue base and palate) TCRFTA is a low‐morbidity, office‐based procedure performed with local anesthesia and is an effective treatment option for patients with OSAS. On average, abnormalities in daytime somnolence, quality of life, and reaction time testing demonstrated improvement from baseline and were normalized after treatment. Polysomnographic respiratory parameters also demonstrated significant improvement with multilevel TCRFTA.
Auricular Cartilage Grafts And Nasal Surgery
Authors: Murrell George L. 
Published: November 2004

AbstractObjective: To illustrate the safety, effectiveness, and versatility of auricular cartilage grafts in nasal surgery.Study Design: Retrospective chart review of the author's nasal surgery experience for an 8‐year period.Methods: Five hundred eight rhinoplasties were performed over an 8‐year period. One hundred one of these cases used auricular cartilage grafts as donor material.Results: Donor cartilage was used in a wide range of grafting techniques: tip grafts, dorsal onlays, spreader grafts, septal replacements, alar battens, composite grafts, etc. The average follow up was 12 months. The complication rate was low. Five patients experienced complications involving the auricular cartilage graft or its donor site. No patients experienced graft resorption or infection. Donor site morbidity was limited. No auricular infections or hematomas were observed.Conclusion: Septal cartilage is usually the first choice as donor material in nasal surgery; however, when indicated, auricular cartilage grafts can serve as a safe, effective, and versatile alternative. This conclusion is supported by their successful use in a wide variety of surgical techniques, with long‐term follow‐up. The author feels strongly that autografts should be favored over alloplastic material. Alloplastic grafts continue to present a risk of infection over the entire life of their use. When a rhinoplasty is performed skillfully with a cartilage autograft, time becomes an ally of the surgeon rather than an enemy.
Surgical Management of Chronic Sinusitis in Children
Authors: Ramadan Hassan H. 
Published: November 2004

AbstractObjectives/Hypothesis: The objective was to compare three common surgical modalities in children for the treatment of chronic sinusitis that is refractory to medical management.Study Design: Prospective nonrandomized study in a pediatric otolaryngology tertiary service.Methods: Two hundred two children who satisfied criteria for surgery and were referred over a 10‐year period were studied. Children were divided into three surgical groups. Group 1 had both endoscopic sinus surgery and adenoidectomy, group 2 had endoscopic sinus surgery alone, and group 3 had adenoidectomy. After a follow‐up period of 12 months, improvement of symptoms was assessed.Results: One hundred eighty‐three children had adequate follow‐up. Eighty seven percent of children in group 1 had improved symptoms, compared with 75% in group 2 and 52% in group 3 (P < .0001). Multivariate analysis showed that surgical procedure was a predictor of success. Asthma, smoke exposure, and age were independent predictors of success.Conclusion: Children who fail medical therapy benefit from surgery. Following certain criteria, one can chose between adenoidectomy alone or endoscopic sinus surgery with adenoidectomy to optimize surgical treatment of these children.
Prognostic Factors in Well‐Differentiated Thyroid Carcinoma
Authors: Cushing Sharon L. , Palme Carsten E. , Audet Nathalie , Eski Spiro , Walfish Paul G. , Freeman Jeremy L. 
Published: November 2004

AbstractObjectives: To test the prognostic significance of standard clinicopathologic factors in patients with well‐differentiated thyroid carcinoma (WDTC).Study Design: A retrospective chart review of the thyroid cancer database at Mount Sinai Hospital (Toronto, Canada 1963–2000) was carried out.Methods: All patients consecutively treated for WDTC with a follow‐up period of at least 5 years were eligible for inclusion. Relevant patient, tumor, treatment, and outcome data were collected. The main outcome measures were recurrence rate, actuarial overall, and disease‐specific survival at 20 years.Results: Three hundred and thirty‐three patients (F 275, M 58) with a median age of 39.7 (range 9–82.9) years were eligible for inclusion in this study (median follow‐up 10.4 years, range 5–34.4 years, minimum 5 years). The recurrence rate was 15.6% (52 /333). The overall and disease‐specific survival at 10 years was 97.5% and 98.5%, respectively. Likewise, the overall and disease‐specific survival at 20 years was 88.4% and 93.3%, respectively. Clinicopathologic factors significant on multivariate regression for the development of disease recurrence included family history of WDTC, advanced stage, and total thyroidectomy (all P < .05). Similarly, advanced stage on presentation was associated with a worse disease‐specific survival on multivariate regression (all P < .05). There was a trend for age 60 or greater to predict disease‐specific survival (P = .09).Conclusions: WDTC is associated with a significant recurrence rate but good disease‐specific survival. The most important prognostic factors are family history of WDTC, extent of surgical treatment (i.e., total thyroidectomy), and advanced initial stage of disease, with a trend for age 60 years and older.
Cochlear Implant Fixation Using Polypropylene Mesh and Titanium Screws
Authors: Davis Bryan M. , Labadie Robert F. , McMenomey Sean O. , Haynes David S. 
Published: November 2004

AbstractHypothesis: Fixation of cochlear implants using prosthetic mesh is an improvement of the traditional fixation methods.Study Design: A retrospective chart review was performed examining all adult and pediatric patients between 1998 and 2003 who underwent cochlear implantation using polypropylene mesh and titanium screws to fix the cochlear implant internal receiver. Patient age at implantation, postoperative infections, device failures, device migrations or extrusions, cerebrospinal fluid (CSF) leaks, flap complications, epidural hematoma data, and follow‐up data were evaluated.Results: Two hundred and eighty‐five patients were identified who received cochlear implantation using the polypropylene mesh securing technique. There were five postoperative infections, two device failures, zero flap complications, zero device migrations or extrusions, zero cerebral spinal fluid leaks, and zero epidural hematomas. The two delayed device failures in this series were not related to fixation technique.Conclusions: We conclude that this technique is widely applicable, technically superior, and not associated with increased complications.
Pepsin and Carbonic Anhydrase Isoenzyme III as Diagnostic Markers for Laryngopharyngeal Reflux Disease
Authors: Johnston Nikki , Knight John , Dettmar Peter W. , Lively Mark O. , Koufman Jamie 
Published: November 2004

AbstractObjectives/Hypothesis: The objective was to investigate the potential use of pepsin and carbonic anhydrase isoenzyme III (CA‐III) as diagnostic markers for laryngopharyngeal reflux disease.Study Design: Prospective cell biological investigation was conducted of laryngeal biopsy specimens taken from 9 patients with laryngopharyngeal reflux disease and 12 normal control subjects using antibodies specific for human pepsin (produced in the authors' laboratory within the Department of Otolaryngology at Wake Forest University Health Sciences, Winston‐Salem, NC) and CA‐III.Methods: Laryngeal biopsy specimens were frozen in liquid nitrogen for Western blot analysis and fixed in formalin for pepsin immunohistochemical study. Specimens between two groups (patients with laryngopharyngeal reflux disease and control subjects) were compared for the presence of pepsin. Further analyses investigated the correlation between pepsin, CA‐III depletion, and pH testing data.Results: Analysis revealed that the level of pepsin was significantly different between the two groups (P < .001). Secondary analyses demonstrated that presence of pepsin correlated with CA‐III depletion in the laryngeal vocal fold and ventricle (P < .001) and with pH testing data in individuals with laryngopharyngeal reflux disease.Conclusion: Pepsin was detected in 8 of 9 patients with laryngopharyngeal reflux disease, but not in normal control subjects (0 of 12). The presence of pepsin was associated with CA‐III depletion in the laryngeal vocal fold and ventricle. Given the correlation between laryngopharyngeal reflux disease and CA‐III depletion, it is highly plausible that CA‐III depletion, as a result of pepsin exposure during laryngopharyngeal reflux, predisposes laryngeal mucosa to reflux‐related inflammatory damage.
Auditory Brainstem Implantation in Patients with Neurofibromatosis Type 2
Authors: Kanowitz Seth J. , Shapiro William H. , Golfinos John G. , Cohen Noel L. , Roland J Thomas 
Published: November 2004

AbstractObjectives: Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) and schwannomas involving the internal auditory canal (IAC) or cerebellopontine angle (CPA), regardless of hearing loss (HL). The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. This study aims to review the surgical and audiologic outcomes in 18 patients implanted by our Skull Base Surgery Team from 1994 through 2003.Study Design: A retrospective chart review of 18 patients with ABIs.Methods: We evaluated demographic data including age at implantation, number of tumor resections before implantation, tumor size, surgical approach, and postoperative surgical complications. The ABI auditory results at 1 year were then evaluated for number of functioning electrodes and channels, hours per day of use, nonauditory side effect profile and hearing results. Audiologic data including Monosyllable, Spondee, Trochee test (MTS) Word and Stress scores, Northwestern University Children's Perception of Speech (NU‐CHIPS), and auditory sensitivity are reported.Results: No surgical complications caused by ABI implantation were revealed. A probe for lateral recess and cochlear nucleus localization was helpful in several patients. A range of auditory performance is reported, and two patients had no auditory perceptions. Electrode paddle migration occurred in two patients. Patient education and encouragement is very important to obtain maximum benefit.Conclusions: ABIs are safe, do not increase surgical morbidity, and allow most patients to experience improved communication as well as access to environmental sounds. Nonauditory side effects can be minimized by selecting proper stimulation patterns. The ABI continues to be an emerging field for hearing rehabilitation in patients who are deafened by NF2.
Preoperative Ultrasound Is Worthwhile for Reoperative Parathyroid Surgery
Authors: Ghaheri Bobak A. , Koslin D Bradley , Wood Aaron H. , Cohen James I. 
Published: November 2004

AbstractObjectives/Hypothesis: High‐resolution ultrasound and sestamibi scanning are regarded as the first‐line methods for preoperative localization of parathyroid adenomas. The utility of ultrasound in reoperative cases has been questioned because of concern that scarring will obscure normal tissue planes and vascularity that are critical to identification of an adenoma using this imaging modality. The purposes of the study were to evaluate the ability of high‐resolution ultrasound to accurately localize parathyroid adenomas in the reoperative exploration and to identify any factors that influence its accuracyStudy Design: Retrospective chart review at a tertiary care academic medical center.Methods: All patients seen in referral for parathyroid surgery between May 1994 and September 2002 underwent high‐resolution ultrasound as their initial diagnostic test. Patients who subsequently underwent exploration were included in the study. Intraoperative and ultrasound findings were compared.Results: One hundred forty‐two patients were included, 116 without and 26 with prior exploration. The sensitivity and positive predictive value of ultrasound were 86.9% and 89.1%, respectively. These data were not significantly different in patients without (88.2% and 90%) and in patients with (80% and 84.2%) prior thyroid or parathyroid surgery. The overall accuracy was 79% with a false‐negative rate of 11.3%. Thyroid nodularity was significantly more common (81.8%) in patients who had a false‐positive or false‐negative finding on ultrasound than in the total population (61.3%).Conclusion: High‐resolution ultrasound is an accurate method for localizing parathyroid adenomas even in patients who have previously undergone parathyroid exploration. However, the presence of thyroid nodules can interfere with its accuracy.
Familial Non‐Medullary Thyroid Cancer: A Matched‐Case Control Study
Authors: Maxwell Evelyn Linda , Hall Francis T. , Freeman Jeremy L. 
Published: November 2004

AbstractObjectives: Familial non‐medullary thyroid cancer (FNMTC) is a newly recognized disease entity and can be distinguished from the more common sporadic non‐medullary thyroid cancer. The purpose of this study was to determine some of the potential distinguishing features of FNMTC.Study Design: Retrospective association study and matched‐case control study.Methods: Five hundred forty‐three cases of well‐differentiated follicular origin thyroid cancers were identified and collected in a database. Among this population, 24 cases of FNMTC were identified. A case of FNMTC was defined as a patient with the following two criteria: a well‐differentiated follicular origin thyroid cancer and at least one first‐degree relative with a well‐differentiated epithelial origin thyroid cancer. The unmatched sporadic and FNMTC groups were compared using t test, Phi test, Cramer V test, and Pearson and Spearman correlation tests. Twenty‐four FNMTC cases were matched to 24 sporadic cases based on age, gender, stage of disease at presentation, and tumor size. Clinicopathologic features, management, and outcome were analyzed statistically using a matched‐proportional z test. Disease‐free survival and disease‐specific survival were analyzed using log‐rank test and the Kaplan‐Meier function. A P‐value less than .05 was considered statistically significant.Results: There was no significant difference in ionizing radiation exposure, disease multifocality, surgical management, or recurrence between the sporadic and FNMTC patients. Although FNMTC patients tend to have improved disease‐free survival and disease‐specific survival, the difference was not significant at the 5% level.Conclusion: Although FNMTC is characterized by strong family history, these patients do not tend to have worse prognosis.
Microtia Chondrocytes as a Donor Source for Tissue‐Engineered Cartilage
Authors: Kamil Syed H. , Vacanti Martin P. , Vacanti Charles A. , Eavey Roland D. 
Published: November 2004

AbstractObjectives/Hypothesis: Current surgical techniques for the correction of microtia are challenging. Research in the field of tissue engineering is providing insight into chondrocyte behavior for a possible future treatment of microtia. The authors wished to evaluate the biological potential of chondrocytes isolated from microtia cartilage as compared with normal auricular cartilage as a source of tissue‐engineered cartilage.Study Design: A comparative research design to study the potential of microtia cartilage chondrocytes with normal auricular chondrocytes as a source of tissue‐engineered cartilage.Methods: Cartilage specimens from 12 pediatric patients (six normal auricular specimens and six auricular specimens with microtia) were obtained. The chondrocytes were isolated and cultured in vitro; chondrocyte number was increased by passaging. Each type of cell was implanted in nude mice to generate tissue‐engineered cartilage. Eight weeks after implantation the specimens were dissected and removed. Results were compared between the normal auricular and microtia specimens in regard to cell number expansion in vitro and generation of tissue‐engineered cartilage in vivo.Results: An initial mean cell number of 150,000 cells in each group (normal and microtia) increased to an average cell number of 120 million cells/mL in the normal and 130 million cells in the microtia subgroups, respectively, at the end of the second passage. Histologically, both types of chondrocytes generated normal elastic cartilage.Conclusion: The study demonstrated the potential of cells isolated from microtia cartilage to generate tissue‐engineered cartilage. Microtia cartilage represents an important additional donor source for the possible generation of a human tissue‐engineered auricle.
Cochlear Implant Surgery at 12 Months of Age or Younger
Authors: James Adrian L. , Papsin Blake C. 
Published: November 2004

AbstractObjectives: Early presentation of congenitally deaf children for cochlear implantation is leading to surgery in younger candidates. The safety of cochlear implantation in children aged 12 months and younger is reviewed with radiologic assessment of mastoid bone anatomy and surgical outcome data.Study Design: Analysis of case records and temporal bone computed tomography (CT) scans with description of surgical technique in infants.Methods: Chart analysis of children aged 12 months or younger at cochlear implantation. Mastoid bone anatomy was compared with older children (mean age 2 years) using CT scans.Results: Twenty‐five infants received implants at 7 to 12 months of age because of meningitis (n = 4) or early detection of deafness (n = 21). Mastoid marrow content on CT scan was significantly greater in this age group (P < .001 Mann‐Whitney rank sum test), but pneumatization was always adequate for safe identification of surgical landmarks. The smaller size of the mastoid bone was not restrictive. An extended postauricular approach was used in the first 11 cases and a 2.5 cm hair‐line incision in the remainder. Ligature tie‐down of the device was completed in all cases. No complications occurred. All are full‐time implant users, except one with other neurologic sequelae of preoperative meningitis.Conclusions: In our experience, cochlear implant surgery is safe in children aged 7 to 12 months with appropriate anesthetic and postoperative support. The small incision technique is particularly suited to this age group. Ligature fixation of the device is considered advisable because of the increased risk of displacement from frequent falls when learning to walk.
Bilateral Glossopharyngeal Nerve Paralysis after Tonsillectomy: Case Report and Anatomic Study
Authors: Ford Lloyd C. , Cruz Raul M. 
Published: November 2004

AbstractObjective: To present a case report and to propose an anatomic explanation for a rare complication of tonsillectomy, severe dysphagia caused by bilateral paralysis of the glossopharyngeal nerve.Study Design: Retrospective case review and prospective cadaveric dissection.Methods: The medical record and radiologic data were reviewed from a patient who had severe dysphagia after tonsillectomy. In addition, 10 formalin‐preserved cadaver head and neck specimens were dissected to identify the anatomic course of 20 glossopharyngeal nerves. The distance between the nerve and tonsillar fossa was measured at two sites.Results: The patient was diagnosed with bilateral paralysis of the glossopharyngeal nerve and required use of gastrotomy tube for years postoperatively. The mean distance from the posterosuperior tonsillar fossa and the main trunk of the glossopharyngeal nerve was 10.7 mm, and the mean distance from the posteroinferior tonsillar fossa and the closest lingual branch of the glossopharyngeal nerve was 6.5 mm.Conclusions: Direct nerve injury seems the most plausible explanation for this rare complication of tonsillectomy. The proximity of the glossopharyngeal nerve to the tonsillar fossa emphasizes the importance of maintaining the correct surgical plane during surgery.
Cervical Sympathetic Chain Schwannoma
Authors: Wax Mark K. , Shiley Samuel G. , Robinson Jamie L. , Weissman Jane L. 
Published: November 2004

AbstractObjectives: Schwannomas are benign, slow‐growing tumors that arise from nerves. Those originating from the sympathetic cervical chain are rare. We describe our experience with the clinical presentation, surgical management, and outcomes of patients with this pathology.Study Design: Retrospective chart review of a case series in a tertiary referral center.Methods: Four cases of cervical sympathetic chain schwannomas were reviewed. Patients presented with either an asymptomatic neck mass discovered on routine physical examination (1 patient), an enlarging neck mass (2), or an acute onset of a Horner's syndrome (1). All patients underwent preoperative imaging (magnetic resonance imaging, computed tomography, or both).Results: The location and soft‐tissue characteristics of the mass, along with displacement of the carotid sheath vessels, were typical of a cervical sympathetic chain schwannoma. All patients underwent surgical excision of the mass. Postoperative Horner's syndrome was encountered in all patients. First bite syndrome was encountered in two patients.Conclusions: Cervical sympathetic chain schwannomas are rare tumors. Preoperative imaging characteristics facilitate the diagnosis. First bite syndrome can occur and may be debilitating postoperatively. Long‐term prognosis is excellent.