OtoRhinoLaryngology News

Πέμπτη 18 Φεβρουαρίου 2016

An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery.

An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery.

Odontology. 2016 Feb 17;

Authors: Iwai T, Omura S, Honda K, Yamashita Y, Shibutani N, Fujita K, Takasu H, Murata S, Tohnai I

Abstract
Bimaxillary orthognathic surgery has been widely performed to achieve optimal functional and esthetic outcomes in patients with dentofacial deformity. Although Le Fort I osteotomy is generally performed before bilateral sagittal split osteotomy (BSSO) in the surgery, in several situations BSSO should be performed first. However, it is very difficult during bimaxillary orthognathic surgery to maintain an accurate centric relation of the condyle and decide the ideal vertical dimension from the skull base to the mandible. We have previously applied a straight locking miniplate (SLM) technique that permits accurate superior maxillary repositioning without the need for intraoperative measurements in bimaxillary orthognathic surgery. Here we describe the application of this technique for accurate bimaxillary repositioning in a mandible-first approach where the SLMs also serve as a condylar positioning device in bimaxillary orthognathic surgery.

PMID: 26886571 [PubMed - as supplied by publisher]

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Traumatic dental injury: a case review.

Traumatic dental injury: a case review.

Minerva Stomatol. 2016 Feb 16;

Authors: Gualniera P, Scurria S, Sapienza D, Asmundo A

Abstract
BACKGROUND: To retrospectively evaluate the incidence of traumatic dental injury and consequential dental impairment following road traffic accidents and to examine the factors that can affect the monetary value of compensation for bodily injury payable pursuant to current insurance regulations.
METHOD: During the decade from 2004 to 2014, 7,233 persons involved in road traffic accidents in the province of Messina, eastern Sicily, were examined by insurance physicians to assess bodily injury damage. Data were collected from cases of traumatic dental injury causing malocclusion and temporomandibular joint dysfunction, either alone or concomitant with injuries to other parts of the body. Injury characteristics and consequential bodily injury damage were classified and the incidence calculated using Microsoft Excel.
RESULTS: The incidence of traumatic dental injuries was 3% of the total population (195 persons: 127 males and 68 females); the majority of cases (56%) involved riders of two-wheeled vehicles. A high percentage of riders received injury to one or more teeth, i.e. fractures and dislocations, more frequently to the anterior teeth (68%) than the posterior teeth because of their position in the dental arch. Temporomandibular joint injuries were far fewer (8%) and resulted from either direct or indirect trauma associated with severe head and/or neck injury. The incidence of permanent bodily damage consequential to these injuries was fairly low.
CONCLUSION: Although the incidence of dental trauma following road traffic accidents is low, the monetary compensation for consequential dental impairment based on current insurance regulatory law is far from negligible.

PMID: 26884252 [PubMed - as supplied by publisher]

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[Deliberate release of the laryngeal adductor reflex via microdroplet impulses : Development of a device].

[Deliberate release of the laryngeal adductor reflex via microdroplet impulses : Development of a device].

HNO. 2016 Feb 17;

Authors: Ptok M, Schroeter S

Abstract
BACKGROUND: The laryngeal adductor reflex (LAR), a reflexive vocal fold closing mechanism, includes an early, probably di- or oligosynaptic ipsilateral LAR1- and a late ipsilateral and contralateral LAR2 polysynaptic component. In a clinical evaluation of dysphagia the LAR can be triggered by air pulses or tactile stimuli and typically assessed only qualitatively.
METHODOLOGY: The development and construction of a device that can selectively shoot very small water droplets (microdroplet impulse testing MIT).
RESULTS: The MIT device has a water reservoir with an infinitely adjustable pressure. The opening period of the piezo-electrically operated valve determines the droplet size. With a high-speed camera system, the change in the airspeed of the drop can be determined, depending on the set water reservoir pressure. With the knowledge of the droplet size, the shooting speed and the estimation of the distance between the valve and laryngeal mucosa or airspeed can be determined the muzzle energy. By mounting the MIT device to a high speed glottography system, the time between the impact of the droplet on the laryngeal mucosa and the start of the laryngeal adduction, the LAR latency can be determined using an image by image evaluation.
DISCUSSION: In dysphagia with penetration or aspiration it is presumed that the protective function of the larynx is no longer adequately ensured. The MIT-LAR device provides a valid and reliable method to assess LAR quantitatively. Furthermore, it holds the promise of being a simple to handle method that can be used clinically for routine diagnostics.

PMID: 26886492 [PubMed - as supplied by publisher]

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Application experience of intraoperative neuromonitoring in thyroidectomy.

Application experience of intraoperative neuromonitoring in thyroidectomy.

Int J Clin Exp Med. 2015;8(12):22359-64

Authors: Zheng H, Jiang L, Wang X, Hu J, Ning J, Wang D, Li B, Zheng G, Xu J

Abstract
OBJECTIVE: The aim of this study is to summarize the experience of intraoperative neuromonitoring system for monitoring and protection of recurrent laryngeal nerve during thyroid surgery.
METHODS: There were 220 cases in this study, male 53, female 167, mean age 38.2 years old. 85 cases in the study had thyroid cancer, 19 cases had thyroid benign tumor, 90 cases had thyroid goiter, 3 cases had Hashimoto's diseases, and 23 cases had hyperthyroidism. The tumor diameters were over than 5 cm in 113 cases. In the procedure, two recording needle electrodes were put into cricothyroid muscle; one stimulator electrodes was explored in tracheo-asophageal groove, if recurrent laryngeal nerves were right there or near, doctors could see the electromyogram and hear the toot honk. With careful dissection, recurrent laryngeal nerve could be found out till explored into the larynx site.
RESULTS: 207 cases (278 sizes) of 220 were finished, electromyogram was not drawn out in 13 cases; 9 cases were false-negative because of system and anesthesia questions; needle electrodes cannot be put in properly in 4 cases because of cricothyroid muscle cancer invasion. No permanent recurrent laryngeal nerve paralysis occurred, 2 cases with transient nerve paralysis recovered in one month.
CONCLUSION: The intraoperative neuromonitoring system can avoid damage of the recurrent laryngeal nerves when exposing the recurrent laryngeal nerve in the whole operation, therefore, with less medical complications.

PMID: 26885214 [PubMed]

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Propranolol treatment of subglottic hemangiomas: a review of the literature.

Propranolol treatment of subglottic hemangiomas: a review of the literature.

Int J Clin Exp Med. 2015;8(11):19886-90

Authors: Wu L, Wu X, Xu X, Chen Z

Abstract
Subglottic hemangiomas (SGH), which are rare benign tumors of the airway, are potentially life-threatening conditions that may require intervention. Propranolol appears to be an effective treatment for these tumors and should therefore be a first-line treatment for SGH that require intervention. This review presents the clinical presentation and diagnosis of SGH and discusses current knowledge regarding the use of propranolol for the treatment of SGH.

PMID: 26884900 [PubMed]

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Autofluorescence spectroscopy in the differentiation of laryngeal epithelial lesions - preliminary results.

Autofluorescence spectroscopy in the differentiation of laryngeal epithelial lesions - preliminary results.

Acta Otolaryngol. 2016 Feb 16;:1-5

Authors: Winiarski P, Szewczyk-Golec K, Orłowski P, Kałużna E, Wamka M, Mackiewicz-Nartowicz H, Sinkiewicz A, Fisz JJ

Abstract
Conclusions Autofluorescence spectroscopy may be a supporting tool for differential diagnosis of changes in laryngeal epithelium. Objectives Early detection and differential diagnosis of proliferative changes in the larynx are still a challenge for laryngologists. The aim of the study was to evaluate the autofluorescence spectroscopy technique to in vitro differential diagnosis of pathological changes in the epithelium of the larynx. Methods Forty-two patients aged 34-79 years were included in the study. The fifty-two tissue specimens, including 10 samples of cancerous lesion, 10 adjacent normal tissue, 10 chronic inflammation, eight cyst, three leukoplakia, four polyp, and seven Reinke's edema, were obtained during laryngological procedures. All tissue samples were independently diagnosed histopathologically. The autofluorescence emission spectra at two excitation wavelengths, 290 nm and 370 nm, were measured for every sample studied. Results The autofluorescence signals of cancerous tissue samples at both excitations exhibited identical emission band shapes of much lower intensities at their maxima as compared to the adjacent healthy tissue samples studied. The autofluorescence spectra intensities of cancerous and normal tissues varied inter-individually. Evident differences in autofluorescence intensities and its band shapes of different pathological laryngeal changes at the 290 nm excitations were demonstrated.

PMID: 26881757 [PubMed - as supplied by publisher]

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The utility of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography for detecting lung and esophagus multiple primary cancers involved in the larynx: Two case reports.

The utility of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography for detecting lung and esophagus multiple primary cancers involved in the larynx: Two case reports.

J Cancer Res Ther. 2015 Oct-Dec;11(4):1039

Authors: Wang Q, Chai L, Zhou S

Abstract
Multiple primary cancers involved in the larynx of differentiating synchronous multiple primary cancers from metastasis can often be very difficult, especially when they have the same histology. However, it is very important because the therapeutic approach is completely different. Clinical situations like this appear to be increasing as a result of the recent popular use of [18F] fluorodeoxyglucose-positron emission tomography/computed tomography. Herein, we report two cases of multiple primary cancers involved in the larynx.

PMID: 26881654 [PubMed - in process]

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Osteosarcoma of larynx: A rare case report with review of literature.

Osteosarcoma of larynx: A rare case report with review of literature.

J Cancer Res Ther. 2015 Oct-Dec;11(4):1038

Authors: Bahl A, George P, Bhattacharyya T, Ghoshal S, Bakshi J, Das A

Abstract
Laryngeal osteosarcoma is an extremely rare and aggressive malignancy. Only very few cases of primary laryngeal osteosarcomas are reported in literature, and all have a dismal prognosis. A 50-year-old male presented with recurrent hoarseness of voice and was evaluated and diagnosed as sarcoma larynx. Detailed histopathology report of laryngectomy specimen revealed presence of osteoid, which confirmed the diagnosis of osteosarcoma larynx. He was further treated with adjuvant chemotherapy and radiation and is disease free after 9 months. Surgery remains the mainstay of treatment in this disease and role of adjuvant chemotherapy and radiotherapy is still evolving.

PMID: 26881648 [PubMed - in process]

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Tracheal Involvement in Crohn Disease: the First Case in Korea.

Tracheal Involvement in Crohn Disease: the First Case in Korea.

Clin Endosc. 2016 Feb 16;

Authors: Park S, Park J, Kim HK, Kim JY, Hur SC, Lee JH, Jung JW, Lee J

Abstract
Respiratory involvement in Crohn disease (CD) is rare condition with only about a dozen reported cases. We report the first case of CD with tracheal involvement in Korea. An 18-year-old woman with CD was hospitalized because of coughing, dyspnea, and fever sustained for 3 weeks. Because she had stridor in her neck, we performed computed tomography of the neck, which showed circumferential wall thickening of the larynx and hypopharynx. Bronchoscopy revealed mucosal irregularity, ulceration, and exudates debris in the proximal trachea, and bronchial biopsy revealed chronic inflammation with granulation tissue. Based on these findings, we suspected CD with tracheal involvement and began administering intravenous methylprednisolone at 1 mg/kg per day, after which her symptoms and bronchoscopic findings improved.

PMID: 26879553 [PubMed - as supplied by publisher]

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Relationship of the Cricothyroid Space with Vocal Range in Female Singers.

Relationship of the Cricothyroid Space with Vocal Range in Female Singers.

J Voice. 2016 Feb 13;

Authors: Pullon B

Abstract
OBJECTIVES: This study aims to investigate the relationship between the anterior cricothyroid (CT) space at rest with vocal range in female singers. Potential associations with and between voice categories, age, ethnicity, anthropometric indices, neck dimensions, laryngeal dimensions, vocal data along with habitual speaking fundamental frequency were also explored.
STUDY DESIGN: This is a cohort study.
METHODS: Laryngeal dimensions anterior CT space and heights of the thyroid and cricoid cartilages were measured using ultrasound in 43 healthy, classically trained, female singers during quiet respiration. Voice categories (soprano and mezzo-soprano), age, ethnicity, weight, height, body mass index, neck circumference and length, anterior thyroid and cricoid cartilage heights, practice and performance vocal range, lowest and highest practice and performance notes along with habitual speaking fundamental frequency were collected.
RESULTS: The main finding was that mezzo-sopranos have a significantly wider resting CT space than sopranos (11.6 mm versus 10.4 mm; P = 0.007). Mezzo-sopranos also had significantly lower "lowest and highest" performance notes than sopranos. There was no significant correlation between the magnitudes of the anterior CT space with vocal range. The participants with the narrowest and widest anterior CT space had similar vocal ranges.
CONCLUSIONS: These results suggest that the CT space is not the major determinant of performance vocal range.

PMID: 26879074 [PubMed - as supplied by publisher]

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Increased Expression of MuRF1 Is Associated with Radiation-induced Laryngeal Muscle Atrophy.

http:--highwire.stanford.edu-icons-exter

Increased Expression of MuRF1 Is Associated with Radiation-induced Laryngeal Muscle Atrophy.

Anticancer Res. 2015 Nov;35(11):6049-56

Authors: Han X, Pires L, Browne JD, Sullivan CA, Zhao W, Feng X

Abstract
BACKGROUND: Laryngeal muscles play an important role in breathing, sound production and trachea protection against food. Laryngeal dysfunctions during radiotherapy for head and neck cancers are common. In the present study, we aimed to investigate the early effect of radiation on the laryngeal muscles in vivo and possible mechanisms involved in this process.
MATERIALS AND METHODS: Eight-week-old female C57bl/ mice received neck irradiation with a single dose of 25 Gy and bilateral thyroarytenoid (TA) muscles of mice were collected at day 3, 7 and 10 post-irradiation for evaluating muscle size, myosins, myosin heavy chain (MyHC) composition and MuRF1 protein levels.
RESULTS: A significant reduction in the size of muscle fibers and myosins in the TA muscles were observed at days 3, 7, 10 after radiation (p<0.05). The loss of IIB myosin was more severe than that of IIA/X myosins at day 7 post-irradiation (75% vs. 64%). MuRF1 protein level was markedly increased at day 7 and 10 after radiation (p<0.05).
CONCLUSION: Radiation induced an acute muscle fiber atrophy and myosin loss in the intrinsic laryngeal muscles. MuRF1 may play an important role in the radiation-induced protein degradation in the laryngeal muscles and warrants further investigation.

PMID: 26504028 [PubMed - indexed for MEDLINE]

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Reinke Edema: Watch For Vocal Fold Cysts.

http:--pt.wkhealth.com-pt-pt-core-templa

Reinke Edema: Watch For Vocal Fold Cysts.

J Craniofac Surg. 2015 Jun;26(4):e338-9

Authors: Tüzüner A, Demirci S, Yavanoglu A, Kurkcuoglu M, Arslan N

Abstract
Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

PMID: 26080256 [PubMed - indexed for MEDLINE]

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The behavioural treatment of muscle tension voice disorders: A systematic review.

The behavioural treatment of muscle tension voice disorders: A systematic review.

Int J Speech Lang Pathol. 2015 Jun;17(3):287-303

Authors: Eastwood C, Madill C, Mccabe P

Abstract
PURPOSE: A systematic review of behavioural intervention for the treatment of adults with muscle tension voice disorders (MTVD).
METHOD: A search of 12 electronic databases and reference lists for studies published between the years 1990-2014 was conducted using the PRISMA guidelines. Inclusion and exclusion criteria included type of publication, participant characteristics, intervention, outcome measures and report of outcomes. Methodological quality rating scales and confidence in diagnostic scale supported the literature evaluation.
RESULT: Seven papers met the inclusion criteria. Significant improvement on at least one outcome measure was reported for all studies. Effect sizes were small-to-large. Methodological qualities of research were varied. No study explicitly reported treatment fidelity and cumulative intervention intensity could only be calculated for two out of seven studies. Outcome measures were used inconsistently and less than half of the measures had reported reliability values. Confidence in the accuracy of subject diagnosis on average was rated as low. Specific "active ingredients" for therapeutic change were not identified.
CONCLUSION: Voice therapy for the treatment of MTVD is associated with positive treatment outcomes; however, there is an obvious need for systematic and high quality research designs to expand the evidence base for the behavioural treatment of MTVD.

PMID: 25953458 [PubMed - indexed for MEDLINE]

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Gone but not forgotten: a case of respiratory distress.

Gone but not forgotten: a case of respiratory distress.

Clin Pediatr (Phila). 2015 Jun;54(7):697-9

Authors: Wing R, Manno M

PMID: 25896724 [PubMed - indexed for MEDLINE]

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Intraoral pressures produced by thirteen semi-occluded vocal tract gestures.

Intraoral pressures produced by thirteen semi-occluded vocal tract gestures.

Logoped Phoniatr Vocol. 2015 Jul;40(2):86-92

Authors: Maxfield L, Titze I, Hunter E, Kapsner-Smith M

Abstract
The use of semi-occluded vocal tract (SOVT) exercises as habilitative and rehabilitative tools has grown substantially in the past two decades. As the use of these exercises has grown, so too has the number of variations of the phonatory gestures used to create oral semi-occlusions. While much of the research on SOVT exercises to this point has been conducted using straw phonation, there has been little discussion or investigation regarding how other phonatory gestures that are considered to be SOVT compare to one another. The current study sought to measure the intraoral pressure produced by 13 phonatory gestures generally thought of as oral semi-occlusions. Twenty subjects (10 male, 10 female) produced three tokens of each gesture, and intraoral pressure was recorded via a thin, flexible-cannula pressure transducer. Pressures ranged between 0.1 and 1.0 kPa, but varied significantly between gestures and between subjects.

PMID: 24865621 [PubMed - indexed for MEDLINE]

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An estimation of the population incidence of adult unilateral vocal fold mobility impairment in England.

An estimation of the population incidence of adult unilateral vocal fold mobility impairment in England.

Logoped Phoniatr Vocol. 2015 Jul;40(2):93-4

Authors: Nouraei SA, Middleton SE, Butler CR, Sandhu GS

Abstract
We estimate the population incidence of adult unilateral vocal fold mobility impairment at 5.13 per 100,000 per year.

PMID: 24850272 [PubMed - indexed for MEDLINE]

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A classification system for airway compromise due to bilateral vocal fold mobility impairment.

A classification system for airway compromise due to bilateral vocal fold mobility impairment.

Logoped Phoniatr Vocol. 2015 Jul;40(2):95-7

Authors: Nouraei SA, Sandhu GS

Abstract
We present a system for classification of bilateral vocal fold mobility impairment. Type 1 obstructions are caused by bilateral laryngeal denervation, most commonly due to bilateral recurrent laryngeal nerve palsy. Type 2 obstructions are caused by crico-arytenoid joint ankylosis. Type 3 obstructions are due to inter-arytenoid granulation tissue. Type 4 lesions are caused by mature inter-arytenoid scar tissue and type 5 lesions are complex or total laryngeal stenoses.

PMID: 24850271 [PubMed - indexed for MEDLINE]

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A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery.

A new multilayer reconstruction using nasal septal flap combined with fascia graft dural suturing for high-flow cerebrospinal fluid leak after endoscopic endonasal surgery.

Neurosurg Rev. 2016 Feb 17;

Authors: Horiguchi K, Nishioka H, Fukuhara N, Yamaguchi-Okada M, Yamada S

Abstract
This study aimed to evaluate the usefulness and reliability of a new endoscopic multilayer reconstruction using nasal septal flap (NSF) to prevent high-flow cerebrospinal fluid leak after endoscopic endonasal surgery. This study was a retrospective review on 97 patients who underwent multilayer reconstructions using NSF combined with fascia graft dural suturing after endoscopic endonasal surgery between July 2012 and March 2014. Patients were divided into two groups, third ventricle opening group and nonopening group, based on the presence of a direct connection between the third ventricle and the paranasal sinus after tumor removal. Furthermore, we compared this procedure with our previous reconstruction after resection of craniopharyngioma. Finally, we checked the patients who had postoperative prolonged discomfort of the nasal cavity for over a year. Postoperative cerebrospinal fluid (CSF) leak occurred in three patients (3.1 %): one from the third ventricle opening group and the remaining two from the nonopening group. External lumbar drain was performed after surgery in only seven patients (7.2 %). The incidence of postoperative CSF leak was similar in both groups, whereas the rate of craniopharyngioma in the third ventricle opening group was significantly higher. The incidence of postoperative CSF leak after resection of craniopharyngioma was not statistically significant but obviously higher in the previous group (12.2 %) compared with that in the present group (2.3 %). Twelve patients (12.4 %) had postoperative nasal discomfort of the nasal cavity for over a year. Multilayer reconstruction using NSF combined with fascia graft dural suturing is a more reliable method for preventing postoperative high-flow CSF leakage after endoscopic endonasal surgery even if there is a direct connection between the third ventricle and the paranasal sinus. However, we should pay close attention especially to prolonged discomfort of the nasal cavity after harvesting NSF.

PMID: 26886779 [PubMed - as supplied by publisher]

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Extended Pneumocephalus after Drainage of Chronic Subdural Hematoma Associated with Intracranial Hypotension : Case Report with Pathophysiologic Consideration.

Extended Pneumocephalus after Drainage of Chronic Subdural Hematoma Associated with Intracranial Hypotension : Case Report with Pathophysiologic Consideration.

J Korean Neurosurg Soc. 2016 Jan;59(1):69-74

Authors: Shin HS, Lee SH, Ko HC, Koh JS

Abstract
Chronic subdural hematoma (SDH) is a well-known disease entity and is traditionally managed with surgery. However, when associated with spontaneous intracranial hypotension (SIH), the treatment strategy ought to be modified, as classical treatment could lead to unwanted consequences. A 59-year-old man presented with a case of SIH that manifested as a bilateral chronic SDH. He developed fatal extensive pneumocephalus and SDH re-accumulation as a complication of burr-hole drainage. Despite application of an epidural blood patch, the spinal cerebrospinal fluid leak continued, which required open spinal surgery. Chronic SDH management should not be overlooked, especially if the exact cause has not been determined. When chronic SDH assumed to be associated with SIH, the neurosurgeon should determine the exact cause of SIH in order to effectively correct the cause.

PMID: 26885290 [PubMed]

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Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery.

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery.

J Korean Neurosurg Soc. 2016 Jan;59(1):52-7

Authors: Kshettry VR, Lobo B, Lim J, Sade B, Oya S, Lee JH

Abstract
OBJECTIVE: Many surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction.
METHODS: We conducted a retrospective review of operations performed by the senior author from 2004-2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications.
RESULTS: Incisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05).
CONCLUSION: When primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

PMID: 26885286 [PubMed]

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An Analysis of Adverse Event Reporting in Balloon Sinus Procedures.

An Analysis of Adverse Event Reporting in Balloon Sinus Procedures.

Otolaryngol Head Neck Surg. 2016 Feb 16;

Authors: Prince A, Bhattacharyya N

Abstract
OBJECTIVE: (1) Become familiar with reported adverse events related to balloon dilation of the paranasal sinus ostia. (2) Understand the sequelae occurring with these events.
STUDY DESIGN: Retrospective analysis of a prospective database.
SETTING: OpenFDA database.
SUBJECTS AND METHODS: The OpenFDA program website of the Food and Drug Administration was queried with the Application Program Interface query system for medical device adverse events involving balloon devices for the dilation of paranasal sinus ostia from January 2006 through December 2014. The raw data were then tabulated, with adverse events codified by event type, sinus involved, injury type, device malfunction, surgeon error, and qualitative data. Sequelae were also quantified.
RESULTS: In sum, 114 adverse events were identified. Patient injury was the most frequently reported adverse event (n = 72), followed by 36 device malfunctions, 4 deaths, and 2 unclassified. The most common injury involved orbital complications, including 23 (20.2%) orbital wall fractures and 22 (19.3%) postseptal and 22 (19.3%) preseptal orbital injuries. In addition, there were 17 (14.9%) skull base injuries and 7 (6.1%) cases of severe epistaxis observed; 11 (9.6%) cases mentioned surgeon error. Cerebrospinal fluid leak was significantly associated with frontal surgery (P = .002) and sphenoid surgery (P = .001), whereas post- and preseptal orbital injury was associated with maxillary surgery (P = .017 and P = .002). Epistaxis was associated with sphenoid surgery (P = .032).
CONCLUSIONS: Based on the number of balloon sinus procedures performed, Food and Drug Administration-reported adverse events are uncommon, although a select portion can be severe. Surgeons should be aware of different complications reported with specific sinuses addressed with balloon techniques.

PMID: 26884361 [PubMed - as supplied by publisher]

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Τρίτη 16 Φεβρουαρίου 2016

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

Abstract
BACKGROUND: Cholesteatoma is keratinising epithelium within the middle-ear cleft or mastoid. This disease destroys the peripheral organs of balance and hearing, with possible intracranial sequelae. The management of cholesteatoma is surgical and the primary aim is to remove the disease and prevent recurrence. Secondary aims are to obtain a non-discharging, hearing ear. Cholesteatoma surgery falls into two broad categories: open cavity surgery and combined approach surgery. A third surgical category is reconstruction of an open mastoid cavity after open surgery. This study performed a pooled analysis of the worldwide literature to compare the rates of cholesteatoma not being cured (i.e. recidivism), ear discharge and hearing change among open cavity, combined approach and reconstruction mastoid surgery for primary cholesteatoma.
METHODS: A literature search for all types of cholesteatoma surgery in the PubMed, Google Scholar and Medline databases and in published conference proceedings was undertaken.
RESULTS: There was no level 1 evidence for the best method of primary cholesteatoma surgery. The highest evidence level found (level 2; 5366 patients) shows no difference in hearing change or discharge rate between open and combined approach surgery; however, these methods fail to cure the cholesteatomas in 16.0 per cent and 29.4 per cent of cases, respectively. In a total of 640 patients, reconstruction and/or repair mastoid surgery using a variety of non-comparable techniques had a failure rate of between 5.3 per cent and 20 per cent.
CONCLUSION: The available evidence suggests that reconstruction of the posterior canal wall and/or obliteration of the mastoid may be the best surgical treatment alternative. This technique appears to provide the lowest recidivism rate combined with a low post-operative ear discharge rate.

PMID: 26878375 [PubMed - as supplied by publisher]

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Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

J Laryngol Otol. 2016 Mar;130(3):321

Authors: Kouhi A, Vakili Zarch V

PMID: 26878378 [PubMed - as supplied by publisher]

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Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.

Iran J Otorhinolaryngol. 2016 Jan;28(84):39-43

Authors: Mishra SK, Mathew GA, Paul RR, Asif SK, John M, Varghese AM, Kurien M

Abstract
INTRODUCTION: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting.
MATERIALS AND METHODS: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year.
RESULTS: Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak.
CONCLUSION: Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

PMID: 26878002 [PubMed]

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Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners.

Int J Audiol. 2016 Feb 15;:1-10

Authors: Schulz KA, Modeste N, Lee J, Roberts R, Saunders GH, Witsell DL

Abstract
OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework.
DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires.
STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved.
RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001).
CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted.

PMID: 26878243 [PubMed - as supplied by publisher]

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Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Predicting three-month and 12-month post-fitting real-world hearing-aid outcome using pre-fitting acceptable noise level (ANL).

Int J Audiol. 2016 Feb 15;:1-10

Authors: Wu YH, Ho HC, Hsiao SH, Brummet RB, Chipara O

Abstract
OBJECTIVE: Determine the extent to which pre-fitting acceptable noise level (ANL), with or without other predictors such as hearing-aid experience, can predict real-world hearing-aid outcomes at three and 12 months post-fitting.
DESIGN: ANLs were measured before hearing-aid fitting. Post-fitting outcome was assessed using the international outcome inventory for hearing aids (IOI-HA) and a hearing-aid use questionnaire. Models that predicted outcomes (successful vs. unsuccessful) were built using logistic regression and several machine learning algorithms, and were evaluated using the cross-validation technique.
STUDY SAMPLE: A total of 132 adults with hearing impairment.
RESULTS: The prediction accuracy of the models ranged from 61% to 68% (IOI-HA) and from 55% to 61% (hearing-aid use questionnaire). The models performed more poorly in predicting 12-month than three-month outcomes. The ANL cutoff between successful and unsuccessful users was higher for experienced (∼18 dB) than first-time hearing-aid users (∼10 dB), indicating that most experienced users will be predicted as successful users regardless of their ANLs.
CONCLUSIONS: Pre-fitting ANL is more useful in predicting short-term (three months) hearing-aid outcomes for first-time users, as measured by the IOI-HA. The prediction accuracy was lower than the accuracy reported by some previous research that used a cross-sectional design.

PMID: 26878163 [PubMed - as supplied by publisher]

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Role of endoscopic surgery in the management of sinonasal and skull base schwannomas.

Role of endoscopic surgery in the management of sinonasal and skull base schwannomas.

Head Neck. 2016 Feb 15;

Authors: Karligkiotis A, Turri-Zanoni M, Sica E, Facco C, Freguia S, Mercuri A, Pistochini A, Bignami M, Castelnuovo P

Abstract
BACKGROUND: The purpose of this study was to report our experience with the endoscopic management of sinonasal schwannomas, analyzing the advantages, limitations, and outcomes of the technique.
METHODS: A retrospective analysis was carried out on 11 patients treated endoscopically between 2000 and 2014 at a single institution.
RESULTS: Eight patients underwent an exclusive endoscopic endonasal approach, whereas, in 3 patients, an osteoplastic flap was combined because of massive or lateral frontal sinus involvement. The tumor extended into the orbit in 5 cases, and involved the skull base in 5 patients who required a concomitant endoscopic duraplasty. No evidence of disease was observed in 10 patients after a mean follow-up of 90.1 months (range, 14-189 months). One patient was alive with persistence of disease, although asymptomatic.
CONCLUSION: The endoscopic endonasal approach is a valid alternative for the vast majority of sinonasal schwannomas with minimal morbidity for the patient. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26876981 [PubMed - as supplied by publisher]

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How I do it: the combined petrosectomy.

How I do it: the combined petrosectomy.

Acta Neurochir (Wien). 2016 Feb 15;

Authors: Troude L, Carissimi M, Lavieille JP, Roche PH

Abstract
BACKGROUND: Petroclival and ventral brain stem tumors require a complex approach.
METHOD: The combined petrosectomy is an epidural transtentorial-transpetrosal otoneurosurgical approach to achieve a retrolabyrinthine presigmoidal approach and an anterior petrosectomy in one single procedure. The different steps of this approach are described and illustrated by figures and a video. The indications and limitations of the technique are presented.
CONCLUSION: The combined petrosectomy offers multiple corridors to the petroclival region and ventral brainstem while preserving the intrapetrous neurotological structures. Meticulous stepwise bony resection optimizing the dural opening and preservation of veins contributes to reducing the risk inherent to this technique.

PMID: 26876566 [PubMed - as supplied by publisher]

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Uncontrolled spread following radiosurgery for a skull base aspergilloma misdiagnosed as schwannoma: is radiosurgery responsible?

Uncontrolled spread following radiosurgery for a skull base aspergilloma misdiagnosed as schwannoma: is radiosurgery responsible?

Acta Neurochir (Wien). 2016 Feb 15;

Authors: Mukherjee KK, Salunke P

Abstract
BACKGROUND: Little is known about the natural history of skull base fungal lesions in immunocompetent individuals and the effect of high-dose radiation on fungal lesions.
METHOD AND RESULTS: We report a case where radiosurgery was given to a skull base aspergilloma, mistaking it to be a trigeminal schwannoma. There was dramatic spread of the lesion to periventricular region with significant increase in the skull base lesion. The patient never received steroids. A stereotactic biopsy established the diagnosis, and treatment with voriconazole helped.
CONCLUSIONS: It is possible that radiosurgery decreases local immunity due to vascular sclerosis and aids in spread of the fungal lesion, though it is only speculative. This again highlights the importance of establishing the diagnosis prior to radiosurgery.

PMID: 26876565 [PubMed - as supplied by publisher]

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Advantage of extended craniofacial resection for advanced malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and surgical management.

Advantage of extended craniofacial resection for advanced malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and surgical management.

World Neurosurg. 2016 Feb 11;

Authors: Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M

PMID: 26875653 [PubMed - as supplied by publisher]

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Endoscopic endonasal transmaxillary transpterygoid approach to meckel cave: anatomical study and preliminary clinical results.

Endoscopic endonasal transmaxillary transpterygoid approach to meckel cave: anatomical study and preliminary clinical results.

J Neurol Surg A Cent Eur Neurosurg. 2015 May;76(3):205-10

Authors: Gu Y, Yu Y, Zhang X, Hu F, Wang X, Xu W, Xie T

Abstract
OBJECTIVE: Tumors involving Meckel cave (MC) always present challenges to neurosurgeons. We performed an investigation of the anatomical characteristics of the endoscopic endonasal transmaxillary transpterygoid approach to MC as an alternative to routine transcranial approaches and further confirmed its efficacy in the clinical setting.
METHODS: Five adult fresh head specimens (10 sides) were studied to identify crucial anatomical landmarks and quantify the anatomical structures involved in the endoscopic endonasal transmaxillary transpterygoid approach. Two patients with a tumor involving the left MC were treated using the endoscopic endonasal transmaxillary transpterygoid approach.
RESULTS: The distance from the columella nasi to the choana, the sphenoid ostium, the anterior aperture of the palatosphenoidal canal (PSC), the sphenopalatine foramen, and the anterior aperture of the vidian canal (VC) was 66.5 ± 3.3 mm, 61.2 ± 1.6 mm, 64.6 ± 1.4 mm, 62.8 ± 2.3 mm, and 75.4 ± 3.3 mm, respectively. The distance from the anterior aperture of the VC to the anterior aperture of the PSC and the foramen rotundum (FR) was 2.1 ± 0.7 mm and 7.5 ± 0.7 mm, respectively; the length of the PSC and the VC was 6.4 ± 0.5 mm and 13.3 ± 1.2 mm, respectively. The landmarks of this route included the PSC, the VC, and the paraclival carotid prominence (CP). Subtotal resection and gross total resection were achieved in the first and second patients, respectively.
CONCLUSION: The anatomical landmarks of the endoscopic endonasal transmaxillary transpterygoid route are useful for clinical application. The endoscopic endonasal transmaxillary transpterygoid approach is an effective and minimally invasive route for certain tumors involving MC. Identifying the anatomical landmarks including the PSC, the VC, the FR, and the CP is crucial for safe manipulation.

PMID: 25539067 [PubMed - indexed for MEDLINE]

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Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):79-82

Authors: Izadi F, Ghanbari H, Azizi MR, Gasembaglou S, Manteghi MJ, Ghanbari A

Abstract
INTRODUCTION: Inflammatory myofibroblastic pseudotumors are initially described in the lung and various extrapulmonary sites such as the orbits, palatine tonsils, ears, gingiva, pterygomaxillary space, and periodontal tissues. These tumors rarely involve the larynx and predilection to the glottis occurs in an indolent manner.
CASE REPORT: This case describes a laryngeal myofibroblastic tumor in a 46-year-old woman who presented with an aggressive tumor that extended to the floor of the mouth and the base of the tongue. Extended supraglottic laryngectomy was undertaken for the patient. The diagnosis was spindle cell proliferation with dense lymphoplasma cell infiltration compatible with inflammatory myofibroblastic tumor (Inflammatory pseudotumor or plasma cell granuloma). Definitive diagnosis was achieved with immunohistochemical (IHC) staining.
CONCLUSION: We believe that further IHC studies are required to define the true nature of these tumors especially for those that behave in an aggressive pattern.

PMID: 26878008 [PubMed]

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Pleomorphic Adenoma of the Larynx: A Case Report.

Pleomorphic Adenoma of the Larynx: A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):73-7

Authors: Motahari SJ, Khavarinejad F, Salimi S, Bahari M

Abstract
INTRODUCTION: Pleomorphic adenomas are tumors mostly originating from salivary glands. These lesions in the larynx are very rare.
CASE REPORT: We report a rare case of pleomorphic adenoma that originated from the mucosal lining, just above the glottic area at the level of the laryngeal ventricle in a 55-year-old female patient. The tumor could not be palpated easily but was observed in the CT scan. We resected the large and firm tumor using trans hyoid pharyngotomy as the surgical approach.
CONCLUSION: Pleomorphic adenoma in the ventricle of the larynx is an extremely rare lesion. Trans-hyoid pharyngotomy can have good results as the surgical approach in removing such lesions.

PMID: 26878007 [PubMed]

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Relapsing polychondritis: A clinical update.

Relapsing polychondritis: A clinical update.

Autoimmun Rev. 2016 Feb 11;

Authors: Longo L, Greco A, Rea A, Vasco VR, De Virgilio A, De Vincentiis M

Abstract
Relapsing polychondritis (RP) is a rare connective tissue disease in which recurrent bouts of inflammation, involve the cartilage of the ears, nose, larynx, tracheobronchial tree and cardiovascular system. RP is generally observed in the fourth and fifth decade of life and occur with equal frequency in both sexes. The cause of RP is still unknown. It is considered an immune-mediated disease, as there is an overlap well documented RP with other rheumatic and autoimmune diseases. There is a significant association of RP with the antigen HLA-DR4. RP include loss of basophilic staining of cartilage matrix perichondral accompanied by inflammation of the cartilage. Cells are present perivascular mononuclear and polymorphonuclear cells infiltrated. The chondrocytes become vacuolated and necrotic and are replaced by fibrous tissue. Common symptoms are often absent in the early stages of the disease in almost half the cases, resulting in delay in diagnosis. The development of chondrite allows the diagnosis of RP in patients initially evaluated for joint abnormalities, ocular, cutaneous, or audio-vestibular. Diagnostic criteria for RP are based on characteristic clinical manifestations. According to Damiani and Levine, the diagnosis can be considered final when one or more of the clinical features are present in conjunction with biopsy confirmation. The course of symptoms for patients with relapsing polychondritis is often unpredictable. Patients with mild signs of acute inflammation are usually treated with non-steroidal anti-inflammatory drugs and small doses of prednisone. Patients with severe manifestations, such as airway compromise may require high doses of prednisone or even intravenous pulse methyl-prednisone.

PMID: 26876384 [PubMed - as supplied by publisher]

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The involvement of upper airway in Wegener's granulomatosis - about four cases.

The involvement of upper airway in Wegener's granulomatosis - about four cases.

Rom J Morphol Embryol. 2015;56(2):613-8

Authors: Sarău CA, Lighezan DF, Doroş IC, Ştefănescu EH, Iovănescu G, Balica NC, Horhat ID, Poenaru M

Abstract
The authors present four cases of Wegener's granulomatosis patients with multiorganic manifestation forms, but with a prevalent involvement in upper-airway. Granulomatosis diseases of the nose include bacterial infections (rhinoscleroma, tuberculosis, syphilis, lupus, and leprosy), fungal infections (rhinosporidiosis, aspergillosis, mucormycosis, candidosis, histoplasmosis, and blastomycosis) and diseases with unspecified etiology (Wegener's granulomatosis, mediofacial malignant granuloma, and sarcoidosis). We consider an interesting experience regarding Wegener's granulomatosis due to its rarity, being an autoimmune systemic disease, with continuous evolution and multiorganic involvement. The beginning of the disease is like upper airway affection, a kind of "persistent cold", being difficult to differentiate it from a common cold in the head, with a prolonged evolution. It is important to mention that we establish the diagnosis of Wegener's granulomatosis starting with Ear Nose and Throat (ENT) clinical exam, followed by other tests and investigations realized in our Clinic and completed with specialty tests (nephrology, internal medicine and dermatology), meaning that we need a close cooperation with these medical specialties. All the patients presented multiorganic involvement. Notably significant for our four cases is the prolonged evolution in a stable condition in one patient.

PMID: 26193239 [PubMed - indexed for MEDLINE]

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Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host.

Chronic Invasive Fungal Granuloma-A Diagnostic Dilemma in an Immunocompetent Host.

Iran J Otorhinolaryngol. 2016 Jan;28(84):83-8

Authors: S Chavan S, Bhople KS, Deshmukh SD, V Jain P, Sonavani M

Abstract
INTRODUCTION: Invasive fungal sinusitis, though considered to be rare entity, is nowadays frequently encountered, not only in immunocompromised patients but also in immunocompetent patients. The changing prevalence towards immunocompetent hosts is due to the indiscriminate usage of broad spectrum antibiotics, steroids, and immunosuppressive drugs. Diagnosing invasive fungal sinusitis should not pose any difficulty to both the clinician [a whitish colour secretion in elderly Diabetics, and CT Scan PNS showing concretion in the sinus along with destruction of the surrounding bone] and to the pathologist; however, when the invasive fungal sinus infection presents in a form of a granuloma then its diagnosis imposes a challenge to medical professionals.
CASE REPORT: We are presenting a case study,which consists of 3 cases of chronic invasive fungal sinus infection.Two patients were treated for tuberculoma and had completed a course of Anti Koch's Treatment and one patient was given a trial of broad spectrum antibiotics and steroids.Eventually all cases were diagnosed as a chronic invasive form of fungal granuloma (CIFG).
CONCLUSION: CIFG of the paranasal sinuses is seen in immunocompetent hosts, especially those that are in the 2nd and 3rd decades of their lives. Gradually progressive proptosis is the primary presenting symptom. MRI scanning is a better imaging modality compared to CT scanning. Routine H&E staining may prove inadequate and special stains such as the GMS stain should be employed in the slightest doubt of a fungal aetiology. A team approach towards patients is paramount for early diagnosis and timely medical and surgical intervention.

PMID: 26878009 [PubMed]

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Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Inflammatory Myofibroblastic Tumor of the Larynx:A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):79-82

Authors: Izadi F, Ghanbari H, Azizi MR, Gasembaglou S, Manteghi MJ, Ghanbari A

PMID: 26878008 [PubMed]

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Pleomorphic Adenoma of the Larynx: A Case Report.

Pleomorphic Adenoma of the Larynx: A Case Report.

Iran J Otorhinolaryngol. 2016 Jan;28(84):73-7

Authors: Motahari SJ, Khavarinejad F, Salimi S, Bahari M

PMID: 26878007 [PubMed]

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An Unusual Case of Cauda Equina Secondary to Spinal Metastasis of Thyroid Cancer.

An Unusual Case of Cauda Equina Secondary to Spinal Metastasis of Thyroid Cancer.

Iran J Otorhinolaryngol. 2016 Jan;28(84):67-71

Authors: Akhtar S, Adeel M

Abstract
INTRODUCTION: Cauda equina secondary to metastatic follicular thyroid cancer of the lumbosacral area is a rare entity.
CASE REPORT: We report an unusual case of a 52-year-old male who presented with backache, lower limb weakness, and perianal numbness. A CT-scan of the lumbosacral area showed an enhancing mass at the L4, L5 and S1 vertebrae. Histopathology after excision revealed a metastatic thyroid cancer. Hence, a CT scan of the neck and chest was performed which showed a nodule in the left lobe of the thyroid and a mass in the left chest wall. A total thyroidectomy and excision of the chest wall lesion was undergone, which was diagnosed as a follicular carcinoma of the thyroid.
CONCLUSION: Metastatic workup of spinal metastasis should include evaluation of the thyroid gland.

PMID: 26878006 [PubMed]

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Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children.

Effects of Tonsil size on Pulmonary Function test Results after Tonsillectomy in Children.

Iran J Otorhinolaryngol. 2016 Jan;28(84):61-6

Authors: Samareh Fekri M, Arabi Mianroodi A, Shakeri H, Khanjani N

Abstract
INTRODUCTION: Adenotonsillar hypertrophy is a typical cause of surgery in children. Evaluation and identification of patients as potential candidates tonsillectomy is a primary concern for otolaryngologists. This study focuses on the results of pulmonary function tests (PFTs) after tonsillectomy in children.
MATERIALS AND METHODS: This cross-sectional study examined 50 patients suffering from tonsillar hypertrophy in 2013. Full details and results of otolaryngology examinations were recorded. Moreover, patients were examined with respect to forced inspiratory flow at 50% of vital capacity (FIF50%), forced expiratory flow at 50% of vital capacity (FEF50%), forced expiratory volume in 1 second (FEV1)/peak expiratory flow rate (PEFR), and FEV1/forced expired volume in 0.5 seconds (FEV0.5) before and after surgery using spirometry. All data were analyzed using SPSS Software (version 19), and central descriptive measures, and data were compared by performing T-test and Chi-square tests.
RESULTS: According to tonsil size, patients were distributed as follows: 18 patients (36%) with +1 tonsil size, 18 patients (36%) with +2 tonsil size, and seven patients (14%) with +3 tonsil size, and seven patients (14%) with +4 tonsil size. Thirty-three (66%) and 17 patients (34%) were female and male, respectively, with a mean of age of 9.7[Formula: see text]2.97 years (range, 7-18 years). Seventy-eight percent of patients were aged 10 years or less. Moreover, 25 patients (50%), 17 patients (34%), and eight patients (16%), respectively, reported obstructive symptoms, recurrent tonsillitis, and both symptoms. In patients with +3 and +4 tonsil size, spirometric parameters indicated relief of symptoms of obstruction. Only in patients with +4 tonsil size were the changes statistically significant.
CONCLUSION: Tonsillectomy can relieve obstructive symptoms in patients with tonsils larger than +3 to a great extent. Additionally, spirometry can identify patients with +3 and +4 tonsils who do not have clinical signs of an obstructive upper airway.

PMID: 26878005 [PubMed]

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MTA1 Expression in Benign and Malignant Salivary gland Tumors.

MTA1 Expression in Benign and Malignant Salivary gland Tumors.

Iran J Otorhinolaryngol. 2016 Jan;28(84):51-9

Authors: Andisheh-Tadbir A, Dehghani-Nazhvani A, Ashraf MJ, Khademi B, Mirhadi H, Torabi-Ardekani S

Abstract
INTRODUCTION: Salivary gland tumors (SGTs) are important parts of human neoplasms. The most common SGT is pleomorphic adenoma and the most common malignant SGTs are mucoepidermoid carcinoma and adenoid cystic carcinoma (ACC). Metastasis-associated genes 1 (MTA1), a member of the nucleosome remodeling and histone deacetylation complex, is one newly discovered gene which recruits histone deacetylation, causing ATP-dependent chromosome remodeling, and regulating transcription. MTA1 had been shown to be overexpressed in malignant tumors with the enhancement of invasion and metastasis.
MATERIALS AND METHODS: Fifty-six samples of salivary gland tumors from the Khalili Hospital archive, including 20 cases of pleomorphic adenoma, 17 cases of mucoepidermoid carcinoma, 19 cases of ACC, and 23 cases of normal salivary gland tissues were chosen for immunohistochemical analysis of MTA1.
RESULTS: MTA1 expression in the malignant tumors was significantly higher than that in pleomorphic adenoma (P<0.001), and higher in pleomorphic adenoma than the normal salivary glands(P< 0.001). In total, 69.6% of normal salivary gland tissues showed MTA1, but all cases of salivary gland tumors were positive for MTA1. High nuclear expression of MTA1 was detected in 83.3% (30/36) of the malignant salivary gland tumors and 45% (9/20) of pleomorphic adenoma, while low MTA1 expression was seen in all of the normal salivary gland tissues. No statistically significant correlation was found between MTA1 protein expression and any clinicopathological features (P>0.05).
CONCLUSION: Our findings demonstrate that MTA1 was significantly overexpressed in malignant salivary gland neoplasm in comparison to a lower level in benign pleomorphic adenoma, suggesting that MTA1 protein might be involved in carcinogenesis.

PMID: 26878004 [PubMed]

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Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

J Laryngol Otol. 2016 Mar;130(3):321

Authors: Kouhi A, Vakili Zarch V

PMID: 26878378 [PubMed - as supplied by publisher]

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Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion.

Outcome evaluation of clarithromycin, metronidazole and lansoprazole regimens in Helicobacter pylori positive or negative children with resistant otitis media with effusion.

J Laryngol Otol. 2016 Mar;130(3):318

Authors: Bakshi SS

PMID: 26878377 [PubMed - as supplied by publisher]

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You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients.

You can't pay me to quit: the failure of financial incentives for smoking cessation in head and neck cancer patients.

J Laryngol Otol. 2016 Mar;130(3):278-283

Authors: Ghosh A, Philiponis G, Bewley A, Ransom ER, Mirza N

Abstract
OBJECTIVE: A prospective randomised study was conducted at a tertiary care hospital to evaluate the effects of financial incentives for smoking cessation targeted at a high-risk population.
METHODS: Patients with a past history of head and neck cancer were voluntarily enrolled over a two-year period. They were randomised to a cash incentives or no incentive group. Subjects were offered enrolment in smoking cessation courses. Smoking by-product levels were assessed at 30 days, 3 months and 6 months. Subjects in the incentive group received $150 if smoking cessation was confirmed.
RESULTS: Over 2 years, 114 patients with an established diagnosis of head and neck cancer were offered enrolment. Twenty-four enrolled and 14 attended the smoking cessation classes. Only two successfully quit smoking at six months. Both these patients were in the financially incentivised group and received $150 at each test visit.
CONCLUSION: Providing a financial incentive for smoking cessation to a population already carrying a diagnosis of head and neck cancer in order to promote a positive behaviour change was unsuccessful.

PMID: 26878376 [PubMed - as supplied by publisher]

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Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

Pooled analysis of the evidence for open cavity, combined approach and reconstruction of the mastoid cavity in primary cholesteatoma surgery.

J Laryngol Otol. 2016 Mar;130(3):235-241

Authors: Harris AT, Mettias B, Lesser TH

PMID: 26878375 [PubMed - as supplied by publisher]

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Medications for Ménière's disease?

Medications for Ménière's disease?

J Laryngol Otol. 2016 Mar;130(3):213

Authors: Youngs R, Fisher E, Hussain M, Fishman J

PMID: 26878374 [PubMed - as supplied by publisher]

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Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites.

Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites.

J Laryngol Otol. 2016 Feb 15;:1-5

Authors: Morand GB, Madana J, Da Silva SD, Hier MP, Mlynarek AM, Black MJ

Abstract
BACKGROUND: Merkel cell carcinoma is a rare, aggressive neurocutaneous malignancy. This study investigated whether patients with Merkel cell carcinoma in the head and neck had poorer outcomes than patients with Merkel cell carcinoma located elsewhere.
METHODS: A retrospective study was performed of patients with Merkel cell carcinoma treated at the Jewish General Hospital in Montréal, Canada, from 1993 to 2013. Associations between clinicopathological characteristics and disease-free and disease-specific survival rates were examined according to the Kaplan-Meier method.
RESULTS: Twenty-seven patients were identified. Although basic clinicopathological characteristics and treatments were similar between head and neck and non-head and neck Merkel cell carcinoma groups, disease-free and disease-specific survival rates were significantly lower in the head and neck Merkel cell carcinoma group (log-rank test; p = 0.043 and p = 0.001, respectively). Mortality was mainly due to distant metastasis.
CONCLUSION: Patients with head and neck Merkel cell carcinoma had poorer survival rates than patients with non-head and neck Merkel cell carcinoma in our study. The tendency to obtain close margins, a less predictable metastatic pattern, and/or intrinsic tumour factors related to the head and neck may explain this discrepancy.

PMID: 26875509 [PubMed - as supplied by publisher]

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Δευτέρα 15 Φεβρουαρίου 2016

Cholesteatoma growth patterns: are there audiometric differences between posterior epitympanic and posterior mesotympanic cholesteatoma?

Cholesteatoma growth patterns: are there audiometric differences between posterior epitympanic and posterior mesotympanic cholesteatoma?

Eur Arch Otorhinolaryngol. 2016 Feb 13;

Authors: Rosito LP, Teixeira AR, Netto LS, Selaimen FA, da Costa SS

Abstract
The objective of this is to verify whether the hearing impairment caused by posterior epitympanic differed from that caused by posterior mesotympanic cholesteatomas by a cross-sectional study. We evaluated 264 ears of patients with cholesteatoma, who had not been subjected to ear surgery. Otoendoscopy and pure-tone audiometry were performed. Analyzed route involved in cholesteatoma formation: posterior epitympanic or posterior mesotympanic, air-bone gaps at 512-4000 Hz and pure-tone averages. The mean age of the patients enrolled in this study was 33.8 years, and 51.8 % of them was male. Posterior epitympanic cholesteatoma was found in 50.4 % of the study population. When the air-bone gaps were compared, the mesotympanic group had greater thresholds at 500, 2000 Hz, and a greater pure-tone average (P = 0.003, P = 0.03, and P = 0.02, respectively). Posterior mesotympanic cholesteatoma showed greater air-bone gaps thresholds at the speech frequencies than posterior epitympanic cholesteatoma did. Moreover, the two growth patterns were very similar with regard to all other audiometric parameters analyzed in this study.

PMID: 26874734 [PubMed - as supplied by publisher]

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Predictors of post-treatment smoking and drinking behavior of head and neck cancer survivors: results of a population-based survey.

Predictors of post-treatment smoking and drinking behavior of head and neck cancer survivors: results of a population-based survey.

Eur Arch Otorhinolaryngol. 2016 Feb 13;

Authors: Schiller U, Inhestern J, Burger U, Singer S, Guntinas-Lichius O

Abstract
Predictors for smoking and alcohol drinking behavior were investigated in head and neck cancer survivors (HNCS) with survivorship of ≥6 months. 165 HNCS registered in a regional cancer registry and treated 2005-2014 were included. Patients completed a survey including the Fagerström Test for nicotine dependence and the Alcohol Use Disorders Identification Test. Smoking and drinking cessation rates were 51 and 13 %, respectively. Multinomial logistic regression analyses showed that male patients [odds ratio (OR) 35.4; confidence interval (CI) 7.5-168.1; p < 0.0001], single persons (OR 9.9; CI 2.5-40.0; p = 0.001), and younger patients (OR 1.1; CI 1.0-1.1; p = 0.002) had significantly higher probability to be current smokers. Male gender (OR 48.7; CI 5.0-470.7; p < 0.0001) and younger age (OR 1.1; CI 1.0-1.3; p = 0.003) were predictors of risky alcohol consumption. Male, young, and single smoking and/or drinking HNCS should be stimulated to take part in smoking and/or alcohol drinking cessation programs.

PMID: 26874733 [PubMed - as supplied by publisher]

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Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis.

Effectiveness of superselective intra-arterial chemoradiotherapy targeting retropharyngeal lymph node metastasis.

Eur Arch Otorhinolaryngol. 2016 Feb 13;

Authors: Suzuki T, Sakashita T, Homma A, Hatakeyama H, Kano S, Mizumachi T, Yoshida D, Fujima N, Onimaru R, Tsuchiya K, Yasuda K, Shirato H, Suzuki F, Fukuda S

Abstract
We sought to evaluate the efficacy and feasibility of superselective intra-arterial infusion of high-dose cisplatin with concomitant radiotherapy (hereafter RADPLAT) for head and neck squamous cell cancer (hereafter HNSCC) patients with retropharyngeal lymph node (hereafter RPLN) metastasis. A retrospective case series review was conducted at University medical center in Japan. Ten HNSCC patients with RPLN metastasis treated by RADPLAT were analyzed. The ascending pharyngeal artery was targeted for the treatment of RPLN metastasis in 9 patients. The median total dose of cisplatin was 26.6 mg/m(2) (mean 31.5 mg/m(2), range 11.7-87.9 mg/m(2)). In the remaining patient, the RPLN was supplied by the ascending palatine artery. As grade 3 and 4 adverse effects, leukopenia was observed in three, mucositis in four and nausea in one patient. No neurological complications were observed in any patients. Metastatic RPLNs were evaluated as a complete response in all patients. There was no recurrence of RPLN metastasis in any patients. Four patients remain alive without any evidence of disease and six patients died of disease. The 5-year overall survival rate was 50 %. We have shown that superselective intra-arterial cisplatin infusion for RPLNs was a feasible and effective approach for HNSCC patients with RPLN metastasis.

PMID: 26874732 [PubMed - as supplied by publisher]

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The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center.

The increasing incidence of paranasal organizing hematoma: a 20-year experience of 23 cases at a single center.

Rhinology. 2016 Feb 14;

Authors: Kim JS, Oh JS, Kwon SH

Abstract
BACKGROUND AND OBJECTIVES: Sinonasal organized hematoma is a rare, benign disease that can be locally aggressive and may be mistaken for malignancy. Because of its rarity, the clinical characteristics are not well known. The aim of this study is to investigate the distinguishing features of organized hematoma with an emphasis on incidence change.
MATERIALS AND METHODS: In this retrospective study, we reviewed the records of 23 patients with organized hematoma con rmed histopathologically among 5,378 patients who underwent endoscopic sinus surgery performed by a single surgeon from January 1995 to December 2014 at a tertiary care center. Clinical symptoms, endoscopic photography, computed tomography, and operative ndings were reviewed. We also reviewed the relevant literature. Age, sex, site, origin subsite and histopathology were investigated. A statistical review was performed using R 3.1.2 to examine incidence change.
RESULTS: The most common complaint was frequent epistaxis and nasal obstruction (52.1%). Of the 23 patients, eight were women and 15 were men with an age range of 18 to 75 years. (mean 38.9 years). Nine of these hematomas occurred on the right side and 14 on the left side. The predominant occurrence site was the antrum (65%), followed by the septum (17.3%), inferior turbinate (8%), and ethmoid sinus (8%). The incidence steadily increased over 20 years.
CONCLUSION: Investigation of the clinical characteristics and incidence change of organized hematoma can provide useful information. Through analysis of the 23 cases in our study, the age distribution was found to be bimodal and the incidence of organizing hematoma was observed to steadily increase. Clinicians should be aware of these characteristics to avoid misdiagnoses of malignant tumors.

PMID: 26874999 [PubMed - as supplied by publisher]

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Primary school children often underestimate their nasal obstruction.

Primary school children often underestimate their nasal obstruction.

Rhinology. 2016 Feb 14;

Authors: Occasi F, Duse M, Vittori T, Rugiano A, Tancredi G, De Castro G, Indinnimeo L, Zicari AM

Abstract
BACKGROUND: No consensus has ever been reached about the correlation between nasal resistance and the subjective sensation of nasal patency. The aim of the present study was to better de ne whether primary school and secondary school aged children correctly estimate their nasal obstruction.
MATERIALS AND METHODS: Two hundred eighty four children (168 males and 116 female) aged between 6 and 14 years (9.5+2.9 years) a ected by Pediatric Allergic Rhinitis underwent Rhinomanometry and they were considered as correctly estimating their nasal obstruction when the grade of nasal patency corresponded to the severity of the NOSE score, overestimating when the grade of nasal patency was smaller than 1 when compared to the severity of the score, underestimating when the grade of nasal patency was larger than 1 when compared to the severity of the score.
RESULTS: Correlation between NOSE score and nasal patency was statistically significant (r -0.74; p smaller than 0.001). Children between 6 and 9 years of age underestimate (43.7%) and children over 12 overestimate (34.7%) their symptoms more frequently than children among other age ranges (p smaller than 0.001).
CONCLUSION: Although NOSE score approximately allow to quantify nasal obstruction, in children, especially between 6 and 9 years of age, an objective measurement of nasal patency should be performed to better define the therapeutic approach.

PMID: 26874896 [PubMed - as supplied by publisher]

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Stereotactic Approach Combined with 3D CT Reconstruction for Difficult-to-Access Foramen Ovale on Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia.

Stereotactic Approach Combined with 3D CT Reconstruction for Difficult-to-Access Foramen Ovale on Radiofrequency Thermocoagulation of the Gasserian Ganglion for Trigeminal Neuralgia.

Pain Med. 2016 Feb 13;

Authors: Guo Z, Wu B, Du C, Cheng M, Tian Y

Abstract
OBJECTIVES: The authors describe a technique that includes a stereotactic approach in the preoperative plan in cases where the foramen ovale is difficult to access for radiofrequency thermocoagulation of the Gasserian ganglion.
METHODS: The study included 395 patients for whom three-dimensional computed tomographic reconstruction of the skull base, maxilla, and mandible was conducted before surgery. Accessibility of the foramen ovale was defined using numerical data from the three-dimensional computed tomographic reconstruction images. In those patients for whom accessibility of the foramen ovale was considered difficult, the authors used a stereotactic frame to design an individual operative plan. Adjustments of a single point of data,-that is, a change in X axis, Y axis, or an arc angle-were guided by radiographic fluoroscopy images. After verifying successful cannulation and electroneurophysiology, thermocoagulation targets-especially multiple targets recorded as data on the Z axis of the stereotactic approach-were identified and treated.
RESULTS: There were 24 patients who met the predetermined criteria for having a difficult-to-access foramen ovales-that is, they had at least two contributing factors and/or involvement of division V1 . Twenty-one of the 24 patients required a single satisfactory puncture; three patients required two to three punctures to successfully access the foramen ovale. There were no permanent complications from the procedure.
CONCLUSIONS: The authors conclude that this stereotactic approach combined with three-dimensional computed tomographic reconstruction model can improve the accuracy, safety, and efficiency of percutaneous radiofrequency thermocoagulation in patients with trigeminal neuralgia for whom the foramen ovale is difficult to access.

PMID: 26874883 [PubMed - as supplied by publisher]

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Κυριακή 14 Φεβρουαρίου 2016

Stage IV sporadic Burkitt's leukaemia with osteolysis in the maxillary sinuses.

Stage IV sporadic Burkitt's leukaemia with osteolysis in the maxillary sinuses.

J Surg Case Rep. 2016;2016(2)

Authors: Yoshioka Y, Yamachika E, Matsubara M, Iida S, Okayama University Hospital and Okayama University, Okayama, Japan

Abstract
We present a case of paediatric Stage IV sporadic Burkitt's leukaemia presenting as cheek enlargement with osteolysis of the maxilla. An 8-year-old boy was referred to our department with diffuse swelling of both cheeks. Head and neck examination revealed bilateral diffuse nontender swelling, non-fluctuant but slightly compressible. Computed tomography imaging showed enhancing bilateral bulky lesions expanding the maxillary sinuses, with associated osteolysis in the posterior walls of both sinuses. Laboratory results included blast cells in the peripheral blood, suggesting a haematopoietic tumour. We referred the patient to the Department of Paediatric Haematology and Oncology. Additional examinations eventually led to the diagnosis of Stage IV sporadic Burkitt's leukaemia.

PMID: 26872961 [PubMed]

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Expression and clinical significance of MAGE and NY-ESO-1 cancer-testis antigens in adenoid cystic carcinoma of the head and neck.

Expression and clinical significance of MAGE and NY-ESO-1 cancer-testis antigens in adenoid cystic carcinoma of the head and neck.

Head Neck. 2016 Feb 13;

Authors: Veit JA, Heine D, Thierauf J, Lennerz J, Shetty S, Schuler PJ, Whiteside T, Beutner D, Meyer M, Grünewald I, Ritter G, Gnjatic S, Sikora AG, Hoffmann TK, Laban S

Abstract
BACKGROUND: Adenoid cystic carcinoma (ACC) of the head and neck is a rare but highly malignant tumor. Cancer-testis antigens (CTAs) represent an immunogenic family of cancer-specific proteins and thus represent an attractive target for immunotherapy.
METHODS: Eighty-four cases of ACC were identified, the CTAs pan-Melanoma antigen (pan-MAGE; M3H67) and New York esophageal squamous cell carcinoma (NY-ESO-1; E978) were detected immunohistochemically (IHC) and correlated with clinical data.
RESULTS: Expression of NY-ESO-1 was found in 48 of 84 patients (57.1%) and of pan-MAGE in 28 of 84 patients (31.2%). Median overall survival (OS) in NY-ESO-1 positive versus negative patients was 130.8 and 282.0 months (p = .223), respectively. OS in pan-MAGE positive versus negative patients was 105.3 and 190.5 months, respectively (p = .096). Patients expressing both NY-ESO-1 and pan-MAGE simultaneously had significantly reduced OS with a median of 90.5 months compared with 282.0 months in negative patients (p = .047).
CONCLUSION: A significant fraction of patients with ACC show expression of the CTAs NY-ESO-1 and/or pan-MAGE with promising immunotherapeutic implications. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26874246 [PubMed - as supplied by publisher]

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Impact of neck failure on survival in older patients with differentiated thyroid cancer.

Impact of neck failure on survival in older patients with differentiated thyroid cancer.

Head Neck. 2016 Feb 13;

Authors: Marcus DM, Jiang R, Ward KC, Higgins KA, Saba NF, Wadsworth JT, Beitler JJ

Abstract
BACKGROUND: Regional recurrence of differentiated thyroid cancer (DTC) is often salvaged with neck dissection without survival penalty. It is unknown whether recurrence may be associated with inferior survival in older patients.
METHODS: Surveillance, Epidemiology, and End Results (SEER) and Medicare data were linked to identify patients age ≥65 with nonmetastatic DTC. Patients undergoing neck dissection >6 months after their initial diagnosis were considered to have regional recurrent disease. We compared overall survival (OS) and cause-specific survival (CSS) for patients with recurrent disease versus a matched cohort of patients with non-recurrent DTC.
RESULTS: Of 6235 patients, 143 had treatment-defined recurrent disease. Patients with recurrent disease had inferior OS (p < .01) and CSS (p < .01). Multivariate analysis demonstrated that recurrent disease was independently associated with inferior 10-year OS (hazard ratio [HR] = 1.75; p < .01) and CSS (HR = 3.05; p < .01).
CONCLUSION: Regional recurrence of DTC may negatively impact OS and CSS in patients ≥65 years old. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26874073 [PubMed - as supplied by publisher]

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Survival and overall treatment time after postoperative radio(chemo)therapy in patients with head and neck cancer.

Survival and overall treatment time after postoperative radio(chemo)therapy in patients with head and neck cancer.

Head Neck. 2016 Feb 13;

Authors: Tribius S, Donner J, Pazdyka H, Münscher A, Gröbe A, Petersen C, Krüll A, Tennstedt P

Abstract
BACKGROUND: Generally, overall treatment time for patients with locally advanced head and neck cancer should be as short as reasonably possible. This analysis was undertaken to determine at what overall treatment time additional survival/locoregional control benefits could be achieved compared to a 100-day cutoff.
METHODS: Clinical impact of overall treatment time was assessed in 272 patients by multivariable Cox regression and Kaplan-Meier analyses using the historical 100-day cutoff and the optimal overall treatment time, determined using recursive partitioning analysis. Survival endpoints were determined for the 100-day and optimal overall treatment times validated using bootstrap resampling.
RESULTS: Recursive partitioning determined the optimal overall treatment time as 87 days. In the 87-day multivariable analysis, adverse factors for overall survival (OS) and disease-free survival (DFS) were overall treatment time ≥87 days and extracapsular spread, and overall treatment time and R1 status, respectively.
CONCLUSION: Overall treatment time is important for survival in patients with head and neck cancer. Completing treatment within as short a timeframe as possible may be associated with longer OS and DFS. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26873810 [PubMed - as supplied by publisher]

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Prophylactic neck dissection for low-risk differentiated thyroid cancers: Risk-benefit analysis.

Prophylactic neck dissection for low-risk differentiated thyroid cancers: Risk-benefit analysis.

Head Neck. 2016 Feb 13;

Authors: Dubernard X, Dabakuyo S, Ouedraogo S, Amroun K, Kere D, Nasser T, Deguelte S, Pochart JM, Merol JC, Makeieff M, Chays A, Schvartz C

Abstract
BACKGROUND: The benefit of neck dissection is the subject of debate in differentiated thyroid cancer (DTC). We analyze the risk-benefit of neck dissection for low-risk DTC without detectable lymph nodes.
METHODS: We conducted a retrospective study from 1983 to 2003; which included 295 patients without detectable lymph nodes who were treated by thyroidectomy with (C+) or without (C-) neck dissection. All patients had iodine131 therapy. We compared the frequency of remission, disease progression, and permanent complications between groups.
RESULTS: Two hundred twelve patients comprised the C+ group, and 83 patients the C- group. Respectively for C+ versus C-, remission rates were 92% versus 89.2% (p = .40), and progressive disease observed was 3.3% versus 7.2% (p = .10). Permanent hypoparathyroidism occurred in 15.1% in C+ versus 3.6% in C- (p = .006).
CONCLUSION: The risk-benefit analysis of neck dissection in patients with low-risk DTC shows no benefit in terms of complete remission or occurrence of progression. However, risk of complications seems to be higher in patients with neck dissection. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26873677 [PubMed - as supplied by publisher]

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Outcomes of endoscopic cricopharyngeal myotomy with CO2 laser surgery: A retrospective study of 47 patients.

Outcomes of endoscopic cricopharyngeal myotomy with CO2 laser surgery: A retrospective study of 47 patients.

Head Neck. 2016 Feb 13;

Authors: Hoesseini A, Honings J, Taus-Mohamedradja R, van den Hoogen FJ, Marres HA, van den Broek GB, Kalf H, Takes RP

Abstract
BACKGROUND: Endoscopic cricopharyngeal myotomy (ECPM) using CO2 laser surgery presents a less invasive treatment technique when compared to transcervical cricopharyngeal myotomy.
METHODS: Forty-seven patients who underwent ECPM from 2002 until 2013 were included in this study. Patient characteristics, and preoperative and postoperative outcome and complications were scored by retrospective chart review and by using the Deglutition Handicap Index (DHI).
RESULTS: Overall, 40 of 47 patients (85%) experienced relief of symptoms postoperatively. Ten patients (25%) developed recurrent symptoms of dysphagia requiring re-laser surgery. All 40 patients were satisfied at the postoperative visit after an average of 1.3 interventions. DHI scores were better in patients with idiopathic dysfunction and neurologic disease, compared to dysfunction because of prior treatment of head and neck cancer. One patient developed mediastinitis that was successfully treated with antibiotics. There was no mortality.
CONCLUSION: ECPM is an effective treatment for cricopharyngeal dysfunction with a low rate of surgical morbidity and complications. © 2015 Wiley Periodicals, Inc. Head Neck, 2015.

PMID: 26873575 [PubMed - as supplied by publisher]

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Functional benefits of implants placed during ablative surgery: A 5-year prospective study on the prosthodontic rehabilitation of 56 edentulous oral cancer patients.

Functional benefits of implants placed during ablative surgery: A 5-year prospective study on the prosthodontic rehabilitation of 56 edentulous oral cancer patients.

Head Neck. 2016 Feb 13;

Authors: Wetzels JG, Koole R, Meijer GJ, de Haan AF, Merkx MA, Speksnijder CM

Abstract
BACKGROUND: The timing of placement as well as the functional benefit of interforaminal implants in edentulous patients treated for oral cancer is unclear.
METHODS: Fifty-six patients were recruited at 2 institutions. In 1 institution, interforaminal implants were placed during ablative surgery, the other institution used conventional prosthodontics with optional placement of implants postsurgery (postponed-placement). Masticatory performance, bite force, and subjective masticatory function were assessed before and 6 months, 1 year, and 5 years after surgery.
RESULTS: Implant-retained overdentures (IODs) demonstrated the highest bite force and the least problems with solid food and food choice. Masticatory performance was equal for IODs and conventional dentures. After 5 years, IODs from patients in the during-ablative-surgery cohort tend to have higher bite force and masticatory performance than those from patients in the postponed-placement cohort.
CONCLUSION: IODs produce the highest overall masticatory function. Implant placement during ablative surgery seems to be functionally beneficial. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26873437 [PubMed - as supplied by publisher]

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Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience.

Transoral laser microsurgery for locally advanced (T3-T4a) supraglottic squamous cell carcinoma: Sixteen years of experience.

Head Neck. 2016 Feb 13;

Authors: Vilaseca I, Blanch JL, Berenguer J, Grau JJ, Verger E, Muxí Á, Bernal-Sprekelsen M

Abstract
BACKGROUND: Controversy exists regarding treatment of advanced laryngeal cancer. The purpose of this study was to evaluate the oncologic and functional outcomes of T3 to T4a supraglottic squamous carcinomas treated with transoral laser microsurgery (TLM).
METHODS: We conducted a retrospective analysis from an SPSS database. Primary outcomes were: locoregional control, overall survival (OS), disease-specific survival (DSS), laryngectomy-free survival, and function-preservation rates. Secondary objectives were: rate of tracheostomies and gastrostomies according to age. Risk factors for local control and larynx preservation were also evaluated.
RESULTS: One hundred fifty-four consecutive patients were chosen for this study. Median follow-up was 40.7 + /- 32.8 months. Five and 10-year OS, DSS, and laryngectomy-free survival were 55.6% and 47%, 67.6% and 58.6%, and 75.2% and 59.5%, respectively. Paraglottic involvement was an independent factor for larynx preservation. Six patients (3.9%) needed a definitive tracheostomy, a gastrostomy, or both. The gastrostomy rate was higher in the group of patients above 65 years of age (p = .03). Five-year laryngectomy-free survival with preserved function was 74.5%.
CONCLUSION: TLM constitutes a true alternative for organ preservation in locally advanced supraglottic carcinomas with good oncologic and functional outcomes. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26872432 [PubMed - as supplied by publisher]

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Αρχειοθήκη ιστολογίου

Πέμπτη 18 Φεβρουαρίου 2016

Τρίτη 16 Φεβρουαρίου 2016

Δευτέρα 15 Φεβρουαρίου 2016

Κυριακή 14 Φεβρουαρίου 2016