Auris Nasus Larynx

Effect of preservation on the physical and chemical properties of the temporal fascia Publication date: Available online 23 January 2020 Source: Auris Nasus Larynx Author(s): Shunsuke Tarumoto, Kazuma Sugahara, Makoto Hashimoto, Yoshinobu Hirose, Junko Tsuda, Yosuke Takemoto, Hironori Fujii, Takafumi Matsuura, Hiroaki Shimogori, Junji Ohgi, Hiroshi Yamashita Abstract Objective The temporal fascia has been widely used in tympanoplasty. In addition, the preserved fascia has been also used in the ear surgery. In this study, we planned the experiments to determine whether physical and chemical properties of the fascia preserved at a low temperature. Methods Preserved temporal fasciae from 21 patients were used in this study. The thickness of the temporal fascia was measured under a 3D laser microscope. The tensile strength was evaluated using a tensile tester. In addition, the chemical property evaluated was the biologic antioxidative potential of samples. Results The results showed that the strength of the fascia was not affected by the retention period. The thick fascia tended to show the less tensile strength. The intensity was highest in middle-aged donors when compared to young and older donor. The antioxidative potentials did not affect the preservation. Conclusion The results suggested that the preserved temporal fascia could be safely used for tympanoplasty.

Facial nerve and chorda tympani schwannomas: Case series, and advantages of using non-rigid registration of post-enhanced 3D-T1 Turbo Field Echo and CT images (TURFECT) in their diagnosis and surgical treatment Publication date: Available online 13 January 2020 Source: Auris Nasus Larynx Author(s): Takatoshi Furukawa, Cristoforo Fabbris, Tsukasa Ito, Toshitada Hiraka, Takanari Goto, Toshinori Kubota, Hirooki Matsui, Rintaro Ohe, Masafumi Kanoto, Seiji Kakehata Abstract Objective Facial nerve schwannomas (FNSs) and chorda tympani schwannomas are very rare. Diagnosis of these tumors is sometimes difficult, and treatment consensus has not yet been reached. We report here a series of cases of FNS and chorda tympani schwannoma and highlight the usefulness of our newly developed technique of non-rigid registration of post-enhanced 3D-T1 Turbo Field Echo and CT images (TURFECT) in their diagnosis and treatment. Methods MRI images were adjusted with the corresponding CT images in terms of angle and position in order to index the anatomical structures. The well-enhanced T1-Gd+ lesions of tumors having good blood flow show up as bright red after color mapping. Results Between 2014 and 2018, five patients were diagnosed with schwannomas in the temporal bone: three with FNS and two with chorda tympani schwannoma. Gd-enhanced MRI showed only a high-intensity mass, and we could not detect the relationship between tumor-like mass and bone (including the ossicles) by MRI only. In contrast, TURFECT was very useful for diagnosing the precise location, allowing us to decide on an endoscopic surgical plan in some of our cases. An endoscope enabled visualization of the medial wall of the tympanic cavity and the status of the tumors, thus we could successfully perform transcanal endoscopic biopsy and resections. Conclusion TURFECT can be very useful for diagnosis of FNSs and chorda tympani schwannomas and for deciding surgical treatments such as a transcanal endoscopic approach.

Endoscopic open rhinoplasty enables a cosmetic approach for a rare case of intraosseous cavernous hemangioma in the nasal bone Publication date: Available online 10 January 2020 Source: Auris Nasus Larynx Author(s): Yoko Tomioka, Kenji Kondo, Takao Numahata, Yuta Moriwaki, Mutsumi Okazaki Abstract A rare case of intraosseous cavernous hemangioma was identified in the nasal root. Using a combination of endoscopic surgery and open rhinoplasty, an osteotomy was performed and resection of the hemangioma was successfully achieved with transcolumellar and infracartilaginous incisions and 2 stab incisions. No adverse side effects were observed after the procedure, no tumor recurrence was observed at the 16-month-postoperative follow-up. The preserved periosteum contributed to the osteogenesis and thus, a need for a reconstructive surgery was indicated. The favorable outcomes associated with this approach justify and authenticate the use of endoscopy-assisted open rhinoplasty in the treatment of intraosseous cavernous hemangiomas without leaving ventral surgical scarring.

MiRNA-506 presents multiple tumor suppressor activities by targeting EZH2 in nasopharyngeal carcinoma Publication date: Available online 10 January 2020 Source: Auris Nasus Larynx Author(s): Da-Chuan Fan, Yan-Ru Zhao, Hai Qi, Jin-Xiao Hou, Tian-Hong Zhang Abstract Objective MiR-506 has been reported to be associated with multiple malignancies, but its roles in nasopharyngeal cancer (NPC) are not fully understood. Our objective is to demonstrate its effects on NPC and the underlying mechanisms. Methods Totally fifteen pairs of NPC and adjacent non-tumorous tissues were collected for the detection of miR-506 and enhancer of zeste homolog 2 (EZH2) expression. Dual luciferase reporter assay was employed for verifying the relationship between miR-506 and EZH2. The flow cytometry and MTT assays were employed to explore the effects of miR-506 and EZH2 on the cell apoptosis and proliferation, respectively. Wound closure and transwell assays were used to evaluate the cell migration and invasion abilities. Western blotting or RT-qPCR assays were applied to detect the alterations of miR-506, EZH2 and epithelial-mesenchymal transition (EMT)-related markers. Morphological changes of cells with EMT were assessed by light microscopy. Results MiR-506 was significantly decreased and EZH2 was obviously increased in NPC tissues. Overexpression of miR-506 decreased the EZH2 level, promoted apoptosis, inhibited proliferation, invasion and migration of NPC cells. Accordingly, miR-506 overexpression attenuated EMT process of NPC cells as demonstrated by the alterations of EMT-related markers and the morphological changes. In addition, the luciferase assay proved that miR-506 directly targeted EZH2. Furthermore, the overexpression of EZH2 reversed the tumor-suppressive effects induced by miR-506 mimics. Conclusion MiR-506 acted as a tumor suppressor to promote apoptosis and inhibit invasion and migration via directly targeting EZH2. MiR-506 can be a candidate target for gene therapy against NPC.

Superior mediastinal lymphadenopathy by silicosis mimicking metastasis of papillary thyroid carcinoma – Case report and literature review Publication date: Available online 31 December 2019 Source: Auris Nasus Larynx Author(s): Toshiaki Tsukatani, Hideki Niwa, Takeshi Komori, Tatsuya Yoneyama, Hiroyuki Tsuji, Takatoshi Michigishi, Kunihiko Yokoyama, Tomokazu Yoshizaki Abstract Silicosis is caused by inhalation of silica dust and is the most common type of pneumoconiosis. The characteristics of silicosis are inflammation of lung tissue and calcified lymphadenopathy of pulmonary hilum, mediastinum and paratrachea. We present a papillary thyroid carcinoma (PTC) case with paratracheal and superior mediastinal calcified lymphadenopathy caused by silicosis. The patient did not exhibit any respiratory symptoms or abnormal chest x-ray findings due to early phase silicosis. The lymph nodes were thought to be metastasis of PTC before surgery. Patient underwent total thyroidectomy with neck and superior mediastinum dissection. Post-surgery pathological examination exhibited coexistence of silica nodules and micrometastasis of PTC in paratracheal lymph nodes, but only silica nodules were observed in superior mediastinum lymph nodes. Patient's occupation was office worker but had worked as a stonemason for several decades prior. This is a first observed case of superior mediastinal lymphadenopathy by silicosis mimicking metastasis of PTC. Benign calcified lymphadenopathy may mimic metastasis of PTC in the evaluation of neck or mediastinal lesions.

Regional flap practice patterns: A survey of 197 head and neck surgeons Publication date: Available online 26 December 2019 Source: Auris Nasus Larynx Author(s): Andrew T. Day, Alex M. Yang, Liyang Tang, Eli A. Gordin, Kevin S. Emerick, Jeremy D. Richmon

Development of proficiency-based knot-tying and suturing curriculum for otolaryngology residents: A pilot study Publication date: Available online 24 December 2019 Source: Auris Nasus Larynx Author(s): Eriko Sato, Sohei Mitani, Naoki Nishio, Takashi Kitani, Tomoyoshi Sanada, Toru Ugumori, F. Christopher Holsinger, Fred M. Baik, Naohito Hato Abstract Objective Basic surgical skills such as knot-tying and suturing are important for all otolaryngologists, regardless of subspecialty. The present study was undertaken in order to assess basic surgical techniques such as knot-tying and suturing required for novice otolaryngology residents with taking the variety of subspecialties into consideration, and evaluate the impact of a proficiency-based training curriculum based on these techniques. Methods A prospective study was performed for developing of proficiency-based knot-tying and suturing curriculum for otolaryngology residents in the third post-graduate year (PGY-3). The proficiency-based training curriculum was developed based on the tasks selected by RAND/UCLA method with expert panel, which is an iterative and anonymous survey used to establish consensus among participants. Expert panelists were selected from various divisions to reflect variety of their subspecialties. PGY-3 residents trained with the developed curriculum that included proctored pre-test, self-training to proficiency, and proctored post-test. Visual analogue scale (VAS) of trainees’ overall competence in the operating room was self-assessed by each resident, before and after completing the training curriculum. Results Nine PGY-3 residents were enrolled as trainees. Eleven experts chosen as panelists had various subspecialty, including 2 from otology, 2 from rhinology, 2 from laryngology, 2 from head and neck surgery, and 3 from general otolaryngology. Seven tasks were selected from RAND/UCLA method and used to develop the curriculum. Trainee scores at pre-test were significantly lower than expert scores for all 7 tasks (p < 0.01) and each coefficient of variation of trainee score was larger than that of expert score (p < 0.05), supporting construct validity. The mean of composite scores between pre-test and post-test had statistical significance (68.6 ± 11.6 vs 95.9 ± 3.6, p < 0.01), documenting substantial improvement after training. Self-assessment VAS was also improved pre- to post-training (1.2 ± 0.9 vs 4.5 ± 1.4, p < 0.01). A follow-up questionnaire showed that trainees felt the educational curriculum to be beneficial. Conclusion In the present study, seven basic technical skills were selected using the RAND/UCLA method and used to create a proficiency-based training curriculum. Our results indicate that this curriculum significantly improves proficiency of basic surgical skills of junior otolaryngology residents.

Spinal solitary fibrous tumor of the neck: Next-generation sequencing-based analysis of genomic aberrations Publication date: Available online 24 December 2019 Source: Auris Nasus Larynx Author(s): Mizuo Ando, Hiroshi Kobayashi, Aya Shinozaki-Ushiku, Hirotaka Chikuda, Yoshitaka Matsubayashi, Masafumi Yoshida, Yuki Saito, Shinji Kohsaka, Katsutoshi Oda, Kiyoshi Miyagawa, Hiroyuki Aburatani, Hiroyuki Mano, Tatsuya Yamasoba Abstract A solitary fibrous tumor (SFT) is a rare neoplasm with recurrent NAB2–STAT6 gene fusion. An SFT may develop almost anywhere throughout the body, including the head and neck region, and is characterized by a broad spectrum of malignancy. Here we present a case involving a 57-year-old male with a dumbbell-shaped SFT in the cervical spine that mimicked schwannoma. Repeated fine-needle aspiration cytology failed to establish a definitive diagnosis. Given that the tumor size increased significantly over a 10-month period, open biopsy was then performed. Though the biopsy result was inconclusive, a nonepithelial tumor, including sclerosing epithelioid fibrosarcoma or ossifying fibromyxoid tumor, was suspected. The tumor was then completely removed together with adjacent parts of C2 and C3 vertebrae and left vertebral artery via combined anterior and posterior approaches. Histologically, the tumor consisted of round cells with prominent stromal hyalinization and was immunohistochemically positive for STAT6, CD34, and cytokeratin. Finally, Todai OncoPanel, a next-generation sequencing-based molecular profiling system using formalin-fixed paraffin-embedded samples, demonstrated fusion transcript in which NAB2 exon 6 was fused to STAT6 exon 16 supporting the diagnosis of SFT, while whole-exome sequencing analysis detected no somatic mutations which were known to be oncogenic.

Management of extracranial arteriovenous malformations of the head and neck Publication date: Available online 18 December 2019 Source: Auris Nasus Larynx Author(s): Veronica Fernández-Alvarez, Carlos Suárez, Remco de Bree, Iain J. Nixon, Antti A. Mäkitie, Alessandra Rinaldo, Jonathan Downer, Alfio Ferlito Abstract The purpose of this study was to review the outcomes of the different therapies for extracranial head and neck arteriovenous malformations (AVMs). AVMs are high-flow congenital vascular anomalies. They are composed of a complex system of vessels directly connecting feeding arteries to draining veins forming a nidus. They may be potentially life-threatening due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly affect the head and neck area (47.4%) followed by the extremities (28.5%). AVMs are best characterized as being either focal or diffuse. Focal AVMs have good outcomes following adequate treatment. Diffuse lesions have multiple feeding vessel, which results in high rates of recurrence despite treatment. The management of AVMs includes conventional surgery and endovascular techniques. A combination of embolization and surgical resection has become the treatment of choice over the last years. The main goal of both forms of treatment being the complete blockage or resection of the nidus. Transcatheter embolization of vessels has evolved over the years and new embolic agents have emerged. The types of materials available for embolization are classified into mechanical devices, liquid agents and particulates. Efficacy, rate of recurrence and most common complications were evaluated. AVMs recurrence after embolization or resection is reported in up to 80% of cases. Incomplete resection and embolization can induce aggressive growth of the remaining nidus and the risk of progression is up to 50% within the first 5 years and recurrences can occur up to 10 years later. Although ethanol seems to be associated with the highest degree of cure and permanent occlusion, the overall complication rate reported was 48%. Other materials, such as cyanoacrylate, have obtained modest rates of complete remission, while the reported rates of complete regression of AVMs with Fibrin glue and Polyvinyl alcohol are above 50%. At present, there are no unified agreement on the ideal embolic agent. Therefore, a multidisciplinary approach is recommended to support decision making about the best therapeutic approach and to achieve optimal outcome. A long-term post-treatment follow-up is recommended to recognize early recurrence.

Deep cervical fascia as an anatomical landmark of lingual lymph nodes: An anatomic and histologic study Publication date: Available online 18 December 2019 Source: Auris Nasus Larynx Author(s): Kohtaro Eguchi, Satoru Muro, Koh Miwa, Kumiko Yamaguchi, Keiichi Akita Abstract Objectives We aimed to discuss the definition of lingual lymph nodes based on the deep cervical fascia anatomy. Methods A total of 11 cadavers were histopathologically evaluated. Specimens were dissected into serial stepwise cross-sections. The deep cervical fascia and lymph nodes were evaluated by staining the cross-sections with Elastica van Gieson and hematoxylin and eosin stains, respectively. The gross anatomy of the deep cervical fascia was evaluated in 1 cadaver after bilateral dissection. Results A single severely degenerated medial lingual lymph node (MLLN) was identified in the lingual septum of 1 cadaver. A single lateral lingual lymph node (LLLN) was identified in 1 cadaver, between the genioglossus and the hyoglossus. The superficial layer of deep cervical fascia (SLDF) was found to split into two layers encapsulating the submandibular gland. The deeper portion of this fascia was in close contiguity with the hyoglossus and formed the boundary between the mouth and the neck. The SLDF was found to be discontinuous with the area between the sublingual space and the submandibular gland. Conclusions The SLDF could serve as an anatomical landmark for lingual lymph nodes, since it is considered to be the demarcating boundary during neck dissection. When lymph nodes that are located deeper than the SLDF were defined as lingual lymph nodes, 1 MLLN and 1 LLLN were identified.