Head and Neck

ORIGINAL ARTICLE

Endoscopic transoral parathyroidectomy: Initial experience

Luis‐Mauricio Hurtado‐López MD, PhD  Sandra‐Haydee Gutiérrez‐Román MD, MSc  Erich Basurto‐Kuba MD  Kuauhyama Luna‐Ortiz MD

First published: 03 June 2019 https://doi.org/10.1002/hed.25828

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Background

We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism.

Methods

We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency.

Results

Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 mL. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%).

Conclusions

TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.

ORIGINAL ARTICLE

Association between blood pressure and postoperative hematomas in the patients undergoing head and neck cancer reconstruction

Kuan‐Ying Wang MD  Kuo‐Chung Yang MD  Fang‐Yi Su MD  Yu‐Ching Chen MD  Yu‐Hsuan Hsieh MD Shiao‐Lin Huang MD  Wen‐Chung Liu MD, PhD

First published: 07 June 2019 https://doi.org/10.1002/hed.25831

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Background

Postoperative hematoma is one of the most common complications of free flap reconstruction and compromises the perfusion of pedicles and perforators. Therefore, we reviewed our patients to analyze the associated risk factors.

Method

This study involved a retrospective chart review from 2014 to 2016. We identified the patients undergoing free flap reconstructions for head and neck cancer. Patients with postoperative hematoma requiring surgical intervention were included.

Result

We enlisted 289 patients undergoing head and neck reconstructions. Eighteen patients (6.2%) had postoperative hematomas of which 12 hematomas occurred within the first 3 days and 9 in the first 24 hours. Elevated systolic blood pressure increased the risk of hematoma formation, but hematoma was not associated with higher failure rate. Tachycardia was observed in the patients with hematoma.

Conclusions

Transient elevated blood pressure increased the risk of hematoma. We suggest controlling systolic blood pressure below 150 mm Hg for prevention of hematoma.

BOOK REVIEW

Infections of the ear, nose, throat, and sinuses.  By Durand, Marlene L., Deschler, Daniel G.. Springer, New York City, NY. 2018. $199.00 US. 404 pp

Jonathan S. Choi MD  Benjamin D. Lovin MD

First published: 07 June 2019 https://doi.org/10.1002/hed.25835

ORIGINAL ARTICLE

Efficacy of posttreatment radioiodine scanning in patients with differentiated thyroid cancer

Shorook Na'ara MD, PhD  Kamel Mahameed MD  Moran Amit MD, PhD  Jacob T. Cohen MD  Michal Weiler‐Sagie MD, PhD  Igor Albitskiy MD  Ziv Gil MD, PhD  Salem Billan MD

First published: 04 June 2019 https://doi.org/10.1002/hed.25833

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Background

Differentiated thyroid cancers often require radioiodine treatment followed by posttreatment scan. We aimed in this study to assess the utility of the posttreatment radioiodine scan in this population.

Methods

An analysis of patients who received radioiodine treatment at Rambam Campus, during 2006‐2013. Scans showing remnant normal thyroid tissue were considered as normal. Positive uptake was defined as uptake in the lateral neck or distant sites.

Results

A total of 455 patients were analyzed, 68% had T1‐T2 and 28% had positive lymph nodes. Positive uptake in the lateral neck was recorded in 52 (11.4%) and in distant sites in 41 (9%) patients. Tracheal invasion, esophageal invasion, nerve invasion, and N1b classification were associated with a positive scan (P < .05). A positive radioactive iodine scan was not related to poor prognosis.

Conclusions

Posttreatment scans are positive in only 20% of patients. Locally invasive tumor and positive nodes are associated with positive scans.

CLINICAL REVIEW

Efficacy and toxicity of sorafenib in the treatment of advanced medullary thyroid carcinoma: A systematic review and meta‐analysis

Huy Gia Vuong MD, PhD  An Thi Nhat Ho MD  Thao T. K. Tran MD  Jaume Capdevila MD, PhD  Mustafa Benekli MD, PhD  Tadao Nakazawa MD, PhD  Ryohei Katoh MD, PhD  Tetsuo Kondo MD, PhD

First published: 04 June 2019 https://doi.org/10.1002/hed.25832

Section Editor: Nabil Saba

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Introduction

The aim of this study is to investigate and summarize the treatment efficacy and adverse effects (AEs) of sorafenib in the treatment of metastatic medullary thyroid carcinomas (MTCs).

Methods

We included studies reporting the treatment efficacy or drug toxicity of sorafenib as a single therapeutic agent in MTCs. Pooled incidence and its 95% confidence interval (CI) for complete response, partial response (PR), stable disease (SD), and sorafenib‐related AEs were calculated using random‐effect model.

Results

Eight trials with 101 metastatic MTCs were included for meta‐analyses. The overall PR and SD were 21% (95% CI = 9‐33) and 58% (95% CI = 41‐75), respectively. Hand‐foot syndrome, diarrhea, alopecia, mucositis, skin rash, fatigue, and hypertension were the most commonly observed AEs.

Conclusion

Our results show that sorafenib treatment has a modest effect and might be a candidate treatment in patients with metastatic MTCs who have failed other therapeutic regimens.

ORIGINAL ARTICLE

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

Tomasz Powrózek PhD  Anna Brzozowska PhD  Marcin Mazurek MSc  Radosław Mlak PhD  Grzegorz Sobieszek PhD  Teresa Małecka‐Massalska

First published: 04 June 2019 https://doi.org/10.1002/hed.25830

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Background

Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients' quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH‐induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with miRNA‐181a expression.

Results

Patients with simultaneous presence of low PA and high miRNA expression were at a significantly higher risk of decreasing the fat‐free mass index (FFMI) <14.9 kg/m2 (odds ratio [OR] = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high miRNA and low PA negatively affected patients' survival (OR = 5.12; P = .02).

Conclusion

Evaluation of PA in combination with miRNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH‐induced changes in body composition of patients with cancer.

ORIGINAL ARTICLE

Level of plasma catecholamine predicts surgical outcomes of carotid body tumors: Retrospective cohort study

Huanrui Hu PhD  Jichun Zhao PhD  Zhoupeng Wu PhD  Bin Huang PhD

First published: 03 June 2019 https://doi.org/10.1002/hed.25827

Funding information: West China Hospital post‐doctor fund, Grant/Award Number: 2018HXBH045

Read the full text

ePDFPDFTOOLS SHARE

Abstract

Backgrounds

Carotid body tumors (CBTs) are rare neoplasms and some of them produce catecholamine. Although operations for catecholamine‐producing CBTs are safe, the relationship between prognosis and endocrine function has not been analyzed before.

Methods

Patients diagnosed with CBTs in our department between 2009 and 2018 were analyzed. Plasma catecholamine was examined as a variable of surgical outcomes and prognosis by using statistical methods.

Results

Patients who suffered CBTs and underwent operations were divided into two groups according to their plasma catecholamine. Patients in the normal group had more or heavier surgical complications, such as neurological complications (P = .008) and blood loss (P = .03), than those in the high group. However, overall survival, local recurrence, and remote metastasis were not varied significantly in both groups.

Conclusions

A high level of plasma catecholamine was a predictor for the improved operative outcomes of CBTs. Hence, nonfunctional CBTs had further short‐term surgical complications.

EDITORIAL COMMENTARY

Transoral parathyroidectomy—Why make a simple operation complicated? A surgical fantasy

Ashok R. Shaha MD

First published: 03 June 2019 https://doi.org/10.1002/hed.25829

Synopsis for Table of Contents: Transoral vestibular approach to parathyroid surgery is a new innovative technique as a scarless surgical procedure. Several issues related to long‐term complications, recurrent hyperparathyroidism, and learning curve need to be addressed prior to routine application of this new technology.

ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182