Selectively sparing the submandibular gland when level Ib lymph nodes are included in the radiation target volume: An initial safety analysis of a novel planning objective

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Vamsi Varra, Richard B. Ross, Aditya Juloori, Shauna Campbell, Martin C. Tom, Nikhil P. Joshi, Neil M. Woody, Matthew C. Ward, Ping Xia, Shlomo A. Koyfman, John F. Greskovich

Abstract

Background

Submandibular gland (SMG) metastases are extremely rare in head and neck cancer, even in the presence of level Ib lymph node (LN) involvement. In recent years, we have contoured the SMG and specifically attempted to limit its dose exposure even in patients in whom the level Ib LN station is targeted. This study reports our preliminary feasibility and safety experience with selective submandibular gland sparing.

Methods

Patients with squamous cell cancer (SCC) of the oral cavity or oropharynx with T1-2, N0-3, M0 disease in whom at least a single level Ib lymph node region was included in the target volume were identified. All patients were treated from 2009 to 2014 with definitive or postoperative IMRT with or without chemotherapy. Patients with recurrent disease, previous radiation or treated palliatively were excluded.

Results

A total of 174 patients met criteria for inclusion. Among the 185 level Ib LN stations that were deliberately targeted in the clinical treatment volume, 32 submandibular glands were contoured, excluded from the target volume and avoided during treatment planning. Mean dose to the spared SMG were reduced by 12% (66.6 Gy vs. 58.9 Gy, p < .001). None of these patients experienced any level 1b LN failures.

Conclusion

Selective sparing of the submandibular gland when targeting the level 1b nodes in oral cavity and oropharynx cancer is feasible, reduces the mean dose to submandibular glands and does not result in increased level 1b nodal failure rates. Additional studies with larger cohorts are needed to validate this preliminary observation.

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Comment on “‘Chronic traumatic ulcer of lateral tongue’ – An underestimated ‘oral potentially malignant disorder’?”

Publication date: Available online 26 December 2018

Source: Oral Oncology

Author(s): Jerónimo P. Lazos, René L. Panico, Gerardo M. Gilligan, Eduardo D. Piemonte

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A rare case of nasopharyngeal adenoid cystic carcinoma treated with cetuximab-based induction therapy followed by concurrent chemoradiotherapy

Publication date: Available online 26 December 2018

Source: Oral Oncology

Author(s): Shihai Wu, Jingwen Liu, Rencui Quan, Ling Han

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Unusual Supernumerary Teeth and Treatment Outcomes Analyzed for Developing Improved Diagnosis and Management Plans

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ken-Chung Chen, Jehn-Shyun Huang, Meng-Yen Chen, Ke-Hsin Cheng, Tung-Yiu Wong, Tze-Ta Huang.

Abstract

Purpose

Supernumerary teeth (SNT) are teeth or tooth-like structures that have erupted or might erupt in addition to the twenty primary or thirty-two permanent teeth. The simultaneous presentation of multiple SNT, syndrome-related multiple SNT, SNT inside the maxillary sinus, and treatment outcomes were analyzed for developing improved diagnosis and management plans.

Patients and Methods

This retrospective study reviewed the medical records of National Cheng Kung University Hospital patients who had undergone surgical intervention with general anesthesia between February 2014 and November 2017, analyzed panoramic radiographs and cone-beam computed tomography (CBCT) scans of their multiple SNT, and used descriptive statistics to discuss treatment and relative complications, especially of unusual SNT.

Results

The records of 165 patients (male/female: 127/38; mean age: 12.4 years) with 241 SNT (120 had one SNT; 35 had two; 3 had three; 2 had four; 2 had five; 2 had six; and 1 had twelve) were reviewed. There were 185 SNT in the maxilla and 56 in the mandible; 153 were mesiodens and 115 were inverted; 142 were asymptomatic and 137 were conical; 228 were fully impacted and 210 were partial roots. Two patients had SNT inside the maxillary sinus and one had five SNT and Marfan syndrome. Two patients had postoperative lip or chin paresthesia, and 2 had postoperative sinusitis.

Conclusion

Patient demographics provided useful epidemiological information. We recommend panoramic radiographs and CBCT for managing patients with possible multiple SNT and for extracting SNT.

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Effect of the surgeon’s dominant hand on postoperative periodontal status of adjacent molars after removal of lower third molars

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Hari Petsos, Jörg Korte, Peter Eickholz, Thomas Hoffmann, Raphael Borchard

Abstract

Purpose

Investigation of the effect of the surgeon's dominant hand and the side (right/left) of surgical removal of third molars in the mandible on probing pocket depths and probing attachment level on the adjacent second molars.

Methods

73 patients (46 women; 27 men; average age: 15.9 ± 1.9) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars were included in this study and surgically removed by a right-handed surgeon. Probing pocket depths and probing attachment level (outcome variables), as well as the gingiva and plaque index (other variables) were documented preoperatively and six months after surgical removal. Descriptive and bivariate statistics were computed and the p value was set at 0.05.

Results

Mean probing pocket depths decreased by 0.69 mm on tooth 18 and by 0.64 mm on tooth 31 over the follow-up of 6 months. Tooth 18 gained mean attachment of 0.45 mm and tooth 31 of 0.40 mm, respectively. The side difference between these changes in probing pocket depths (p = 0.620) and probing attachment level (p = 0.545) were not significant. Gingival (p = 0.029) and plaque index (p = 0.007) deteriorated significantly on tooth 31 compared to tooth 18.

Conclusions

For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent second molars.

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The “European Mandibular Angle” research project: the epidemiological results from a multicenter European collaboration.

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Matteo Brucoli, Paolo Boffano, Andrea Pezzana, Arnaldo Benech, Pierre Corre, Helios Bertin, Petia Pechalova, Nikolai Pavlov, Petko Petrov, Tiia Tamme, Andrey Kopchak, Anna Romanova, Eugen Shuminsky, Emil Dediol, Marko Tarle, Vitomir S. Konstantinovic, Drago Jelovac, K Hakki Karagozoglu, Tymour Forouzanfar

Abstract

Introduction

The aim of this study was to analyze the demographics, causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Methods

This study is based on a multicenter systematic database that allowed the recording of all patients with mandibular angle fractures between 1^st January 2013 and 31^st December 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, osteosynthesis.

Results

1162 patients (1045 males, 117 females) were included in the study. A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (p<.0000005). Furthermore, assaults were associated with the presence of voluptuary habits (p<.00005), a younger mean age (p<.00000005), male gender (p<.00000005), and left angle fractures (p<.00000005).

Conclusions

Assaults and falls actually represent the most frequent causes of angle fractures. The presence of third molars may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.

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Unusual Supernumerary Teeth and Treatment Outcomes Analyzed for Developing Improved Diagnosis and Management Plans

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Ken-Chung Chen, Jehn-Shyun Huang, Meng-Yen Chen, Ke-Hsin Cheng, Tung-Yiu Wong, Tze-Ta Huang.

Abstract

Purpose

Supernumerary teeth (SNT) are teeth or tooth-like structures that have erupted or might erupt in addition to the twenty primary or thirty-two permanent teeth. The simultaneous presentation of multiple SNT, syndrome-related multiple SNT, SNT inside the maxillary sinus, and treatment outcomes were analyzed for developing improved diagnosis and management plans.

Patients and Methods

This retrospective study reviewed the medical records of National Cheng Kung University Hospital patients who had undergone surgical intervention with general anesthesia between February 2014 and November 2017, analyzed panoramic radiographs and cone-beam computed tomography (CBCT) scans of their multiple SNT, and used descriptive statistics to discuss treatment and relative complications, especially of unusual SNT.

Results

The records of 165 patients (male/female: 127/38; mean age: 12.4 years) with 241 SNT (120 had one SNT; 35 had two; 3 had three; 2 had four; 2 had five; 2 had six; and 1 had twelve) were reviewed. There were 185 SNT in the maxilla and 56 in the mandible; 153 were mesiodens and 115 were inverted; 142 were asymptomatic and 137 were conical; 228 were fully impacted and 210 were partial roots. Two patients had SNT inside the maxillary sinus and one had five SNT and Marfan syndrome. Two patients had postoperative lip or chin paresthesia, and 2 had postoperative sinusitis.

Conclusion

Patient demographics provided useful epidemiological information. We recommend panoramic radiographs and CBCT for managing patients with possible multiple SNT and for extracting SNT.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Al8N8J

Effect of the surgeon’s dominant hand on postoperative periodontal status of adjacent molars after removal of lower third molars

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Hari Petsos, Jörg Korte, Peter Eickholz, Thomas Hoffmann, Raphael Borchard

Abstract

Purpose

Investigation of the effect of the surgeon's dominant hand and the side (right/left) of surgical removal of third molars in the mandible on probing pocket depths and probing attachment level on the adjacent second molars.

Methods

73 patients (46 women; 27 men; average age: 15.9 ± 1.9) with 146 asymptomatically submucosal (fully covered by oral mucosa) or impacted (completely enclosed by bone) lower third molars were included in this study and surgically removed by a right-handed surgeon. Probing pocket depths and probing attachment level (outcome variables), as well as the gingiva and plaque index (other variables) were documented preoperatively and six months after surgical removal. Descriptive and bivariate statistics were computed and the p value was set at 0.05.

Results

Mean probing pocket depths decreased by 0.69 mm on tooth 18 and by 0.64 mm on tooth 31 over the follow-up of 6 months. Tooth 18 gained mean attachment of 0.45 mm and tooth 31 of 0.40 mm, respectively. The side difference between these changes in probing pocket depths (p = 0.620) and probing attachment level (p = 0.545) were not significant. Gingival (p = 0.029) and plaque index (p = 0.007) deteriorated significantly on tooth 31 compared to tooth 18.

Conclusions

For a right-handed surgeon, the operated side had no influence on the changes in probing depth and attachment level on the adjacent second molars.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Sshx48

The “European Mandibular Angle” research project: the epidemiological results from a multicenter European collaboration.

Publication date: Available online 27 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Matteo Brucoli, Paolo Boffano, Andrea Pezzana, Arnaldo Benech, Pierre Corre, Helios Bertin, Petia Pechalova, Nikolai Pavlov, Petko Petrov, Tiia Tamme, Andrey Kopchak, Anna Romanova, Eugen Shuminsky, Emil Dediol, Marko Tarle, Vitomir S. Konstantinovic, Drago Jelovac, K Hakki Karagozoglu, Tymour Forouzanfar

Abstract

Introduction

The aim of this study was to analyze the demographics, causes and characteristics of mandibular angle fractures managed at several European departments of maxillofacial surgery.

Methods

This study is based on a multicenter systematic database that allowed the recording of all patients with mandibular angle fractures between 1^st January 2013 and 31^st December 2017. The following data were recorded: gender, age, etiology, side of angle fracture, associated mandibular fractures, presence of third molar, intermaxillary fixation, osteosynthesis.

Results

1162 patients (1045 males, 117 females) were included in the study. A significant association was found between the presence of a third molar and the diagnosis of an isolated angle fracture (p<.0000005). Furthermore, assaults were associated with the presence of voluptuary habits (p<.00005), a younger mean age (p<.00000005), male gender (p<.00000005), and left angle fractures (p<.00000005).

Conclusions

Assaults and falls actually represent the most frequent causes of angle fractures. The presence of third molars may let the force completely disperse during the determination of the angle fracture, finding a point of weakness.

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Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): X. Liu, J. Zheng, X. Cai, A. Abdelrehem, C. Yang

Abstract

Disc displacement is a common disorder affecting the temporomandibular joint. According to previous publications, the displaced disc can be categorized into pure anterior displacement and rotational displacement (anteromedial and anterolateral). However, the technique of arthroscopy treatment has only been reported for patients with pure anterior disc displacement. In this study, an arthroscopic discopexy for rotational anterior disc displacement was developed and its effectiveness evaluated over 24 months of follow-up. A total of 532 patients (749 joints) with rotational anterior disc displacement, admitted to Shanghai Ninth People's Hospital between January 2011 and December 2015, were included. The success rate was based on clinical parameters (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiographic data. The clinical and radiographic data were collected preoperatively and at 1, 6, 12, and 24 months postoperative. The VAS score decreased to 0.73 ± 1.43 following surgery (P < 0.001). A significant improvement in MIO (34.73 ± 6.28 mm) was also detected (P < 0.001). Magnetic resonance imaging showed discs repositioned in both sagittal and coronal images for 714 of the 749 joints, giving a success rate of 95.3%. This study reports an effective and predictable technique of arthroscopic discopexy for rotational anterior disc displacement.

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Microstructured beta-tricalcium phosphate for alveolar cleft repair: a two-centre study

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N.G. Janssen, R. Schreurs, A.P. de Ruiter, H.-C. Sylvester-Jensen, G. Blindheim, G.J. Meijer, R. Koole, H. Vindenes

Abstract

The current standard of care in alveolar cleft repair is timing the procedure in the mixed dentition stage and making use of autologous bone to restore the maxillary defect. Using a synthetic bone substitute bypasses the risk of donor site morbidity and reduces the operation time. In this study, the outcome of alveolar cleft repair using microporous beta-tricalcium phosphate (β-TCP) was investigated in patients with unilateral cleft lip and palate. Twenty patients were enrolled prospectively in this study, divided between two centres. Continuity of the alveolar process, recurrence of oronasal fistulas, and eruption of teeth into the repaired cleft were evaluated at 1 year postoperative. Also, cone beam computed tomography scans were analyzed using a volume-based semi-automatic segmentation protocol. No adverse events were reported. The mean residual bone volume in the repaired cleft at 1 year postoperative was 65%. There was no recurrence of oronasal fistula. Furthermore, 90% of the teeth adjacent to the cleft erupted spontaneously and all patients showed a continuous alveolar process. Secondary alveolar grafting using microporous β-TCP can safely be used in the clinical situation. Residual calcified tissue, canine eruption, and complication rates at the recipient site are comparable to those with autologous grafts.

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Learners’ acceptance of a webinar for continuing medical education

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): C. Knipfer, F. Wagner, K. Knipfer, G. Millesi, J. Acero, J.A. Hueto, E. Nkenke

Abstract

The aim of this study was to evaluate learners' acceptance of a webinar for continuing medical education that was instigated by the International Association of Oral and Maxillofacial Surgeons (IAOMS). A live, interactive webinar on orthognathic surgery was broadcast via the Internet. The learners' acceptance of the webinar was evaluated using a standardized, validated questionnaire (Student Evaluation of Educational Quality, SEEQ). One hundred and fifty-three participants attended the webinar; 55 participants (46 male, nine female) completed the questionnaire. The mean age of the respondents was 41.6 ± 10.0 years. The age of male and female respondents did not differ significantly. The respondents were spread over five continents, with the highest number from Brazil. The SEEQ showed a high level of acceptance for almost all subscales. There was no statistically significant difference between male and female respondents concerning acceptance of the webinar (P = 0.614). The wide distribution of participants shows the potential for webinars as facilitators of barrier-free distribution of knowledge. The webinar was well accepted by the attendees independent of sex, specialty, and work experience. However, the sex ratio reflects the underrepresentation of women in oral and maxillofacial surgery.

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Can radiological examination of mandibular bone invasion accurately predict the need for mandibular resection in oral squamous cell carcinoma?

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. DeAngelis, O. Breik, C. Angel, C. Goh, T. Iseli, A. Nastri, M. McCullough, D. Wiesenfeld

Abstract

Bone invasion by oral squamous cell carcinoma necessitates jaw resection, with preoperative imaging ideally able to guide the resection. A retrospective review of 109 patients with oral squamous cell carcinoma who underwent mandibular resection was performed. Eighty-three had preoperative computed tomography (CT) imaging and 72 underwent magnetic resonance imaging (MRI). The presence of bone invasion on imaging was compared to histopathology. Bone invasion was detected in 44 of 109 resection specimens (40.4%) and was identified on CT in 31 of 83 cases (37.4%) and on MRI in 35 of 72 cases (48.6%). The sensitivity and specificity of CT for detecting bone invasion was 69.0% and 79.6%, respectively, while for MRI was 87.1% and 80.5%, respectively. Histological detection of bone invasion was associated with greater disease-specific mortality (P = 0.002), as was MRI detection of bone invasion (P = 0.027). CT detection was not significant (P = 0.240). Negative prediction of bone invasion was 95% accurate for both modalities in clinically non-invaded mandibles. Survival was reduced in patients who underwent marginal mandibular resection when bone invasion was detected histologically (33.3% vs. 70.5%, P = 0.277) and with CT, although this was not statistically significant. More data are required to determine whether more aggressive resection is warranted when bone invasion is detected preoperatively.

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Techniques of Yang’s arthroscopic discopexy for temporomandibular joint rotational anterior disc displacement

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): X. Liu, J. Zheng, X. Cai, A. Abdelrehem, C. Yang

Abstract

Disc displacement is a common disorder affecting the temporomandibular joint. According to previous publications, the displaced disc can be categorized into pure anterior displacement and rotational displacement (anteromedial and anterolateral). However, the technique of arthroscopy treatment has only been reported for patients with pure anterior disc displacement. In this study, an arthroscopic discopexy for rotational anterior disc displacement was developed and its effectiveness evaluated over 24 months of follow-up. A total of 532 patients (749 joints) with rotational anterior disc displacement, admitted to Shanghai Ninth People's Hospital between January 2011 and December 2015, were included. The success rate was based on clinical parameters (visual analogue scale (VAS) for pain, maximum inter-incisal opening (MIO), and complications) and radiographic data. The clinical and radiographic data were collected preoperatively and at 1, 6, 12, and 24 months postoperative. The VAS score decreased to 0.73 ± 1.43 following surgery (P < 0.001). A significant improvement in MIO (34.73 ± 6.28 mm) was also detected (P < 0.001). Magnetic resonance imaging showed discs repositioned in both sagittal and coronal images for 714 of the 749 joints, giving a success rate of 95.3%. This study reports an effective and predictable technique of arthroscopic discopexy for rotational anterior disc displacement.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SlWdNp

Microstructured beta-tricalcium phosphate for alveolar cleft repair: a two-centre study

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): N.G. Janssen, R. Schreurs, A.P. de Ruiter, H.-C. Sylvester-Jensen, G. Blindheim, G.J. Meijer, R. Koole, H. Vindenes

Abstract

The current standard of care in alveolar cleft repair is timing the procedure in the mixed dentition stage and making use of autologous bone to restore the maxillary defect. Using a synthetic bone substitute bypasses the risk of donor site morbidity and reduces the operation time. In this study, the outcome of alveolar cleft repair using microporous beta-tricalcium phosphate (β-TCP) was investigated in patients with unilateral cleft lip and palate. Twenty patients were enrolled prospectively in this study, divided between two centres. Continuity of the alveolar process, recurrence of oronasal fistulas, and eruption of teeth into the repaired cleft were evaluated at 1 year postoperative. Also, cone beam computed tomography scans were analyzed using a volume-based semi-automatic segmentation protocol. No adverse events were reported. The mean residual bone volume in the repaired cleft at 1 year postoperative was 65%. There was no recurrence of oronasal fistula. Furthermore, 90% of the teeth adjacent to the cleft erupted spontaneously and all patients showed a continuous alveolar process. Secondary alveolar grafting using microporous β-TCP can safely be used in the clinical situation. Residual calcified tissue, canine eruption, and complication rates at the recipient site are comparable to those with autologous grafts.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AgXVJc

Learners’ acceptance of a webinar for continuing medical education

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): C. Knipfer, F. Wagner, K. Knipfer, G. Millesi, J. Acero, J.A. Hueto, E. Nkenke

Abstract

The aim of this study was to evaluate learners' acceptance of a webinar for continuing medical education that was instigated by the International Association of Oral and Maxillofacial Surgeons (IAOMS). A live, interactive webinar on orthognathic surgery was broadcast via the Internet. The learners' acceptance of the webinar was evaluated using a standardized, validated questionnaire (Student Evaluation of Educational Quality, SEEQ). One hundred and fifty-three participants attended the webinar; 55 participants (46 male, nine female) completed the questionnaire. The mean age of the respondents was 41.6 ± 10.0 years. The age of male and female respondents did not differ significantly. The respondents were spread over five continents, with the highest number from Brazil. The SEEQ showed a high level of acceptance for almost all subscales. There was no statistically significant difference between male and female respondents concerning acceptance of the webinar (P = 0.614). The wide distribution of participants shows the potential for webinars as facilitators of barrier-free distribution of knowledge. The webinar was well accepted by the attendees independent of sex, specialty, and work experience. However, the sex ratio reflects the underrepresentation of women in oral and maxillofacial surgery.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2ShKWOa

Can radiological examination of mandibular bone invasion accurately predict the need for mandibular resection in oral squamous cell carcinoma?

Publication date: Available online 26 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. DeAngelis, O. Breik, C. Angel, C. Goh, T. Iseli, A. Nastri, M. McCullough, D. Wiesenfeld

Abstract

Bone invasion by oral squamous cell carcinoma necessitates jaw resection, with preoperative imaging ideally able to guide the resection. A retrospective review of 109 patients with oral squamous cell carcinoma who underwent mandibular resection was performed. Eighty-three had preoperative computed tomography (CT) imaging and 72 underwent magnetic resonance imaging (MRI). The presence of bone invasion on imaging was compared to histopathology. Bone invasion was detected in 44 of 109 resection specimens (40.4%) and was identified on CT in 31 of 83 cases (37.4%) and on MRI in 35 of 72 cases (48.6%). The sensitivity and specificity of CT for detecting bone invasion was 69.0% and 79.6%, respectively, while for MRI was 87.1% and 80.5%, respectively. Histological detection of bone invasion was associated with greater disease-specific mortality (P = 0.002), as was MRI detection of bone invasion (P = 0.027). CT detection was not significant (P = 0.240). Negative prediction of bone invasion was 95% accurate for both modalities in clinically non-invaded mandibles. Survival was reduced in patients who underwent marginal mandibular resection when bone invasion was detected histologically (33.3% vs. 70.5%, P = 0.277) and with CT, although this was not statistically significant. More data are required to determine whether more aggressive resection is warranted when bone invasion is detected preoperatively.

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Safety and Immunotherapeutic Activity of an Anti-PD-1 Antibody (Cemiplimab) in HIV-1-infected Participants on Suppressive cART

Condition:   HIV Infections Interventions:   Biological: Cemiplimab;   Biological: Placebo Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Safety and Immunotherapeutic Activity of an Anti-PD-1 Antibody (Cemiplimab) in HIV-1-infected Participants on Suppressive cART

Condition:   HIV Infections Interventions:   Biological: Cemiplimab;   Biological: Placebo Sponsor:   National Institute of Allergy and Infectious Diseases (NIAID) Not yet recruiting (Source: ClinicalTrials.gov)

MedWorm Message: Have you tried our new medical search engine? More powerful than before. Log on with your social media account. 100% free.

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Utility of response assessment PET-CT to predict residual disease in neck nodes: A comparison with the Histopathology

Publication date: Available online 26 December 2018

Source: Auris Nasus Larynx

Author(s): Khuzema Saifuddin Fatehi, Shivakumar Thiagarajan, Harsh Dhar, Nilendu Purandare, Anil K. DCruz, Devendra Chaukar, Sarbani Ghosh Laskar, Kumar Prabhash, Venkatesh Rangarajan

Abstract

Objective

To assess the ability of Positron Emission Tomography-Computed Tomography (PET-CT) scans to detect residual disease in neck nodes with the Histopathology (HPR) as the gold standard. To obtain a Standardized Uptake Value max cutoff in these patients to predict residual disease in neck.

Methods

Head and neck squamous cell carcinoma patients who underwent Salvage neck dissection with or without primary site surgery post Concurrent Chemo-Radiotherapy (CCRT) during the period January 2008–December 2017 were included. All patients had response assessment PET-CT scan at 10–14 weeks. Agreement analysis was performed between PET-CT and HPR, fine needle aspiration cytology and HPR. Positive predictive value, Negative predictive value of PET-CT to detect residual neck nodal disease in comparison to HPR was analyzed. A Receiver Operating Characteristic (ROC) curve was plotted between the SUV max values and the HPR. A SUV max cutoff value was obtained from the ROC curve.

Results

A total of 75 patients were included. Thirty-one underwent salvage neck dissection along with surgery for primary disease and 45 underwent salvage neck dissection alone. PET-CT showed good agreement with the HPR to detect residual disease in neck nodes (Kappa = 0.604). PET-CT had a PPV and NPV of 87.5% and 79.15% respectively as compared against the HPR. A SUV max cutoff of 4.62 had a specificity of 92.3% and sensitivity of 73.5% to detect residual disease in neck nodes on the HPR.

Conclusion

PET-CT surveillance is an accepted treatment strategy. A neck node with SUV max of 4.62 and above is most likely to harbor residual nodal disease.

Level of evidence: Level 2b

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Utility of response assessment PET-CT to predict residual disease in neck nodes: A comparison with the Histopathology

Publication date: Available online 26 December 2018

Source: Auris Nasus Larynx

Author(s): Khuzema Saifuddin Fatehi, Shivakumar Thiagarajan, Harsh Dhar, Nilendu Purandare, Anil K. DCruz, Devendra Chaukar, Sarbani Ghosh Laskar, Kumar Prabhash, Venkatesh Rangarajan

Abstract

Objective

To assess the ability of Positron Emission Tomography-Computed Tomography (PET-CT) scans to detect residual disease in neck nodes with the Histopathology (HPR) as the gold standard. To obtain a Standardized Uptake Value max cutoff in these patients to predict residual disease in neck.

Methods

Head and neck squamous cell carcinoma patients who underwent Salvage neck dissection with or without primary site surgery post Concurrent Chemo-Radiotherapy (CCRT) during the period January 2008–December 2017 were included. All patients had response assessment PET-CT scan at 10–14 weeks. Agreement analysis was performed between PET-CT and HPR, fine needle aspiration cytology and HPR. Positive predictive value, Negative predictive value of PET-CT to detect residual neck nodal disease in comparison to HPR was analyzed. A Receiver Operating Characteristic (ROC) curve was plotted between the SUV max values and the HPR. A SUV max cutoff value was obtained from the ROC curve.

Results

A total of 75 patients were included. Thirty-one underwent salvage neck dissection along with surgery for primary disease and 45 underwent salvage neck dissection alone. PET-CT showed good agreement with the HPR to detect residual disease in neck nodes (Kappa = 0.604). PET-CT had a PPV and NPV of 87.5% and 79.15% respectively as compared against the HPR. A SUV max cutoff of 4.62 had a specificity of 92.3% and sensitivity of 73.5% to detect residual disease in neck nodes on the HPR.

Conclusion

PET-CT surveillance is an accepted treatment strategy. A neck node with SUV max of 4.62 and above is most likely to harbor residual nodal disease.

Level of evidence: Level 2b

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Sclerostin injection enhances orthodontic tooth movement in rats

Publication date: Available online 26 December 2018

Source: Archives of Oral Biology

Author(s): Wenxin Lu, Xuan Zhang, Fiona Firth, Li Mei, Jianru Yi, Changyang Gong, Hanshi Li, Wei Zheng, Yu Li

Abstract

Objective

It was aimed to investigate the in vivo effects of local injection of sclerostin protein on orthodontic tooth movement.

Design

A total of 48 rats underwent orthodontic mesialization of the maxillary first molars on both sides. Local injection was given at the compression side in the alveolar bone on both maxillary sides, with sclerostin protein carried by hydrogel on one side, and the same volume of normal saline carried by hydrogel on the other side serving as the control. After two weeks, the tooth movement amount and effects on the periodontium were assessed through micro-computed tomography (μCT) analysis, tartrate-resistant acid phosphatase (TRAP) staining and immunohistochemistry (IHC) analysis.

Results

After two weeks of intervention, tooth movement was significantly greater in the 4 μg/kg and 20 μg/kg sclerostin injection groups, compared to the control. Analysis of the furcation area of the maxillary first molar showed that the 20 μg/kg group had significantly decreased BV/TV. At the compression side, the number of TRAP-positive osteoclasts was significantly increased in 20 μg/kg group compared to the control. The expression of RANKL was statistically higher in all the sclerostin groups, while the expression of OPG was statistically lower in the 4 μg/kg and 20 μg/kg groups, compared to the control. At the tension side, the expression of RUNX2 and COL-1 was statistically higher in the 20 μg/kg group compared to the control.

Conclusions

Local injection of sclerostin protein in the alveolar bone at the compression side accelerates OTM in rats by promoting osteoclastogenesis.

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Effect of dentinal fluid on enamel permeability under simulated pulpal pressure

Publication date: Available online 26 December 2018

Source: Archives of Oral Biology

Author(s): Narinee Chinajitphan, Ekachai Chunhacheevachaloke, Orapin Ajcharanukul

Abstract

Objective

To determine the effect of pulpal perfusion on the fluid flow through human tooth after different treatments at the enamel surface. Changes in mineral density along with fluid flow rate were also analyzed before and after etching.

Design

The experiments were carried out on 97 human premolars. Ringer's solution and distilled water (DW) were applied under pressure of 20 mm Hg to the pulpal cavity of tooth crowns in the Ringer's-perfused and water-perfused groups respectively. Fluid flow through each specimen was recorded before and 0, 30, 60, 180 min after treatments at the enamel surface. The treatments included DW, 0.2% sodium fluoride solution, 1.23% acidulated phosphate fluoride gel (APF), 2.26% fluoride varnish (FV), 37% phosphoric acid gel (Etch) and artificial saliva (AS). Mineral density of the enamel was evaluated using micro-computed tomography.

Results

In water-perfused group, fluid flow rates recorded after etching were significantly increased (p = 0.005) with the significant reduction of mineral density (p = 0.018) from baseline. A significant negative correlation was found (r = -0.78, p = 0.015). After FV, the percentage reduction from baseline was significant at 180 min (p = 0.003). In Ringer's-perfused group, etching immediately produced the greatest mean flow rate and subsequently returned to the baseline within 60 min after treatment (p < 0.001). There were approximately 40, 55, and 63% reductions of flow rates within 60 min after AS, APF and FV respectively.

Conclusion

Under simulated pulpal pressure, enamel fluid involves the process of enamel remineralization, particularly after etching.

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Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Background

Whether for research or quality improvement, assessment of postoperative quality of life outcomes faces a challenge in reliable data collection. Typical coordinator‐led studies cite response rates from 35% to 70%. This study evaluates the utility of a digital patient engagement platform to track patient‐reported outcome measures (PROMs) following septoplasty and functional endoscopic sinus surgery (FESS).

Methods

A prospective cohort was recruited at a tertiary care center from January 2017 to March 2018. A mobile phone application relayed PROMs, including pain (assessed on a 0 to 10 visual analogue scale [VAS] every other day for 2 weeks, as well as the patient‐reported outcome measure information system [PROMIS] pain interference short form 4a at baseline, 2 weeks, and 3 months) and timing of return to work.

Results

Of 288 patients enrolled, 249 (86.5%) provided clinical data, including 208 who underwent septoplasty or FESS. Granular VAS scores, submitted by 195 patients, demonstrated 80% of these patients achieved minimal pain by postoperative day 8. A nonsignificant trend of increased days to pain relief by procedure emerged: septoplasty (mean ± standard deviation [SD], 3.60 ± 2.44), FESS (3.96 ± 3.25), FESS with septoplasty (4.40 ± 3.04), and FESS with drilling (4.86 ± 3.68). Across procedures, PROMIS pain interference increased at 2 weeks (9.17 ± 4.15) and decreased at 3 months (5.32 ± 2.61) compared with baseline (7.09 ± 4.63), with greater improvement noted in the FESS subgroup at 3 months. Patients returned to work at mean 7.1 days regardless of procedure.

Conclusions

With its high response rate, mobile digital patient engagement platforms may effectively track postoperative outcomes with the potential for reduced sample bias.

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Sclerostin injection enhances orthodontic tooth movement in rats

Publication date: Available online 26 December 2018

Source: Archives of Oral Biology

Author(s): Wenxin Lu, Xuan Zhang, Fiona Firth, Li Mei, Jianru Yi, Changyang Gong, Hanshi Li, Wei Zheng, Yu Li

Abstract

Objective

It was aimed to investigate the in vivo effects of local injection of sclerostin protein on orthodontic tooth movement.

Design

A total of 48 rats underwent orthodontic mesialization of the maxillary first molars on both sides. Local injection was given at the compression side in the alveolar bone on both maxillary sides, with sclerostin protein carried by hydrogel on one side, and the same volume of normal saline carried by hydrogel on the other side serving as the control. After two weeks, the tooth movement amount and effects on the periodontium were assessed through micro-computed tomography (μCT) analysis, tartrate-resistant acid phosphatase (TRAP) staining and immunohistochemistry (IHC) analysis.

Results

After two weeks of intervention, tooth movement was significantly greater in the 4 μg/kg and 20 μg/kg sclerostin injection groups, compared to the control. Analysis of the furcation area of the maxillary first molar showed that the 20 μg/kg group had significantly decreased BV/TV. At the compression side, the number of TRAP-positive osteoclasts was significantly increased in 20 μg/kg group compared to the control. The expression of RANKL was statistically higher in all the sclerostin groups, while the expression of OPG was statistically lower in the 4 μg/kg and 20 μg/kg groups, compared to the control. At the tension side, the expression of RUNX2 and COL-1 was statistically higher in the 20 μg/kg group compared to the control.

Conclusions

Local injection of sclerostin protein in the alveolar bone at the compression side accelerates OTM in rats by promoting osteoclastogenesis.

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Effect of dentinal fluid on enamel permeability under simulated pulpal pressure

Publication date: Available online 26 December 2018

Source: Archives of Oral Biology

Author(s): Narinee Chinajitphan, Ekachai Chunhacheevachaloke, Orapin Ajcharanukul

Abstract

Objective

To determine the effect of pulpal perfusion on the fluid flow through human tooth after different treatments at the enamel surface. Changes in mineral density along with fluid flow rate were also analyzed before and after etching.

Design

The experiments were carried out on 97 human premolars. Ringer's solution and distilled water (DW) were applied under pressure of 20 mm Hg to the pulpal cavity of tooth crowns in the Ringer's-perfused and water-perfused groups respectively. Fluid flow through each specimen was recorded before and 0, 30, 60, 180 min after treatments at the enamel surface. The treatments included DW, 0.2% sodium fluoride solution, 1.23% acidulated phosphate fluoride gel (APF), 2.26% fluoride varnish (FV), 37% phosphoric acid gel (Etch) and artificial saliva (AS). Mineral density of the enamel was evaluated using micro-computed tomography.

Results

In water-perfused group, fluid flow rates recorded after etching were significantly increased (p = 0.005) with the significant reduction of mineral density (p = 0.018) from baseline. A significant negative correlation was found (r = -0.78, p = 0.015). After FV, the percentage reduction from baseline was significant at 180 min (p = 0.003). In Ringer's-perfused group, etching immediately produced the greatest mean flow rate and subsequently returned to the baseline within 60 min after treatment (p < 0.001). There were approximately 40, 55, and 63% reductions of flow rates within 60 min after AS, APF and FV respectively.

Conclusion

Under simulated pulpal pressure, enamel fluid involves the process of enamel remineralization, particularly after etching.

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Utilization of a novel interactive mobile health platform to evaluate functional outcomes and pain following septoplasty and functional endoscopic sinus surgery

Background

Whether for research or quality improvement, assessment of postoperative quality of life outcomes faces a challenge in reliable data collection. Typical coordinator‐led studies cite response rates from 35% to 70%. This study evaluates the utility of a digital patient engagement platform to track patient‐reported outcome measures (PROMs) following septoplasty and functional endoscopic sinus surgery (FESS).

Methods

A prospective cohort was recruited at a tertiary care center from January 2017 to March 2018. A mobile phone application relayed PROMs, including pain (assessed on a 0 to 10 visual analogue scale [VAS] every other day for 2 weeks, as well as the patient‐reported outcome measure information system [PROMIS] pain interference short form 4a at baseline, 2 weeks, and 3 months) and timing of return to work.

Results

Of 288 patients enrolled, 249 (86.5%) provided clinical data, including 208 who underwent septoplasty or FESS. Granular VAS scores, submitted by 195 patients, demonstrated 80% of these patients achieved minimal pain by postoperative day 8. A nonsignificant trend of increased days to pain relief by procedure emerged: septoplasty (mean ± standard deviation [SD], 3.60 ± 2.44), FESS (3.96 ± 3.25), FESS with septoplasty (4.40 ± 3.04), and FESS with drilling (4.86 ± 3.68). Across procedures, PROMIS pain interference increased at 2 weeks (9.17 ± 4.15) and decreased at 3 months (5.32 ± 2.61) compared with baseline (7.09 ± 4.63), with greater improvement noted in the FESS subgroup at 3 months. Patients returned to work at mean 7.1 days regardless of procedure.

Conclusions

With its high response rate, mobile digital patient engagement platforms may effectively track postoperative outcomes with the potential for reduced sample bias.

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English Translation and Validation of the Zurich Chronic Middle Ear Inventory (ZCMEI‐21‐E) Assessing Quality of Life in Chronic Otitis Media: A Prospective International Multicenter Study

Abstract

Objectives

To translate and validate the Zurich Chronic Middle Ear Inventory (ZCMEI‐21) for the English language in order to provide an English instrument to assess health‐related quality of life in chronic otitis media (COM).

Design

Pilot translation study including cognitive debriefings, prospective multicenter cross‐sectional psychometric validation study.

Setting

Four tertiary referral centers in three different English‐speaking countries (United Kingdom, United States of America and Australia).

Participants

Adult patients suffering from COM.

Main outcome measures

The English translation of the ZCMEI‐21 (ZCMEI‐21‐E) and the five‐level version of the EQ‐5D questionnaire. The EQ‐5D, which constitutes a generic measure of health‐related quality of life, consists of a descriptive system score and a visual analogue scale. Statistical outcomes included single item descriptive statistics, internal consistency (Cronbach's α) as an indicator of reliability, as well as construct validity.

Results

A total of 124 patients suffering from COM were included. The mean age was 50.1 years (SD 16.9 years) and 72 (58.1%) were males. The Cronbach's α of the ZCMEI‐21‐E was 0.91, suggesting an excellent internal consistency. The Spearman's correlation coefficient of the ZCMEI‐21‐E total score was 0.55 (p < 0.0001) for convergent construct validity with EQ‐5D descriptive system score and 0.57 (p < 0.0001) with the EQ‐5D visual analogue scale.

Conclusions

The ZCMEI‐21‐E is a new validated questionnaire that provides clinicians with a short, comprehensive and reliable instrument to quantify health‐related quality of life in patients suffering from COM. The ZCMEI‐21‐E may be of use in clinical routine as well as in outcome research and monitoring.

This article is protected by copyright. All rights reserved.

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Quality of life improvement following parathyroid surgery: a preliminary three‐year review of fifty‐six patients from a single surgical centre

Abstract

We describe our experience of quality of life outcomes in patients who underwent parathyroid surgery for primary hyperparathyroidism within a single surgical centre at a district general hospital. We present a retrospective cohort analysis of all patients who underwent parathyroid surgery for primary hyperparathyroidism over a three‐year period within a new surgical service. We describe our experience of surgical outcomes between symptomatic and asymptomatic patients with PHPT. To our knowledge, this is the first paper to describe patient reported outcome measures (PROM) in parathyroid surgery for PHPT using the Glasgow Benefit Inventory.

This article is protected by copyright. All rights reserved.

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Feasibility of Parotid Duct Transposition for the Treatment of Dry Eye: A Cadaveric Study

This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7  cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1–1.50 cm in length . Parotid duct can be transposed easily to the lower conjunctival cul...

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A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study

AbstractTo study the survival in patients affected with hypopharyngeal cancer among treatment groups and different stages. Data of hypopharyngeal cancer patients diagnosed from 1st January 2010 to 31st December 2010 was used in the present study. The cases were analyzed for gender, age group distribution, sub-sites at presentation, stage at diagnosis and the type of treatments. Survival from the date of first diagnosis was estimated and hazard ratios were calculated. Survival probability and hazards ratios (HR) were calculated by Kaplan –Meier method and Cox-proportional regression analysis respectively. Censoring of patient who survived longer than 5 years was done. Active follow-up was done for the survival analysis. The study cohort included 217 patients and treatment compliance was ...

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Dermoid Cyst of the Parotid Gland: A Rare Entity

We present a rare case of this entity and the challenges faced in making diagnosis with a short review of the literature. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

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English Translation and Validation of the Zurich Chronic Middle Ear Inventory (ZCMEI‐21‐E) Assessing Quality of Life in Chronic Otitis Media: A Prospective International Multicenter Study

Abstract

Objectives

To translate and validate the Zurich Chronic Middle Ear Inventory (ZCMEI‐21) for the English language in order to provide an English instrument to assess health‐related quality of life in chronic otitis media (COM).

Design

Pilot translation study including cognitive debriefings, prospective multicenter cross‐sectional psychometric validation study.

Setting

Four tertiary referral centers in three different English‐speaking countries (United Kingdom, United States of America and Australia).

Participants

Adult patients suffering from COM.

Main outcome measures

The English translation of the ZCMEI‐21 (ZCMEI‐21‐E) and the five‐level version of the EQ‐5D questionnaire. The EQ‐5D, which constitutes a generic measure of health‐related quality of life, consists of a descriptive system score and a visual analogue scale. Statistical outcomes included single item descriptive statistics, internal consistency (Cronbach's α) as an indicator of reliability, as well as construct validity.

Results

A total of 124 patients suffering from COM were included. The mean age was 50.1 years (SD 16.9 years) and 72 (58.1%) were males. The Cronbach's α of the ZCMEI‐21‐E was 0.91, suggesting an excellent internal consistency. The Spearman's correlation coefficient of the ZCMEI‐21‐E total score was 0.55 (p < 0.0001) for convergent construct validity with EQ‐5D descriptive system score and 0.57 (p < 0.0001) with the EQ‐5D visual analogue scale.

Conclusions

The ZCMEI‐21‐E is a new validated questionnaire that provides clinicians with a short, comprehensive and reliable instrument to quantify health‐related quality of life in patients suffering from COM. The ZCMEI‐21‐E may be of use in clinical routine as well as in outcome research and monitoring.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BG0ap1

Quality of life improvement following parathyroid surgery: a preliminary three‐year review of fifty‐six patients from a single surgical centre

Abstract

We describe our experience of quality of life outcomes in patients who underwent parathyroid surgery for primary hyperparathyroidism within a single surgical centre at a district general hospital. We present a retrospective cohort analysis of all patients who underwent parathyroid surgery for primary hyperparathyroidism over a three‐year period within a new surgical service. We describe our experience of surgical outcomes between symptomatic and asymptomatic patients with PHPT. To our knowledge, this is the first paper to describe patient reported outcome measures (PROM) in parathyroid surgery for PHPT using the Glasgow Benefit Inventory.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QUqma6

Feasibility of Parotid Duct Transposition for the Treatment of Dry Eye: A Cadaveric Study

This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7  cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1–1.50 cm in length . Parotid duct can be transposed easily to the lower conjunctival cul...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VbQLyv

A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study

AbstractTo study the survival in patients affected with hypopharyngeal cancer among treatment groups and different stages. Data of hypopharyngeal cancer patients diagnosed from 1st January 2010 to 31st December 2010 was used in the present study. The cases were analyzed for gender, age group distribution, sub-sites at presentation, stage at diagnosis and the type of treatments. Survival from the date of first diagnosis was estimated and hazard ratios were calculated. Survival probability and hazards ratios (HR) were calculated by Kaplan –Meier method and Cox-proportional regression analysis respectively. Censoring of patient who survived longer than 5 years was done. Active follow-up was done for the survival analysis. The study cohort included 217 patients and treatment compliance was ...

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Q7i35s

Dermoid Cyst of the Parotid Gland: A Rare Entity

We present a rare case of this entity and the challenges faced in making diagnosis with a short review of the literature. (Source: Indian Journal of Otolaryngology and Head and Neck Surgery)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2VbQCLt

The glottis is not round: Teardrop‐shaped glottic dilation for early posterior glottic stenosis

Objectives

Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no treatment for patients with "early" PGS. Dilation is often used for stenotic disease, but present dilation methods are limited to a round shape and the glottis is a sector (teardrop‐shaped). Round dilation of the larynx results in compression of the membranous vocal folds (with potential for injury) and minimal expansion of the posterior larynx. We present a novel laryngeal dilation method that matches the unique anatomic shape of the glottis: teardrop‐shaped glottis dilation (TSGD).

Methods

We present a clinical series of early PGS patients treated with a TSGD. Five patients with dyspnea and significantly reduced vocal fold mobility due to early PGS were treated with TSGD, which involves placement of a triangular static stent in the anterior glottis, with simultaneous use of a round balloon dilator in the posterior glottis.

Results

All patients reported improved ease of breathing and decrease in Dyspnea Index score and were decannualated following treatment. Video perceptual analysis of pre‐/postlaryngoscopy examinations was performed with five blinded reviewers, and all patients were scored to have improved posterior glottic airway space following treatment with a mean improvement of 2.4 on a 11‐point scale.

Conclusion

These clinical results demonstrate that there is enormous potential for the identification and treatment of patients with early PGS and use of a laryngeal dilation technique that matches the anatomic configuration of the glottis.

Level of Evidence

4. Laryngoscope, 2018

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Subpectoral implantation of the hypoglossal nerve stimulator: An effective technical modification

Upper airway stimulation is now a well‐established treatment option for selected patients with obstructive sleep apnea. The implanted pulse generator of this system activates the hypoglossal nerve and is routinely placed in a subcutaneous pocket overlying the pectoralis muscle. This case report describes a patient with a history of bilateral mastectomy and radiation for breast cancer who required explantation due to device exposure and infection. The patient was successfully reimplanted by placing the implantable pulse generator deep to the pectoralis major muscle. Clinical circumstances involving the chest wall may warrant subpectoral placement of the implanted pulse generator. Laryngoscope, 2018

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Is routine genetic testing warranted in head and neck paragangliomas?

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The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

Objectives

The medial sural artery perforator (MSAP) free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. We aim to describe the MSAP flap and compare it to other commonly used free flaps in the head and neck.

Study Design

Retrospective case series.

Methods

A retrospective review of all MSAP cases performed at New York University Langone Health was performed from July 2016 to November 2017. We examined the patients' age, diagnosis, history of prior radiation therapy, and comorbidities, as well as flap‐specific information and recipient site.

Results

Twenty‐one patients underwent a variety of different head and neck procedures with coverage using an MSAP flap. Recipient sites included tongue, cheek, soft and hard palate, cervical esophagus, and pharynx. Pedicle length ranged from 8 cm to 12 cm. The smallest surface area harvested was 24 cm² (6 cm × 4 cm), and the largest was 120 cm² (15 cm × 8 cm). The flaps ranged from 5 to 12 mm in thickness. Venous coupler size ranged from 2.0 to 3.5 mm. Primary closure of the donor site was achieved in 18 of 21 flaps. Twenty of 21 flaps were transferred successfully.

Conclusion

The MSAP flap is a highly versatile and reliable option for a thin, pliable soft tissue flap with a donor site that may be preferable over the radial forearm free flap and anterolateral thigh flap in complex head and neck reconstruction.

Level of Evidence

4. Laryngoscope, 2018

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A novel silk‐based vocal fold augmentation material: 6‐month evaluation in a canine model

Objectives

Ideal long‐term vocal fold augmentation materials should be biocompatible, easily administered, allow tissue integration for long‐term effect, and remain at the site of injection. A novel silk protein particle suspended in hyaluronic acid (Silk‐HA) has been developed specifically for vocal fold augmentation to address this unmet need. This article presents the 6‐month, preclinical findings of a canine vocal fold injection trial for Silk‐HA.

Methods

Twelve beagle dogs were injected transorally in the lateral/deep aspect of their right thyroarytenoid muscles with 0.3 cc of Silk‐HA or calcium hydroxylapatite in carboxymethyl cellulose (CaHA‐CMC). The Silk‐HA particle injectable was delivered via a custom catheter, whereas CaHA‐CMC was delivered through a commercially available malleable needle. The six dogs from each material group were sacrificed 6 months from the injection date for the evaluation of implant longevity, immune response, and material migration.

Results

Silk‐HA provides immediate medialization of the right vocal fold, lasting for a minimum of 6 months in a canine model. Silk‐HA and CaHA‐CMC both demonstrate similar inflammatory responses. The Silk‐HA was shown to remain without migration at the site of injection in all six canine subjects, whereas CaHA‐CMC demonstrated migration in four of the six canines. In two canines implanted with CaHA‐CMC, material was discovered to migrate to the retropharyngeal lymph nodes.

Conclusion

In a canine subject model, the Silk‐HA material compares favorably in terms of longevity and immune response to CaHA‐CMC. The lack of migration of the Silk‐HA material demonstrates a promising potential for vocal fold injection in the clinic.

Level of Evidence

NA Laryngoscope, 2018

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Management of difficult airway among patients with oropharyngeal angioedema

Objective

The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients.

Methods

Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre‐DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post‐DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre‐DART and post‐DART cohort.

Results

The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post‐DART cohort and 56% of the pre‐DART cohort. The incidence of patients requiring intubation was higher in the post‐DART cohort (18 out of 27 [67%]) than the pre‐DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post‐DART and pre‐DART cohorts.

Conclusion

Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic‐guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway.

Level of Evidence

3. Laryngoscope, 2018

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Safe use of systemic bevacizumab for respiratory recurrent papillomatosis in two children

Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 2018

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Safety of outpatient unilateral medialization laryngoplasty across two academic institutions

Objectives/Hypothesis

Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary‐care academic medical centers.

Study Design

Retrospective chart review,

Methods

A review of patients undergoing unilateral ML at two tertiary‐care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML.

Results

One hundred three total procedures met inclusion criteria. Fifty‐seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore‐Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas.

Conclusions

The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions.

Level of Evidence

4 Laryngoscope, 2018

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Table of contents

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Tracheal replacement revisited: Use of a vascularized tracheal transplant in a porcine model

Objectives/Hypothesis

To determine if a long segment of trachea can be transplanted as a vascularized organ and to determine if a tracheal transplant is a potential surgical option for a long‐segment circumferential tracheal defect.

Study Design

Animal model.

Methods

Four (two donors and two recipients) adult domestic Yorkshire swine were used. Two sets of transplants were performed from a donor to recipient pig. The transplant was placed heterotopically (not in continuity with the airway), and the recipient animals were monitored for 14 days to ensure the transplants were well vascularized. Immunosuppressive therapies included methylprednisolone, cyclosporine, and azathioprine. Gross as well as histological examination of multiple tissues types including mucosa, cartilage, muscle, and blood vessels were performed postsacrifice on day 14.

Results

Recipient animal weights ranged from 40 to 42 kilograms. Both recipient pigs survived the full 14 days of study and exhibited normal activity and appetite. Ischemia time of transplanted grafts ranged from 63 to 72 minutes. Transplanted tracheas included a minimum of 15 cartilaginous rings and measured greater than 10 cm in length. Both grafts maintained a robust blood supply throughout the duration of study.

Conclusions

The entire visceral compartment can be reliably transplanted, either as a single component (trachea) or as a chimeric flap with multiple components (trachea, esophagus, larynx, and pharynx). Further studies in the swine model should be considered to study the effects of transplanting the trachea orthotopically into the native airway. Further studies are needed into the reliability of this technique of transplantation in humans.

Level of Evidence

NA Laryngoscope, 128:S1–S9, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AjAyhR

Masthead

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SnL2Uq

Surgical treatment of glottic web using butterfly mucosal flap technique: Experience on 12 patients

Objectives

Many surgical methods have been described for the treatment of glottic web, with very little experience of each. Butterfly mucosal flap technique utilizes superior and inferior mucosal flaps on corresponding surfaces of the web; superior flap is elevated with its base on one vocal fold; and inferior flap is elevated with its base on the other vocal fold. These flaps are sutured to the vocal fold where flap's base is located. This requires four to six microsutures. The disadvantage of this technique is its difficulty. The advantages are single‐stage endoscopic outpatient surgery and high success rate.

Methods

This is an individual prospective cohort study. All consecutive 12 cases of glottic web were treated with butterfly mucosal flap technique and followed for at least 1 year postoperatively. Voice Handicap Index (VHI)‐30 including physical, functional, emotional, and total scores; acoustic analysis with /a/; aerodynamic measures; and respiratory function tests with a spirometer were determined pre‐ and postoperatively.

Results

Six patients were male; five were female; and one was male‐to‐female transsexual. Their ages ranged between 9 and 60 years with a mean of 36. All webs were caused by surgical trauma. All webs were cured with one surgery. The postoperative VHI scores, acoustic analysis results, aerodynamic measures, and respiratory function test results of patients improved significantly postoperatively (P < 0.05).

Conclusion

Although technically difficult, butterfly mucosal flap technique is a very successful single‐stage endoscopic surgical option for the treatment of glottic webs.

Level of Evidence

2. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AjeDaR

Opioid prescription and postoperative outcomes in pediatric patients

Objectives/Hypothesis

To determine if the amount of opioid prescribed and postoperative outcomes after adenotonsillectomy changed following implementation of mandated opioid consent forms.

Study Design

Retrospective cohort study.

Methods

Patients undergoing adenotonsillectomy 6 months before and after implementation of mandated opioid consent forms at a tertiary‐care pediatric hospital were studied. Demographics, operative data, weight‐based opioid dosage, and postoperative outcome measures, including nursing calls, emergency department (ED) visits, hospital readmission, and bleed rates, were collected and analyzed.

Results

Of 300 patients, opioid prescription was provided for 211 patients (70.3%), 112 preconsent (74.7%) and 99 postconsent (66.0%). Mean (standard deviation) total opioid prescribed (milligrams/kilogram) was significantly higher preconsent 4.8 (5.6) than postconsent 3.2 (4.7), (P = .003). There were no differences between number of nursing calls (P = .134) or ED visits (P = .083). Interestingly, preconsent patients had more hospital readmission for pain/dehydration (odds ratio OR: 368, P = .016) and bleeding concerns (OR: 244, P = .003).

Conclusions

A mandated consent form prior to opioid prescription was associated with decreased overall opioid prescription without resultant increase in postoperative complications in pediatric patients. These data provide support for minimizing opioid prescription on a systems‐based level.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SlICpt

The glottis is not round: Teardrop‐shaped glottic dilation for early posterior glottic stenosis

Objectives

Posterior glottic stenosis (PGS) results in severe derangement of laryngeal configuration and function with significant morbidity as a sequalae. Presently, there is no treatment for patients with "early" PGS. Dilation is often used for stenotic disease, but present dilation methods are limited to a round shape and the glottis is a sector (teardrop‐shaped). Round dilation of the larynx results in compression of the membranous vocal folds (with potential for injury) and minimal expansion of the posterior larynx. We present a novel laryngeal dilation method that matches the unique anatomic shape of the glottis: teardrop‐shaped glottis dilation (TSGD).

Methods

We present a clinical series of early PGS patients treated with a TSGD. Five patients with dyspnea and significantly reduced vocal fold mobility due to early PGS were treated with TSGD, which involves placement of a triangular static stent in the anterior glottis, with simultaneous use of a round balloon dilator in the posterior glottis.

Results

All patients reported improved ease of breathing and decrease in Dyspnea Index score and were decannualated following treatment. Video perceptual analysis of pre‐/postlaryngoscopy examinations was performed with five blinded reviewers, and all patients were scored to have improved posterior glottic airway space following treatment with a mean improvement of 2.4 on a 11‐point scale.

Conclusion

These clinical results demonstrate that there is enormous potential for the identification and treatment of patients with early PGS and use of a laryngeal dilation technique that matches the anatomic configuration of the glottis.

Level of Evidence

4. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LAlWiK

Subpectoral implantation of the hypoglossal nerve stimulator: An effective technical modification

Upper airway stimulation is now a well‐established treatment option for selected patients with obstructive sleep apnea. The implanted pulse generator of this system activates the hypoglossal nerve and is routinely placed in a subcutaneous pocket overlying the pectoralis muscle. This case report describes a patient with a history of bilateral mastectomy and radiation for breast cancer who required explantation due to device exposure and infection. The patient was successfully reimplanted by placing the implantable pulse generator deep to the pectoralis major muscle. Clinical circumstances involving the chest wall may warrant subpectoral placement of the implanted pulse generator. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2rVB8xF

Is routine genetic testing warranted in head and neck paragangliomas?

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2LB8lHV

The medial sural artery perforator flap: A better option in complex head and neck reconstruction?

Objectives

The medial sural artery perforator (MSAP) free flap is an uncommonly utilized soft tissue flap in head and neck reconstruction. It is a thin, pliable, fasciocutaneous flap that provides significant pedicle length. The donor site can be closed primarily, and its location is more aesthetically pleasing to patients. We aim to describe the MSAP flap and compare it to other commonly used free flaps in the head and neck.

Study Design

Retrospective case series.

Methods

A retrospective review of all MSAP cases performed at New York University Langone Health was performed from July 2016 to November 2017. We examined the patients' age, diagnosis, history of prior radiation therapy, and comorbidities, as well as flap‐specific information and recipient site.

Results

Twenty‐one patients underwent a variety of different head and neck procedures with coverage using an MSAP flap. Recipient sites included tongue, cheek, soft and hard palate, cervical esophagus, and pharynx. Pedicle length ranged from 8 cm to 12 cm. The smallest surface area harvested was 24 cm² (6 cm × 4 cm), and the largest was 120 cm² (15 cm × 8 cm). The flaps ranged from 5 to 12 mm in thickness. Venous coupler size ranged from 2.0 to 3.5 mm. Primary closure of the donor site was achieved in 18 of 21 flaps. Twenty of 21 flaps were transferred successfully.

Conclusion

The MSAP flap is a highly versatile and reliable option for a thin, pliable soft tissue flap with a donor site that may be preferable over the radial forearm free flap and anterolateral thigh flap in complex head and neck reconstruction.

Level of Evidence

4. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2rTj5IA

A novel silk‐based vocal fold augmentation material: 6‐month evaluation in a canine model

Objectives

Ideal long‐term vocal fold augmentation materials should be biocompatible, easily administered, allow tissue integration for long‐term effect, and remain at the site of injection. A novel silk protein particle suspended in hyaluronic acid (Silk‐HA) has been developed specifically for vocal fold augmentation to address this unmet need. This article presents the 6‐month, preclinical findings of a canine vocal fold injection trial for Silk‐HA.

Methods

Twelve beagle dogs were injected transorally in the lateral/deep aspect of their right thyroarytenoid muscles with 0.3 cc of Silk‐HA or calcium hydroxylapatite in carboxymethyl cellulose (CaHA‐CMC). The Silk‐HA particle injectable was delivered via a custom catheter, whereas CaHA‐CMC was delivered through a commercially available malleable needle. The six dogs from each material group were sacrificed 6 months from the injection date for the evaluation of implant longevity, immune response, and material migration.

Results

Silk‐HA provides immediate medialization of the right vocal fold, lasting for a minimum of 6 months in a canine model. Silk‐HA and CaHA‐CMC both demonstrate similar inflammatory responses. The Silk‐HA was shown to remain without migration at the site of injection in all six canine subjects, whereas CaHA‐CMC demonstrated migration in four of the six canines. In two canines implanted with CaHA‐CMC, material was discovered to migrate to the retropharyngeal lymph nodes.

Conclusion

In a canine subject model, the Silk‐HA material compares favorably in terms of longevity and immune response to CaHA‐CMC. The lack of migration of the Silk‐HA material demonstrates a promising potential for vocal fold injection in the clinic.

Level of Evidence

NA Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SnIgyz

Management of difficult airway among patients with oropharyngeal angioedema

Objective

The objective of our study was to assess the impact of a multidisciplinary difficult airway response team (DART), a quality improvement program, in the management of patients with difficult airway associated with oropharyngeal angioedema patients.

Methods

Individual retrospective cohort study. Retrospective review of patient charts from July 2003 to June 2008 (pre‐DART) and retrospective review of prospectively collected data from July 2008 to June 2013 (post‐DART). Patients with angioedema were identified using International Classification of Disease codes 995.1 and 277.6. Patients were included in the study if an otolaryngologist was consulted for airway management. Patients were excluded if they had a history of angioedema but no active issues. Patient characteristics, airway evaluation, and interventions (intubation/surgical airway) were compared between the pre‐DART and post‐DART cohort.

Results

The DART team attended to 27 patients with advanced oropharyngeal angioedema. Response time averaged 3.36 minutes. Preintubation fiberoptic airway evaluations were performed in 81% of the post‐DART cohort and 56% of the pre‐DART cohort. The incidence of patients requiring intubation was higher in the post‐DART cohort (18 out of 27 [67%]) than the pre‐DART (14 out of 36 [39%]) cohort. One emergency cricothyroidotomy was performed in each of the post‐DART and pre‐DART cohorts.

Conclusion

Angioedema of the larynx is a predictor of intubation or cricothyroidotomy. Fiberoptic‐guided intubation is primarily used for establishing airway in angioedema patients. A multidisciplinary standardized approach such as the DART program offers adequate time and resources for airway evaluation prior to intervention and allows fewer number of attempts to secure an airway.

Level of Evidence

3. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AeZd79

Safe use of systemic bevacizumab for respiratory recurrent papillomatosis in two children

Recurrent respiratory papillomatosis can be a devastating condition for a child, with severe consequences. Currently, there is no proven successful medical treatment. We describe the use of systemic bevacizumab to treat two children affected by aggressive recurrent respiratory papillomatosis. Respiratory symptoms and quality of life improved dramatically in both patients, without observing any toxicity. The only complication was mild proteinuria. Systemic bevacizumab is a promising adjuvant treatment in aggressive recurrent respiratory papillomatosis in children. It is effective and well tolerated. Further studies are needed to establish the optimal dosing frequency and duration of therapy. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SnbdL8

Safety of outpatient unilateral medialization laryngoplasty across two academic institutions

Objectives/Hypothesis

Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary‐care academic medical centers.

Study Design

Retrospective chart review,

Methods

A review of patients undergoing unilateral ML at two tertiary‐care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML.

Results

One hundred three total procedures met inclusion criteria. Fifty‐seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore‐Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas.

Conclusions

The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AjzHxG

Table of contents

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SkuxZi

Tracheal replacement revisited: Use of a vascularized tracheal transplant in a porcine model

Objectives/Hypothesis

To determine if a long segment of trachea can be transplanted as a vascularized organ and to determine if a tracheal transplant is a potential surgical option for a long‐segment circumferential tracheal defect.

Study Design

Animal model.

Methods

Four (two donors and two recipients) adult domestic Yorkshire swine were used. Two sets of transplants were performed from a donor to recipient pig. The transplant was placed heterotopically (not in continuity with the airway), and the recipient animals were monitored for 14 days to ensure the transplants were well vascularized. Immunosuppressive therapies included methylprednisolone, cyclosporine, and azathioprine. Gross as well as histological examination of multiple tissues types including mucosa, cartilage, muscle, and blood vessels were performed postsacrifice on day 14.

Results

Recipient animal weights ranged from 40 to 42 kilograms. Both recipient pigs survived the full 14 days of study and exhibited normal activity and appetite. Ischemia time of transplanted grafts ranged from 63 to 72 minutes. Transplanted tracheas included a minimum of 15 cartilaginous rings and measured greater than 10 cm in length. Both grafts maintained a robust blood supply throughout the duration of study.

Conclusions

The entire visceral compartment can be reliably transplanted, either as a single component (trachea) or as a chimeric flap with multiple components (trachea, esophagus, larynx, and pharynx). Further studies in the swine model should be considered to study the effects of transplanting the trachea orthotopically into the native airway. Further studies are needed into the reliability of this technique of transplantation in humans.

Level of Evidence

NA Laryngoscope, 128:S1–S9, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AjAyhR

Masthead

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SnL2Uq

Surgical treatment of glottic web using butterfly mucosal flap technique: Experience on 12 patients

Objectives

Many surgical methods have been described for the treatment of glottic web, with very little experience of each. Butterfly mucosal flap technique utilizes superior and inferior mucosal flaps on corresponding surfaces of the web; superior flap is elevated with its base on one vocal fold; and inferior flap is elevated with its base on the other vocal fold. These flaps are sutured to the vocal fold where flap's base is located. This requires four to six microsutures. The disadvantage of this technique is its difficulty. The advantages are single‐stage endoscopic outpatient surgery and high success rate.

Methods

This is an individual prospective cohort study. All consecutive 12 cases of glottic web were treated with butterfly mucosal flap technique and followed for at least 1 year postoperatively. Voice Handicap Index (VHI)‐30 including physical, functional, emotional, and total scores; acoustic analysis with /a/; aerodynamic measures; and respiratory function tests with a spirometer were determined pre‐ and postoperatively.

Results

Six patients were male; five were female; and one was male‐to‐female transsexual. Their ages ranged between 9 and 60 years with a mean of 36. All webs were caused by surgical trauma. All webs were cured with one surgery. The postoperative VHI scores, acoustic analysis results, aerodynamic measures, and respiratory function test results of patients improved significantly postoperatively (P < 0.05).

Conclusion

Although technically difficult, butterfly mucosal flap technique is a very successful single‐stage endoscopic surgical option for the treatment of glottic webs.

Level of Evidence

2. Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AjeDaR

Opioid prescription and postoperative outcomes in pediatric patients

Objectives/Hypothesis

To determine if the amount of opioid prescribed and postoperative outcomes after adenotonsillectomy changed following implementation of mandated opioid consent forms.

Study Design

Retrospective cohort study.

Methods

Patients undergoing adenotonsillectomy 6 months before and after implementation of mandated opioid consent forms at a tertiary‐care pediatric hospital were studied. Demographics, operative data, weight‐based opioid dosage, and postoperative outcome measures, including nursing calls, emergency department (ED) visits, hospital readmission, and bleed rates, were collected and analyzed.

Results

Of 300 patients, opioid prescription was provided for 211 patients (70.3%), 112 preconsent (74.7%) and 99 postconsent (66.0%). Mean (standard deviation) total opioid prescribed (milligrams/kilogram) was significantly higher preconsent 4.8 (5.6) than postconsent 3.2 (4.7), (P = .003). There were no differences between number of nursing calls (P = .134) or ED visits (P = .083). Interestingly, preconsent patients had more hospital readmission for pain/dehydration (odds ratio OR: 368, P = .016) and bleeding concerns (OR: 244, P = .003).

Conclusions

A mandated consent form prior to opioid prescription was associated with decreased overall opioid prescription without resultant increase in postoperative complications in pediatric patients. These data provide support for minimizing opioid prescription on a systems‐based level.

Level of Evidence

4 Laryngoscope, 2018

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SlICpt

Baseline intraoperative intact parathyroid hormone levels in parathyroid surgery

Abstract

Background

We sought to evaluate the relationship between the preoperative core‐laboratory parathyroid hormone (CL‐PTH) level and the baseline intraoperative PTH (IOPTH) level and assess the impact of any differences on clinical decision making in consecutive surgical patients with primary hyperparathyroidism undergoing parathyroidectomy.

Methods

The CL‐PTH and baseline IOPTH levels were compared. The influence of relying on either the CL‐PTH or baseline PTH levels for intraoperative decision making was determined.

Results

Data were available for 316 patients. Baseline IOPTH measurements were usually higher than the CL‐PTH (247 patients; 78.2%) measurements, with a mean difference of 68.2 pg/mL (P < .001). Using the CL‐PTH as a surrogate for the baseline parathyroid hormone (PTH) would have prolonged the operation in 23 patients (7.3%).

Conclusion

Baseline point‐of‐care IOPTH levels were higher than the preoperative CL‐PTH levels in >75% of patients undergoing parathyroidectomy. Using the CL‐PTH in lieu of an IOPTH baseline value would prolong the operation in some patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RhTnf5

Baseline intraoperative intact parathyroid hormone levels in parathyroid surgery

Abstract

Background

We sought to evaluate the relationship between the preoperative core‐laboratory parathyroid hormone (CL‐PTH) level and the baseline intraoperative PTH (IOPTH) level and assess the impact of any differences on clinical decision making in consecutive surgical patients with primary hyperparathyroidism undergoing parathyroidectomy.

Methods

The CL‐PTH and baseline IOPTH levels were compared. The influence of relying on either the CL‐PTH or baseline PTH levels for intraoperative decision making was determined.

Results

Data were available for 316 patients. Baseline IOPTH measurements were usually higher than the CL‐PTH (247 patients; 78.2%) measurements, with a mean difference of 68.2 pg/mL (P < .001). Using the CL‐PTH as a surrogate for the baseline parathyroid hormone (PTH) would have prolonged the operation in 23 patients (7.3%).

Conclusion

Baseline point‐of‐care IOPTH levels were higher than the preoperative CL‐PTH levels in >75% of patients undergoing parathyroidectomy. Using the CL‐PTH in lieu of an IOPTH baseline value would prolong the operation in some patients.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RhTnf5

Dermoid Cyst of the Parotid Gland: A Rare Entity

Abstract

Dermoid cysts of the head and neck are a rare entity. These cysts are benign cystic malformations and histologically composed of tissues originating from ectoderm and mesoderm. Dermoid cysts usually presents as midline neck mass and rarely appear in lateral region. These are extremely rare in parotid gland, however should be considered as a differential in the list of parotid mass. There are a few cases published till date. Superficial parotidectomy is suggested as surgical treatment, however sometimes enucleation is also sufficient. There are only very few case reports published on dermoid cysts in parotid glands. We present a rare case of this entity and the challenges faced in making diagnosis with a short review of the literature.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QRnJpq

A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study

Abstract

To study the survival in patients affected with hypopharyngeal cancer among treatment groups and different stages. Data of hypopharyngeal cancer patients diagnosed from 1st January 2010 to 31st December 2010 was used in the present study. The cases were analyzed for gender, age group distribution, sub-sites at presentation, stage at diagnosis and the type of treatments. Survival from the date of first diagnosis was estimated and hazard ratios were calculated. Survival probability and hazards ratios (HR) were calculated by Kaplan–Meier method and Cox-proportional regression analysis respectively. Censoring of patient who survived longer than 5 years was done. Active follow-up was done for the survival analysis. The study cohort included 217 patients and treatment compliance was observed in 46.9% of cases. The median age at diagnosis was 57 years (range 24–90), 86.2% of cases were locally advanced cases (stage III and IV), pyriform sinus was major sub-site (96%), radiotherapy was main treatment modality alone in 84.8% of cases, median survival was 31 months and 5-year overall survival was 36.9%, and HR for stage IV was 1.9 (P = 0.03, 95% CI − 1.04 to 3.7). In developing setting of North East India, radiotherapy was the main modality of treatment for hypopharyngeal cancer patients, and understanding the clinical parameters and survival of this group of cancers is crucial for its control.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BEiVt4

Feasibility of Parotid Duct Transposition for the Treatment of Dry Eye: A Cadaveric Study

Abstract

Total dry eye is encountered less frequently, but it may lead to blindness. Transposition of parotid duct to the conjunctival cul-de-sac is a method of treatment for advanced cases of xerophthalmia to prevent blindness. Tears and parotid secretions have similar composition; therefore saliva provides an excellent replacement for tears. Limitation of this procedure is that the length of the parotid duct may not be adequate to reach the conjunctival cul-de-sac. This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7 cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1–1.50 cm in length. Parotid duct can be transposed easily to the lower conjunctival cul-de-sac in majority of the cases. If the parotid duct is falling short than a cuff of the buccal mucosa can be taken in order to gain length.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QVkFJ1

Dermoid Cyst of the Parotid Gland: A Rare Entity

Abstract

Dermoid cysts of the head and neck are a rare entity. These cysts are benign cystic malformations and histologically composed of tissues originating from ectoderm and mesoderm. Dermoid cysts usually presents as midline neck mass and rarely appear in lateral region. These are extremely rare in parotid gland, however should be considered as a differential in the list of parotid mass. There are a few cases published till date. Superficial parotidectomy is suggested as surgical treatment, however sometimes enucleation is also sufficient. There are only very few case reports published on dermoid cysts in parotid glands. We present a rare case of this entity and the challenges faced in making diagnosis with a short review of the literature.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QRnJpq

A Survival Analysis of Hypopharyngeal Cancer Patients: A Hospital-Cancer registry Based Study

Abstract

To study the survival in patients affected with hypopharyngeal cancer among treatment groups and different stages. Data of hypopharyngeal cancer patients diagnosed from 1st January 2010 to 31st December 2010 was used in the present study. The cases were analyzed for gender, age group distribution, sub-sites at presentation, stage at diagnosis and the type of treatments. Survival from the date of first diagnosis was estimated and hazard ratios were calculated. Survival probability and hazards ratios (HR) were calculated by Kaplan–Meier method and Cox-proportional regression analysis respectively. Censoring of patient who survived longer than 5 years was done. Active follow-up was done for the survival analysis. The study cohort included 217 patients and treatment compliance was observed in 46.9% of cases. The median age at diagnosis was 57 years (range 24–90), 86.2% of cases were locally advanced cases (stage III and IV), pyriform sinus was major sub-site (96%), radiotherapy was main treatment modality alone in 84.8% of cases, median survival was 31 months and 5-year overall survival was 36.9%, and HR for stage IV was 1.9 (P = 0.03, 95% CI − 1.04 to 3.7). In developing setting of North East India, radiotherapy was the main modality of treatment for hypopharyngeal cancer patients, and understanding the clinical parameters and survival of this group of cancers is crucial for its control.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2BEiVt4

Feasibility of Parotid Duct Transposition for the Treatment of Dry Eye: A Cadaveric Study

Abstract

Total dry eye is encountered less frequently, but it may lead to blindness. Transposition of parotid duct to the conjunctival cul-de-sac is a method of treatment for advanced cases of xerophthalmia to prevent blindness. Tears and parotid secretions have similar composition; therefore saliva provides an excellent replacement for tears. Limitation of this procedure is that the length of the parotid duct may not be adequate to reach the conjunctival cul-de-sac. This study was conducted in 30 fresh cadavers to assess the length of parotid duct and technical feasibility of parotid duct transposition for the treatment of dry eye. The parotid duct was dissected and resting length of parotid duct was measured on both sides without stretching. The distance between ear lobule to lateral canthus was also measured on both sides in each cadaver. The length of parotid duct ranges from 4.5 to 7 cm with average length was 5.8 cm. The majority of the cadavers had parotid duct length of 6 cm. Length of the right and left parotid duct was found to be equal in all cadavers. Parotid duct reached comfortably in 24 cadavers (80%) while it was short in 6 cadavers (20%) by 1–1.50 cm in length. Parotid duct can be transposed easily to the lower conjunctival cul-de-sac in majority of the cases. If the parotid duct is falling short than a cuff of the buccal mucosa can be taken in order to gain length.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2QVkFJ1