bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vocal Fold Mobility Following Anterior Cervical Disk Surgery: A Randomized Prospective Study
Authors: Artz Gregory James , Keane William M 
Published: August 2004

ProblemThe true incidence of vocal fold dysfunction following anterior cervical disk fusion (ACDF) is unknown, with few studies documenting laryngeal examination before and after surgery. Consequently, the effect of potential interventions such as limiting endotracheal tube cuff pressure and its effect on this incidence cannot be properly assessed.MethodsThis study was a randomized, prospective clinical trial performed at an academic institution. Over a 4‐year time period, patients undergoing primary ACDF surgery volunteered to participate. Preoperative and postoperative laryngeal endoscopy was performed. Recorded examinations were reviewed by independent laryngologists for determination of vocal fold mobility. Patients were randomized intraoperatively into 2 groups: a control group and an intervention group. Patients in the intervention group had endotracheal tube cuff pressures maintained below 20 mmHg throughout the surgical procedure.ResultsOne hundred patients were studied and randomized into 2 groups of 50 patients each. In the acute postoperative period, vocal cord paresis was seen in 8% and paralysis in 4% of studied patients. There was no significant difference in paresis or paralysis rates of the vocal fold on the side of surgery between the control and intervention groups.ConclusionVocal cord dysfunction is a common complication of ACDF surgery that can result in significant patient morbidity. Manipulating endotracheal tube cuff pressures did not decrease the risk of intraoperative recurrent laryngeal nerve injuries.SignificanceThis study demonstrates the true incidence of vocal fold dysfunction after ACDF surgery and that this incidence is unaltered by intraoperative interventions such as reducing endotracheal tube cuff pressures.SupportNone reported.
Brachytherapy as Adjunctive Therapy in Subglottic Stenosis
Authors: Pogodzinski Matthew S , Garces Yolanda , Kruse Jon , Thompson Dana M , Cheville John , Kasperbauer Jan L 
Published: August 2004

ProblemNew technique for treating subglottic stenosis.MethodsA blinded, randomized, controlled study was performed using a dog model of subglottic stenosis. Standardized methods were used to induce and dilate the stenoses. When they required dilation, dogs were randomized to a brachytherapy arm, which delivered 20 gray to the subglottis, and a control arm. Dogs were followed for 21 days after randomization. Data points included the number of subsequent airway dilations, final airway size, as well as histological and growth factor differences between the groups. All data were gathered in a blinded fashion. The Rank Sum test was used to evaluate clinical results.ResultsThere was a trend for increased airway size in the radiated group with an average size of 5.5 ET tube versus 4.6 for the control group. Also, one dog required redilation from the radiated group while 2 dogs from the control group required redilation. These trends did not reach statistical significance when using the Wilcoxon Rank Sum test.ConclusionThere were trends for improved airway size in the brachytherapy arm. Statisitcal significance was not reached owing to small numbers or restenosis overall.SignificanceThis is the first controlled study looking at use of radiation as a potential treatment for subglottic stenosis. Brachytherapy could be a helpful adjuvant treatment for subglottic stenosis in adults.SupportNucletron Corporation provided a partial grant and free equipment for this experiment.
Parental Satisfaction with Ambulatory Surgery
Authors: Song Christopher S , Habib Ramez , Rosenfeld Richard M 
Published: August 2004

ProblemPatient satisfaction is an important aspect of modern health care. Few studies have specifically addressed parental satisfaction with pediatric ambulatory surgery and no validated surveys exist.MethodsParents of children aged 6 months to 12 years completed the AmbSurg Survey, an 18‐item self‐administered measure of satisfaction using a 7‐point scale. Additional data collected included casemix variables and validated measures of child health‐related quality of life (PedsQL 4.0 survey), positive response bias (Marlowe‐Crowne Social Desirability Scale), and satisfaction with the decision to have surgery (Satisfaction with Decision Scale). Approximately 2 to 4 weeks after surgery, parents rated the degree of clinical change in their child and their satisfaction with this change.ResultsWe enrolled 152 parents (median age, 35) and children (median age, 4.8). Seven items were eliminated from the AmbSurg Survey because they were unclear, unimportant, or had poor test‐retest reliability. The final 11‐item survey had good test‐retest reliability (r =. 73), internal consistency (alpha =. 88), and construct validity (r =. 32 to. 59). Factor analysis revealed subscales relating to medical care (4 items), nursing care (2 items), and communication (5 items). Survey scores were significantly associated with surgeon used, parental anxiety, child general quality of life, and parental satisfaction with the decision to have surgery. Stepwise regression, however, identified satisfaction with decision as the only significant predictor (35% of variance). AmbSurg Survey scores did not correlate with clinical change or satisfaction with change reported by parents after a median 24 days.ConclusionParent satisfaction with their child's ambulatory experience can be measured efficiently with the AmbSurg survey, and correlates with satisfaction reported about the initial decision to undergo surgery.SignificanceThe AmbSurg Survey is a valid and reliable 11‐item measure of parental satisfaction with ambulatory surgery. The ease of use and clinically relevant subscales make the survey ideal for practice audit, quality assurance endeavors, and health services research.SupportNone reported.
Spectrometric Measurements in Laryngeal Cancer
Authors: Arens Christoph , Glanz Hiltrud Katharina 
Published: August 2004

ObjectivesDirect and indirect autofluorescence endoscopy of the larynx have proven to facilitate the detection and delineation of precancerous lesions, carcinoma in situ and cancer. The aim of the study is to evaluate spectrometric changes during autofluorescence examination in laryngeal dysplasia and cancer.MethodsIn a prospective study, 42 patients with suspected precancerous or cancerous lesions were investigated during microlaryngoscopy. Autofluorescence was induced by filtered blue light (375‐440 nm) of a xenon short are lamp and processed by a CCD camera system (D‐light‐AF‐system).Autofluorescecne images were gathered in a contact mode. For spectrometric measurements, an optical multi channel analyzer (AVS‐USB200) was applied. Results were compared to pathohistological findings.ResultsAutofluorescence spectra of normal laryngeal mucosa demonstrated peaks at 475, 510, 550, 600, and 630 nm. Highest intensity was observed in the green spectrum resulting in green autofluorescence images. In precancerous and cancerous alterations of the mucosa the autofluorescence signal changed from green fluorescence to a reddish‐violet color. Highest loss of intensity was observed at 510 nm.ConclusionsAccording to our results, the autofluores‐cence spectroscopy of the larynx seems to be a promising diagnostic tool for the early detection of laryngeal cancer and its precursor lesions. A difference between precancerous and cancerous laryngeal mucosa could not be detected. Scarring, marked hyperkeratosis and inflammation can limit the predictive value of the method.
Impact of Vocal Fold Medialization on Pharyngeal Transit Time and Incidence of Aspiration
Authors: Yip Helena T , Leonard Rebecca , Kendall Katherine A 
Published: August 2004

ObjectivesLittle objective data exists to support the belief that medialization of a paralyzed vocal fold (VF) decreases the risk of aspiration. On the other hand, an association between increased risk of aspiration pneumonia and a prolonged bolus pharyngeal transit time has been documented. This study assesses the impact of medialization on the incidence of aspiration and duration of pharyngeal transit.MethodsTwo groups of patients (1996‐2000) with unilateral VF paralysis were identified. One group (n = 12) had isolated VF paralysis due to recurrent laryngeal nerve injury. A second group (n = 7) had multiple cranial neuropathies secondary to skull base surgery or strokes. All patients underwent VF medialization with pre‐ and postmedialization videofluoroscopic swallow studies.ResultsPrior to medialization, aspiration occurred in 33% (4/12) of the patients with isolated VF paralysis, and in 100% of the multiple cranial neuropathy group (overall incidence 58%). Both groups demonstrated prolonged pharyngeal transit (overall mean = 1.3 seconds) compared to controls (mean = 0.84 seconds) (P < 0.0001). Postmedialization, aspiration in the isolated VF paralysis group decreased to 16% (2/12) and to 57% (4/7) in the multiple cranial neuropathy group (overall incidence 32%). Pharyngeal transit time did not improve after medialization (1.2 seconds) (P < 0.0001).ConclusionsAspiration occurs in patients with isolated unilateral VF paralysis or with multiple cranial neuropathies, although the incidence is higher in the second group. VF medialization reduces the incidence of aspiration by 50% but does not eliminate it. Prolonged pharyngeal transit following medialization suggests that the risk of aspiration pneumonia is not eliminated even when aspiration is not identified.
Validation of the Reflux Finding Score (RFS) for Chronic Laryngopharyngitis
Authors: Ivey Chandra M , Welge Jeffrey , Steward David L 
Published: August 2004

ObjectivesTo externally validate the reliability of the Reflux Finding Score (RFS), a recently published laryngeal grading system, in a cohort of subjects with chronic laryngopharyngitis thought secondary to acid reflux disease.MethodsTwo blinded otolaryngologists independently graded 66 videostrobe laryngeal examinations of 33 patients with chronic symptoms of laryngopharyngitis before and 2 months after treatment. The raters evaluated the examinations on 2 separate occasions at least 24 hours apart, blinded to the previous evaluation. Linear correlation was performed to assess inter‐ and intrarater reliability using the total reflux finding score.ResultsIntrarater reliability was very good for both raters for the total reflux finding score (r = 0.87, P < 0.0001, intercept P = 0.37; and r = 0.93, P < 0.0001, intercept P = 0.51). Interrater reliability was also good between raters (r = 0.71, P < 0.0001) but raised the possibility of bias between raters (intercept = 2.4, std error = 1.4, P = 0.08). Among the individual component scores for interrater reliability, true vocal fold edema demonstrated good correlation without bias, while diffuse laryngeal edema and posterior commisure hypertrophy demonstrated good correlation with significant interrater bias. Ventricular obstruction demonstrated moderate correlation with significant bias. Thick endolaryngeal mucous demonstrated fair correlation and subglottic edema poor correlation. Granuloma showed no correlation due to low prevalence.ConclusionsThe total reflux finding score demonstrates very good intrarater and good interrater correlation in this cohort of subjects with symptoms of chronic laryngopharyn‐gitis. Individual component scores demonstrate variable cor‐relation and significant bias between raters.
Endoscopic Transnasal Approach to Sphenoid and Clivus
Authors: Ruggeri Carlos Santiago , Lella Federico A Di , Parisini Cecilla 
Published: August 2004

ObjectivesThe purpose of this study is to evaluate the efficacy of the endoscopic transnasal approach to sphenoid sinus and clivus, for the treatment of isolated inflamatory pathology, tumor biopsy, and excision of pituitary tumors.MethodsA retrospective review of 18 patients that were treated during the last 6 years in the Italian Hospital of Buenos Aires with transnasal technique, using a 30 degree rigid endoscope.ResultsThree patients with sphenoid inflamatory pathology: cronic sinusitis, mucocele (2), 1 with CN VI paresis, were cured (normal postoperative CT after 3 years). Seven were benign tumors biopsies: fibrous dysplasia, meningioma (3), prolactin cell adenomas (3). In one patient a mucosal flap of nasopharynx was performed and a clivus biopsy was obtained, resulting a metastasis carcinoma of cervix. Seven were hipophysis approaches: adenomas (6) and craniopharyngioma. The total or partial resection of the middle or superior turbinate was not necessary. There were no complications and postoperative morbidity was minimal.ConclusionThe endoscopic transnasal approach to sphenoid is a fast and secure technique for the otorhinolaryngologists who are trained in endoscopic surgery. We consider this is the technique of choice for the treatment of localized sphenoid inflamatory disease and tumor biopsy. It provides significant advantages for safe excision of pituitary tumors.
Laryngotracheal Reconstruction with Prefabricated Composite Forearm Flaps
Authors: Maier Wolfgang , Schipper Jorg , Ridder Gerd J , Horch Raymund E. 
Published: August 2004

ObjectivesTo demonstrate the impact of modern prelamination and preconditioning techniques for manufacturing a stable flap for laryngotracheal reconstruction after subtotal laryngectomy.MethodsIn 2 patients who had undergone subtotal laryngectomy with partial resection of the upper trachea and postoperative irradiation for extended laryngeal cancer, we formed a bilaterally epithelisized forearm flap under application of vacuum‐assisted prelamination technique. Stabilization of the flap was achieved by insertion of rib cartilage during the preconditioning period. In a second surgical session, the flap was transferred to the throat and vascularized by microvascular anastomosis to cervical vessels.ResultsIn both patients, surgery was successful and resulted in closure of the tracheostoma, and in speech and swallowing rehabilitation. The neolarynx remained stable during the follow‐up period of 12 months.ConclusionSubtotal laryngectomy requiring a permanent laryngostoma or tracheostoma is associated with severe impairment of the patient and lifelong reduction of his quality of life. Reconstructive methods after subtotal anterior laryngotracheal resection published so far have not really been convincing. We present a successful method, combining the modern surgical and biomedical techniques of prelamination and preconditioning for extended laryngotracheal reconstruction, resulting in the restoration of a stable neolarynx and upper trachea. Our report indicates that previous or subsequent irradiation is no contraindication to this reconstruction procedure.
Impact of Rehabilitation Facility on Outcomes in Head and Neck Surgical Patients
Authors: Bhatia Nitin , Shah Rahul K , Villacorta Marlon , McQuillan Racheal , Annino Donald J , Rebeiz Elie E 
Published: August 2004

ObjectivesTo determine the significance of in‐hospital rehabilitation facility versus distant rehabilitation facilities in the outcomes and complications of postoperative head and neck surgical patients.MethodsRetrospective review of head and neck surgical patients over a 5‐year period at a tertiary care medical center.ResultsFifty patients met criteria for this study (35 males, 15 females). Forty‐two patients had a primary squamous cell carcinoma, and 8 patients had other primary malignancy of the head and neck. Thirty‐two patients were placed in an in‐hospital rehabilitation facility, and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles; range 2‐250 miles). Seventeen patients (34%) had complications including infection/drainage (7 patients), fistula (6 patients), pneumonia (2 patients), wound dehiscence (2 patients), bleeding from carotid stump, fluctuance, exudate, ulcer, eschar, delay in Blom‐Singer valve teaching and displacement. The difference between the rate of complications among the 2 groups was not statistically significant (37.5% in‐hospital rehabilitation, 27.8% distant rehabilitation; P = 0.496). The difference between the rate of hospital readmission was not statistically significant either (25% for in‐hospital rehabilitation patients and 16.7% for distant rehabilitation patients; P = 0.505). The average length of stay of patients without complications was 18.5 days (SD = 17) for in‐hospital rehabilitation and 12.9 days (SD = 5.8) for distant rehabilitation. This difference was not statistically significant (P = 0.346).ConclusionOne third of postoperative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re‐admission rate, and frequency of complications does not correlate with the distance of the rehabilitation facility from the treating institution.
Variations in Osteo‐Meatal Drainage and Its Clinical Implications
Authors: Haider Haula Faruk , Branco Gabriel , Oliveira E Carmo Diogo , Cacador Maria , Paco Joao 
Published: August 2004

ObjectivesThe authors suggest a systematization of osteo‐meatal drainage based on nonselected consecutive observations of sinus CT scans. The maxillary drainage is classically described as a mucociliar activity converged to the maxillary ostium (natural ostium), nevertheless there might be accessory ostiuns.MethodsThe authors observed 50 consecutive sinus CT scans (high spatial resolution 2.5 mm coronal plans). We also used virtual endoscopy and compared the findings with microscopic and endoscopic observation of anatomic human specimen in cadavers.ResultsThe maxillary drainage area is usually observed in 3 continuous plans: Segment 1, anterior or ethmoidomaxillary channel (consists of a long channel that communicates maxillary sinus with the anterior ethmoidal complex). Segment 2: Medium or labial (consists of the horizontal portion of uncinate process that acts like a vertical wall separating infundibular lumen from middle meatus). Segment 3: Posterior or direct meatal (corresponds to the most posterior and horizontal portion of uncinate process, communicating directly to the middle meatus). This is the most inconstant of the 3 segments. The results are equally comparable to those achieved in anatomic human specimen in cadavers.ConclusionBased on facts achieved by virtual endoscopy we conclude that maxillary drainage is done through a cleft or multiple, continuous ostiuns. This clinical systematization has implications in a clinical and surgical perspective, permits to explain why in cases of massive ethmoidal inflammatory disease, maxillary sinus remains intact since one of the drainage segments is not blocked. Otherwise, if those segments are blocked there is maxillary disease.
Laryngostroboscopy: Perceptual and Acoustic Evaluation of Male Smokers
Authors: Dedivitis Rogerio , Queija Debora S , Barros Ana P B. , Corazza Vera R , Silva Vanessa F , Rezende Wilma T M 
Published: August 2004

ObjectivesThe objective of this study was to evaluate the conventional laryngoscopy, laryngostroboscopy, perceptual and acoustic evaluation of 28 male chronic smokers.MethodsVolunteer sample of 28 male smokers whose ages averaged 53 years. Smoking habit varied from 96 to 720 months. Standard transoral rigid videolaryngoscopy with stroboscopy was performed. The examinations were recorded on videotape (video home system format). The recorded material was analyzed by a physician according to Hirano & Bless protocol (1993). A grading system described by Yonekawa (1983) was used in order to assess the severity of the Reinke edema (RE). The subjective judgment of the voice quality was carried out by 5 experienced speech‐language pathologists. The GRBAS system was used to describe the voice quality. For the acoustic assessment, the following factors were analyzed: fundamental frequency; jitter; shimmer; NNE; and HNR.ResultsThe conventional laryngoscopy was able to identify RE in 9 patients. In the laryngostroboscopy, RE was identified in 16 examinations with prevalence of type II. Besides it, 1 polyp, 1 leucoplakia; 1 bilateral angiodisgenesia and 1 vocal fold scar were described. The perceptual evaluation presented revealed prevalence of strainless and roughness. The acoustic analysis demonstrated higher rates of fundamental frequency, shimmer, and HNR. The jitter rates were lower than the normal.ConclusionA rate of 57% of chronicle male smokers presented RE with no significant vocal repercussion. The perceptual evaluation showed alterations in larger scale related to the vocal tract ressonance and all the acoustic rates alterated.
Sympathetic Chain Paragangliomas of the Parapharyngeal Space
Authors: Shiley Samuel Gardner , Kim Jason , Robinson Jaime , Wax Mark K 
Published: August 2004

ObjectivesThe parapharyngeal space is a complex anatomical feature of the head and neck that contains many important anatomic structures. Masses of the parapharyngeal space have an extensive differential diagnosis. Because of the vascular nature of some of the lesions that can occur in the parapharyngeal space, familiarity with a complete differential diagnosis, as well as radiologic investigation, is of paramount importance.MethodsWe present a series of patients who had sympathetic schwannomas and presented with neck masses. Setting: Tertiary academic referral center at Oregon Health and Sciences University.ResultsFrom 1998 to 2003, a series of 5 patients presented to the Otolaryngology Department with head and neck schwannomas of the sympathetic chain. The majority
Temporal Mandibular Joint Reconstruction Using Vascularized Bone Graft with Alloderm
Authors: Khariwala Samir , Chan James , Alam Daniel 
Published: August 2004

ObjectivesVascularized free bone grafts have been used extensively for reconstruction of the mandible. When surgical resection includes the temporal mandibular joint, definitive management remains controversial. We describe a novel technique that involves the use of a fibula free flap with alloderm to reconstruct the lateral hemimandible and temporal mandibular joint capsule.MethodsRetrospective case series at an academic center. Patients undergoing composite resection of the lateral hemimandible including the condyle, or with disruption of the temporal mandibular joint were evaluated in this study.ResultsThere were 6 patients (5 male, 1 female) with a mean age of 53.7 years. Indications for surgery were carcinoma (n = 4) and osteoradionecrosis (n = 2). Mean follow‐up was 12 months. All patients reported improved facial symmetry, decreased trismus, adequate jaw opening, and improved occlusion. The majority of patients demonstrated good postoperative speech and swallowing. All but one patient was able to chew and tolerate a normal diet. There were no flap failures, infections, or complications.ConclusionThe lateral hemimandible and temporal mandibular joint can be resected and successfully reconstructed using a fibula free flap with alloderm. Improved cosmesis, decreased trismus, adequate jaw opening, minimal jaw drift, and the ability to chew were achieved in the majority of patients treated in this manner.