51.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28553. [Epub ahead of print]
Ultrasound-Guided Suture Lateralization in Pediatric Bilateral Vocal Fold Immobility.
KEYWORDS:
Pediatric; suture lateralization; ultrasound, larynx, bilateral; vocal fold paralysis
52.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28578. [Epub ahead of print]
What is the Role of Transoral Thyroidectomy?
53.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28513. [Epub ahead of print]
Comparison of Recording Electrode Arrays in Endotracheal Thyroid Monitoring Tubes in a Porcine Model.
Abstract
OBJECTIVES:
Alteration in positioning or head manipulation during thyroid surgery can lead to endotracheal tube movement and potentially a change in intraoperative neural monitoring readings. We sought to study the impact of positional changes on two different commercially available recording electrode arrays.
MATERIALS:
Eight pigs divided equally into two study groups based on recording electrode arrays were used: Neurosign Lantern Laryngeal Electrode (LLE) (Neurosign_Technomed, The Netherlands) and Medtronic NIM EMG [neural integrity monitor electromyogram] endotracheal tube (ETT) (Medtronic, Jacksonville, FL). Neck movement and reposition were performed for all pigs. Signal data, including amplitude and latency, were collected for vagus nerve, recurrent laryngeal nerve (RLN), and external branch of superior laryngeal nerve (EBSLN) before and after repositioning. The differences of amplitude and latency by pre- and post-repositioning were compared for all animals.
RESULTS:
Eight pigs were included in the current study. ETT group (Medtronic) had a significant decrease in amplitude of all tested nerves: for the vagus nerve on the left side by 36.30% (P = .021) and on the right by 49.29% (P = .024), for RLN on the left by 30.22% (P = .014) and on the right by 42.34% (P = .004), and for EBSLN on the left by 63.62% (P = .003) and on the right by 13.58% (P = .010). The amplitude changes in LLE group (Neurosign) repositioning were not statistically significant in all nerves.
CONCLUSION:
Recording electrode array configuration can impact the stability of nerve monitoring signal during thyroid surgeries. Repositioning was associated with changes in nerve signal amplitude in ETT group (Medtronic), whereas LLE (Neurosign) did not show any significant differences. Human studies are warranted.
LEVEL OF EVIDENCE:
NA Laryngoscope, 2020.
© 2020 The American Laryngological, Rhinological and Otological Society, Inc.
KEYWORDS:
Intraoperative neural monitoring; Lantern Laryngeal Electrode; NIM EMG endotracheal tube; thyroidectomy
54.
Laryngoscope. 2020 Feb 21. doi: 10.1002/lary.28545. [Epub ahead of print]
Pediatric Epiglottopexy Using an Endoscopic Suturing Device.
55.
Swiss Med Wkly. 2020 Feb 21;150:w20195. doi: 10.4414/smw.2020.20195. eCollection 2020 Feb 10.
Identifying cancer driver genes from functional genomics screens.
Togar T1, Desai S1, Mishra R2, Terwadkar P2, Ramteke M2, Ranjan M2, Kawle D2, Sahoo B2, Pal A2, Upadhyay P1, Dutt A1.
Abstract
With the emerging advances made in genomics and functional genomics approaches, there is a critical and growing unmet need to integrate plural datasets in order to identify driver genes in cancer. An integrative approach, with the convergence of multiple types of genetic evidence, can limit false positives through a posterior filtering strategy and reduce the need for multiple hypothesis testing to identify true cancer vulnerabilities. We performed a pooled shRNA screen against 906 human genes in the oral cancer cell line AW13516 in triplicate. The genes that were depleted in the screen were integrated with copy number alteration and gene expression data and ranked based on ROAST analysis, using an integrative scoring system, DepRanker, to compute a Rank Impact Score (RIS) for each gene. The RIS-based ranking of candidate driver genes was used to identify the putative oncogenes AURKB and TK1 as essential for oral cancer cell proliferation. We validated the findings, showing that shRNA mediated genetic knockdown of TK1 or pharmacological inhibition of AURKB by AZD-1152 HQPA in AW13516 cells could significantly impede their proliferation. Next we analysed alterations in AURKB and TK1 genes in head and neck cancer and their association with prognosis using data on 528 patients obtained from TCGA. Patients harbouring alterations in AURKB and TK1 genes were associated with poor survival. To summarise, we present DepRanker as a simple yet robust package with no third-party dependencies for the identification of potential driver genes from a pooled shRNA functional genomic screen by integrating results from RNAi screens with gene expression and copy number data. Using DepRanker, we identify AURKB and TK1 as potential therapeutic targets in oral cancer. DepRanker is in the public domain and available for download at http://www.actrec.gov.in/pi-webpages/AmitDutt/DepRanker/DepRanker.html.
56.
J Vestib Res. 2020 Feb 17. doi: 10.3233/VES-200692. [Epub ahead of print]
Veterans with dizziness recruit compensatory saccades in each semicircular canal plane although VOR gain is normal.
Abstract
BACKGROUND:
Exposure to brain injury via blast or blunt mechanisms disrupts multiple sensorimotor systems simultaneously. Large numbers of US Gulf War era and Operation Iraqi/Enduring Freedom veterans with traumatic brain injury (TBI) are suffering the symptom of dizziness - presumed due to "Multi-Sensory Impairment", a clinical pattern of damage to the auditory, visual and vestibular sensorimotor systems.
OBJECTIVE:
To describe the oculomotor response to rapid head rotation in a population of veterans with dizziness. We also describe the reliability of using the video head impulse test (vHIT) in a veteran population.
METHODS:
We used the vHIT to evaluate the vestibular-ocular reflex (VOR) gain and presence of compensatory saccades (CS) in each semicircular canal of 81 veterans (31% TBI) with dizziness. Data was collected using the GN Otometric™ vHIT. Data was processed using both the Otometric™ software and custom software written in MATLAB™. This data was evaluated through Kruskal-Wallis rank-sum test and analysis of regression.
RESULTS:
Veterans with dizziness recruit CS in all semicircular canal planes even though their VOR gain is normal. The vHIT is a reliable clinical test to quantify the metrics of the VOR and CS in veterans.
CONCLUSION:
Veterans with dizziness symptoms use compensatory saccades in all planes of semicircular canal rotation, despite having normal peripheral VOR gain during rapid head rotation. The video head impulse test is a stable measure of vestibular slow phase and metrics of compensatory saccades in veterans with dizziness.
KEYWORDS:
Traumatic brain injury; compensatory saccade; vestibular-ocular reflex; video head impulse test
57.
Jpn J Clin Oncol. 2020 Feb 21. pii: hyaa016. doi: 10.1093/jjco/hyaa016. [Epub ahead of print]
MUC5AC enhances tumor heterogeneity in lung adenocarcinoma with mucin production and is associated with poor prognosis.
Abstract
OBJECTIVE:
The clinicopathological significance of Mucin5AC (MUC5AC) in lung adenocarcinoma with mucin production is still unclear. This study aimed to explore MUC5AC expression in lung adenocarcinoma with mucin production and its correlation with histological subtypes, common driver mutations and its impact on prognosis.
METHODS:
MUC5AC and thyroid transcription factor 1 immunohistochemistry was performed on surgical samples from 90 patients with lung adenocarcinoma with mucin production. Common driver mutations including EGFR and KRAS mutations and ALK rearrangement were detected by established methods.
RESULTS:
MUC5AC was significantly associated with lymphovascular invasion (P = 0.023) and tumors with intra-cytoplasmic mucin (P < 0.001). Moreover, MUC5AC was more significant in invasive mucinous adenocarcinoma (P < 0.001), as well as in tumors with KRAS mutations (P = 0.005) and a lack of thyroid transcription factor 1 expression (P < 0.001). Conversely, MUC5AC was less significantly detected in acinar predominant adenocarcinoma (P = 0.036) and tumors with EGFR mutations (P = 0.001). Notably, MUC5AC in non-pure mucinous subtype of lung adenocarcinoma with mucin production showed more aggressive behavior, distinct expression pattern and a lack of significant correlation with thyroid transcription factor 1 (P = 0.113) when compared with pure mucinous subtype. MUC5AC-positive tumors were significantly associated with a worse prognosis compared to MUC5AC-negative tumors (P < 0.001). A multivariate survival analysis showed that MUC5AC was an independent prognosis factor for poor prognosis (P = 0.006).
CONCLUSIONS:
The clinicopathological features of non-pure mucinous subtype of lung adenocarcinoma with mucin production were distinct and should be distinguished from pure mucinous subtype. MUC5AC was associated with poor prognosis and could be a potential therapeutic target for this distinct type of lung adenocarcinoma that has few effective treatments.
© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permission@oup.com.
KEYWORDS:
MUC5AC ; heterogeneity; lung adenocarcinoma with mucin production; prognosis
58.
World J Otorhinolaryngol Head Neck Surg. 2020 Jan 14;5(4):222-227. doi: 10.1016/j.wjorl.2019.05.002. eCollection 2019 Dec.
Are demographics associated with mucoepidermoid or acinic cell carcinoma parotid malignancies in children?
Abstract
OBJECTIVE:
To identify possible associations between patient demographics and parotid cancer histological type in pediatric patients.
METHODS:
Pediatric patients (ages: birth-18.0 years) in the Surveillance, Epidemiology, and End Results (SEER) database were included from 1973 to 2014 based on a diagnosis of mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland using the ICD O-3 codes of C07.9 and 8430 or 8550. Patients were classified into the following cohorts: <14 and 14-18 years of age based on the mean age at diagnosis.
RESULTS:
Three hundred and three pediatric patients were diagnosed with mucoepidermoid carcinoma or acinic cell carcinoma of the parotid gland within the SEER 18 registries. Female pediatric patients 14-18 years of age were 7.68 times more likely to have an acinic cell carcinoma (adjusted OR: 7.68 [95% CI: 2.01-29.44]). When stratified by histological type, 58.9% of female pediatric patients ≥14 years of age had an acinic cell carcinoma as compared to 37.3% of male pediatric patients ≥14 years of age, 36.5% of female pediatric patients <14 years of age, and 34.0% of male pediatric patients <14 years of age (P = 0.01).
CONCLUSIONS:
Based on this study, pediatric female patients between the ages of 14 and 18 years are the most likely cohort to have acinic cell carcinoma. The results of this study may assist providers during the work up of a pediatric patient with a suspected parotid malignancy.
© 2019 The Authors.
KEYWORDS:
Head and neck surgery; Level of evidence: 4; Pediatric otolaryngology; Pediatric parotid cancer
59.
World J Otorhinolaryngol Head Neck Surg. 2019 Dec 5;5(4):215-221. doi: 10.1016/j.wjorl.2019.01.004. eCollection 2019 Dec.
Neck dissection does not add to morbidity or mortality of laryngectomy.
Abstract
OBJECTIVES:
To examine the national rates of complications, readmission, reoperation, death and length of hospital stay after laryngectomy. To explore the risks of neck dissection with laryngectomy using outcomes.
METHODS:
The American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database was reviewed retrospectively. The database was analyzed for patients undergoing laryngectomy with and without neck dissection. Demographic, perioperative complication, reoperation, readmission, and death variables were analyzed.
RESULTS:
754 patients who underwent total laryngectomy during this time were found. Demographic analysis showed average age was 63 years old, 566 (75.1%) were white, and 598 (79.3%) were male. Of these patients, 520 (69.0%) included a neck dissection while 234 (31.0%) did not. When comparing patients who received a neck dissection to those who did not, there were no significant differences in median length of hospital stay (12.5 days w/vs. 13.3 days w/o, P = 0.99), rates of complication (40% w/vs. 35% w/o, P = 0.23), reoperation (13.5% w/vs. 14% w/o, P = 0.81), readmission (14% w/vs. 18% w/o, P = 0.27), and death (1.3% w/vs. 1.3% w/o, P > 0.99). Furthermore, neck dissection did not increase the risk of complication (P = 0.23), readmission (P = 0.27), reoperation (P = 0.81), death (P = 0.94), or lengthened hospital stay (P = 0.38).
CONCLUSIONS:
Concurrent neck dissection does not increase postoperative morbidity or mortality in patients undergoing total laryngectomies. These results may help physicians make decisions regarding concurrent neck dissection with total laryngectomy.
© 2019 The Authors.
KEYWORDS:
Complication rates; Laryngectomy; Neck dissection; Outcomes; Total laryngectomy
60.
World J Otorhinolaryngol Head Neck Surg. 2019 Oct 18;5(4):207-214. doi: 10.1016/j.wjorl.2019.04.003. eCollection 2019 Dec.
Management of pediatric peritonsillar and deep neck infections- cross- sectional retrospective analysis.
Abstract
OBJECTIVE:
Deep neck infections (DNI) are responsible for significant morbidity in children and healthcare expenditures. Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population. Our goal was to analyse the demographic characteristics, clinical presentation, diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.
METHODS:
The medical records of patients, aged up to 18 years, admitted for peritonsillar and DNI at our department, from 2011 to 2016, were retrospectively reviewed and compared with the literature available. Ninety-eight patients were enrolled.
RESULTS:
The mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections. Admissions have significantly increased from 2011. There was a seasonal variation for DNI incidence, with a peak incidence in Summer and Spring. All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures. Incision and drainage was performed in 72 patients. The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications. Only 2 patients developed complications during hospital stay. The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes, Streptococcus Mitis and anaerobic bacteria.
CONCLUSIONS:
Surgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach. However, in selected cases, medical therapy may be an alternative to surgical management in uncomplicated infections.
© 2019 The Authors.
KEYWORDS:
Abscess; Deep neck infection; Epidemiology; Microbiology; Parapharyngeal; Peritonsillar; Retropharyngeal
61.
World J Otorhinolaryngol Head Neck Surg. 2019 Sep 28;5(4):200-206. doi: 10.1016/j.wjorl.2019.02.003. eCollection 2019 Dec.
Predictors of occult lymph node metastasis in cutaneous head and neck melanoma.
Abstract
OBJECTIVE:
To use the Surveillance, Epidemiology, and End Results (SEER) database to verify the findings of a recent National Cancer Database (NCDB) study that identified factors predicting occult nodal involvement in cutaneous head and neck melanoma (CHNM) while identifying additional predictors of occult nodal metastasis and comparing two distinct cancer databases.
METHODS:
Cases of CHNM in the SEER database diagnosed between 2004 and 2014 were identified. Demographic information and oncologic data were obtained. Univariate and multivariate analysis were performed to identify factors associated with pathologic nodal positivity.
RESULTS:
There were 34002 patients with CHNM identified. Within this population, 16232 were clinically node-negative, 1090 of which were found to be pathologically node-positive. On multivariate analysis, factors associated with an increased risk of occult nodal metastasis included increasing depth of invasion (stepwise increase in adjusted odds ratio [OR]), nodular histology (aOR: 1.47 [95% CI: 1.21-1.80]), ulceration (aOR: 1.74 [95% CI: 1.48-2.05]), and mitoses (aOR: 1.86 [95% CI: 1.36-2.54]). Factors associated with a decreased risk of occult nodal metastasis included female sex (aOR: 0.80 [0.67-0.94]) and desmoplastic histology (aOR: 0.37 [95% CI: 0.24-0.59]). Between the SEER database and the NCDB, factors associated with occult nodal involvement were similar except for nodular histology and female sex, which did not demonstrate significance in the NCDB.
CONCLUSION:
Regarding clinically node-negative CHNM, the SEER database and the NCDB have similarities in demographic information but differences in baseline population sizes and tumor characteristics that should be considered when comparing findings between the two databases.
LEVEL OF EVIDENCE:
4.
© 2019 The Authors.
KEYWORDS:
Head and neck melanoma; Lymph node metastasis; Occult nodal metastasis; Sentinel lymph node biopsy
62.
World J Otorhinolaryngol Head Neck Surg. 2019 Dec 30;5(4):193-199. doi: 10.1016/j.wjorl.2019.11.001. eCollection 2019 Dec.
Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre.
Abstract
OBJECTIVE:
To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.
MATERIAL AND METHODS:
A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014. A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included. Anterior epistaxis was managed via one of: Nasal clip, Merocel®, Silver Nitrate cautery, Vaseline packing, other treatment or no treatment. Both the direct and indirect hospital costs ($CDN) for anterior epistaxis treatment were calculated from the hospital's perspective. Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.
RESULTS:
Three hundred and fifty-three patients (49% female) with a mean age of (69.9 ± 18.5) years were included in the analysis. The median (interquartile ranges) costs of treatment ranged from C$227.83 (C$167.96, C$328.69) for observation to C$763.98 (C$632.25,C$830.23) for Merocel®. The overall median total hospital costs incurred across all modalities was C$566.24 (C$459.61, C$753.46) for the management of anterior epistaxis. Silver Nitrate, nasal clip, and observation were statistically associated with a lower cost when compared to Merocel® (P < 0.001) even after potential confounding factors were controlled.
CONCLUSIONS:
Our results show wide difference in the hospital cost of epistaxis across treatment modalities. These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.
© 2019 The Authors.
KEYWORDS:
Anterior epistaxis; Cautery; Hospital costs; Nasal packing; Silver nitrate
63.
World J Otorhinolaryngol Head Neck Surg. 2020 Jan 3;5(4):180-187. doi: 10.1016/j.wjorl.2019.04.001. eCollection 2019 Dec.
MRI detection of endolymphatic hydrops in Meniere's disease in 8 minutes using MIIRMR and a 20-channel coil after targeted gadolinium delivery.
Abstract
BACKGROUND:
Endolymphatic hydrops (EH) become visible in vertigo patients, particularly in those with Meniere's disease (MD), in vivo using gadolinium-enhanced MRI. However, the image quality is not satisfying after intravenous injection of gadolinium chelate (GdC), and occasional failure in GdC uptake has been noticed after traditional intratympanic injection. In the present report, targeted delivery of GdC and using a cost-effective MRI system to obtain high quality images of EH in only 8 min will be introduced.
METHODS:
39 MD patients were recruited in the study. First, 0.1 ml of 20-fold diluted gadolinium-diethylenetriamine acid (Gd-DTPA) was delivered onto the posterior upper part of the tympanic medial wall using a soft-tipped micro-irrigation catheter through an artificially perforated tympanic membrane. Inner ear MRI was performed 24 h after Gd-DTPA administration using a 3T MR machine and a 20-channel head/neck coil with an 8 min sequence of medium inversion time inversion recovery imaging with magnitude reconstruction (MIIRMR). The parameters were as follows: TR 16000 ms, TE 663 ms, inversion time 2700 ms, flip angle 180°, slices per slab 60.
RESULTS:
Efficient inner ear uptake of Gd-DTPA was detected 24 h after delivery and it created excellent contrast in the inner ear of all cases. High quality images demonstrating EH in the vestibule and cochlea were obtained.
CONCLUSION:
Targeted delivery of minimum Gd-DTPA (0.1 ml, 20-fold dilution) onto the posterior upper portion of the tympanic medial wall and MRI with MIIRMR in a 3T machine and 20-channel head/neck coil are clinically practical to obtain high quality images displaying EH.
© 2019 The Authors.
KEYWORDS:
Drug delivery; Endolymphatic hydrops; MRI; Meniere's disease; Targeting
64.
World J Otorhinolaryngol Head Neck Surg. 2019 Dec 13;5(4):175-179. doi: 10.1016/j.wjorl.2019.01.003. eCollection 2019 Dec.
Recurrent glomangioma ("true" glomus tumor) of the middle ear and mastoid.
Abstract
OBJECTIVE:
To review current literature and experience with glomangiomas, or true glomus tumors of the middle ear and mastoid as well asto report on the exceptionally rare case of a glomangiomastemming from the middle ear space with multiple recurrences.
METHODS:
Review of existing world literature and description of personal experience with rare cases of a glomangioma of the middle ear and mastoid.
RESULTS:
Review of existing literature revealed two cases of patients presenting with tinnitus and hearing loss refractory to medical management. Both patients were ultimately diagnosed with glomangioma on histopathology. Complete surgical excision is thought to be curative.
PATIENT:
A 36-year-old woman presented with a rare case of a glomangioma of the middle ear presenting with unilateral hearing loss. She was noted to have a mass behind the tympanic membrane. Imaging revealed a diffuse mass filling the mastoid air cells. Imaging characteristics and histology were consistent with a glomangioma.
INTERVENTION:
Initial resection via mastoidectomy using a postauricular approach. The tympanic membrane was reconstructed with temporalis tissue. Follow-up revision tympanomastoidectomy was performed upon recurrence of disease. The chorda tympani were sacrificed due to tumor involvement. The incus and head of the malleus were removed to gain better access to the tumor. The ossicular chain was reconstructed with a Goldenberg Total Ossicular Prosthesis.
MAIN OUTCOME MEASURE:
Recurrence of disease.
FOLLOW-UP:
In the 67 months since her most recent surgery, there has been no evidence of recurrence by CT or physical exam.
CONCLUSION:
Glomangioma of the middle ear represents an exceptionally rare entity that can present in a similar fashion to a paraganglioma.
© 2019 The Authors.
KEYWORDS:
Glomangioma; Glomus tumor; Glomuvenous malformation; Middle ear tumor; Unilateral hearing loss
65.
OTO Open. 2020 Feb 6;4(1):2473974X19900761. doi: 10.1177/2473974X19900761. eCollection 2020 Jan-Mar.
Gaps in Treatment and Surveillance: Head and Neck Cancer Care in a Safety-Net Hospital.
Abstract
OBJECTIVE:
Treatment delays and suboptimal adherence to posttreatment surveillance may adversely affect head and neck cancer (HNC) outcomes. Such challenges can be exacerbated in safety-net settings that struggle with limited resources and serve a disproportionate number of patients vulnerable to gaps in care. This study aims to characterize treatment delays and adherence with posttreatment surveillance in HNC care at an urban tertiary care public hospital in San Francisco.
STUDY DESIGN:
Retrospective chart review.
SETTING:
Urban tertiary care public hospital in San Francisco.
SUBJECTS AND METHODS:
We identified all cases of HNC diagnosed from 2008 to 2010 through the electronic medical record. We abstracted data, including patient characteristics, disease characteristics, pathology and radiology findings, treatment details, posttreatment follow-up, and clinical outcomes.
RESULTS:
We included 64 patients. Median time from diagnosis to treatment initiation (DTI) was 57 days for all patients, 54 days for patients undergoing surgery only, 49 days for patients undergoing surgery followed by adjuvant radiation ± chemotherapy, 65 days for patients undergoing definitive radiation ± chemotherapy, and 29 days for patients undergoing neoadjuvant chemotherapy followed by radiation or chemoradiation. Overall, 69% of patients completed recommended treatment. Forty-two of 61 (69%) patients demonstrated adherence to posttreatment visits in year 1; this fell to 14 out of 30 patients (47%) by year 5.
CONCLUSION:
DTI was persistently prolonged in this study compared with prior studies in other public hospital settings. Adherence to posttreatment surveillance was suboptimal and continued to decline as the surveillance period progressed.
© The Authors 2020.
KEYWORDS:
delay to treatment initiation; head and neck cancer; monitoring; public hospital; safety-net hospital; surveillance
66.
Front Pediatr. 2020 Jan 31;8:13. doi: 10.3389/fped.2020.00013. eCollection 2020.
Congenital Cytomegalovirus Infection: A Narrative Review of the Issues in Screening and Management From a Panel of European Experts.
Abstract
Maternal primary and non-primary cytomegalovirus (CMV) infection during pregnancy can result in in utero transmission to the developing fetus. Congenital CMV (cCMV) can result in significant morbidity, mortality or long-term sequelae, including sensorineural hearing loss, the most common sequela. As a leading cause of congenital infections worldwide, cCMV infection meets many of the criteria for screening. However, currently there are no universal programs that offer maternal or neonatal screening to identify infected mothers and infants, no vaccines to prevent infection, and no efficacious and safe therapies available for the treatment of maternal or fetal CMV infection. Data has shown that there are several maternal and neonatal screening strategies, and diagnostic methodologies, that allow the identification of those at risk of developing sequelae and adequately detect cCMV. Nevertheless, many questions remain unanswered in this field. Well-designed clinical trials to address several facets of CMV treatment (in pregnant women, CMV-infected fetuses and both symptomatic and asymptomatic neonates and children) are required. Prevention (vaccines), biology and transmission factors associated with non-primary CMV, and the cost-effectiveness of universal screening, all demand further exploration to fully realize the ultimate goal of preventing cCMV. In the meantime, prevention of primary infection during pregnancy should be championed to all by means of hygiene education.
Copyright © 2020 Lazzarotto, Blázquez-Gamero, Delforge, Foulon, Luck, Modrow and Leruez-Ville.
KEYWORDS:
clinical laboratory techniques; congenital CMV; cytomegalovirus; maternal screening; neonatal screening; pregnancy; prenatal diagnosis
67.
Iran J Otorhinolaryngol. 2020 Jan;32(108):57-61. doi: 10.22038/ijorl.2019.38807.2280.
Embryonal Rhabdomyosarcoma - A Mimicker of Squamosal Otitis Media.
Abstract
INTRODUCTION:
Rhabdomyosarcoma is the most frequently occurring intrusive soft tissue sarcoma in the pediatric age group. Orbit is the most common location for a pediatric rhabdomyosarcoma, but it can occur in the oral cavity, pharynx, face and neck in the descending order of incidence. Rhabdomyosarcoma in the ear is extremely rare.
CASE REPORT:
A 5-year-old girl presented to the outpatient department of our tertiary care hospital with complaints of foul smelling, non-blood stained right ear discharge of one-month duration and deviation of angle of mouth to the left side of acute onset. Investigations revealed a diagnosis of embryonal rhabdomyosarcoma. Multimodal therapy was carried out, and the child was rendered disease-free after two years.
CONCLUSION:
Embryonal rhabdomyosarcoma of the head and neck mimics chronic otitis media. Early diagnosis is essential to deliver prompt treatment and prevent locoregional spread and metastasis.
KEYWORDS:
Acute facial paralysis; Chemotherapy; Pediatric; Radiotherapy; Rhabdomyosarcoma; Temporal Bone
- PMID:
- 32083033
- PMCID:
- PMC7007992
- DOI:
- 10.22038/ijorl.2019.38807.2280
68.
Iran J Otorhinolaryngol. 2020 Jan;32(108):35-41. doi: 10.22038/ijorl.2019.31926.2050.
Correlation of Serum Vitamin D Levels with Chronic Rhinosinusitis Disease Severity.
Abstract
INTRODUCTION:
The present study was conducted to investigate the association between the serum vitamin D levels and severity of disease in chronic rhino sinusitis (CRS) patients.
MATERIALS AND METHODS:
This prospective cross-sectional study was conducted on a total of 93 patients suffering from chronic rhino sinusitis with nasal polyposis (CRS w NP). Serum level of 25-hydroxyvitamin D was detected using a simple blood test. A22-item questionnaire, namely the sinonasal outcome test-22 (SNOT-22), was used to assess the subjective disease severity and patients' quality of life. In addition, the radiographic signs of the disease severity were evaluated using the Lund-Mackay Scale (LMS).
RESULTS:
The mean age and serum vitamin D level of the patients were measured at 37.7±13.6 years and 24.6±16.9 ng/ml, respectively. Moreover, the mean of LMS and SNOT-22 scores were calculated at 14.2±11.2 and 40.8±17.6, respectively. There was a negative correlation between the SNOT-22 and serum levels of vitamin D (P=0.034). Similarly, LMS and serum vitamin D levels were correlated negatively (P=0.027). Furthermore, the results revealed a direct relationship between LMS and SNOT-22 (P<0.0001).
CONCLUSION:
According to the obtained results, there was a significant relationship between the serum vitamin D levels and severity of disease in patients with CRS w NP. Therefore, serum vitamin D levels could be added to the routine workup of the patients suffering from CRS w NP.
KEYWORDS:
CRS w NP; Lund-Mackay Scale; SNOT-22; Vitamin D
- PMID:
- 32083029
- PMCID:
- PMC7007989
- DOI:
- 10.22038/ijorl.2019.31926.2050
69.
Iran J Otorhinolaryngol. 2020 Jan;32(108):29-34. doi: 10.22038/ijorl.2019.31930.2051.
Titanium Snoreplasty- A New Surgical Technique.
Abstract
INTRODUCTION:
Based on the previous data, among the general population aged between 30 and 60 years, snoring is observed in 44% and 28% of males and females, respectively. Therefore, it is important to treat snoring to reduce the disruption of the bed partner's sleep and the patients' own problems. This study aimed to present a minimally invasive procedure which is easy to perform with less tissue damage.
MATERIALS AND METHODS:
This study included 13 patients suffering from primary snoring with soft palate length of 2.5cm or more. All of the patients were examined and their partners were asked to fill-out the relevant questionnaires at baselines, 90 days, 6 months and 1 year after the surgery in order to assess snoring. A crescent strip of oral mucosa along with the underlying muscle were removed under general anesthesia followed by the insertion of a piece of oval-shaped titanium mesh. Moreover, two subjective methods were employed to assess the snoring of all patients.
RESULTS:
11 patients were male, and the mean age and the mean body mass index of the patients were 48.69 years and 28.34 kg/m2, respectively. The scores obtained from the Visual Analog Scale for snoring loudness before surgery reduced from 7.63 to 3.54, which was statistically significant (P<0.05). None of the patients experienced major complications after surgery; however, there was a partial extrusion of the implant in one case which was managed conservatively with spontaneous healing.
CONCLUSIONS:
Titanium snoreplasty was successful in the reduction of snoring in this study. This method is a single-stage treatment for simple snoring with the multiple effects of palatal shortening, space increasing, and palatal stiffening.
KEYWORDS:
Apnea; Snoring; Titanium; Visual analog scale
- PMID:
- 32083028
- PMCID:
- PMC7007991
- DOI:
- 10.22038/ijorl.2019.31930.2051
70.
Iran J Otorhinolaryngol. 2020 Jan;32(108):21-28. doi: 10.22038/ijorl.2019.37766.2241.
Effects of Vitamin D Supplementation on Recurrence of Nasal Polyposis after Endoscopic Sinus Surgery.
Abstract
INTRODUCTION:
Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a relatively common disease with serious impacts on patient quality of life. Recurrence of polyps after functional endoscopic sinus surgery (FESS) is a dilemma. Vitamin D3 (VD3) is known to inhibit the proliferation of nasal polyp-derived fibroblasts. The present study aimed to investigate the effects of oral VD3 on the recurrence of polyposis after FESS.
MATERIALS AND METHODS:
This triple-blind placebo-controlled clinical trial was conducted on 40 patients with CRSwNP who did not respond to medical treatment and were candidates for FESS. In addition, the patients had VD3 insufficiency. Following the surgery, all the patients received routine treatment (i.e., fluticasone spray, irrigation, cefixime 400 mg daily for 10 days, and montelukast for a month). Moreover, the case group received oral VD3 tablets 4000 IU (single daily dose) for a month, and the control group received placebo in the same manner. The Sino-Nasal Outcome Test (SNOT-22) and Meltzer endoscopic grading scores were recorded at months 1, 3, and 6 after the study.
RESULTS:
In this study, 6 months following the intervention, the severity of polyposis was reported to be significantly lower in the VD3 group compared to the placebo group based on SNOT-22 (16.25±10.16 in the VD3 group vs. 47.45±13.55 in the placebo group; P<0.001) and Meltzer scores (0.50±0.60 in the VD3 group vs. 2.65±0.93 in the placebo group; P<0.001). No adverse effects were observed in the case group.
CONCLUSION:
This study showed the efficacy and safety of vitamin D supplementation in the reduction of polyposis recurrence after FESS in patients with CRSwNP.
KEYWORDS:
Chronic rhinosinusitis; Endoscopy; Nasal polyposis; Vitamin D3
- PMID:
- 32083027
- PMCID:
- PMC7007990
- DOI:
- 10.22038/ijorl.2019.37766.2241
71.
Front Oncol. 2020 Jan 31;10:47. doi: 10.3389/fonc.2020.00047. eCollection 2020.
The miR-372-ZBTB7A Oncogenic Axis Suppresses TRAIL-R2 Associated Drug Sensitivity in Oral Carcinoma.
Abstract
miR-372 has been shown a potent oncogenic miRNA in the pathogenesis of oral squamous cell carcinoma (OSCC). The zinc finger and BTB domain containing 7A protein (ZBTB7A) is a transcriptional regulator that is involved in a great diversity of physiological and oncogenic regulation. However, the modulation of ZBTB7A in OSCC remains unclear. Tissue analysis identifies a reverse correlation in expression between miR-372 and ZBTB7A in OSCC tumors. When OSCC cells have stable knockdown of ZBTB7A, their oncogenic potential and drug resistance is increased. By way of contrast, such an increase is attenuated by expression of ZBTB7A. Screening and validation confirms that ZBTB7A is able to modulate expression of the death receptors TRAIL-R1, TRAIL-R2, Fas and p53 phosphorylated at serine-15. In addition, ZBTB7A transactivates TRAIL-R2, which sensitizes cells to cisplatin-induced apoptosis. The ZBTB7A-TRAIL-R2 cascade is involved in both the extrinsic and intrinsic cisplatin-induced pathways of apoptosis. Database analysis indicates that the expression level of and the copy status of ZBTB7A and TRAIL-R2 are important survival predictors for head and neck cancers. Collectively, this study indicates the importance of the miR-372-ZBTB7A-TRAIL-R2 axis in mediating OSCC pathogenesis and in controlling OSCC drug resistance. Therefore, silencing miR-372 and/or upregulating ZBTB7A would seem to be promising strategies for enhancing the sensitivity of OSCC to cisplatin therapy.
Copyright © 2020 Yeh, Yang, Wu, Kao, Liu, Chen, Lin and Chang.
KEYWORDS:
TRAIL-R2; ZBTB7A; apoptosis; miR-372; suppressor
72.
Front Oncol. 2020 Jan 29;10:39. doi: 10.3389/fonc.2020.00039. eCollection 2020.
Significance of the Neutrophil-to-Lymphocyte Ratio in p16-Negative Squamous Cell Carcinoma of Unknown Primary in Head and Neck.
Abstract
Objective: The neutrophil-to-lymphocyte ratio (NLR) has been reported to be associated with survival in solid malignancies. The main goal was to evaluate the prognostic significance of the NLR in patients with p16-negative squamous cell carcinoma of unknown primary (SCCUP) in head and neck. Methods: The association between the NLR and clinical pathologic variables was evaluated by the chi-square test. The primary endpoint of interest was disease-specific survival (DSS). Univariate and Coxmodel analyses were used to evaluate prognostic factors. Results: A total of 153 patients were included in the analysis. Cancer cachexia was noted in 10 patients. The mean NLR value was 3.9 (range: 1.4-8.3). A high NLR was significantly associated with cancer cachexia development. The 5-year DSS rate was 58%. In patients with NLRs varying from 1.4 to 3.7, the 5-year DSS rate was 71%; in patients with NLRs varying from 3.7 to 6.0, the 5-year DSS rate was 57%; in patients with NLRs varying from 6.0 to 8.3, the 5-year DSS rate was 39%, and the difference was significant (p = 0.001). Further Cox model analysis confirmed the independence of the NLR in predicting survival. Conclusions: In patients with p16-negative SCCUP, an NLR ≥ 6.0 is significantly associated with worse prognosis.
Copyright © 2020 Xu, Yuan, Du, Wu, Fang, Zhang and Li.
KEYWORDS:
cancer cachexia; head neck squamous cell carcinoma; neutrophil-to-lymphocyte ratio; prognosis; squamous cell carcinoma of unknown primary
73.
Front Oncol. 2020 Jan 31;10:16. doi: 10.3389/fonc.2020.00016. eCollection 2020.
3D Exoscopic Surgery (3Des) for Transoral Oropharyngectomy.
Abstract
Over the past three decades, the incidence of oropharyngeal squamous cell carcinoma has increased, primarily related to the spread of human papillomavirus. Treatment has always been preferentially unimodal (surgery or radiotherapy) for early stage disease and multimodal (surgery with adjuvant therapy or concomitant chemoradiotherapy) for advanced stages. Recently, the surgical approach has gained renewed interest due to the morbidity of non-surgical treatments and also to technical innovations. We have coined the term 3Des (3D exoscope surgery) to describe the use of the 3D Vitom Exoscope System for transoral surgery of oropharyngeal cancers. During the period from June 2017 to May 2018, 10 patients with oropharyngeal cancer were treated by oropharyngeal surgery with the 3Des approach at FPO IRCCS Institute of Candiolo. The aim of the present prospective study was to evaluate the utility of 3Des for the treatment of early-stage oropharyngeal cancer. 3Des could represent a viable alternative to the operating microscope and robotic surgery thanks to its excellent ability to provide 3D visual information, depth of field, magnification, image contrast, color imaging, and low running costs. It promises great utility in the learning process, with the possibility of recording in high definition.
Copyright © 2020 Crosetti, Arrigoni, Manca, Caracciolo, Bertotto and Succo.
KEYWORDS:
3D; 3D exoscopic surgery; oropharyngeal cancer; transoral oropharyngectomy; transoral surgery
74.
Case Rep Otolaryngol. 2020 Jan 31;2020:7134789. doi: 10.1155/2020/7134789. eCollection 2020.
Verrucous Carcinoma in a Giant Cutaneous Horn: A Case Report and Literature Review.
Abstract
BACKGROUND:
A cutaneous horn is a common clinical entity which usually presents as a cutaneous lesion. Because of its subtle nature, patients usually tend to present late unless the lesion is big or complications develop. Because of its resemblance to animal horn, it has been given the term "horn." Cutaneous horn seems to have a remarkable history. Though cutaneous horn is benign most of the times, chances of malignancy (20-25%) should be kept in mind. Old age, giant cutaneous horn carries more chances of transformation into malignancy like in our case. Thus, early diagnosis and treatment is required in all cases. Case Presentation. We report a case of a 74-year-old farmer with a cutaneous projection measuring ∼8 × 5 × 3 cm3 over the medial surface of the right pinna for 1 year. It started as a small projection which was progressively enlarging. The primary reason behind him presenting to us was cosmetic reason since it resembled an animal horn. The projection was not associated with pain or similar lesions anywhere else in body. Understanding the malignancy risks and the cosmetic benefits, he was planned for excision biopsy of the horn. He had no systemic signs of malignancy. Histopathological reports were consistent with malignancy.
CONCLUSIONS:
Cutaneous horns are usually benign lesions and mostly found in the head and neck region. Because of the chances of malignancy, cutaneous horns should undergo surgical removal and biopsy for early and definitive diagnosis and management.
Copyright © 2020 Sudha Shahi et al.
75.
Case Rep Endocrinol. 2020 Jan 30;2020:6827109. doi: 10.1155/2020/6827109. eCollection 2020.
Current Approach of Functioning Head and Neck Paragangliomas: Case Report of a Young Patient with Multiple Asynchronous Tumors.
Terrones-Lozano A1, Hernández-Hernández A2, Nathal Vera E2, Guinto-Nishimura GY2, Balderrama-Bañares JL3, Ramírez-Rentería C4, de la Serna-Soto J5, Reza-Albarran AA6, Portocarrero-Ortiz L1.
Abstract
Introduction. Pheochromocytomas (Pheo) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla and from the extra-adrenal autonomic paraganglia, respectively. Only 1-3% of head and neck PGL (HNPGL) show elevated catecholamines, and at least 30% of Pheo and PGL (PCPG) are associated with genetic syndromes caused by germline mutations in tumor suppressor genes and proto-oncogenes. Clinical Case. A 33-year-old man with a past medical history of resection of an abdominal PGL at the age of eleven underwent a CT scan after a mild traumatic brain injury revealing an incidental brain tumor. The diagnosis of a functioning PGL was made, and further testing was undertaken with a PET-CT with 68Ga-DOTATATE, SPECT-CT 131-MIBG, and genetic testing. Discussion and Conclusion. The usual clinical presentation of functioning PCPG includes paroxistic hypertension, headache, and diaphoresis, sometimes with a suggestive family history in 30-40% of cases. Only 20% of PGL are located in head and neck, of which only 1-3% will show elevated catecholamines. Metastatic disease is present in up to 50% of cases, usually associated with a hereditary germline mutation. However, different phenotypes can be observed depending on such germline mutations. Genetic testing is important in patients with PCPG since 31% will present a germline mutation. In this particular patient, an SDHB gene mutation was revealed, which can drastically influence the follow-up plan and the genetic counsel offered. A multidisciplinary approach is mandatory for every patient presenting with PCPG.SDHB gene mutation was revealed, which can drastically influence the follow-up plan and the genetic counsel offered. A multidisciplinary approach is mandatory for every patient presenting with PCPG.
Copyright © 2020 Alejandro Terrones-Lozano et al.
76.
Immun Ageing. 2020 Feb 12;17:3. doi: 10.1186/s12979-020-0174-7. eCollection 2020.
Age-related changes in T lymphocytes of patients with head and neck squamous cell carcinoma.
Jeske SS#1, Schuler PJ#1, Doescher J1, Theodoraki MN1, Laban S1, Brunner C1, Hoffmann TK1, Wigand MC1.
Abstract
INTRODUCTION:
The number of aging cancer patients has increased continuously and will do so further in the future. The immune system of elderly people experiences critical changes over the time. Therefore, tumor-induced changes in the immune system are believed to differ in young and elderly cancer patients as well.
METHODS:
The effect of aging on the immune system was measured in peripheral blood lymphocytes (PBL) of healthy volunteers (n = 48, 21-84 yrs.) divided into three different age groups. Seventy years was set as a cut-off for defining subjects as elderly. Results were compared to two groups of adult cancer patients, which donated PBL and tumor infiltrating lymphocytes (TIL): young cancer patients (40-69 yrs.; blood: n = 13; TIL: n = 17) and elderly cancer patients (70-90 yrs.; blood: n = 20; TIL: n = 15) with head and neck squamous cell carcinoma (HNSCC). Frequencies and phenotypes of CD4+ and CD8+ T cells as well as regulatory T cells (Treg) were assessed by flow cytometry.
RESULTS:
We observed lower frequencies of CD8+ cytotoxic T cells during aging in both groups. Frequencies of tumor infiltrating regulatory T cells were significantly higher than in the peripheral blood but showed a significant decline in older tumor patients. With increasing age, expression of immunosuppressive CD73 and CCR7 was lower and expression of PD1 elevated on peripheral T cells in healthy volunteers and tumor patients.
CONCLUSION:
Immunosenescence takes place in healthy donors and cancer patients. Our results suggest that in elderly tumor patients, the immune system is impaired and the tumor-induced immune escape is less pronounced. The increased expression of PD1 implies the potential for effective immunotherapies in elderly, as treatment with checkpoint inhibitors could be more beneficial for elderly HNSCC patients.
© The Author(s). 2020.
KEYWORDS:
Aging; Head and neck cancer; Immune escape; Immunosenescence; T cells
77.
Allergy Asthma Clin Immunol. 2020 Feb 11;16:13. doi: 10.1186/s13223-020-0411-9. eCollection 2020.
Replication study of susceptibility variants associated with allergic rhinitis and allergy in Han Chinese.
Abstract
BACKGROUND:
Allergic rhinitis (AR) is believed to be a complex genetic disease. The last decade has been marked by the publication of more than 20 genome-wide association studies (GWASs) of AR and associated allergic phenotypes and allergic diseases, which have shown allergic diseases and traits to share a large number of genetic susceptibility loci. The aim of present study was therefore to investigate the highly replicated allergy related genes and variants as candidates for AR in Han Chinese subjects.
METHODS:
A total of 762 AR patients and 760 control subjects were recruited, and a total of 58 susceptible variants previously reported to be associated with allergic traits were choose for replication.
RESULTS:
Logistic regression analyses revealed that in the co-dominant-effect model as assessed by the AIC, compared with wild-type carriers, significant AR risk were associated with rs9865818 in LPP (P = 0.029, OR = 1.469 for GG vs. AA); rs6554809 in DNAH5 (P = 0.000, OR = 1.597 for TC vs. CC); rs1438673 in WDR36-CAMK4 loci (P = 0.037, OR = 1.396 for CC vs.TT), rs7775228 in HLA region (P = 0.000, OR = 1.589 for TC vs.TT), rs7203459 in CLEC16A (P = 0.025, OR = 0.731 for TC vs. TT).
CONCLUSION:
We replicated Han Chinese AR-specific susceptibility loci in LPP, DNAH5, HLA, CLEC16A and WDR36-CAMK4. Further understanding the molecular mechanisms underlying these associations may provide new insights into the etiology of allergic disease.
© The Author(s) 2020.
KEYWORDS:
Allergic rhinitis; Replication; Single nucleotide polymorphism
78.
Front Neurol. 2020 Jan 31;11:4. doi: 10.3389/fneur.2020.00004. eCollection 2020.
Persistent Feeding and Swallowing Deficits in a Mouse Model of 22q11.2 Deletion Syndrome.
Welby L1, Caudill H2, Yitsege G3,4, Hamad A5, Bunyak F5, Zohn IE2,3,4,6, Maynard T7, LaMantia AS7,8, Mendelowitz D2, Lever TE1.
Abstract
Disrupted development of oropharyngeal structures as well as cranial nerve and brainstem circuits may lead to feeding and swallowing difficulties in children with 22q11. 2 deletion syndrome (22q11DS). We previously demonstrated aspiration-based dysphagia during early postnatal life in the LgDel mouse model of 22q11DS along with disrupted oropharyngeal morphogenesis and divergent differentiation and function of cranial motor and sensory nerves. We now ask whether feeding and swallowing deficits persist in adult LgDel mice using methods analogous to those used in human patients to evaluate feeding and swallowing dysfunction. Compared to wild-type mice, videofluoroscopic swallow study revealed that LgDel mice have altered feeding and swallowing behaviors, including slower lick rates, longer inter-lick intervals, and longer pharyngeal transit times with liquid consistency. Transoral endoscopic assessment identified minor structural anomalies of the palate and larynx in one-third of the LgDel mice examined. Video surveillance of feeding-related behaviors showed that LgDel mice eat and drink more frequently. Furthermore, LgDel animals engage in another oromotor behavior, grooming, more frequently, implying that divergent craniofacial and cranial nerve structure and function result in altered oromotor coordination. Finally, LgDel mice have significantly increased lung inflammation, a potential sign of aspiration-based dysphagia, consistent with results from our previous studies of early postnatal animals showing aspiration-related lung inflammation. Thus, oromotor dysfunction, feeding, and swallowing difficulties and their consequences persist in the LgDel 22q11DS mouse model. Apparently, postnatal growth and/or neural plasticity does not fully resolve deficits due to anomalous hindbrain, craniofacial, and cranial nerve development that prefigure perinatal dysphagia in 22q11DS. This new recognition of persistent challenges with feeding and swallowing may provide opportunities for improved therapeutic intervention for adolescents and adults with 22q11DS, as well as others with a history of perinatal feeding and swallowing disorders.
Copyright © 2020 Welby, Caudill, Yitsege, Hamad, Bunyak, Zohn, Maynard, LaMantia, Mendelowitz and Lever.
KEYWORDS:
22q11 deletion syndrome; DiGeorge syndrome; deglutition; dysphagia; feeding; mouse model; pediatric dysphagia
79.
Front Psychol. 2020 Jan 14;10:2854. doi: 10.3389/fpsyg.2019.02854. eCollection 2019.
Using Beatboxing for Creative Rehabilitation After Laryngectomy: Experiences From a Public Engagement Project.
Abstract
Laryngectomy is the surgical removal of the larynx (voice box), usually performed in patients with advanced stages of throat cancer. The psychosocial impact of losing the voice is significant, affecting a person's professional and social life in a devastating way, and a proportion of this patient group subsequently must overcome depression (22-30%) and social isolation (40%). The profound changes to anatomical structures involved in voicing and articulation, as a result of surgery, radiotherapy or chemotherapy (separately or in combination with one another), introduce challenges faced in speech rehabilitation and voice production that complicate social reintegration and quality of life. After laryngectomy, breathing, voicing, articulation and tongue movement are major components in restoring communication. Regular exercise of the chest, neck and oropharyngeal muscles, in particular, is important in controlling these components and keeping the involved structures supple. It is, however, a difficult task for a speech therapist to keep the patient engaged and motivated to practice these exercises. We have adopted a multidisciplinary approach to explore the use of basic beatboxing techniques to create a wide variety of exercises that are seen as fun and interactive and that maximize the use of the structures important in alaryngeal phonation. We herein report on our empirical work in developing patients' skills, particularly relating to voiced and unvoiced consonants to improve intelligibility. In collaboration with a professional beatboxing performer, we produced instructional online video materials to support patients working on their own and/or with support from speech therapists. Although the present paper is focused predominantly on introducing the structure of the conducted workshops, the rationale for their design and the final public engagement performance, we also include feedback from participants to commence the critical discourse about whether this type of activity could lead to systematic underlying research and robustly assessed interventions in the future. Based on this exploratory work, we conclude that the innovative approach that we employed was found to be engaging, useful, informative and motivating. We conclude by offering our views regarding the limitations of our work and the implications for future empirical research.
Copyright © 2020 Moors, Silva, Maraschin, Young, Quinn, de Carpentier, Allouche and Himonides.
KEYWORDS:
beatboxing; head and neck cancer; laryngectomy; throat cancer; voice rehabilitation
80.
Med Arch. 2019 Dec;73(6):394-398. doi: 10.5455/medarh.2019.73.394-398.
A Clinical Study of Basal Cell Carcinoma.
Abstract
INTRODUCTION:
Basal cell carcinoma (BCC) is a non-melanocytic skin malignancy arising from basal cells of epidermis or follicular structures. Etiology of BCC is a multifactorial combination of genotype, phenotype, and environmental factors. There are several clinical variants of BCC including nodular, cystic, superficial, morphoeic, keratotic, pigmented and micronodular.
AIM:
The aim of our study was to analyze the recent clinical trends of basal cell carcinoma by reviewing a single institution's experience.
METHODS:
Total number of 422 patients clinically diagnosed with basal cell carcinoma were included in the study. Data on age, gender, skin type, personal and family history, duration of disease, localization of lesions, clinical type of lesions, and recurrence rate were collected and analyzed. The data were statistically evaluated.
RESULTS:
More than 80% of all BCC's were located on sun-exposed skin areas (p<0.05).The male /female ratio was 1:0.92. The nodular BCC was the most frequent type (59.2%), followed by the superficial (16.1%), pigmented (15.2%) and morphoeic (9.5%) types. The nodular and pigmented types were predominant located on the head and neck, whereas the trunk was the most common location for the superficial type (p<0.05). The tumor is commonly found in concomitance with skin lesion related to chronic sun exposure, such as actinic keratoses, solar lentigines and facial telangiectasia. During this study period, 41 cases showed recurrence of the cancer as the overall recurrence rate was 9.7%. There were no cases with metastasis or fatal outcome.
CONCLUSIONS:
The factors related to the development of BCC were older age and exposure to ultraviolet rays both in recreational and in occupational form. The prevention of BCC is based on the knowledge of risk factors, early diagnosis and treatment, particularly in susceptible populations.
© 2019 Emina Kasumagic-Halilovic, Mediha Hasic, Nermina Ovcina-Kurtovic.
KEYWORDS:
basal cell carcinoma; subtype; ultraviolet radiation
- PMID:
- 32082007
- PMCID:
- PMC7007603
- DOI:
- 10.5455/medarh.2019.73.394-398
81.
Sci Rep. 2020 Feb 21;10(1):3192. doi: 10.1038/s41598-020-60209-w.
Association between Serum Calcium and Risk of Cardiometabolic Disease among Community-dwelling Adults in Taiwan.
Abstract
Serum calcium, although only comprising 1% of total body calcium, is involved in intracellular signal pathways, vascular dilatation/constriction, and muscle contraction, which are crucial for insulin secretion, cholesterol catabolism, and blood pressure regulation. As far as we know, research on the relationship between serum calcium level and metabolic syndrome (MetS), diabetes, and hypertension in one longitudinal study is rare. Owing to the crucial role of serum calcium in human cardiometabolic physiology and lack of related study so far, this study aims to describe the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. During the period 2010-2016, there are two parts to our study: cross-sectional analysis and longitudinal analysis. Logistic regression was applied for cross-sectional analysis of the association between serum calcium level or albumin-corrected calcium (ACCA) and the prevalence of MetS, diabetes, or hypertension. Receiver operating characteristic (ROC) curve analysis was used for calculating of optimal cut-off value of serum calcium and ACCA. Cox proportional regression for development of MetS, diabetes, and hypertension according to different cut-off values of serum calcium level and ACCA were conducted. At baseline, there were 27,364 participants in our study. Serum calcium level had positive association with diabetes in the total population, male, and female. ACCA level had positive association with diabetes in the total population, male, and female. In unadjusted and multivariate Cox proportional hazard models, serum calcium level was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident MetS in the total population and male. ACCA was associated with increased risk of incident diabetes in the total population and male participants. This study describes the relationship between serum calcium level and the incidence of MetS, diabetes, and hypertension. Higher serum calcium level is associated with increased risk of MetS, diabetes, and hypertension.
82.
Sci Data. 2020 Feb 21;7(1):63. doi: 10.1038/s41597-020-0392-z.
Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors.
Elhalawani H1, Awan MJ2,3, Ding Y2, Mohamed ASR2,4, Elsayes AK2, Abu-Gheida I2,5, Wang J6, Hazle J7,8, Gunn GB2, Lai SY7, Frank SJ2, Ginsberg LE6, Rosenthal DI2, Fuller CD9,10.
Abstract
Node positive head and neck squamous cell carcinomas (HNSCCs) patients exhibit worse outcomes in terms of regional neck control, risk for distant metastases and overall survival. Smaller non-palpable lymph nodes may be inflammatory or may harbor clinically occult metastases, a characterization that can be challenging to make using routine imaging modalities. Ferumoxytol has been previously investigated as an intra-tumoral contrast agent for magnetic resonance imaging (MRI) for intracranial malignancies and lymph node agent in prostate cancer. Hence, our group was motivated to carry out a prospective feasibility study to assess the feasibility of ferumoxytol dynamic contrast enhanced (DCE)-weighted MRI relative to that of gadolinium-based DCE-MRI for nodal and primary tumor imaging in patients with biopsy-proven node-positive HNSCC or melanoma. Although this institutional review board (IRB)-approved study was prematurely terminated because of an FDA black box warning, the investigators sought to curate and publish this unique dataset of matched clinical, and anatomical and DCE MRI data for the enrolled five patients to be available for scientists interested in molecular imaging.
83.
World Neurosurg. 2020 Feb 17. pii: S1878-8750(20)30326-0. doi: 10.1016/j.wneu.2020.02.051. [Epub ahead of print]
Supracerebellar Approach for Resection of a Falcotentorial DAVF with Pial Tectal AVM Component Associated with a Left Parafalcine Meningioma.
Abstract
A 66-year-old female presented with a 4.5 x 4 cm left posterior parafalcine meningioma and visual loss in her left eye. Prior to meningioma embolization, the angiography confirmed an incidental high-risk falcotentorial dural arteriovenous fistula (DAVF) with pial-tectal arteriovenous malformation (AVM) and flow-related aneurysms of the superior cerebellar artery (SCA) and posterior cerebral artery (PCA). Arterial supply via branches of the middle meningeal artery (MMA), tentorial branches of the internal carotid arteries, as well as the PCA and SCA. Drainage into the vein of Galen (VG), and venous reflux into the precentral cerebellar vein (PCCV) were identified. The patient underwent transarterial embolization of the DAVF via left MMA utilizing Onyx with a significant decrease of the arterial-venous shunting. A semi-sitting supracerebellar approach was performed. The subarachnoid space of the tentorium, cerebellar hemispheres, vermis, quadrigeminal, and ambient cisterns was dissected to reveal the boundaries of the lesion. Indocyanine green video angiography was done before and after in-situ occlusion to identify the arterial supply and the early venous drainage. The vascular lesion was disconnected circumferentially around the edges of the pial portion of the AVM, and the feeders were carefully cauterized and cut. The vessels on the surface of the brainstem were occluded in-situ to prevent any parenchymal transgression. Lastly, the drainage into the VG and the venous reflux to PCCV were ligated. Post-operative angiography showed no residual DAVF or AVM and regression of aneurysms. The patient was discharged with no added deficits, and the meningioma was totally resected several months later.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
aneurysm; arteriovenous malformation; dural arteriovenous fistula; falcontentorial; meningioma; supracerebellar approach; tectal
84.
J Allergy Clin Immunol Pract. 2020 Feb 17. pii: S2213-2198(20)30152-5. doi: 10.1016/j.jaip.2020.02.003. [Epub ahead of print]
A Pragmatic Approach Towards Sinonasal Diseases.
Abstract
Sinonasal disease in its multiple forms affects billions of people worldwide. Although physicians train to precisely diagnose a patient and then treat appropriately, the sheer number of people afflicted with sinonasal disease precludes this approach. We argue that patients should first be treated with an intranasal corticosteroid for 2 weeks. Based on their perceived response, they should be triaged. Those who respond well can be instructed on how to continue to manage their disease. Those who don't would be referred to allergists or otolaryngologists for diagnosis and treatment. We believe this pragmatic approach is safe, provided first line physicians, physician assistants and nurse practitioners recognize some warning symptoms and signs of serious, but infrequently occurring, sinonasal diseases that would not lend themselves to this proposed approach.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS:
allergic rhinitis; chronic rhinosinusitis; classification; intranasal corticosteroids; sinonasal disease
85.
J Oral Maxillofac Surg. 2020 Jan 23. pii: S0278-2391(20)30089-6. doi: 10.1016/j.joms.2020.01.018. [Epub ahead of print]
Influence of Hyperglycemia on Treatment Outcomes of Oral Cavity Squamous Cell Carcinoma.
Abstract
PURPOSE:
The present study investigated the association between perioperative hyperglycemia and the treatment and survival outcomes of patients with oral cavity squamous cell carcinoma (OSCC).
PATIENTS AND METHODS:
From 2004 to 2016, 385 patients with OSCC were enrolled and stratified into normoglycemic (<180 mg/dL) and hyperglycemic (>180 mg/dL) groups. The clinicopathologic characteristics and treatment outcomes of OSCC were subsequently analyzed.
RESULTS:
Of the 385 patients, 61 (15.8%) were in the hyperglycemic group. Hyperglycemia was significantly associated with pT stage, pN stage, overall pathologic stage, extranodal extension, albumin level, and tumor depth (P = .004, P = .042, P = .008, P = .001, P = .004, and P = .011, respectively). Patients with hyperglycemia also had required a longer hospital stay (P = .003). The 5-year overall survival and disease-specific survival were poorer in the hyperglycemic group than in the normoglycemic group (P = .001 and P = .002, respectively). Multivariate analysis revealed that hyperglycemia is a significant adverse prognostic indicator for OSCC (hazard ratio, 1.709; 95% confidence interval, 1.003 to 2.912; P = .049).
CONCLUSIONS:
Hyperglycemia is associated with more advanced disease and poorer survival rates in patients with OSCC. It correlates with adverse clinicopathologic characteristics and longer hospital stay. Screening for hyperglycemia and maintenance of normal glycemic status during the treatment course is imperative in the treatment of OSCC.
Copyright © 2020. Published by Elsevier Inc.
86.
J Oral Maxillofac Surg. 2020 Jan 28. pii: S0278-2391(20)30092-6. doi: 10.1016/j.joms.2020.01.021. [Epub ahead of print]
Efficacy of Sialendoscopy in the Management of Noncalculi-Related Sialadenitis.
Abstract
PURPOSE:
Sialendoscopy has effectively changed the paradigm for the treatment of sialolithiasis. Its effect on noncalculi-related recurrent sialadenitis is, however, unclear, especially regarding the long-term outcomes. The objectives of the present study were to evaluate the long-term efficacy of sialendoscopy for noncalculi-related recurrent sialadenitis and determine the clinical and intraoperative features that might be prognosticate outcomes.
PATIENTS AND METHODS:
We performed a prospective cohort study of 33 consecutive patients who had undergone sialendoscopy for recurrent noncalculi-related sialadenitis by a single surgeon in a tertiary institution from January 2010 to December 2016. The patient-reported outcome measures were used as the primary determinant of treatment efficacy. The clinical features and endoscopic findings were evaluated as variables that might predict the treatment outcomes. The Fischer exact test was used to analyze the descriptive data, and a P value of < .05 was considered to indicate statistical significance.
RESULTS:
Of the 33 patients with recurrent noncalculi-related sialadenitis, 1 was lost to follow-up and thus excluded from the analysis. The mean and median follow-up period for the 32 patients was 27 and 21.5 months, respectively. Of the 33 patients, 28 (87.5%) had reported symptom improvement, and 19 patients (59.4%) were symptom free after a single sialendoscopic treatment. The chronicity of symptoms, younger patient age, and concurrent autoimmune disease were predictive of recurrent symptoms despite sialendoscopy.
CONCLUSIONS:
The use of sialendoscopy achieved sustained long-term improvements or resolution of symptoms for most patients with recurrent noncalculi-related sialadenitis. The data from our study support the benefits of sialendoscopy for patients with recurrent noncalculi-related sialadenitis.
Copyright © 2020. Published by Elsevier Inc.
87.
J Plast Reconstr Aesthet Surg. 2020 Jan 9. pii: S1748-6815(20)30002-4. doi: 10.1016/j.bjps.2019.12.007. [Epub ahead of print]
Recreation of eyelid mechanics using the sling concept✰.
Abstract
BACKGROUND:
Paralytic lagophthalmos causes major functional, aesthetic and psychological problems in patients with facial paralysis. The Bionic Lid Implant for Natural Closure (BLINC) project aims to restore eyelid function using an implanted electromagnetic actuator combined with an eyelid sling. The authors performed a preliminary study using cadaveric heads to investigate the optimal application of an eyelid sling in various configurations around the orbit.
METHODS:
The sling was tested in a cadaveric sheep head using 2 medial anchor points and 4 lateral ostectomy points. An impulse was generated using gravitational force to test each combination of medial and lateral sling insertion sites using weights between 10 and 50 g. Each generated blink was recorded and analysed. The final result was validated in a human cadaveric model.
RESULTS:
The maximum amount of eye closure and closure speed displayed in sheep were 83.7 ± 9.4% of total closure and 70.6 ± 6.9 mm/s at a maximum force of 490 mN, respectively. The 2 inferior lateral attachments performed better at displacing the eyelid than the superior attachments. The position with the highest degree of eye-closure (improvement of 21.6%, p < 0.001) and speed (improvement of 30.4 mm/s, p < 0.001) was the combination of a posterior medial attachment and an inferior-posterior lateral attachment, which resulted in a near physiological closure in human cadaver.
CONCLUSION:
Closure improved with an inferior lateral position due to increased force acting in the direction of closure. Posterior positioning increases force acting radially, towards the centre of eyelid movement. The latter directs the closure force to effectively move the eyelid around the curved globe.
Copyright © 2020 Elsevier Ltd. All rights reserved.
KEYWORDS:
Facial palsy; Lagophthalmos; Reanimation; Sling
88.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Feb 17. pii: S2212-4403(19)31613-X. doi: 10.1016/j.oooo.2019.12.006. [Epub ahead of print]
ErbB3, a possible prognostic factor of head and neck squamous cell carcinoma.
Abstract
OBJECTIVE:
We aimed to identify the prognostic factors in head and neck squamous cell carcinoma (HNSCC) by using gene expression analysis and candidate biomarkers for adjuvant therapy.
STUDY DESIGN:
Complementary DNA (cDNA) microarray analysis was performed by using samples from 8 patients, who had died as a result of fulminant recurrence shortly after postoperative radiation therapy, and the results were compared with those from patients with HNSCC of similar stage, but without recurrence. Tissue microarray and immunohistochemistry of samples from 69 patients with oral cavity squamous cell carcinoma indicated ErbB3 to be a prognostic marker, and its expression was analyzed in the HNSCC cell lines. Sapitinib was tested as a concurrent inhibitor of EGFR, ErbB2, and ErbB3. In 15 mice, tumor xenograft was implanted at the lateral tongue, and tumor growth was evaluated.
RESULTS:
ErbB3 overexpression in patients with treatment-resistant HNSCC was associated with relapse-free survival, disease-free survival, and overall survival (P = .018, P = .006, and P = .003, respectively). In the HNSCC cell line, ErbB2 and ErbB3 overexpression was inhibited by postoperative adjuvant therapy with sapitinib, which was also seen to improve survival in an animal model.
CONCLUSIONS:
ErbB3 overexpression predicts a poor clinical outcome. Sapitinib was shown to be an effective inhibitor in the HNSCC cell line and animal models of cancer but with no statistical significance. Further studies with larger groups are needed to better support these results.
Copyright © 2019 Elsevier Inc. All rights reserved.
89.
Ann Pathol. 2020 Feb 18. pii: S0242-6498(20)30030-4. doi: 10.1016/j.annpat.2020.01.005. [Epub ahead of print]
[Study of the Human Papillomavirus (HPV) prevalence in head and neck carcinomas in a French monocentric cohort of 372 patients].
[Article in French]
Abstract
INTRODUCTION:
French data about HPV role in head and neck carcinomas are sparse, although French patients are mostly heavy smokers. In this series of oropharyngeal et non-oropharyngeal tumors, we aimed to determine what were the clinicopathological features associated with HPV and evaluate survival of patients according to HPV status.
METHODS:
Three hundred and seventy-two cases of head and neck squamous cell carcinomas were reviewed and clinicopathological data were detailed. For each case, we performed a HPV PCR and an immunostaining against p16 protein (paraffin embedded tissues).
RESULTS:
The series contained 90% of heavy smokers and 36% of tumors were located in oropharynx. HPV DNA was detected in 46% of oropharyngeal carcinomas and 16% of non-oropharyngeal carcinomas. Genotype 16 was the most frequently detected (84%). Clinicopathological features significantly associated with HPV DNA were: oropharyngeal location; absence of tobacco smoking; nodal involvement; poorly-differentiated non-keratinizing histology; positive p16 immunostaining. HPV infection was significantly associated with a longer survival for oropharyngeal carcinomas. It was not the case for non-oropharyngeal carcinomas.
CONCLUSION:
In this French series with lot of heavy smokers, under half of carcinomas are HPV induced. Clinicopathological features and survival data associated with HPV infection are the same as those classically described in literature.
Copyright © 2020 Elsevier Masson SAS. All rights reserved.
KEYWORDS:
Carcinome épidermoïde; Head and neck; Human papillomavirus; Oropharynx; Papillomavirus Humain; Prognosis; Pronostic; Squamous cell carcinoma; Voies aérodigestives supérieures
90.
Oral Oncol. 2020 Feb 17:104595. doi: 10.1016/j.oraloncology.2020.104595. [Epub ahead of print]
Molecular landscape of salivary gland cancers.
Abstract
Accurate diagnosis of salivary gland tumors can be challenging because of the many diagnostic entities, the sometimes extensive morphologic overlap, and the rarity of most tumor types. The current understanding of molecular rearrangements in salivary gland tumor pathology, emphasizes the prospects for exploiting molecular alterations in salivary gland tumors for diagnosis and targeted therapy. As new targeted therapies emerge, it will become increasingly vital to incorporate appropriate molecular testing into the pathologic evaluation of salivary gland cancers.
Copyright © 2020 Elsevier Ltd. All rights reserved.
KEYWORDS:
Adenoid cystic Carcinoma; Diagnosis; Molecular pathogenesis; Mucoepidermoid Carcinoma; Salivary gland cancers; p53 Mutation
91.
J Voice. 2020 Feb 17. pii: S0892-1997(20)30049-7. doi: 10.1016/j.jvoice.2020.01.027. [Epub ahead of print]
World Voice Day 2020.
92.
J Voice. 2020 Feb 18. pii: S0892-1997(19)30599-5. doi: 10.1016/j.jvoice.2020.01.021. [Epub ahead of print]
Properties of a Novel Animal Model of LPR.
Abstract
BACKGROUND:
Few satisfactory animal models of laryngopharyngeal reflux (LPR) is available. Interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) may be associated with the pathogenesis of LPR injuries and laryngeal carcinomas.
OBJECTIVES:
To establish an animal model of LPR and to explore the related pathological changes and cytokine expression in the vocal cord tissue.
METHODS:
Twenty rabbits were divided into experimental and control groups. Dilatation of the upper and lower esophageal sphincter were carried out in the experimental group. The pH of the pharynx, pathological, and ultrastructural changes of the laryngeal tissue, and expression of IL-8 and VEGF were compared between the experimental group and controls.
RESULTS:
pH monitoring results and the dilated intercellular space of the vocal cord mucosa showed that the experimental group developed laryngopharyngeal reflux. There were significant differences in the immunohistochemical staining scores of both IL-8 (P = 0.015) and VEGF (P = 0.007) between the experimental and control groups in the vocal cord tissue.
CONCLUSIONS:
We successfully established a model of LPR, showing histopathological and ultrastructural changes consistent with the disease. The expression of IL-8 and VEGF may increase during the pathogenesis of LPR.
Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Animal model; IL-8; Intercellular space; LPR; VEGF; pH
93.
J Voice. 2020 Feb 17. pii: S0892-1997(19)30421-7. doi: 10.1016/j.jvoice.2019.12.017. [Epub ahead of print]
The Dual-Microphone Voice Range Profile Assessment-Interrater Reliability.
Abstract
OBJECTIVES:
The dual-microphone voice range profile (VRP) is an objective measurement of vocal frequency and intensity. Precise assessments are required to ensure correct interpretation of treatment outcome. The objective of this study was to investigate the interrater reliability of the assessment.
STUDY DESIGN:
Prospective repeated measures.
METHODS:
Thirty-five healthy participants underwent two VRP assessments with an interval of 2-84 days. Seven speech-language pathologists with special training in the used VRP protocol conducted the assessments. Dependent variables were voice frequency and intensity (minimum, maximum, and ranges), and VRP area.
RESULTS:
In the frequency measures and highest intensity, intraclass correlations were moderate to excellent and there were no statistically significant differences between test and retest. VRP area, minimum intensity, and intensity range showed poor to moderate reliability and significant enlargement in the retest; VRP area (117 cells, [{95% CI: 69-164}, P < 0.001]), softest intensity (-2.2 dB [{95% CI: -3.3 to -1.0}, P < 0.001]), and intensity range (2.3 dB [{95% CI: 0.5-4.1}, P < 0.001]). The 10% and 90% percentiles were provided. Minor systematical differences were detected in max SPL, max fo, and VRP area; otherwise no systematical sources of error could explain the results.
CONCLUSION:
The VRP assessment is a reliable tool when assessing frequency and maximum intensity. Care must be taken in interpretation of minimum intensity, intensity range, and VRP area. Different speech-language pathologists can assess the individual voice before and after treatment, if they are trained in and adhere to the same protocol.
Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Phonetogram; Repeated assessment; Reproducibility, Voice evaluation; Test-retest reliability; Voice assessment; Voice range profile
94.
J Voice. 2020 Feb 17. pii: S0892-1997(19)30463-1. doi: 10.1016/j.jvoice.2019.12.015. [Epub ahead of print]
Incidence of and Risk Factors Associated With Vocal Fold Hemorrhage Following Type I Thyroplasty With Gore-Tex Implant.
Abstract
OBJECTIVES:
The objectives of this study were to determine the rate of hemorrhage following type I thyroplasty performed exclusively with Gore-Tex implant and to define whether age, comorbidities, anticoagulation therapy, presence of vocal fold ectasia, and operative technique are associated with increased incidence of hemorrhage.
METHODS:
Medical charts of 86 patients who underwent type I thyroplasty with Gore-Tex implant between the years 2013 and 2019 were reviewed retrospectively and divided into two groups based on presence or absence of postoperative vocal fold hemorrhage. Patients were examined on the day following surgery. Hemorrhage was defined as any submucosal erythema on the vocal fold even when isolated to the superior surface. Age, sex, medical comorbidities, preoperative medications with specific attention to anticoagulation therapy, American Society of Anesthesiology score (all procedures were performed under local anesthesia with sedation), operative notes, and pre- and poststroboscopy exams were compared between groups. Statistical analyses were done using Chi-Square (χ 2) Analysis and Student's t test. P values were considered statistically significant at the P < 0.05 level.
RESULTS:
The rate of hemorrhage was 22.3%. There was a statistically significant difference in incidence of hemorrhage associated with a vocal fold varix on preoperative stroboscopic exam and history of discontinued anticoagulation therapy (1-week preoperatively). No difference was found for the other parameters studied.
CONCLUSION:
Presence of vocal fold varix or ectasia and preoperative use of anticoagulation or antiplatelet therapy are associated with an increased risk of hemorrhage following type I Thyroplasty with Gore-Tex implant.
Copyright © 2019 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
KEYWORDS:
Anticoagulation; Antiplatelet; Ectasia; Gore-Tex; Hemorrhage; Type I Thyroplasty; Varix
95.
Am J Surg. 2020 Feb 16. pii: S0002-9610(20)30089-1. doi: 10.1016/j.amjsurg.2020.02.020. [Epub ahead of print]
Prognostic value of tumor size and minimal extrathyroidal extension in papillary thyroid carcinoma.
Abstract
BACKGROUND:
Tumour size and extrathyroidal extension (ETE) may impact papillary thyroid carcinoma (PTC) outcomes. We therefore examined the prognostic value of tumour size and ETE for predicting posttreatment recurrence in PTC patients.
METHODS:
A total of 2,902 patients who underwent thyroidectomy for previously untreated T1-T3 PTC (7th edition American Joint Committee on Cancer) at our tertiary referral center were included. Univariate and multivariate Cox proportional hazard regression analyses were used to determine significant factors predictive of posttreatment recurrence-free survival (RFS).
RESULTS:
In univariate analysis, tumour factors (including tumour size, multifocality, ETE, and lymphovascular invasion), nodal factors (including positive lymph node number, lymph node ratio, and extranodal extension), and MACIS (metastases, age, completeness of resection, invasion, and size) scores were significantly associated with RFS outcomes (P < 0.001). In multivariate analysis, tumour size >4 cm (P < 0.001) and multifocality (P = 0.038) were the independent factors of RFS. Nodal factors and MACIS scores were also independent factors of RFS.
CONCLUSION:
Tumour size impacts RFS after thyroidectomy in T1-T3 PTC patients.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Extrathyroidal extension; Papillary thyroid carcinoma; Recurrence; Thyroidectomy; Tumor size
96.
Am J Otolaryngol. 2020 Feb 7:102419. doi: 10.1016/j.amjoto.2020.102419. [Epub ahead of print]
Predictors of occult lymph node metastases in lip cancer.
Abstract
OBJECTIVE:
The incidence of lymph node metastases (LNM) in squamous cell carcinoma of the lip is modest (8%), making it challenging to identify patients that may benefit from elective pathologic staging evaluation of the neck. We evaluated predictors of LNM in patients with lip cancer in order to potentially refine selection of patients for pathologic staging evaluation of the neck.
STUDY DESIGN:
Retrospective cohort study.
SUBJECTS:
Clinically N0 patients with squamous cell carcinoma of the lip that underwent definitive surgical resection and pathologic evaluation of lymph node metastases in the National Cancer Data Base from 2006 to 2013.
METHODS:
Multivariable binomial logistic-regression was used to assess the relationship between occult pathologic lymph node metastasis and potential preoperative predictors including; patient demographics, T-stage, location, and pathologic details.
RESULTS:
Among 786 patients the overall rate of LNM was 12.1%. Patients were more likely to have LNM with T2 (odds ratio (OR) 2.05; (95% confidence interval (CI) 1.19-3.54) or T3-4 (OR 2.36; CI 1.32-4.22) moderately differentiated (OR 2.65; CI 1.30-5.38) or poorly differentiated (OR 4.37; CI 1.97-9.71), or involvement of the mucosal surface (OR 1.82; CI 1.09-3.03). We created a prediction model based on proportional odd ratios from multivariant binomial logistic-regression analysis from statistically significant factors; incorporating T2-4, moderate/poorly differentiated, or mucosal site.
CONCLUSION:
Our prediction model found that patients with two or more risk factors were the best candidates for elective pathologic nodal evaluation.
Copyright © 2020 Elsevier Inc. All rights reserved.
97.
J Anat. 2020 Feb 20. doi: 10.1111/joa.13175. [Epub ahead of print]
The intercarotid or alar fascia, other cervical fascias, and their adjacent spaces - a plea for clarification of cervical fascia and spaces terminology.
Abstract
Due to varying descriptions and terminology of fascias of the neck, medical advice relying on this basic knowledge is insufficient. Our goal was to provide a precise anatomical description of cervical fascias and spaces with special focus on the intercarotid fascia, or the alar fascia. One hundred bodies donated to science embalmed with Thiel's method were investigated, cervical fascias were dissected layer by layer, and the results were documented by photography, with a focus on the intercarotid fascia. In addition, we performed a review of recent literature concerning cervical surgical interventions, radiological diagnostic pathways, and basic anatomical works focusing on core information on anatomical relations of cervical fascias and spaces. In another 10 bodies donated to science, the spaces of the neck were injected with coloured latex under ultrasound guidance, dissected, and documented by photography. The intercarotid fascia was a constantly developed connective tissue interconnecting the carotid sheath of both sides. In 52 of 100 specimens (52%) it crossed to the opposite side without any fusion to the ventrally situated visceral fascia. Fusion with the visceral fascia was found in 48%, either at the lateral border of the pharynx or on its dorsal side. The results of our dissections strengthen the precise description of the cervical fascias provided by Grodinsky and Holyoke in 1938. Spaces can be confirmed as described by Hafferl in 1969. The international anatomical and ENT societies should codify a unified anatomical terminology of the cervical spaces and fascias to prevent varying interpretations in the future.
© 2020 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.
KEYWORDS:
alar fascia; cervical abscess; cervical fascia; fascia alaris; fascia cervicalis; fascia intercarotica; head and neck; intercarotid fascia; neck anatomy
98.
Strahlenther Onkol. 2020 Feb 20. doi: 10.1007/s00066-020-01595-y. [Epub ahead of print]
Prognostic value of a 15-gene hypoxia classifier in oropharyngeal cancer treated with accelerated chemoradiotherapy.
Abstract
PURPOSE:
A 15-gene hypoxia classifier has been developed and validated as a predictive factor for patients with head and neck squamous cell carcinoma treated with radiotherapy and nimorazole. This paper aimed to investigate the role of this hypoxia classifier as a prognostic factor for patients with oropharyngeal cancer (OPC) treated with accelerated chemoradiotherapy.
METHODS:
P16 and 15-gene hypoxia classifier status, categorising tumours as more or less hypoxic, were determined for 136 OPC patients. Locoregional recurrence rate (LRR) and overall survival (OS) were estimated with cumulative incidence function and Kaplan-Meier method, respectively, stratified according to p16 and hypoxia status.
RESULTS:
P16-positive patients (34.6%) had significantly better LRR and OS than p16-negative patients. The 5‑year LRR of patients with more hypoxic OPC was similar to those with less hypoxic OPC in the overall patient population (27.3% versus 25.1%; p = 0.98; HR = 1.01 [CI95% 0.47;2.17]) and in the p16-negative OPC (36.4% versus 30.1%; p = 0.70; HR = 1.17 [CI95% 0.53;2.56]). No significant OS differences could be observed in neither p16-negative nor p16-positive subgroup with a 5-year OS for p16-negative more hypoxic OPC of 44.2% versus 49.0% in the less hypoxic OPC (p = 0.92; HR 0.97 [CI95% 0.51;1.84]).
CONCLUSION:
No significant outcome differences were observed between more or less hypoxic tumours, as determined by the 15-gene hypoxia classifier. These results suggest that the 15-gene hypoxia classifier may not have prognostic value in an OPC patient cohort treated with accelerated chemoradiotherapy.
KEYWORDS:
Accelerated radiotherapy; Biomarker; Chemoradiotherapy; Hypoxia gene classifier; Oropharyngeal cancer
99.
Otol Neurotol. 2020 Feb 19. doi: 10.1097/MAO.0000000000002599. [Epub ahead of print]
The Pretragal Superficial Musculoaponeurotic System Fascia: A New Graft Material for Transcanal Tympanoplasty.
Abstract
OBJECTIVE:
To compare outcomes of transcanal endoscopic tympanoplasty reconstructed using pretragal superficial musculoaponeurotic system (SMAS) fascia versus temporalis fascia.
STUDY DESIGN:
Retrospective patient review and posttreatment questionnaire survey.
SETTING:
Tertiary referral center.
PATIENTS:
Sixty adult patients with chronic dry tympanic membrane perforation.
INTERVENTIONS:
Patients underwent transcanal endoscopic type I tympanoplasty reconstructed using the SMAS fascia between September 2017 and May 2018; outcomes were compared with a matched cohort of patients where the temporalis fascia was used.
MAIN OUTCOME MEASURES:
Tympanic membrane closure rate, audiogram threshold, duration of procedure, and donor site scar satisfaction survey.
RESULTS:
Sixty patients were included in this study and were evenly divided into the SMAS and temporalis fascia groups. These cohorts were matched for age, sex, side of lesion, perforation size, and preoperative hearing level. The closure rate was 96.7% (29/30) and 93.3% (28/30) (p = 1.0), mean hearing gain was 8.3 ± 6.4 dB versus 8.2 ± 7.1 dB for air-conduction (p = 0.970) and 7.6 ± 5.1 dB versus 8.2 ± 6.8 dB for air-bone gap (p = 0.716), and mean surgical duration was 137.3 ± 23.0 versus 132.2 ± 27.3 minutes (p = 0.432) for the SMAS and temporalis fascia groups, respectively; there were no statistically significant differences for all the parameters listed. The posttreatment questionnaire survey revealed significantly higher acceptance of the SMAS fascia method.
CONCLUSION:
This preliminary outcome report of SMAS fascia grafting in transcanal endoscopic type I tympanoplasty showed equivalent surgical outcomes and better cosmetic satisfaction compared with the temporalis fascia. The SMAS fascia is a reasonable alternative to conventional techniques for transcanal tympanoplasty.
100.
Otol Neurotol. 2020 Feb 19. doi: 10.1097/MAO.0000000000002597. [Epub ahead of print]
Active Transcutaneous Bone Conduction Implant: Audiometric Outcomes Following a Novel Middle Fossa Approach With Self-Drilling Screws.
Abstract
OBJECTIVE:
To present surgical and audiometric outcomes of patients implanted with an active transcutaneous bone conduction implant following the novel middle fossa surgical approach with self-drilling screws.
STUDY DESIGN:
Retrospective review.
SETTING:
Tertiary care center.
PATIENTS:
Thirty-seven adults with either conductive or mixed hearing loss that met indications for an active transcutaneous bone conduction implant were consecutively implanted from April, 2013 to May, 2018.
INTERVENTION:
Unilateral middle fossa implantation of an active transcutaneous bone conduction implant.
MAIN OUTCOME MEASURES:
Patient charts were reviewed for surgical outcomes and complications over the 6-year period. Preoperative air conduction, preoperative bone conduction, and 3-month postoperative aided thresholds were recorded. Speech perception was assessed using CNC words and AzBio sentences. Pure-tone averages (PTAs; measured at 0.5, 1.0, 2.0 and 3.0 kHz), air-bone gap, and functional gain were calculated.
RESULTS:
Mean air conduction and bone conduction PTAs (±standard deviation) of the implanted ear were 66.8 dB (±14.9 dB) and 21.9 dB (±14.0 dB), respectively. Mean aided PTA was 26.5 dB (± 8.5 dB). The average functional gain was 40.3 dB (±19.0 dB). Favorable speech perception outcomes were observed. No complications or instances of revision surgery were reported, with a mean follow-up time of 32 months (range, 9-71 mo).
CONCLUSIONS:
This is the first paper to describe outcomes of patients implanted with an active transcutaneous bone conduction implant via the middle fossa with self-drilling screws. Favorable surgical outcomes were observed with a follow-up of up to 6 years.
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