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Background: This study compares early outcomes of osteofascial fibula free flap (OF‐FFF) with donor‐site primary closure and osteocutaneous (OC) FFF with donor‐site skin grafting in segmental mandibular reconstruction. Methods: A retrospective chart review of FFF mandibular reconstruction patients (2006–2022) divided into OF‐FFF and OC‐FFF groups. Clinical data, operative parameters, and early postoperative outcomes (≤ 90 days) were analyzed. Results: The study included 67 patients (39 OF‐FFF, 28 OC‐FFF). OF‐FFF had significantly lower donor‐site complications (12.8% vs. 53.6%, p < 0.001) and revision surgeries (7.7% vs. 35.7%, p = 0.004) compared to OC‐FFF. Recipient‐site (28.2% vs. 25%, p = 0.77) and flap (15.4% vs. 17.9%, p > 0.99) complications were comparable. Conclusions: OF‐FFF mandibular reconstruction with donor‐site primary closure is a safe and reliable technique associated with superior donor‐site and comparable flap and recipient‐site outcomes to OC‐FFF, thus may be considered as a viable alternative to OC‐FFF for selected patients. [ABSTRACT FROM AUTHOR]

Background: The presence of cervical lymph node (LN) metastasis at the initial presentation of papillary thyroid carcinoma (PTC) constitutes an independent risk factor for disease recurrence, increases the risk for mortality, and impacts overall outcome. The 2016 American Joint Committee on Cancer raised the age cutoff for PTC staging from 45 to 55 years for better prediction of overall survival. Age > 55 years is considered a significant risk factor for a more aggressive and advanced disease with worse outcomes. We identified histopathological factors for disease recurrence in PTC patients younger and older than 55 years of age. Methods: Data on all patients who underwent thyroid surgery due to PTC between 2006 and 2018 in the Tel Aviv Sourasky Medical Center were retrieved for this retrospective cohort study. Patients with lymph node (LN) metastases were further investigated for preoperative presentation, pathological characteristics, and recurrence. A multivariate analysis was used to detect predictors for recurrence and patient outcome for each age-group. Results: Twenty-two of the 183 patients (12%) with PTC who met the inclusion criteria and had sufficient follow-up period sustained recurrence. The predictors of recurrence varied between the two age-groups. The size of thyroid lesions (p = 0.003) was identified as a risk factor in the older group, while the number of metastatic cervical LNs (p = 0.001) and the ratio of metastatic-to-total dissected cervical LNs (p = 0.027) were the main predictors of recurrence for the younger group. Conclusion: The histopathological factors predictive for disease recurrence differed among PTC patients younger and older than 55 years of age. [ABSTRACT FROM AUTHOR]

Background: Masticator space involvement in oral cavity squamous cell carcinoma (OCSCC) is considered an unresectable disease. Nevertheless, achieving negative resection margins is feasible in limited masticatory space involvement. Materials and Methods: A multi‐institutional study on OCSCC patients with masticator space invasion who underwent surgical resection. Margin status was assessed according to anatomic tumor involvement of the inframandibular and supra‐mandibular notch. Results: One‐hundred and thirty‐two patients met the inclusion criteria. Then, 67 patients (50.8%) were diagnosed with a supra‐notch tumor and 65 (49.2%) with an infra‐notch disease. Negative margins were more common in the infra‐notch group (43.3 vs. 23.1%, p = 0.014), and positive margins were more common in the supra‐notch group (41.5 vs. 23.9%, p = 0.041). Multivariable analysis demonstrated that supra‐notch tumors had an increased likelihood for involved resection margins (odds ratio = 2.46, p = 0.036). Conclusion: OCSCC patients with masticator space involvement are prone for positive surgical margins in tumors extending above the supra‐mandibular notch. [ABSTRACT FROM AUTHOR]

Background: Tracheal invasion in thyroid cancer is a well-known form of advanced disease. There is an ongoing controversy over outcomes of tracheal shaving in this situation. The aim of this study was to compare the results of tracheal shaving to radical resections in patients with low-volume tracheal involvement. Methods: An institutional case series and a meta-analysis was conducted. All studies that included patients diagnosed with well-differentiated thyroid cancer (WDTC) and tracheal invasion were analyzed. Patients with low-volume tracheal invasion (according to the Shin classification) were extracted from the various studies and subsequently included in this study. The outcomes of tracheal shaving and radical resection were consolidated and compared. All recurrences and mortality over 10 years of follow-up were calculated using the Kaplan–Meier method. Results: Institutional case series included 22 patients diagnosed with WDTC and tracheal invasion that underwent resection. There was one case of recurrence (4.5%) during the follow-up period and no mortality. The meta-analysis yielded a total of 284 patients from six studies who met the inclusion criteria. The 10-year overall survival was 82.4% for the shave group and 80.8% for the resection group. The combined Kaplan–Meier curves revealed no statistically significant difference between the two techniques (hazard ratio [HR] = 0.86, P =.768). The combined 10-year local control rate of the shave group was 90.2%. Conclusions: The outcomes of tracheal shaving in low-volume invasion are similar to more aggressive forms of tracheal resections. Shave resection is oncologically safe in carefully selected WDTC patients demonstrating minimal tracheal invasion. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the extent of thyroid function control among pregnant women who had previously undergone a therapeutic thyroidectomy. Design: Retrospective cohort study. Setting: The largest health maintenance organization in Israel. Participants: All female patients who were pregnant between May, 2001 and September, 2012 and had a medical history of thyroid surgery. Main outcome measure: The thyroid‐stimulating hormone (TSH) levels throughout the pregnancy were compared to recommended trimestral values. A multivariate analysis was performed to determine risk factors for not attaining TSH recommended range. Results: A total of 477 females with a history of thyroid surgery had given 701 births during the study period. Forty‐three percent (n = 203), had thyroidal malignancy. Nearly half of the women underwent total thyroidectomy (43.4%, n = 207). The women's TSH values were within the recommended range in only 60% (n = 350) of the pregnancies during the first trimester (0.1‐2.5 mIU/L), in 61% (n = 335) during the second trimester (0.2‐3 mIU/L), and in 70% (n = 338) during the third trimester (0.3‐3 mIU/L). In multivariate analysis, women that underwent a total thyroidectomy due to a benign thyroid disease, were at the highest risk for not attaining target TSH levels. Conclusions: This very large cohort of pregnant women with a past history of thyroid surgery demonstrated a significant percentage of pregnancies with TSH values above the recommended range. Women that underwent a total thyroidectomy due to benign thyroid disease were at the highest risk for gestational hypothyroidism. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The effects of different electrocautery power settings on mucosal contraction and margin status in the oral cavity have not been well established. The aim of this study was to examine how different levels of electrocautery energy outputs affect oral mucosal tissue margins. Study Design: Animal model. Methods: A model of 23 adult rats was used (two specimens per rat). After anesthetizing the animals, a 6‐mm biopsy punch marked the resection margin on the buccal mucosa (one per cheek). The specimens were excised by means of three energy levels, a cold knife, and monopolar diathermy that was set on either 20 W or 30 W cut modes. The specimens were evaluated for extent of contraction. Results: A total of 45 samples were obtained and measured, including 15 specimens in the cold‐knife group, 15 specimens in the 20 W group, and 15 specimens in the 30 W group. The median diameters of the specimens after resection were 4.5 mm for the cold‐knife group (interquartile range [IQR] = 4.0–5.0), 3.5 mm for the 20 W group (IQR = 3.5–4.0), and 2.8 mm for the 30 W group (IQR = 2.5–3.0). Specimen contraction was 25.0%, 41.7%, and 53.3%, respectively. The difference in shrinkage between each pair was statistically significant: cold knife versus 20 W, P =.001; cold knife versus 30 W, P <.0001; and 20 W versus 30 W, P <.001. Conclusions: Diathermy power settings result in a significant difference of mucosal tissue contraction, with higher outputs resulting in a narrower mucosal margin. It is imperative that the surgical team take into consideration the diathermy settings during initial resection planning. Laryngoscope, 131:E1514–E1518, 2021 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To describe the histopathology of the invasion patterns of advanced-stage external auditory canal (EAC) squamous cell carcinoma (SCC). Study Design Retrospective cohort study.Methods: Retrospective analysis of medical records of patients diagnosed with EAC SCC available at the Massachusetts Eye and Ear temporal bone (TB) collection. TBs underwent processing for histologic examination. Hematoxylin and eosin-stained slides were examined. Histologic findings were compared to premortem clinical data.Results: Nine TBs were identified. Male:female ratio was 6:3. The average age of diagnosis and duration of survival was 64 (46-80 years) and 2.3 years (1-50 months), respectively. All presented with T4 disease, most commonly due to petrous apex (PA) invasion and facial nerve (FN) weakness. The mastoid air cells system served as a tumor conduit to the tegmen mastoideum and overlying dura in four patients, posterior fossa dura in one patient, vertical segment of FN in four patients, and middle ear (ME) and lateral semicircular canal in five patients. The tumor did not penetrate the tympanic membrane, oval window membrane (fenestra vestibule), or round window (RW) membrane. Supra- and infralabyrinthine pneumatization patterns allowed direct routes to the PA. Translabyrinthine PA invasion was seen in two patients. The most common locus of otic capsule invasion was the cochlea. One patient had FN paralysis due to compression rather than invasion.Conclusions: SCC does not tend to extend from the ME to the inner ear through the RW and vestibule-stapedial ligament. Tumors tend to spread along the preexisting TB air-tract routes. Well-aerated TB, may facilitate extension to the PA.Level Of Evidence: 4 Laryngoscope, 131:E590-E597, 2021. [ABSTRACT FROM AUTHOR]

Objectives: To prove that temporal bone tegmen attenuation in patients with idiopathic intracranial hypertension (IIH) is progressive. Study Design: Retrospective blind study at a tertiary academic medical center. Methods: Enrolled were medical records of patients with IIH that included at least two sequential computed tomography (CT) scans. The vertical distances between the floor of the middle fossa to the superior and lateral semicircular canals (SSC and LSC, respectively), to the scutum and minimal squama thickness were measured. The same measurements were made in scans of control subjects. The impact of demographics and metabolic variables including opening lumbar puncture (LP) pressure were evaluated. Results: Twenty medical records were enrolled. Median age at diagnosis was 21 years; 16 were females. The median body mass index (BMI) was 32 kg/m2. Initial LP pressure was 195 mm cerebrospinal fluid (CSF). The median time interval between CT scans was 58 months. A median attenuation of 0.35 mm and 0.25 mm over the right and left LSC and of 0.5 mm and 0.3 mm over the right and left scutum, was found, respectively. The thicknesses of the SSC and squama remained stable. No attenuation was present in controls. The opening pressure on initial LP (median 195 mm CSF), was positively correlated with the degree of tegmen attenuation, but the age at diagnosis and BMI were not. Conclusions: Tegmen attenuation may be progressive in patients with idiopathic increased intracranial pressure and correlated with the opening pressure on LP. Tegmen defects and CSF leak should be looked for in these patients. Level of Evidence: 4 Laryngoscope, 2020 [ABSTRACT FROM AUTHOR]

Background: The diagnostic yield of core needle biopsies (CNB) in cervical lymphadenopathy for lymphoma diagnosis is controversial. The aim of this study was to calculate the accuracy of cervical CNB in diagnosing lymphoma. Methods: We conducted a meta‐analysis of all studies on patients presenting with cervical lymphadenopathy and referred to CNB. Patients with a diagnosis other than lymphoma were excluded. All cases diagnosed with lymphoma sufficient to guide treatment based on CNB outcome were considered accurate (actionable) results. A separate meta‐analysis was performed for various lymphoma subtypes. Results: Three prospective and 19 retrospective studies, comprising 1120 patients, met the inclusion criteria. The rate of actionable lymphoma diagnoses following CNB ranged from 30% to 96.3%, with a random‐effects model of 82.45% (95% confidence interval [CI] =0.76‐0.88) and a fixed‐effects model of 78.3% (95% CI =0.75‐0.80). Conclusion: CNB for cervical lymphadenopathy in lymphoma cases is relatively accurate in guiding treatment. [ABSTRACT FROM AUTHOR]

Objectives: To study optimal head position after intratympanic steroid injections to enhance drug bioavailability.Study Design: Application of virtual and in vitro models of the intratympanic anatomy.Setting: The surgical 3-dimensional printing laboratory of a tertiary academic medical center.Subjects and Methods: A high-resolution computerized tomographic scan of healthy temporal bone and surrounding soft tissue was segmented and reconstructed to a 3-dimensional model. The tympanic membrane was perforated in the posterior-inferior quadrant. Methylene blue-stained 10-mg/mL dexamethasone was administered to the middle ear cleft, after which a 3-dimensional rotation in space was performed to hypothesize the optimal position in relation to gravity. The same stereolithography file used for the actual model was used for a digital virtual liquid flow simulation. The optimal head position was defined as the one with the maximum vertical distance between the round window membrane and the plane of the aditus ad antrum and eustachian tube orifice.Results: The virtual model yielded the following position of the head as optimal: 53º rotation away from the injected ear in the vertical axis (yaw), 27º rotation toward the noninjected ear in the longitudinal axis (roll), and 10º neck extension in the transverse axis (pitch).Conclusions: Virtual imaging determined that 53º and 27º yaw and roll, respectively, away and 10º pitch were the optimal position for drug delivery after intratympanic injection to the middle ear and that an erect head position provided optimal passage of steroids from the middle ear to the inner ear. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to report our center's experience with infratemporal fossa (ITF) tumors, to review the treatment modalities and outcomes. Methods: Data of patients that underwent resection of ITF tumors in a single tertiary referral medical center were collected and analyzed. Results: Sixty‐three patients were included. Sarcoma was the most common pathology (18; 29%). The most common surgical approach was the preauricular‐orbitozygomatic approach (24; 38%), followed by endoscopic, craniofacial resection, and combined approaches. Forty‐seven patients (75%) required reconstruction, 23 (49%) involving free tissue transfer. Thirty‐five patients (76%) with malignant lesions required adjuvant therapy consisting of radiotherapy, chemotherapy, or both. Thirty‐three patients suffered from complications related to surgery or adjuvant therapy. The three‐ and five‐years survival rates for malignancy were 82% and 66%, respectively. Conclusion: Complete surgical resection of ITF involving tumors is feasible, providing good long‐term survival. Multidisciplinary approach is the key for success. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC). Methods: Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease‐specific survival (DSS) in a multi‐institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990‐2011. Results: In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5‐year disease‐specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5‐10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%. Conclusion: The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined. Methods: We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved. Results: Thirty‐eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5‐year survival was significantly lower in the first posttreatment PET/CT‐positive group (35%) compared to the PET/CT‐negative group (93%) (P = .0008). Conclusion: Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Anterior skull base operations pose the risk for postoperative cerebrospinal fluid (CSF) leak. Routine lumbar continuous drainage catheter (LD) placement is intended to decrease CSF leaks and central nervous system (CNS) complications, but there are no sound evidence-based data on its efficacy. The primary goal of this study was to review CNS complications following anterior open skull base surgery and their association with LD placement. The secondary goal was to define predictors for the development of early CNS complications.Study Design: Retrospective case series.Methods: We conducted a retrospective analysis of all patients who underwent anterior skull base surgery between 2000 and 2016 at the Tel Aviv Sourasky Medical Center, an Israeli tertiary referral center.Results: A total of 226 patients underwent open skull base surgery, of whom 118 had elective perioperative continuous LD insertion and 108 did not. Delayed complications were defined as those occurring more than 30 days after the index operation. Thirty-one (26%) patients in the LD group had early CNS complications compared with only two (1.6%) in the non-LD group, whereas 13 (11%) of the former patients had late CNS complications compared with four (3%) of the latter patients. Early systemic and late wound complications were also significantly more numerous in the LD group. On multivariate analysis, elective LD insertion and intracranial tumor extension were found to be predictors for developing early CNS complications.Conclusions: The placement of continuous LDs might increase the risk of developing early and late CNS complications after open anterior skull base surgery.Level Of Evidence: 4 Laryngoscope, 128:2702-2706, 2018. [ABSTRACT FROM AUTHOR]

Background: Up to half of patients with oral cavity squamous cell carcinoma (OCSCC) have stage I to II disease. When adequate resection is attained, no further treatment is needed; however, re-resection or radiotherapy may be indicated for patients with positive or close margins. This multicenter study evaluated the outcomes and role of adjuvant treatment in patients with stage I to II OCSCC.Methods: Overall survival (OS), disease-specific survival, local-free survival, and disease-free survival rates were calculated with Kaplan-Meier analysis.Results: Of 1257 patients with T1-2N0M0 disease, 33 (2.6%) had positive margins, and 205 (16.3%) had close margins. The 5-year OS rate was 80% for patients with clear margins, 52% for patients with close margins, and 63% for patients with positive margins (P < .0001). In a multivariate analysis, age, depth of invasion, and margins were independent predictors of outcome. Close margins were associated with a >2-fold increase in the risk of recurrence (P < .0001). The multivariate analysis revealed that adjuvant treatment significantly improved the outcomes of patients with close/positive margins (P = .002 to .03).Conclusions: Patients with stage I to II OCSCC and positive/close margins have poor long-term outcomes. For this population, adjuvant treatment may be associated with improved survival. Cancer 2018;124:2948-55. © 2018 American Cancer Society. [ABSTRACT FROM AUTHOR]

Abstract: Background: The purpose of this study was to investigate the association between isolated serous otitis media (SOM) and/or conductive hearing loss (CHL) and nasopharyngeal carcinoma (NPC) in a low‐to‐intermediate endemic area. Methods: Medical records of all adult patients (≥17 years) with SOM/CHL who underwent endoscopic‐guided nasopharyngeal biopsy to exclude NPC during a 10‐year period were reviewed. Statistical analyses were conducted to identify significant predictors for NPC. Results: A total of 195 patients were included (121/195; 62.1% men), among whom 169 (86.7%) presented with isolated SOM/CHL. Overall, 12 patients were diagnosed with NPC (12/195; 6.2%), however, only 1 patient (1/169; 0.6%) had isolated SOM/CHL. Coexisting clinical manifestations and suspicious nasopharyngeal findings on fiber‐optic nasopharyngoscopy were found to be significant predictors for NPC on univariate and multivariate analyses (P < .05). Conclusion: Patients with isolated SOM/CHL and without coexisting clinical manifestations or suspicious findings on nasopharyngoscopy may avoid a routine nasopharyngeal biopsy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the accuracy and utility of intraoperative frozen section examination (iFSE) in patients with a preoperative fine-needle aspiration (FNA) cytology of "suspicious for malignancy" (SFM)-Bethesda V, after the adoption of the Bethesda System for Reporting Thyroid Cytopathology.Study Design: Case series with chart review.Setting: Tertiary medical center.Subjects and Methods: All patients with SFM-Bethesda V who underwent thyroid surgery with iFSE between 2010 and 2015 were included. In cases where the iFSE was reported to be malignant, a total thyroidectomy was performed; otherwise, thyroid lobectomy (hemithyroidectomy) was performed.Results: The current series included 47 patients diagnosed preoperatively with FNA cytology of SFM-Bethesda V. The malignancy rate was 74.5% (35 of 47). Twenty-four patients with nonmalignant iFSE results underwent lobectomy during their initial surgery: 12 were subsequently found with benign final histology and did not undergo completion thyroidectomy; the other 12 patients had malignant results on final histology, but only 4 of them underwent completion thyroidectomy. iFSE resulted in a sensitivity and specificity of 65.7% and 100%, respectively, with a positive predictive value of 100% (23 of 23) and a negative predictive value of 50% (12 of 24). Accuracy of the iFSE methodology was 74.5% (35 of 47).Conclusions: With no significant preoperative clinical or sonographic predictors for thyroid malignancy and given the high specificity of iFSE, our results support the use of iFSE for patients with preoperative FNA cytology of SFM-Bethesda V who are undergoing thyroid surgery, to determine the extent of required surgery. [ABSTRACT FROM AUTHOR]

Background There is no consensus on the impact of preoperative embolization (EMB) on the surgical outcomes of carotid body tumor (CBT) resections. Methods A systematic review and a meta-analysis were conducted to clarify the role of preoperative EMB in patients undergoing surgical removal of CBTs. Results Fifteen studies with a total number of 470 patients met the inclusion criteria. The results of the meta-analysis showed that there is no significant difference in estimated blood loss, operative time, length of hospital stay, or risks of cranial nerve injury, vascular injury, and stroke between the EMB and nonembolization (NEMB) groups. Conclusion This systemic review and meta-analysis demonstrate that preoperative EMB does not confer any operative or postoperative advantage in patients scheduled for CBT surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2386-E2394, 2016 [ABSTRACT FROM AUTHOR]

Background Whether initial clinical presentation and thyroid ultrasonography referral indications can significantly predict malignant/suspicious for malignancy (Bethesda System for Reporting Thyroid Cytopathology [Bethesda] V/VI) thyroid ultrasound-guided fine-needle aspiration (FNA) cytology results is unknown. Methods Between January 2010 and May 2014, we performed 705 thyroid ultrasound-guided FNA biopsies, according to the American Thyroid Association (ATA) guidelines. Univariate analysis was used to identify significant predictors for Bethesda V/VI thyroid ultrasound-guided FNA cytology, including age, sex, imaging modality, thyroid dysfunction, neck pain, breathing difficulties, dysphagia, odynophagia, fatigue, lateral cervical mass, parotid mass, and hyperparathyroidism. Results Sixty percent of patients were referred to thyroid ultrasound-guided FNA because of thyroid incidentalomas and 40% because of palpable thyroid nodules found on physical examination. Only positron emission tomography (PET)-CT emerged as being a significant predictor for Bethesda V/VI thyroid ultrasound-guided FNA cytology (odds ratio [OR] = 5.64; 95% confidence interval [CI] = 1.16-27.33; p = .03). Conclusion Patient symptomatology and initial clinical thyroid ultrasound-guided FNA referral indications cannot predict the nature of thyroid nodules. © 2015 Wiley Periodicals, Inc. Head Neck 38: E991-E995, 2016 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND).Study Design: Retrospective cohort study.Methods: Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction.Results: Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery.Conclusion: Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background. Elective neck irradiation of a clinical nodenegative (N0) neck in squamous cell carcinoma (SCC) of the maxillary sinus is a controversial issue. Methods. A systematic review of electronic databases and a metaanalysis were conducted to clarify the role of elective neck irradiation in patients with SCC of the maxillary sinus and clinical N0 neck. Regional (neck) nodal recurrence was chosen as the primary endpoint. Results. Four retrospective studies with a total of 129 patients met the inclusion criteria. The results of the meta-analysis showed that elective neck irradiation reduced the risk of regional nodal recurrence (fixed effects model: odds ratio [OR]50.16; 95% confidence interval [CI]50.04-0.67; p5.01; random-effects model: OR50.17; 95% CI50.04-0.76; p5.02) compared to observation. Conclusion. This systemic review and first meta-analysis confirmed that elective neck irradiation can significantly reduce the rate of nodal recurrence in patients with N0 SCC of the maxillary sinus. [ABSTRACT FROM AUTHOR]

Background We investigated the risk of neck metastases in patients undergoing salvage total laryngectomy in association with previous radiotherapy. Methods The medical records of 42 patients (51 neck specimens) with clinical N0 classification who underwent salvage total laryngectomy in 2 cancer centers were reviewed. Fourteen patients had previous radiotherapy to the central neck and 28 to the central and lateral neck. Results Staging before salvage total laryngectomy was similar in both groups. The risk of neck metastases in the central and central/lateral radiation groups was 12% and 18%, respectively ( p = .69). Subgroup analysis revealed that 4 of 8 patients initially presenting with clinically N+ had neck metastases before surgery, versus 2 of 26 for those with clinically N0 ( p = .015; relative risk [RR] = 4.67). The risk or metastases in the contralateral neck was 0 of 9. Conclusion The risk of neck metastases in patients who undergo either central or central/lateral neck radiotherapy is similar. Elective neck dissection seems appropriate in patients undergoing SLR. © 2012 Wiley Periodicals, Inc. Head Neck 35: 1392-1396, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate the role of elective central compartment neck dissection ( CND) in patients with recurrent papillary thyroid carcinoma in the jugular chain lymph nodes. Study Design Retrospective medical record review and analysis of survival outcomes. Methods The study was conducted at Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University. Fifty-one patients who had prior thyroidectomy underwent therapeutic lateral neck dissection ( LND) without radiological evidence of central neck metastases. Therapeutic LND without elective CND was performed in 17 patients, and 34 patients had elective CND. The clinical variables were similar in both groups. The median follow-up was 44 months. Disease-free survival and overall survival were the main outcome measures. Results The recurrence rate in the central neck was 9% (n = 3/34) in patients undergoing CND and 12% (n = 2/17) in patients without CND. The overall recurrence rate was 18% (6/34) in patients with CND and 36% (6/17) in patients without CND ( P = 0.16). The 5-year disease-free survival rate was 82% and 65% in patients with or without CND, respectively ( P = 0.69). Long-term thyroglobulin levels and complication rates were similar in both groups. Conclusions The lack of significant disease-free survival advantage demonstrates the need for a prospective evaluation of the common practice of this disease. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

Objective. To determine the incidence of retropharyngeal calcific tendinitis (longus colli tendinitis) in a general urban adult population. Study Design. Observational study in a municipal medical center. Setting. Single tertiary referral center. Methods. All symptomatic patients with a differential diagnosis of retropharyngeal calcific tendinitis underwent fiberoptic assessment, laboratory studies, and imaging studies. The main outcome measure was the incidence of retropharyngeal calcific tendinitis. Results. Thirteen patients with symptoms suggestive of retropharyngeal calcific tendinitis were evaluated in our institution between January 2008 and December 2011. Final diagnosis was made by means of a computed tomographic scan: 8 patients had retropharyngeal calcific tendinitis, 1 had retropharyngeal abscess, and the remaining 4 had other deep neck infections. The mean annual crude retropharyngeal calcific tendinitis incidence was 0.50 cases per 100,000 person-years, and the standardized incidence was 1.31 for the age-matched population. Conclusions. Retropharyngeal calcific tendinitis is not a rare disease and is probably underdiagnosed because symptoms are nonspecific, treating physicians are often unfamiliar with this entity, and it is a self-limiting pathology. [ABSTRACT FROM AUTHOR]

Background The aims of this study were to determine the trends in survival of patients with anterior skull base cancer over several decades and to identify time-related changes in the demographic and clinical characteristics of this population. Methods In all, 282 patients who underwent craniofacial resection at Memorial Sloan-Kettering Cancer Center and Tel Aviv Medical Center were studied. Patients were categorized in accord with the period of surgery: early (1973-1984, n = 34), intermediate (1985-1996, n = 72), and later (1997-2008, n = 176). Results Patients operated after 1996 had higher rates of comorbidity, dural and pterygopalatine invasion, and multicompartmental involvement than those operated before 1996 ( p ≤ .001). There was a significant improvement in 5-year overall and disease-specific survival, from 55% and 57%, respectively, for patients operated before 1996, to 66% and 70%, respectively, for those operated after 1996 ( p = .02 and p = .006, respectively). On multivariate analysis, surgery after 1996 was an independent predictor of outcome (HR, 0.39, p < .001). Conclusions The survival of patients with anterior skull base cancer is improving. Surgery after 1996 is an independent prognostic factor for an improved outcome. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background. Meningitis and cerebrospinal fluid (CSF) leak are serious complications of skull base surgery, but whether postoperative CSF leak increases the risk of meningitis is unknown.Objective. To evaluate any association between meningitis and CSF leak after open or endoscopic skull base resection.Study Design and Setting. A retrospective case series with chart review in a tertiary care university-affiliated medical center.Methods. A total of 156 patients underwent intradural tumor resection in our institution between 1994 and 2009, 135 (86%) via the subcranial approach and 21 (14%) through the expanded endonasal approach. All occurrences of meningitis, brain abscess, and CSF leak had been recorded and were available for analysis.Results. Nine patients (5.7%) had postoperative meningitis, and 3 patients had postoperative CSF leak (1.9%). The risk of meningitis in patients without CSF leak was 4.5% (7/153) compared to 66% (2/3) in those with CSF leak. A statistical analysis revealed a significant association between CSF leak and meningitis, with a relative risk of 14.6 (95% confidence interval, 4.95-42; P = .008).Conclusion. Postoperative CSF leak significantly increases the risk of meningitis. Most cases of meningitis after skull base operation are probably associated with lumbar drainage infection or from an obscure leak. [ABSTRACT FROM AUTHOR]

Objective. Laser soldering of a thick multilayer organ using conventional CO2 lasers is ineffective. The purpose of this work was to develop a method for bonding the multilayer tissue of the upper aerodigestive tracts (UADT) without the need of sutures or stapling.Study Design. Animal model.Setting. Academic research laboratory.Subjects and Methods. The authors developed a multi-wavelength laser system, based on 2 fiber-optic lasers applied simultaneously. A highly absorbable CO2 laser interacts with the muscular layer, and a nonabsorbable GaAs laser interacts with indocyanine-green solid albumin, placed between the mucosa and the muscular layer. The authors used an ex vivo porcine model to examine the capability of this system to effectively correct esophageal tears.Results. The soldered esophagi burst pressure was >175 cm H2O (98% success rate) in 88 of the 90 experiments. A conventional CO2 laser soldering resulted in insufficient bonding (mean burst pressure of 40 ± 7 cm H2O, n = 5), while the multi-wavelength laser system provided an ∼9-fold tighter seal (359 ± 75.4 cm H2O, P < .0001, n = 15). Burst pressures after conventional suturing of the defect was significantly lower (106 ± 65.8 cm H2O, P < .001) than in the multi-wavelength laser system.Conclusions. Bonding of the UADT mucosa using a multi-wavelength, temperature-controlled laser soldering system can support significantly higher pressures then conventional CO2 laser soldering and suture repair. The mean bonding pressure was 3.5-fold higher than the maximal swallowing pressure. Our findings provide a basis for implementation of new surgical tools for repair of esophageal perforations. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this study by the International Collaborative Group, the authors examined a large cohort of patients accumulated from multiple institutions that had experience in craniofacial surgery with the objective of reporting outcomes and complications for craniofacial resection (CFR) in the elderly. METHODS: One hundred seventy patients aged ≥70 years were included in the study. The median age was 75 years (range, 70-98 years). One hundred four patients (61%) had received previous single-modality or combined treatment, which included surgery in 79 patients (46%), radiation in 47 patients (28%), and chemotherapy in 13 patients (8%). The most common histology was squamous cell carcinoma (67 patients; 39%). The margins of resection were close or microscopically positive in 56 patients (33%). Sixty-eight patients received adjuvant radiotherapy (40%), and 3 patients received chemotherapy (2%). Complications were classified into overall, local, central nervous system (CNS), systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by using the Kaplan-Meier method. Outcomes were compared with patients aged <70 years. Statistical analyses for outcomes were performed in relation to patient characteristics, tumor characteristics (including histology and extent of disease), surgical resection margins, previous radiation, and previous chemotherapy to determine predictive factors. RESULTS: Postoperative mortality occurred in 16 patients (9%), and postoperative complications occurred in 72 patients (42%). Local wound complications occurred in 40 patients (24%), CNS complications occurred in 24 patients (14%), systemic complications occurred in 19 patients (11%), and orbital complications occurred in 4 patients (2%). Postoperative mortality and complications were significantly more frequent in elderly patients compared with patients aged <70 years (postoperative mortality: 9% vs 3%; P=.04; complications: 42% vs 32%; P=.0009). The 5- year OS, DSS, and RFS rates were significantly poorer than those for patients aged <70 years (OS: 42% vs 56%; P < .0001; DSS: 53% vs 61%; P=.04; RFS: 46% vs 54%; P=.03). Surgical margin status and primary tumor histology were independent predictors of OS, DSS, and RFS in multivariate analysis. CONCLUSIONS: CFR for malignant skull base tumors in elderly patients (aged ≥70 years) was associated with increased mortality, complications, and poorer outcomes compared with patients aged <70 years. [ABSTRACT FROM AUTHOR]

Objective: We aimed to develop a new technique for treatment of granulation tissue (GT) growth using local hyperthermia. Methods: A temperature-controlled diode laser system was developed for induction of mild hyperthermia in real time. GT was generated by harvesting the skin over the gluteal fascia in rats. Histopathological analysis was used to estimate the effect of hyperthermia on the tissue. Results: In untreated rats, GT was detected within 3 days and reached maximal thickness after 12 days. Hyperthermia at 43°C and above significantly decreased GT thickness (n = 8 per group). Hyperthermia at 48°C for 3 minutes was the most efficient parameter for treatment of GT (51% reduction), with minimal (5%) muscle necrosis. Conclusions: Hyperthermia can significantly inhibit GT growth, with minimal damage to surrounding structures. Our findings suggest a possible role for hyperthermia as a therapeutic model against GT. Further research and long-term studies are needed to explore the utility of laser-induced hyperthermia for inhibition of GT growth. [Copyright &y& Elsevier]

Background The aim of the study was to characterize the distribution of anterior skull base (ASB) cancers in the pediatric population and to identify predictors of outcome. Methods This was an international study of 1307 patients undergoing craniofacial surgery for malignant tumors; 6.4% (n = 84) among these were ≤21 years old. Results The most common histologic type was sarcoma (40%), followed by squamous cell carcinoma (14%). Higher incidence of tumors was found in older children (7.5–21 years) compared to younger children. The 5-year disease-specific and overall survival rates were 61% and 55%, respectively (median follow-up of 30 months). The best prognosis was associated with low-grade sarcomas and the worst with salivary and squamous cell carcinomas. High-grade sarcoma represented an intermediate risk group. On multivariate analysis, prior radiotherapy and histology were independent predictors of survival. Conclusion Surgery for malignant tumors involving the ASB is feasible and safe in children. Histology is significant determinant of poor outcome in this population. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [ABSTRACT FROM AUTHOR]

Background. Skull base tumors are rare neoplasms and the cytogenetic data on these tumors are limited. The authors cytogenetically analyzed a large series of tumors and compared the findings with patients' pathologic data. Methods. The karyotypes of pathologically confirmed samples of 101 patients, who were operated for oncological extirpation of tumors, were analyzed using G-banding and spectral-karyotyping techniques. Results. Of the 67 malignant tumors, 32 (48%) had chromosomal aberrations, some with complex numerical and structural chromosomal anomalies. Recurrent chromosomal breakpoints were identified in squamous cell carcinomas, adenoid cystic carcinomas (ACCs), sinonasal undifferentiated carcinomas, chordomas, and sarcomas. Specific breakpoints established the diagnosis of various soft tissue sarcomas. Novel chromosomal aberrations were found in various other malignant and benign tumors. Conclusion. This study highlights the value of cytogenetic analysis for diagnosis of skull base tumors. The data add further information on the biological behavior of these rare neoplasms. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [ABSTRACT FROM AUTHOR]

Background. Therapeutic paratracheal neck dissection for patients with papillary carcinoma of the thyroid is standard treatment. Its use as an elective procedure is controversial. Methods. Thirty-seven patients with papillary carcinoma of the thyroid and evidence of positive adenopathy at levels II-V underwent selective neck dissection and elective/therapeutic paratracheal neck dissection. Results of preoperative ultrasonography of the neck were compared with the dissection specimens. Results. Morbidity of the surgical procedure was minimal (1 permanent hypocalcemia). All specimens showed metastases from papillary thyroid carcinoma: 100% (37/37) in the jugular chain of lymphatics and 83.7% (31/37) in the paratracheal region. The rate of occult (negative physical examination and ultrasonography) metastases in the paratracheal region in the presence of metastases in the ipsilateral jugular chain was 83.3% (20/24). Conclusion. The high rate of occult metastases in the paratracheal region and the low rate of surgical morbidity speak in favor of elective paratracheal neck dissection in patients with metastatic papillary carcinoma of the thyroid. © 2007 Wiley Periodicals, Inc. Head Neck 2008 [ABSTRACT FROM AUTHOR]

Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 ± 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item 'yes/no' questionnaire on swallowing disturbances (24 replied 'no'). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the 'optimal' score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients. © 2007 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background. This study was designed to evaluate the quality of life (QOL) of patients older than 75 years undergoing major head and neck surgery. Methods. Three groups of patients were included: elderly patients (>75, n = 35) and younger patients (65 to 75 years, n = 30) undergoing major head and neck surgery and healthy controls (>75, n = 40). Measurements were made using the SF-12 health survey, the University of Washington QOL questionnaire, and measurements of the “sense of burden” on the caregiver. Results. With the SF-12, the role physical, role emotional, and bodily pain were decreased by the surgical intervention, while physical function was affected by age alone. With the UW-QOL Questionnaire, overall QOL was preserved. “Appearance” and “Leisure” subscales were affected by the surgical intervention and old age. “Chewing” and “Activity” were decreased by the surgical intervention in the older patients, and “Speech” was affected by the surgical intervention alone. The “sense of burden” was alleviated by surgery in the elderly patients. Conclusions. Several QOL domains are decreased in elderly patients undergoing major head and neck surgery. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [ABSTRACT FROM AUTHOR]

The article presents a study which analyzed a large cohort of patients who underwent surgery for the treatment of skull base tumors. In the study, adjuvant radiotherapy was received by 35% of patients and chemotherapy was received by 10% of patients. The study found that the presence of positive/close margins was the only independent predictor of poor overall, recurrence-free, and disease-specific survival on multivariate analysis.

Background. The utility of preoperative and postoperative whole body integrated positron emission tomography–computed tomography (PET-CT) scanning for staging and follow-up in patients with skull base tumors is undetermined. Methods. We prospectively evaluated PET-CT findings in 47 patients using 57 scans. Most (35/47, 75%) had anterior skull base tumors and the majority (74%) had advanced-stage (III–IV) disease. Results. The scans showed high sensitivity for detection of various types of malignant tumors and provided 39 items of additional information, changing the clinical staging and management of 11 patients (23%). Recurrence of primary tumors was detected in 8 patients, positive regional (neck) metastases in 3, and distant metastases in 3. The positive uptake was due to osteoradionecrosis in 2 other patients. The sensitivity of PET-CT was 0.77 and the specificity was 0.81 (0.83 positive predictive value and 0.76 negative predictive value). Conclusions. PET-CT provides accurate data on anatomy, tumor staging, and early disease recurrence in the skull base. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [ABSTRACT FROM AUTHOR]

Objectives: To compare the effect of preoperative high-dose systemic corticosteroids on the radiographic and endoscopic appearance of allergic fungal rhinosinusitis (AFRS) and chronic rhinosinusitis with nasal polyposis (CRSwNP). Study design and setting: Eight AFRS and 10 CRSwNP patients underwent computed tomographic (CT) scans and then received preoperative 1 mg/kg prednisone for 10 days. CT scans were repeated 1 day before surgery and compared with pretreatment scans (Lund-MacKay radiologic scoring system). The endoscopic appearance was recorded intraoperatively. Results: The score dropped from 16 (66.4%) to 4.75 in the AFRS group and from 18.4 (23%) to 14.1 in the CRSwNP group (P = 0.0064). Intraoperatively, most sinus mucosal surfaces appeared normal in the AFRS patients but were markedly edematous in the CRSwNP patients. Conclusion: Radiographic response of AFRS to systemic corticosteroids is significantly greater compared with CRSwNP. This finding is supported by endoscopic observation. [Copyright &y& Elsevier]

Objective: To analyze the long-term effects of subcranial surgery for anterior skull base tumors on facial growth. Study design and setting: Retrospective study (1994 to 2004) in a university-affiliated hospital. Of 108 patients who underwent a subcranial surgical approach for anterior skull base tumors, six adolescents and five young adults fulfilled study entry criteria for age and follow-up data availability (mean, 3.2 ± 2 years). Cephalometric x-ray films monitored postoperative facial growth. Anteriorly and posteriorly measured horizontal and vertical maxillary growth were compared with normal values. Results: All subjects had superiorly positioned maxillae (shorter in patients with long-standing pathologies). The upper incisor teeth were proclined relative to the cranial base reference planes. All cephalometric changes were within a 10 percent deviation of normal values. Conclusions: Subcranial surgery for these tumors minimally affects vertical facial skeleton growth. Early surgery is essential for unaffected horizontal growth. Significance: Guidelines for anterior skull base tumor surgery in adolescents and young adults. [Copyright &y& Elsevier]

Background. We assessed the added clinical value of fused single photon emission computed tomography (SPECT) and low-dose CT images compared with planar images for sentinel node (SN) mapping in patients with oral cavity squamous cell carcinoma (SCC). Methods. Twenty consecutive patients with newly diagnosed biopsy-proven SCC of the oral cavity were enrolled. Scintigraphy was performed using a hybrid gamma-camera/low-dose CT system. Planar images and fused SPECT/CT images were interpreted separately. All patients underwent a sentinel node biopsy (SNB) followed by a neck dissection. All SNs underwent meticulous pathologic examination and immunohistochemistry staining (cytokeratin complex) in addition to routine pathologic examinations of the neck dissection specimen. Results. The sensitivity for the detection of nodal metastases was 87.5%. SPECT/CT improved SN identification and/or localization compared with planar images in 6 patients (30%). Conclusions. SPECT/CT SN mapping provides additional preoperative data of clinical relevance to SNB in patients with oral cavity SCC. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [ABSTRACT FROM AUTHOR]

Objective: To devise an effective postoperative analgesic protocol. Study design and setting: Two consecutive groups participated in this study. In the first group (n = 100), the pain-control management was pro re nata (PRN). In the second group, (n = 109) we tailored a procedure-specific pain-control protocol for each patient according to the level of pain recorded in the first group. These patients were treated with analgesics given at predetermined hours. Pain was evaluated by using a verbal scale of 1 to 10. Results: In the first group, a significant reduction in the level of pain was monitored 1 hour after PRN drug administration; however, patients reported the return of pain several hours later, after the drug effect subsided. Overall, the patients suffered a substantial level of pain during the entire postoperative period. In the second group, significant reduction in the level of pain was recorded throughout the hospitalization. Conclusion: The PRN protocol is not adequate for management of pain after head and neck surgeries. Significance: We can substantially reduce our patients’ postoperative pain by adopting a procedure-specific analgesic regimen instead of a PRN regimen. EBM rating: B-3b. [Copyright &y& Elsevier]

Objective: To investigate whether monitoring parathyroid hormone (PTH) could predict hypocalcemia following total thyroidectomy or other bilateral thyroid manipulations. Study design and setting: Forty patients undergoing total thyroidectomy as well as other bilateral thyroid procedures were prospectively enrolled. PTH levels were measured preoperatively and 30 minutes postoperatively. Calcium levels were measured preoperatively and every 8-12 hours for the first 72 postoperative hours. Changes in PTH levels as well as symptoms of hypocalcemia were correlated with postoperative hypocalcemia. Results: Hypocalcemia developed in 13/40 patients (32.5%), mainly those patients undergoing total thyroidectomy in conjunction with paratracheal neck dissections. The respective sensitivity and specificity of a drop in PTH for detecting hypocalcemia was 92% and 66% (50% drop), 23% and 75% (75% drop), and 46% and 100% (drop below normal range). Conclusions: A 50% drop in PTH levels 30 minutes following bilateral thyroid procedures is a sensitive predictor of hypocalcemia. A drop of 75% is a highly specific indicator of postoperative hypocalcemia, though not highly sensitive. EBM rating: C-4 [Copyright &y& Elsevier]

Hypothesis/objectives: We tested the effectiveness of a temperature-controlled CO2 laser soldering system on a porcine model for dural defect reconstruction using a fascial patch. Methods: A dural patch was excised and then reconstructed with fascia by a CO2 laser system in vitro in 27 animals and in vivo in five animals. Results: After dural reconstruction, the average burst pressure of the soldered patch in vitro, as measured by a custom-made pressure detector, was 258.5 cm H2O. All five pigs in the in vivo group showed no neurological complications or cerebrospinal fluid leak, and the underlying brain tissue showed no thermal injury. Conclusion: The CO2 laser system created a watertight bond and did not cause thermal injury to the brain. The procedure is potentially faster than conventional repair, and wound healing may also be more rapid. [ABSTRACT FROM AUTHOR]

Background: Sinonasal carcinomas, including nonkeratinizing (NK) squamous cell carcinoma (SCC) and sinonasal undifferentiated carcinoma (SNUC), are uncommon malignant neoplasms arising from the Schneiderian respiratory epithelium of the nasal cavity and paranasal sinuses. Due to their low frequency, the cytogenetic data on these tumors is limited. Methods: Seventeen patients who were operated on in our institution for extirpation of paranasal carcinomas were enrolled in this study. Fourteen pathologically confirmed samples of sinonasal carcinomas were cytogenetically analyzed using G-banding techniques after short-term culture. Three samples did not grow on culture. Results: Five of the 14 sinonasal carcinomas had an abnormal karyotype (36%). Of the 9 NK SCCs, 3 had abnormal karyotypes with numerical and structural chromosomal anomalies. Of the 5 patients with SNUC, 2 had an abnormal karyotype. One case of SNUC had a diploid complex karyotype. Another case of SNUC had a near triploid composite karyotype with 60-69 chromosomes. The chromosome arms that involved frequent breakpoint and rearrangements were: 1p, 6p, 7p, and 12q. We found that 3 of the 3 patients who died of disease displayed an abnormal karyotype, whereas 2 of the 11 patients who are alive displayed an abnormal karyotype (P = 0.027). Conclusions: The study revealed that more than a third of the paranasal carcinomas carry an abnormal karyotype. No specific common aberrations were found in these tumors. To our knowledge this is the first attempt to investigate sinonasal squamous and undifferentiated carcinomas on a genetic level using G-banding technique. Additional studies are required in order to determine whether cytogenetic data may serve as an adjunct to conventional pathology for the diagnosis and prognosis assessment of these rare and highly aggressive tumors. [Copyright &y& Elsevier]

Objective: Chronic isolated frontal sinusitis occurs infrequently. In this condition, most of the ethmoid cells are well aerated and the frontal sinus is involved secondary to anatomical obstruction or inflammatory changes confined to the frontal recess. The purpose of this study was to evaluate a targeted endoscopic technique where standard anterior ethmoidectomy is unnecessary in the treatment of chronic isolated frontal sinusitis. Study design and setting: This retrospective study was conducted in a large university-affiliated hospital and included 11 patients with chronic isolated frontal sinusitis who underwent endoscopic sinus surgery limited to the frontal sinus outflow. The ethmoid bulla was untouched in all cases. Follow-up continued for 19 to 40 months (mean 28.6 months). Results: Frontal sinus outflow patency was verified in 9 patients (81.8%). Nine patients, including one with an apparent nonpatent frontal ostium, reported improvement. Two patients—one of whom had a patent frontal ostium—reported no improvement. There were no complications. Conclusion: Chronic isolated frontal sinusitis can be effectively treated in selected cases by a targeted endoscopic procedure, limited to reestablishment of frontal sinus outflow. EBM rating: C-4 [Copyright &y& Elsevier]

Objective: The purpose of this article is to describe the diagnostic evaluation and surgical approaches to parapharyngeal space tumors in a tertiary referral center. Study design and setting: The study is a retrospective review of 47 patients diagnosed with tumors of the parapharyngeal space (12 with malignant diseases and 35 with benign lesions) and surgically treated during a 10-year period. The transcervical (40%) and the transcervical-transparotid approaches (46%) were the most commonly performed surgical procedures followed by the orbitozygomatic-middle fossa approach (12%) and the transmandibular approach (2%). Results: The surgical procedures were uneventful and there were no postoperative mortalities. Complications were rare; the most common was transient facial nerve paralysis (5 patients). After an average follow-up of 35 months, only 1 of 35 patients with benign diseases had a recurrence 5 years following transcervical resection of a pleomorphic adenoma. Of 12 patients with malignant tumors, 5 (42%) are alive with no evidence of disease. The sensitivity of preoperative fine needle aspiration biopsy (n = 23 patients) was 87% for detection of malignant disease and specificity was 100%. Conclusions: Most benign parapharyngeal space tumors can be removed surgically with a low rate of complications and recurrence. Malignant neoplasms, however, carry an ominous prognosis and a low rate of disease-free survival. Fine needle aspiration may be helpful in preoperative diagnostic evaluation of patients with parapharyngeal space tumors. [Copyright &y& Elsevier]

Purpose: Curcumin, a potential chemopreventive agent, was found to inhibit cancer cells in S/G2M phases of the cell cycle, when radiation is more effective. The purpose of the current study was to investigate whether curcumin can sensitize squamous cell carcinoma (SCC) cells to the ionizing effects of irradiation. Methods: Curcumin (3.5 μΜ) was added for 48 hours to an SCC cell line prior to irradiation. Cell growth (counts) and colony-formation (colonogenic assay) were examined after radiation. Results: Incubation with curcumin only (3.75 μΜ) for 48 hours did not decrease the number of cells or the ability to form colonies in the absence of radiation. However, in plates that were exposed to 1-5 Gy of radiation, cell counts dropped significantly if pretreated with curcumin with a maximal effect at 2.5 Gy (where the cell counts dropped from 1240 to 1017, P < 0.001). The colonogenic assay revealed a significant decrease in the ability to form colonies following pretreatment with curcumin in all radiation doses (P < 0.05). Conclusions: Given the appropriate doses, curcumin exhibits radio-sensitizing effects on SCC cells in vitro. [Copyright &y& Elsevier]

: objectiveAlthough anterior skull base surgery has become a relatively safe and effective procedure, postoperative complications remain a serious problem. One of the most devastating complications of anterior skull base procedures is tension pneumocephalus (TP). In order to prevent TP, authors have recommended the use of prophylactic airway diversion procedures, such as prolonged endotracheal intubation or prophylactic tracheostomy. However, these procedures may mask neurologic deterioration, delay treatment, and prolong rehabilitation. The purpose of this study was to determine the need for airway diversion procedures in anterior skull base surgery.: Study designEighty-five patients underwent anterior skull base operations through the subcranial approach without prophylactic airway diversion. Sixty-four patients underwent resection of tumors, 12 patients underwent repair of cerebrospinal fluid leak, 6 patients underwent surgery due to anterior skull base fungal infections, and 3 patients underwent anterior skull base reconstruction procedures.: ResultsThe complication rate of TP was 1.2% (1/85). This complication rate is similar to that previously reported for operations performed with airway diversion procedures.: ConclusionProphylactic airway diversion procedures are unnecessary in routine anterior skull base operations. Airway diversion should be indicated only when factors that might predispose the patient to risk of TP have been identified (ie, chronic cough or obstructive pulmonary diseases). [Copyright &y& Elsevier]