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select article Mandibular rescue: Application of the ALT fascia free flap to arrest osteoradionecrosis of the mandible
Research articleAbstract only
Mandibular rescue: Application of the ALT fascia free flap to arrest osteoradionecrosis of the mandible
Timothy Haffey, Ryan Winters, Rhorie Kerr, Michael Fritz
In Press, Accepted Manuscript, Available online 8 July 2019
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Abstract
Abstract
Objectives
To evaluate the use of the anterolateral thigh fascia free flap for use in neovascularization of mandibular bone in moderate osteoradionecrosis (ORN). All patients had ORN secondary to prior radiation therapy that was not severe enough to warrant segmental resection and reconstruction.
Study design
Case series.
Setting
Tertiary medical center.
Methods
IRB approval was obtained, and a retrospective chart review performed of all mandibular rescue procedures performed from 2011 to 2014. Patients with a minimum of two years of follow-up were included in the study.
Results
All surgeries were performed by the senior surgeon (MF). Eight patients underwent the mandibular rescue procedure with resolution of pain and return to oral feeding in all patients, and no evidence of ORN progression on follow-up imaging. A total of 9 ALT free flaps were performed (one patient had 2 surgeries). Gender was distributed evenly (4 female/4 male). The average age was 66 (58-78), average length of hospitalization was 2.8 days (1–7), and average follow-up was 46.5 months (25–63).
Conclusions
The mandibular rescue procedure is a novel technique using the ALT fascia lata free flap to provide coverage and nutrient blood flow to mandible devascularized secondary to radiation therapy. The flap provides the advantages of low morbidity, ease of harvest, two-team approach to ablation and reconstruction, and quick recovery resulting in ‘short-stay’ free flap surgery. Although conclusions must be tempered in this small case series, our early clinical experience shows the ALT fascia lata flap holds promise in halting the destructive progression of ORN that is not yet advanced enough to require a segmental resection and reconstruction.
select article A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness
Research articleAbstract only
A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness
Jonathan Hanna, Ajay Malhotra, Philip R. Brauer, Alexander Luryi, Elias Michaelides
In Press, Accepted Manuscript, Available online 8 July 2019
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Abstract
Abstract
Purpose
To compare imaging utilization between patients presenting to the emergency department (ED) with vertigo and dizziness (VDS) who are diagnosed with stroke and benign paroxysmal positional vertigo (BPPV).
Methods
All patients presenting to the ED with VDS (January 2014–June 2018) were identified. Those with a discharge diagnosis of stroke and BPPV were analyzed.
Results
17,884 patients presented to with VDS. 452 were diagnosed with BPPV and 174 with acute stroke. 55.7% of stroke patients had at least one neurologic symptom beyond VDS, 63.8% had a positive neurologic exam, and 80.5% had either; 90.2% had at least one stroke risk factor (RF). 42.0% of BPPV patients received imaging, of which 24.7% had neurologic symptoms beyond VDS, 16.3% had neurologic exam findings, and 34.2% had either (P < 0.001, as compared to stroke). 43 patients (22.6%) lacked neurologic symptoms, exam findings, and stroke RFs; 40 had an adequate HINTS (head impulse, nystagmus, skew) exam. The most common imaging modality received by BPPV patients was plain CT Head (54.2%), followed by CT/CTA (43.7%), and MRI brain (26.3%). CT head was the initial imaging of choice in 44.7% and CT/CTA in 42.6%.
Conclusions
Imaging utilization in BPPV patients presenting with VDS is high. The profile of patients with BPPV that received imaging was substantially more benign than that of stroke patients (a quarter had no neurologic symptoms, exam findings, or stroke RFs). The HINTS exam was underutilized, and computed tomography was heavily utilized despite well-established limitations in diagnosing posterior circulation strokes. This study highlights the need for increased training in the HINTS exam, narrowing of the scope for computed tomography, and a higher threshold for imaging patients with isolated VDS.
select article Endoscopic approach in second stage ossicular chain reconstruction
Research articleAbstract only
Endoscopic approach in second stage ossicular chain reconstruction
Giannicola Iannella, Marco De Vincentiis, Antonio Greco, Claudio Vicini, ... Giuseppe Magliulo
In Press, Corrected Proof, Available online 3 July 2019
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Abstract
Abstract
Purpose
Today limited studies regarding surgical and hearing outcomes in patients undergoing the totally endoscopic ossicular chain reconstruction has been published. The aim of this study is to show the different materials and endoscopic technique used in our experience to perform a second stage endoscopic ossiculoplasty.
Materials and methods
Patients underwent to second stage endoscopic ossiculoplasty has been enrolled in the study. According to the ossicular defect the endoscopic surgical procedures of ossicular chain reconstruction used in our clinical practice were: ossicular chain reconstruction using PORP (13 cases); ossicular chain reconstruction using TORP (11 cases); incus interposition ossiculoplasty (6 cases); cartilage ossiculoplasty (10 cases). Intraoperative and postoperative complications were analyzed. Final hearing recovery at 6 months follow-up was used to evaluate audiological outcomes.
Results
None of the patients developed intraoperative complications. Postoperative TM complications emerged in 5% of cases: one patient (2.5%) presented TM perforation and prosthesis extrusion (TORP) after 3 months follow up.
A significative difference between preoperative and postoperative values of AC-PTA, ABG and WRS (p < 0.05 in each case) emerged.
Conclusions
Different materials and methods can be used for performing an endoscopic ossicular chain reconstruction in order to obtain optimal clinical-audiological outcomes. Endoscopic surgery can be considered a valid alternative technique to traditional microscopic surgery for ossiculoplasty surgery.
select article Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond
Research articleAbstract only
Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond
Kathryn M. Van Abel, Melanie H. Quick, Darlene E. Graner, Christine M. Lohse, ... Eric J. Moore
In Press, Accepted Manuscript, Available online 3 July 2019
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Abstract
Abstract
Objectives
To review swallowing, airway and speech outcomes following transoral robotic surgery (TORS) ± adjuvant therapy for human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV[+]OPSCC).
Methods
Patients underwent TORS ± standard adjuvant therapy from 5/1/2007–5/31/2015. Clinical data were recorded and descriptive analysis was performed.
Results
267 patients met criteria. All patients underwent surgery at Mayo, however, only 41/81 and 71/119 patients received RT and CRT at a Mayo Clinic site. A PEG was placed in 77 patients (3 prior to any treatment, 74 reactively during adjuvant therapy), with 3 PEG dependent and 3 partially PEG reliant at last follow-up. Tracheostomy was performed in 30 (11%) patients; 28 were decannulated.
Swallow evaluations were completed for 20/81 undergoing RT and 50/119 undergoing CRT at a median of 3.8 and 7.6 months post-treatment, respectively. An unrestricted oral diet was reported by 5% following RT and 12% following CRT on the Functional Oral Intake Scale. HN-PSS normalcy of diet scores indicated a diet beyond soft chewable foods for 27% following RT and 46% following CRT. No restriction of place, food, or companion was reported for the HN-PSS for public eating in 13% after RT and 33% after CRT. Aspiration of thin liquid was present in 17% and 28% following RT and CRT, respectively. HN-PSS understandability of speech was “always understandable” in 60% and 63%, following RT and CRT, respectively. Hoarseness was reported in 56% and 45% following RT and CRT respectively.
Conclusion
Long-term PEG and tracheostomy dependence in this cohort is low. However, these outcomes under-represent the decrement in patient speech and swallowing following TORS ± standard adjuvant therapy for HPV(+)OPSCC.
select article Intraoperative cytological examination of bone medullary. A useful technique to predict the extension of bone invasion in segmental mandibulectomy
Research articleAbstract only
Intraoperative cytological examination of bone medullary. A useful technique to predict the extension of bone invasion in segmental mandibulectomy
Paolo Cariati, Almudena Cabello Serrano, Jose Fernandez Solis, Silvano Ferrari, ... Ildefonso Martinez Lara
In Press, Accepted Manuscript, Available online 3 July 2019
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Abstract
Abstract
Aim
The main of the present report is to evaluate the utility of intraoperative cytological analysis of medullary bone to predict the extension of bone infiltration in segmental mandibulectomy.
Materials and method
Between the years 2016 and 2018, a total of 17 previously untreated patients with squamous cell carcinoma of the oral cavity underwent a segmental mandibular resection and intraoperative cytological analysis of the bone medullary at Virgen de las Nieves University Hospital (HUVN). The results of the intraoperative cytological analysis were compared with the result of the postoperative histopathological examination and sensitivity, specificity, positive predictive value, and negative predictive value of the test were calculated.
Results
Cytological analysis was positive in three patients and the bone resection was consequently extended. All the extensions of these bone margins were clean following the postoperative histological examination. However, two other patients previously classified as clean with intraoperative cytological analysis of bone medullary presented infiltration of bone margins postoperatively. The protocol demonstrated a high negative predictive value (85,7%). The positive predictive value, sensitivity, and specificity were 33,3%, 33,3%, and 85,7% respectively.
Conclusion
Intraoperative cytological analysis of bone medullary could represent an easy, fast, reliable and inexpensive method to reduce the rate of r1 surgeries attributable to the infiltration of the bone margin. This may have a positive impact on overall survival without increasing the duration and the iatrogenicity of surgery.
select article The use of 3D printing in shared decision making for a juvenile aggressive ossifying fibroma in a pediatric patient
Case reportAbstract only
The use of 3D printing in shared decision making for a juvenile aggressive ossifying fibroma in a pediatric patient
Andrew Y. Lee, Neha A. Patel, Kenneth Kurtz, Morris Edelman, ... Todd Goldstein
In Press, Corrected Proof, Available online 2 July 2019
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Abstract
Abstract
Juvenile aggressive ossifying fibromas (JAOF) are rare, typically benign pediatric tumors that are locally aggressive and have high recurrence rates. A 7-year old male presented with a palatal mass and a 3D printed model was created and used as a visual aide to highlight the importance of management in terms of functional, cosmetic, and disease-free outcomes with the family. The patient ultimately underwent successful enucleation with final pathology consistent with JAOF. To our knowledge, this is the first description of the use of 3D printing to help in the shared decision-making process for the treatment of this aggressive tumor.
select article Hypermethylation of DcR1, DcR2, DR4, DR5 gene promoters and clinical significance in tongue carcinoma
Research articleAbstract only
Hypermethylation of DcR1, DcR2, DR4, DR5 gene promoters and clinical significance in tongue carcinoma
Yong Zhou, ShuCan Zheng, QingHua Luo, XuYao Huang, ... ZhaoHui Li
In Press, Accepted Manuscript, Available online 2 July 2019
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Abstract
Abstract
Objective
Tongue squamous cell carcinoma (TSCC) is one of the most common malignancies in the oral cavity, and its incidence and mortality have been constantly increasing these years. A large number of tumor suppressor genes are involved in the development of the TSCC and it has been reported that the aberrant hypermethylation of tumor suppressor genes may play a key role in the process of the TSCC. In this study, we sought to analyze the association of methylation of DcR1, DcR2, DR4 and DR5 gene promoters and clinical significance in the TSCC to evaluate association between methylation of DcR1, DcR2, DR4 and DR5 gene and Clinical Significance in tongue squamous cell carcinoma.
Methods
Methylation-specific PCR(MSP) was used to analyze the methylation of the promoters of TRAIL (tumor necrosis factor-related apoptosis-inducing ligand) receptors in 45 TSCC cases. Real-Time PCR was used to detect the expression of the DcR1, DcR2, DR4 and DR5 gene.
Results
All the four genes (DcR1, DcR2, DR4 and DR5) showed different methylation of promoters in TSCC, while methylation of these promoters in paired adjacent normal tissues were almost undetectable. Patients with high methylation index were diagnosed at younger age when compared with the ones with low methylation index. DcR1 and DR4 hypermethylation was correlated significantly with patients' TNM stage.
Conclusions
Methylation of DcR1, DcR2,DR4 and DR5 promoters are found in TSCC and may associate with its occurrence and development. Taking the reversibility of methylation into account，methylation is a potential targeted therapy of TSCC.
select article The utility of narrow band imaging in endoscopic diagnosis of laryngopharyngeal reflux
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The utility of narrow band imaging in endoscopic diagnosis of laryngopharyngeal reflux
Changding He, Jinchao Yu, Fang Huang, Jun Shao
In Press, Corrected Proof, Available online 28 June 2019
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Abstract
Abstract
Objective
This study assessed the utility of narrow band imaging (NBI) in patients with symptoms of laryngopharyngeal reflux (LPR) and tried to quantitatively evaluate the signs found under the NBI Laryngoscope.
Methods
Patients with and without LPR symptoms completed reflux symptom index (RSI) questionnaires prior to enrolment. The throat was examined by standard white light endoscopy followed by NBI. LPR status was determined using the reflux finding score and the RSI. Laryngoscope images and videos from 70 subjects with LPR and 70 control subjects without LPR were obtained. Features seen only by NBI were compared between the two groups. Then the RGB values of the throat mucosa of the two groups were measured by Photoshop software, and finally statistical analysis was performed.
Results
In total, 140 patients were eligible for final analysis (LPR group mean age = 50.0, 47 males; control group mean age = 44.8, 45 males). A significantly higher proportion of patients with LPR had increased vascularity, green spots, contact ulcers and granulomas. Of these, increased vascularity and green spots can only be found under NBI, and the prevalence rates in the LPR group were found to be 92.8% and 88.6% (P < 0.05), respectively. In the control group, the prevalence rates of increased vascularity and green spots were 21.4% and 7.1%, respectively (P < 0.05). The RGB value of the LPR group was generally higher than that of the control group. The difference is statistically significant (P < 0.05).
Conclusion
LPR presents vascularity and green spots with high specificity and sensitivity under NBI which can play a role in the auxiliary diagnosis of LPR.
select article The effectiveness of cognitive rehabilitation program on auditory perception and verbal intelligibility of deaf children
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The effectiveness of cognitive rehabilitation program on auditory perception and verbal intelligibility of deaf children
Mohammad Ashori, Seyyedeh Somayyeh Jalil-Abkenar
In Press, Corrected Proof, Available online 28 June 2019
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Abstract
Abstract
Linguistic information and cognitive rehabilitation has more related with auditory perception and verbal intelligibility. The aim of the present study was to assessment of the effectiveness of cognitive rehabilitation program on the auditory perception and verbal intelligibility of deaf children.
This study was a quasi-experimental study with pre-test, post-test and control group design. Participants were 24 deaf children from Ava rehabilitation center of mother child in Isfahan city, Iran. Participants were selected by convenient sampling method. They were randomly divided into experimental and control groups, each group consisted of 12 children. The experimental group participated in the cognitive rehabilitation training program in 10 sessions for 45 min, while control group did not participate this program. The instruments of present research were Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). The data were analyzed using multivariate analysis of covariance (MANCOVA) in 24th version of SPSS.
The results of MANCOVA showed that cognitive rehabilitation program had significant effect on the auditory perception and verbal intelligibility in the experimental group at post intervention stage (P < 0/0001).
There was a positive and significant increase in auditory perception and verbal intelligibility of experimental group. Our findings showed that Cognitive rehabilitation program training led to promote of auditory perception and verbal intelligibility of deaf children.
select article HPV status in patients with nasopharyngeal carcinoma in the United States: A SEER database study
Research articleAbstract only
HPV status in patients with nasopharyngeal carcinoma in the United States: A SEER database study
Michael Wotman, Eun Jeong Oh, Seungjun Ahn, Dennis Kraus, ... Tristan Tham
In Press, Corrected Proof, Available online 26 June 2019
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Abstract
Abstract
Purpose
To investigate the etiologic and prognostic role of Human Papilloma Virus (HPV) in Nasopharyngeal Carcinoma (NPC).
Materials and methods
Patients diagnosed with NPC were identified with the Surveillance, Epidemiology, and End Results (SEER) database. Logistic regression was used to investigate the effect of clinicopathologic predictors on HPV positivity in NPC. Survival analyses were performed with Kaplan-Meier curves and Cox regression models.
Results
180/517 patients (34.8%) with known HPV testing were positive for HPV-associated NPC. East Asians and individuals over 25 were less likely to have HPV-associated NPC, while controlling for AJCC-7 stage and AJCC-7 M stage. According to the survival analysis, cause-specific survival (CSS) did not differ significantly by HPV status throughout the study period, but did differ significantly by HPV ethnicity group.
Conclusions
The clinical implications of HPV in NPC are further elucidated but require more investigation.
Level of evidence
IV.
select article Evaluation of the quality of life in adults with cochlear implants: As good as the healthy adults?
Research articleAbstract only
Evaluation of the quality of life in adults with cochlear implants: As good as the healthy adults?
Elif Tuğba Saraç, Merve Ozbal Batuk, Gonca Sennaroglu
In Press, Corrected Proof, Available online 24 June 2019
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Abstract
Abstract
Purpose
The aim of this study was to compare the quality of life (QoL) of adult CI users with the QoL of adults in the healthy and normal-hearing population.
Materials and methods
31 patients with CIs were included in the CI group, and 31 normal-hearing subjects were included in the control group. The QoL was evaluated using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) for all subjects.
Results
A comparison of the QoL of the CI group to that of the control group found that the QoL of healthy adults was better than that of the CI users. The results obtained for the subdomains of physical health, psychological health, and social relations showed statistically significant differences between the two groups (p < 0.05). There were no statistically significant differences between the groups in the subdomains of environment and general health (p > 0.05).
Conclusions
The effect of a hearing disability on daily life continues after the CI. As expected, adults with CIs still face challenges in their daily lives due to the hearing impairment.
select article Intratympanic mixture gentamicin and dexamethasone versus dexamethasone for unilateral Meniere's disease
Research articleAbstract only
Intratympanic mixture gentamicin and dexamethasone versus dexamethasone for unilateral Meniere's disease
Kayhan Öztürk, Nurdoğan Ata
In Press, Corrected Proof, Available online 24 June 2019
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Abstract
Abstract
Objective
This study aimed to determine the effectiveness of an intratympanic (IT) injection of a mixture of gentamicin and dexamethasone compared with intratympanic dexamethasone (ITD) for controlling vertigo and protecting the hearing level of Meniere's disease patients who have persistent vertigo attacks, despite medical treatment.
Methods
Thirty eight patients with intractable Meniere's disease were included in this study.
Twenty-one patients were treated with IT mixture gentamicin and dexamethasone injection; seventeen patients were treated with ITD. Pre- and post-treatment audiograms were compared with pure-tone averages. Control of vertigo was classified according to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) vertigo control index.
Results
In the mixture group single IT injection was administered in 18 patients (85.7%), 2 injections were administered in 2 patients (9.5%) and 3 injections were administered in one patient (4.8%). In the ITD group IT injection was performed 3 times (days 1,3,5) at intervals. The mean number of intervals per patient was 3,41 (range 1–6).
Two years after IT treatment there was better control of vertigo in mixture group than in ITD group; 81% of mixture group and 70,6% of the ITD group achieved satisfactory control of vertigo (p = 0,0286). Audiology results of mixture group showed 20 patients (95,24%) with unchanged hearing and 1 patient (4,76%) with only 10-decibel deteriorated hearing. There was no worsening of hearing in the ITD group.
Conclusion
The results of this study showed that an IT injection of a mixture of gentamicin and dexamethasone in intractable Meniere's disease cases is more effective than ITD for vertigo control.
select article Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature
Research articleAbstract only
Fungus ball of the maxillary sinus: Retrospective study of 48 patients and review of the literature
Fabio Costa, Enzo Emanuelli, Leonardo Franz, Alessandro Tel, ... Massimo Robiony
In Press, Corrected Proof, Available online 15 June 2019
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Abstract
Abstract
Background
Maxillary fungus ball (FB) is the most frequent paranasal localization.
Objective
To review clinical presentation, surgery and results of treatment in our series of patients with maxillary FB. To review the literature concerning treatment of maxillary FB.
Patients and methods
48 patients with a diagnosis of maxillary FB were treated with endoscopic sinus surgery (ESS) alone or in association with external approaches. Before surgery all patients received computed tomography (CT), nasal endoscopy and dental examination. All the patients were followed for 1 year after surgery. Studies concerning surgical treatment of maxillary FB from 2006 were reviewed.
Results
The mean age of patients was 53.6 ± 11.9 years. 20 patients (41.6%) did not present any symptom, 19 patients (39.7%) had nasal symptoms, 3 patients (6.2%) had facial pain, 6 patients (12.5%) had a combination of both. Endoscopic examination was positive in 31 patients (64.6%), 17 patients (35.4%) showed negative findings. Logit regression model demonstrated that clinical symptoms contribute to the prediction of a positive endoscopic examination. 25 patients (52.1%) presented odontogenic factors. Complete clinical and radiological resolution of FB was observed in 46 patients (95.8%).
Conclusions
Comparing our sample to the studies reviewed we may concluded that odontogenic factors were frequently reported and should be treated at the same time of maxillary FB. ESS alone or in association with external approaches is an effective treatment for patients with maxillary FB.
select article Microwave ablation: A new technique for the prophylactic management of idiopathic recurrent epistaxis
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Microwave ablation: A new technique for the prophylactic management of idiopathic recurrent epistaxis
Zheng-cai Lou
In Press, Corrected Proof, Available online 14 June 2019
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Abstract
Abstract
Objective
The objective of this study was to compare the re-bleeding of idiopathic recurrent epistaxis with no definite bleeding site treated with either prophylactic microwave ablation (MWA) or continuous observation.
Study design
Case series with chart review.
Subjects and methods
61 patients with idiopathic recurrent epistaxis but no definite bleeding sites in the first operation were assigned to prophylactic MWA group (n = 39) and continuous observation group (n = 22). Patients in prophylactic MWA group were given prophylactic MWA at the common bleeding sites. Patients in continuous observation group were only observed in the ward. The bleeding sites, re-bleeding and complications were evaluated during 3 months follow-up period.
Results
Rebleeding was experienced by 7 of the patients (17.9%) who were treated with prophylactic MWA whereas, 13 of the patients (59.1%) who used continuous observation had rebleeding. The rebleeding rate for patients undergoing prophylactic MWA group was lower than that for the observation-only group (p < 0.01). All the ablations were completed for the patients with known bleeding site within 1–2 min. These patients only had the complain of slight postoperative pain, no serious complications (including nasal adhesion, crust, septal perforation, etc.) were found in the follow-up period.
Conclusions
MWA is a simple, convenient, rapid, and definite hemorrhage control method with minimally invasive therapeutic technique. Prophylactic MWA at the common bleeding sites helps to significantly reduce the rate of rebleeding in patients in whom no definite bleeding sites have been identified.
select article Functional outcomes of temporomandibular joint reconstruction with vascularized tissue
Research articleAbstract only
Functional outcomes of temporomandibular joint reconstruction with vascularized tissue
Nikolaus Hjelm, Timothy E. Ortlip, Michael Topf, Adam Luginbuhl, ... Ryan Heffelfinger
In Press, Corrected Proof, Available online 12 June 2019
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Abstract
Abstract
Objective
To determine how current temporomandibular joint (TMJ) reconstruction methods affect functional outcomes.
Methods
Retrospective review from January 2006 to July 2017 at a single tertiary care center. All patients who underwent mandibulectomy with subsequent reconstruction with vascularized free tissue were included in the study. Condylar segments were reconstructed with vascularized free tissue flap in conjunction with autologous tissue or allograft in the joint space. Preoperative, 3 month, 1 year, and 2 year postoperative records were assessed for trismus, need for tube feeds, and Functional Oral Intake Scale (FOIS).
Results
Joint space was reconstructed with autologous tissue (n = 10), allograft (n = 15) or both (n = 9). At three months, FOIS scores significantly decreased from 5.4 preoperatively to 4.8 post operatively (P = .024) and need for tube feeds significantly increased from 15.8% preoperatively to 35.1% (P ≤0.027). Trismus significantly decreased from 63.2% to 27% (P = .006). At one-year, there were no significant changes in functional status compared to pre-operative state. Patients who had previous RT had significantly worse FOIS scores preoperatively (p = .002), at three months (p < .001), one year (p < .001), and two years (p = .008). There was no significant difference in postoperative functional status of patients based on the method of TMJ reconstruction.
Conclusion
Reconstruction of the TMJ with vascularized free tissue is a viable option and yields acceptable long-term outcomes. While functional status may improve or worsen in the immediate postoperative period, long term results mirror preoperative function. Preoperative trismus will likely improve.
Level of evidence
Level 3; Retrospective Comparative Study.
select article Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: An institutional experience
Research articleAbstract only
Management of the neck after definitive chemoradiation in patients with HPV-associated oropharyngeal cancer: An institutional experience
Michael Wotman, Maged Ghaly, Luke Massaro, Tristan Tham, ... Sewit Teckie
In Press, Corrected Proof, Available online 12 June 2019
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Abstract
Abstract
Purpose
To investigate the multidisciplinary management of patients with Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) and an incomplete nodal response on restaging PET/CT after definitive chemoradiation (CRT).
Materials and methods
A retrospective chart review was performed of patients diagnosed with node-positive HPV-associated OPSCC from 2012 to 2017, who underwent definitive upfront CRT, and had an incomplete response on post-therapy PET/CT according to NCCN criteria. Post-CRT PET/CT results, management decisions, and clinical outcomes were recorded.
Results
Seventy-four patients with node-positive HPV-associated OPSCC were identified; 20 patients with incomplete neck response on PET/CT according to NCCN criteria were included in the final case series. Median follow-up time was 33 months. Patients were managed as follows: 8 underwent observation and surveillance imaging, 6 underwent ultrasound-guided fine needle aspiration (FNA), and 6 had immediate neck dissection. All the observed patients were disease-free at most recent follow-up. None of the patients who underwent immediate neck dissection had residual neck disease on pathological examination; two patients in this group ultimately developed metastatic disease. Among the 6 who underwent FNA, 1 individual had positive pathology, along with residual primary disease, for which the patient underwent salvage surgery. The 5 remaining individuals had negative FNA results, were subsequently observed, and remained free of disease.
Conclusions
This institutional experience supports the notion of a high threshold for neck dissection in this low-risk population; only 1 of 20 patients with suspicious PET/CT findings had residual disease in the neck. Moreover, these patients should be managed by a multidisciplinary tumor board (MTB) since current algorithms do not universally include HPV status. Finally, the use of restaging PET/CT to guide management of the neck can be improved with changes in terminology and consideration of FDG-avidity at the primary site and on pre-therapy scans.
select article Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation
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Outcomes in surgically resectable oropharynx cancer treated with transoral robotic surgery versus definitive chemoradiation
Bhaswanth Dhanireddy, Nicolas P. Burnett, Sreeja Sanampudi, Charles E. Wooten, ... Thomas J. Gal
In Press, Corrected Proof, Available online 4 June 2019
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Abstract
Abstract
Purpose
Optimal treatment strategies for the management of oropharyngeal squamous cell carcinoma (OPSCC) remain unclear. The objective of this study is to examine the role of transoral robotic surgery (TORS) on functional and treatment outcomes.
Materials and methods
A retrospective review of patients with OPSCC (tonsil/base of tongue) who underwent TORS with neck dissection± adjuvant therapy between January 2011 to December 2016 were compared to a stage matched cohort of patients treated with primary chemoradiation. Demographic, treatment, and outcome data were collected.
Results
54 patients received primary chemoradiation and 65 patients (surgical group) received TORS ± adjuvant therapy for clinically staged disease meeting study criteria. 25% (N = 17) were treated with surgery alone. The remainder of the surgical group received postoperative radiation (N = 48), half of which received adjuvant chemotherapy (N = 24) in addition to radiation. 63% (N = 41) of the patients did not have risk factors for chemotherapy. No differences in overall or disease free survival were observed with TORS compared to chemoradiation (p = 0.9), although Charlson Comorbidity Index (CCI) was higher in the surgical group (p = 0.01). The strongest predictor of prolonged gastrostomy tube use was not treatment, but rather co-morbidity (p = 0.03), with no significant differences beyond 12 months.
Conclusion
Although no significant survival differences were observed across treatment groups, this was maintained despite increased comorbidity index in the surgical patients. Given the ability to de-escalate and/or eliminate adjuvant therapy, particularly in a less healthy population, TORS would appear to be the viable treatment option it has become.
select article Head and neck involvement with histoplasmosis; the great masquerader
Research articleAbstract only
Head and neck involvement with histoplasmosis; the great masquerader
A. Singh, M. Gauri, P. Gautam, D. Gautam, ... K.K. Handa
In Press, Corrected Proof, Available online 3 June 2019
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Abstract
Abstract
Introduction
Head and neck involvement with histoplasmosis usually occurs as a part of the disseminated illness. There are no pathognomic features of the upper aerodigestive tract involvement and the lesion may mimic a host of other conditions. The current report presents our experience with head and neck histoplasmosis in a non-endemic tertiary care center.
Materials and methods
We present a case of disseminated histoplasmosis with oral symptoms and lesions as the chief complaints. A 10 years' retrospective institutional database search was undertaken to identify the patients with histoplasmosis affecting head and neck region treated at our institution. The demographic and treatment details of the patients were reviewed.
Results
In addition to the index patient, four more patients (two with gingivobuccal and one each with nasal and laryngeal histoplasmosis) were found. Out of the five patients, only one patient was found to have underlying immunosuppression. All of the patients were diagnosed with biopsy showing typical appearance of the intracellular organism. All the patients were satisfactorily treated with systemic antifungal treatment.
Conclusion
Upper aerodigestive tract involvement with histoplasmosis can present as an intriguing clinical puzzle. A high index of suspicion is needed and biopsy is the gold standard for the diagnosis. Intravenous Liposomal Amphotericin B and oral Itraconazole are standard treatment agents of choice and are highly efficacious in achieving cure.
select article Treatment for lymphedema following head and neck cancer therapy: A systematic review
Review articleAbstract only
Treatment for lymphedema following head and neck cancer therapy: A systematic review
Albina Tyker, Joel Franco, Sean T. Massa, Shaun C. Desai, Scott G. Walen
In Press, Corrected Proof, Available online 30 May 2019
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Abstract
Abstract
Objective
To perform the first systematic review evaluating all established treatment modalities of head and neck lymphedema resulting from head and neck cancer therapy. Since craniofacial lymphedema treatment represents unique challenges not addressed by extremity lymphedema therapies, a systematic review and evaluation of treatment modalities specific to this area is needed to guide clinical management and further research.
Data sources
Four electronic databases were searches from inception to September 2018. These included Scopus (Embase), PubMed (Medline), Clinicaltrials.gov, and Cochrane Databases.
Review methods
A search string was developed, and all databases queried for keywords on three subjects: head and neck cancer, lymphedema, and therapy. Results were uploaded to an EndNote database where relevant items were identified by hand-searching all titles and abstracts. Subsequently results were combined, duplicates removed, and full papers screened according to eligibility criteria.
Results
Of a total 492 search results, twenty-six items met eligibility criteria for this review. These included fourteen cohort studies, seven case reports, two randomized controlled trials, two systematic reviews, and one narrative review totaling 1018 study subjects. The manual lymph drainage group had the largest number of studies and participants, with fewer studies investigating selenium, liposuction, and lymphaticovenular anastomosis.
Conclusion
Evidence for the efficacy of all types of lymphedema therapy is limited by paucity of large randomized controlled trials. While manual lymph drainage is best studied, liposuction and surgical treatments have also been effective in a small number of patients.
select article Morbidity after tonsillectomy in children with autism spectrum disorders
Research articleAbstract only
Morbidity after tonsillectomy in children with autism spectrum disorders
Jillian N. Printz, Katelin A. Mirkin, Christopher S. Hollenbeak, Michele M. Carr
In Press, Corrected Proof, Available online 30 May 2019
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Abstract
Abstract
Objectives
As the incidence of autism spectrum disorder (ASD) increases, otolaryngologists are more likely to encounter patients from this population during tonsillectomy. The purpose of this study was to examine whether outcomes differ between pediatric patients with and without ASD in a national cohort of children undergoing tonsillectomy. Understanding these differences may be used to inform future approaches to improve clinical outcomes and healthcare costs.
Methods
Data for this study were obtained from the Kids Inpatient Database (KID) of the Healthcare Cost Utilization Project. We studied pediatric patients who underwent tonsillectomy during 2003, 2006, 2009, and 2012. Tonsillectomy was identified using ICD-9-CM diagnosis codes 28.2 (tonsillectomy without adenoidectomy) and 28.3 (tonsillectomy with adenoidectomy). ASD was identified using ICD-9-CM diagnosis code 299 (autism). Outcomes including complications, length of hospital stay, and total hospitalization costs. Analyses were performed using multivariable models. Propensity score matching was used to control for covariate imbalance between patients with and without ASD.
Results
In our sample of 27,040 patients, 322 (1.2%) had a diagnosis of ASD. After controlling for potential confounders, multivariable modeling suggested patients with ASD had a shorter LOS of 0.50 days (p < 0.0001), were less likely to experience complications (odds ratio 0.57, p = 0.001), and had lower associated costs of $1308 less (p < 0.0001). Propensity score matching confirmed the findings of the multivariable modeling.
Conclusion
Although ASD alone does not appear to confer additional costs or morbidity, differences between children with and without ASD suggest the need for providers to address patients with ASD uniquely.
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