bluuebunny/crossref_metadata_2025_split huggingface dataset:
Base‐of‐Tongue Cancer: Survival, Function, and Quality of Life After External‐Beam Irradiation and Brachytherapy
Authors: Robertson Matt L. , Gleich Lyon L. , Barrett William L. , Gluckman Jack L. 
Published: November 2003

AbstractObjective Base‐of‐tongue cancer has traditionally been treated by surgical resection followed by radiation therapy. Primary radiation therapy with brachytherapy has recently been proposed as an alternative. In a prior analysis, we found that patients with advanced tongue‐base cancer treated by total glossectomy and postoperative radiation therapy can be cured while potentially maintaining good quality of life. Therefore, we designed the current study to assess survival, function, and quality of life in our patients with tongue‐base cancer who were treated with primary radiation therapy and brachytherapy with neck dissection as indicated.Study Design Consecutive case series.Methods Twenty patients were treated between 1993 and 1997 using the approach just named. The T stages were T1 (3), T2 (10), T3 (6), and T4 (1). The N stages were N0 (3), N1 (3), N2 (11), and N3 (3). At the time of brachytherapy catheter placement, neck dissections were performed in all 14 patients with N2 or N3 disease. Surviving patients completed a functional status survey and quality of life questionnaire.Results The 3‐ and 5‐year Kaplan‐Meier corrected actuarial survival rates were 57% and 38%, respectively. Eight patients remained alive at the time of this writing and completed the functional status survey and quality of life assessment. Function and quality of life were well maintained in patients treated with external‐beam irradiation followed by brachytherapy and neck dissection. However, none of our patients with T3 disease had long‐term survival.Conclusion Although we do not endorse external‐beam irradiation and brachytherapy for advanced tongue‐base cancers, this treatment should be strongly considered for patients with T1 or T2 tumors in whom preservation of function and quality of life is a priority.
An Evolution in the Management of Sinonasal Inverting Papilloma
Authors: Han Joseph K. , Smith Timothy L. , Loehrl Todd , Toohill Robert J. , Smith Michelle M. 
Published: November 2003

AbstractObjective We reviewed the 15‐year experience of our institution (Medical College of Wisconsin, Milwaukee, WI) in managing sinonasal inverting papilloma, examining trends in diagnosis and treatment.Study Design Retrospective.Methods Thirty‐seven patients with inverting papilloma were treated from 1986 to 1999. Demographic data, clinical presentations, pathological findings, surgical approaches and procedures, and recurrence rates were collected retrospectively. Each lesion was categorized into one of four groups based on computed tomography scans and endoscopic findings. This categorization was developed to compare various surgical approaches for tumors in each group.Results Thirty‐one patients had complete information for inclusion in our study. Nineteen patients were treated endoscopically with an average follow‐up of 50 months. Eight patients were in group I, five were in group II, six were in group III, and no patients were in group IV. The recurrence rate for the endoscopic group was 10%. Twelve patients underwent lateral rhinotomy or sublabial degloving approach with an average follow‐up of 58 months. Five patients were in group I, three patients were in group II, 1 patient was in group III, and three patients were in group IV. The recurrence rate for the external group was 8%. Difference in recurrence rates (P = .85) was not observed between the endoscopic and external approach groups. Regardless of approach, patients who had primary resection had a recurrence of 0%, whereas those with secondary resection had a recurrence of 17% (P = .10).Conclusions Technological advancements have led to a trend of detecting sinonasal inverting papilloma before extension beyond the sinonasal region. Difference in recurrence rates was not observed between the endoscopic and the external approach groups. Recurrence rates are lower for primary resection versus secondary resection, regardless of surgical approach.
Sclerotherapy With Picibanil (OK‐432) for Congenital Lymphatic Malformation in the Head and Neck
Authors: Sung Myung‐Whun , Lee Dong‐Wook , Kim Dong‐Young , Lee Sang‐Jun , Hwang Chan Ho , Park Seok‐Woo , Kim Kwang Hyun 
Published: November 2003

AbstractHypothesis/Objectives Congenital lymphatic malformations of the head and neck (LMHN) present special challenges to the otolaryngologist—head and neck surgeon. Recently, a number of sclerotherapy trials have shown promising results. In this study, we present our experiences with picibanil (OK‐432) sclerotherapy for this lesion.Study Design Retrospectively review.Methods We retrospectively reviewed 21 patients who have undergone sclerotherapy with picibanil for LMHN.Results Satisfactory response with complete or nearly complete shrinkage of the lesions was observed in 15 cases after repeated sclerotherapy (average, two times). We did not observe any significant morbidity or complications in the patients treated with picibanil. Reduction in size of the mass was achieved in weeks to months. Some of the patients who had not had any other previous treatment showed remarkable reductions in size even after the first therapy. When we used picibanil sclerotherapy as a primary treatment for the LMHN, most of our patients showed satisfactory results regardless of the size or location of the lesions.Conclusion Given with our experience and the reports that failure of picibanil sclerotherapy does not hinder subsequent surgical salvage procedures, we recommend trying picibanil sclerotherapy as a primary treatment for the LMHN and performing surgical excision as a secondary modality if the response to the sclerotherapy is not satisfactory.
Management of Chronic Otitis Media With Effusion: The Role of Glutathione
Authors: Testa Benedetto , Testa Domenico , Mesolella Massimo , D'Errico Gioacchino , Tricarico Davide , Motta Gaetano 
Published: November 2003

AbstractBackground The inflammatory cells documented in chronic otitis media with effusion (OME) spontaneously release oxidants which can induce middle ear (ME) epithelial cell damage. Glutathione (GSH), a major extracellular antioxidant in humans, plays a central role in antioxidant defense.Purpose To evaluate the effects of GSH treatment on chronic otitis media with effusion (OME).Subjects and Intervention Sixty children with chronic OME were enrolled, 30 of whom were randomly assigned to the treatment group and 30 to the placebo group. Patients in the treatment group received 600 mg glutathione in 4 mL saline per day subdivided into five 2‐minute administrations given by nasal aerosol every 3 or 4 waking hours for 2 weeks. Patients in the control group received 4 mL saline per day following the same procedure as for GSH treatment.Results Three months after therapy improvement had occurred in 66.6% of patients in the GSH‐treated group and in 8% of the control subjects (P <.01).Conclusion On the basis of these results, GSH treatment could be considered for the nonsurgical management of chronic OME.
Feasibility and Outcome of Endoscopic Staple‐Assisted Esophagodiverticulostomy for Zenker's Diverticulum
Authors: Thaler Erica R. , Weber Randal S. , Goldberg Andrew N. , Weinstein Gregory S. 
Published: November 2003

AbstractObjectives/Hypothesis Endoscopic staple‐assisted esophagodiverticulostomy (ESED) is a newly described method of surgically correcting Zenker's diverticulum. Initial reports on the ease and success of the surgery have been quite enthusiastic, making it seem the procedure of choice. We initiated the procedure in an algorithm of treatment of Zenker's diverticulum, to further explore the feasibility and outcome of this new technique.Study Design This is a case series of 23 patients with Zenker's diverticulum who have undergone surgical repair. For each patient, an attempt at ESED was made. If unsuccessful, an open approach was then taken.Results Seven of 23 patients (30%) were unable to be treated with ESED because of inability to expose the diverticulum or unfavorable anatomy of the diverticulum itself. Of the remaining 16 patients, ESED was successful in resolving the symptoms of diverticulum in 14 (87%). Two patients (13%) were somewhat improved but had persistent dysphagia. No significant complications occurred. All patients resumed oral diet within the first 24 hours after surgery.Conclusion Esophagodiverticulostomy is an excellent method of surgically correcting Zenker's diverticulum in many patients, but anatomical considerations may prevent its use, making open approaches of continued importance in a surgeon's armamentarium.
Management of Nasopharyngeal Salivary Gland Malignancy
Authors: Schramm Victor L. , Imola Mario J. 
Published: November 2003

AbstractObjectiveThe objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy.Study DesignRetrospective case review at tertiary care skull base center.MethodsPertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan‐Meier and Cox proportional hazards methods.ResultsHistological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High‐grade tumors had a significantly poorer outcome (P= .035) with a relative risk of 4.6 compared with low‐grade disease. Local control was seen to be 77% at 5 years.ConclusionsPlanned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro‐omental free flap.
Hodgkin's and Non‐Hodgkin's Lymphoma of the Head and Neck
Authors: Urquhart Andrew , Berg Richard 
Published: November 2003

AbstractObjectives/Hypothesis Lymphomas are a frequent cause of malignant lymphadenopathy in the head and neck. This study was performed to evaluate the head and neck manifestations of lymphomas and to emphasize the different presentations of Hodgkin's disease (HD) and non‐Hodgkin's lymphoma (NHL).Study Design Retrospective review.Methods A retrospective review was made of all cases of lymphomas involving the head and neck at Marshfield Clinic (Marshfield, WI) between 1988 and 1996. Specifically, the clinical presentations, staging, and prognosis for HD and NHL with head and neck involvement were sought.Results Three hundred eleven patients were included in the study, 76 with HD and 235 with NHL. The median age at diagnosis for patients with HD was 27.7 years, and for patients with NHL, 67.2 years. This difference was highly significant (P <.001). No significant difference in gender was noted, with male patients occurring in 59% with HD and 49% with NHL (P = .135). Extranodal involvement including the oral cavity, oropharynx, nasopharynx, paranasal sinuses, and larynx occurred with HD in 3 patients (4%) and with NHL in 54 patients (23%P <.001). Cervical adenopathy consisted of a single node in 24% of patients with HD and 33% of those with NHL (no significant difference, P = .236). The difference in mediastinal nodal involvement was highly significant, occurring in 65% of patients with HD and 38% of patients with NHL (P <.001). Abdominal nodes occurred in 20% of cases of HD and 45% of cases of NHL ( P < .001). A significant difference in constitutional symptoms was noted with 41% of cases in HD and 27% of cases in NHL (P = .020). For the percentage of patients with stage IV disease, there was a highly significant difference by diagnosis with 10% in HD and 36% in NHL (P <.001). The median follow‐up time was 51 months, and 12% of patients with HD and 41% of patients with NHL died of their disease. Both the overall survival and survival from death attributable to disease were significantly better for HD (P < .001).Conclusions Hodgkin's disease presents at a younger age and is less common than NHL. Cervical lymphadenopathy is the most common head and neck presentation for both diseases. Associated mediastinal adenopathy was more common with HD, and abdominal adenopathy with NHL. Constitutional symptoms were more common with HD. More advanced disease with a decreased overall survival was seen with NHL.
Intraoperative Magnetic Resonance Imaging for Skull Base Surgery
Authors: Dort Joseph C. , Sutherland Garnette R. 
Published: November 2003

AbstractObjectives/Hypothesis Skull base surgery has evolved over the past several decades. Major improvements in the imaging of skull base pathology led to better target localization and better surgical planning. The objectives of this study were to assess the use of intraoperative magnetic resonance (MR) imaging in the management of a series of patients with skull base pathology. We hypothesized that high‐quality intraoperative MR imaging would have an impact on surgery in this patient group.Study Design Prospective, non‐randomized, cohort study.Methods Thirty‐one patients with skull base lesions underwent surgery in a 1.5‐Tesla intraoperative MR suite. The concepts of a moving magnet, high magnetic field strength, and radiofrequency coil design are presented.Results Eleven of 31 patients had the course of surgery significantly altered by the information acquired from the images obtained during surgery.Conclusions Intraoperative MR imaging is a valuable adjunct to skull base surgery. One third of patients had altered surgery as a result of this adjunct. Intraoperative MR imaging is of particular value in the treatment of pituitary adenomas and benign skull base tumors.
Nasal Nitric Oxide and the Nasal Cycle
Authors: Qian Wei , Sabo Reni , Ohm Mikael , Haight James S. J. , Fenton Ron S. 
Published: November 2003

AbstractObjectives To establish the relationship between nasal patency and the nitric oxide (NO) concentration in the nasal airways.Methods Unilateral nasal NO concentration (n = 11) and inhaled nasal NO concentration at oropharynx (n = 9) were measured in healthy adult volunteers. Subjects breathed normally through the nose with a known resistance (ranged from none to total occlusion) placed in one nostril. In a subgroup (n = 7), the unilateral nasal NO concentrations were determined with nasal cavity congestion induced by lateral decubitus.Results When the added nasal resistance was less than 6 cm H20 per liter per second, the peak NO concentrations in the nose remained below 80 parts per billion (ppb). Thereafter, the higher the resistance, the greater the NO concentration. It was up to 1109.7 ppb when the front nostril was totally occluded. There was no correlation between oropharyngeal NO concentrations and resistance in the front of the nose (r = 0.4). There was a significantly negative correlation between nasal cavity volumes and nasal NO concentrations (r = ‐0.8, P <.001).Conclusions Increases in nasal resistance to levels encountered in the nasal cycle and in recumbency augments the NO concentration within the obstructed side of the nose. Although that within the nose changes with patency, the NO concentration is constant down to the lower airways. The modulation role of the upper airways to the inhaled NO concentration remains unclear.
Cochlear Reimplantation: Surgical Techniques and Functional Results
Authors: Alexiades George , Roland J. Thomas , Fishman Andrew J. , Shapiro William , Waltzman Susan B. , Cohen Noel L. 
Published: November 2003

AbstractObjectives/Hypothesis The most common indication for cochlear reimplantation is device failure. Other, less frequent indications consist of “upgrades” (e.g., single to multichannel), infection, and flap breakdown. Although the percentage of failures has decreased over time, an occasional patient requires reimplantation because of device malfunction. The varying designs of internal receiver/stimulators and electrode arrays mandate an examination of the nature and effects of reimplantation for the individual designs. The purpose of the current study was to investigate the reimplantation of several implant designs and to determine whether differences in surgical technique, anatomical findings, and postoperative performance exist.Study Design Retrospective chart review.Methods The subjects were 33 of 618 severely to profoundly deaf adults and children who had implantation at the New York University Medical Center (New York, NY) between February 1984 and December 2000. The subjects had previously had implantation with either a single‐channel 3M/House (House Ear Institute, Los Angeles, CA) or 3M/Vienna (Technical University of Vienna, Vienna, Austria) device or with one of the multichannel Clarion (Advanced Bionics, Sylmar, CA), Ineraid (Smith & Nephew Richards, TN), or Nucleus (including the Contour) devices (Cochlear Corp., Englewood, CO) before reimplantation.Results Length of use before reimplantation ranged from 1 month to 13 years and included traumatic and atraumatic (electronic) failures, as well as device extrusion or infection. Results indicated that postoperative performance was either equal to or better than scores before failure. None of the devices explanted caused damage that precluded the implantation of the same or an upgraded device. These findings support the efficacy and safety of internal implant designs as related to the maintenance of a functional cochlea for the purpose of reimplantation.Conclusions Cochlear reimplantation can be performed safely and without decrement to performance. The number of implanted electrodes at reinsertion were either the same or greater in all cases.
Connection Between the Inner Ear and the Lymphatic System
Authors: Yimtae Kwanchanok , Song Haitao , Billings Peter , Harris Jeffrey P. , Keithley Elizabeth M. 
Published: November 2003

AbstractObjective The aim of this study was to identify the lymphatic drainage of the inner ear in guinea pigs.Study Design Prospective study.Methods The prospective study was performed in guinea pigs by injection of keyhole limpet hemocyanin (KLH) into either the right‐side scala tympani or the middle ear cavity. The left side was not injected and served as a control. Fifteen minutes after injection, the animals were killed by intracardiac perfusion with paraformaldehyde and tissue specimens (right and left temporal bones, cervical lymph nodes, and the spleen) were collected. The presence of KLH in each specimen was determined by immunohistochemical assay of frozen sections using polyclonal mouse anti‐KLH antibodies.Results After injection into the middle ear, labeled cells were identified in the parotid, superficial ventral, mandibular, and deep cranial cervical lymph nodes. However, after inner ear injections KLH was present in only the parotid and superficial ventral cervical nodes. The spleen contained KLH‐positive cells following injection into either the middle or inner ear, but not all animals contained labeled spleen cells.Conclusions The inner ear has a connection to the lymphatic drainage system. Because fewer lymph nodes contained labeled cells after inner ear injection than after middle ear injection, it is concluded that the inner ear does not simply drain to the middle ear and subsequently to the lymph nodes but seems likely to have its own connections.
Timing of Endoscopic Sinus Surgery in Children: Is There an Impact on Outcome?
Authors: Ramadan Hassan H. 
Published: November 2003

AbstractObjectives/Hypothesis Endoscopic sinus surgery in children continues to be a controversial issue. Major factors in determining when to operate are the duration of the disease and duration of medical treatment.Study Design Prospective study of children referred to a tertiary center.Patients and Methods Eighty‐three patients underwent endoscopic sinus surgery for refractory chronic sinusitis. All patients were followed prospectively to evaluate their response to surgery for a mean follow‐up period of at least 1 year. A χ2 analysis and logistic regression analysis were performed to determine statistical difference between duration of symptoms and outcome.Results The overall success rate of endoscopic sinus surgery was 80%. Children who had surgery between 6 and 12 months of symptoms despite continued medical therapy had an 84% success rate, those who had surgery between 12 and 18 months had a 74% success rate, and those with more than 18 months of treatment for symptoms had an 81% success rate (P >.05).Conclusions Duration of the symptoms of chronic sinusitis in children of more than 6 months was not a predictor of success of endoscopic sinus surgery in these children. Although there seemed to be a trend toward having a more successful procedure in children who had surgery between 6 and 12 months of medical treatment versus those who had surgery after more than 12 months of medical treatment, this did not reach statistical significance. A prospective study with more patients may shed more light on this subject.
The Temporalis Muscle Flap for Reconstruction After Head and Neck Oncologic Surgery
Authors: Hanasono Matthew M. , Utley David S. , Goode Richard L. 
Published: November 2003

AbstractObjective To explain the applications, technique, and potential complications of the temporalis muscle flap used for immediate or delayed reconstruction of head and neck oncologic defects.Study Design Fresh cadaver dissection and 5‐year retrospective chart review.Methods A fresh cadaver dissection was performed to illustrate the surgical anatomy of the temporalis muscle flap with attention to specific techniques useful in avoiding donor site morbidity (facial nerve injury and temporal hollowing). A chart review was performed for 13 consecutive patients from the last 5 years who underwent temporalis muscle flap reconstruction after oncologic resection of the lateral and posterior pharyngeal wall, hard and soft palate, buccal space, retromolar trigone, and skull base.Results Patient follow‐up ranged from 2 to 45 months. Nine patients had radiation therapy. There were no cases of flap loss. Resection of the zygomatic arch followed by wire fixation facilitates flap rotation and minimizes trauma to the flap during placement into the oropharynx. Preservation of the temporal fat pad attachment to the scalp flap decreases temporal hollowing and protects the facial nerve. Replacing the zygoma and preserving the anterior third of the temporalis muscle in situ further diminishes donor‐site hollowing.Conclusions Compared with other regional flaps, such as the pectoralis myocutaneous flap, the temporalis muscle flap is associated with low donor‐site esthetic and functional morbidity and offers great flexibility in reconstruction. The temporalis muscle flap is a useful, reliable flap that belongs in the armamentarium of surgeons who are involved with reconstruction of head and neck tissue defects.