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Objectives/hypothesis For patients with submandibular sialolithiasis, there are many gland-preserving treatment options including sialendoscopy. Sialendoscopy, however, requires expensive instrumentation with limited availability, which may not be required for routine cases. The objective of this study is to compare the outcomes of patients with submandibular sialolithiasis undergoing sialendoscopy versus those undergoing transoral incisional sialithotomy. Study design Longitudinal, prospective study of patient undergoing gland-preserving therapy for submandibular sialolithiasis. Methods The study was a prospective, nonrandomized trial of 30 patients with submandibular sialolithiasis who received gland-preserving treatment by either sialendoscopy-assisted techniques (Scope group; 14 patients) or transoral sialithotomy with or without dochoplasty (No Scope group; 16 patients). Factors analyzed between the two groups included age, race, gender, size of stone, location of stone, gland(s) involved, surgical method, and modified salivary Oral Health Impact Profile (sOHIP) scores before and after therapy. Results There were no significant differences between the Scope and No Scope groups regarding age, race, or gender. There was a significant difference in stone size between the groups, with the No Scope group having larger stones on average. Both treatments led to statistically significant symptomatic improvement in sOHIP scores. There was no statistically significant difference in salivary quality of life improvement between the Scope and No Scope groups (P = .33). Conclusions Sialendoscopy is an important diagnostic and therapeutic tool in the management of salivary disorders, but is not associated with improved outcomes in gland-preserving treatments for routine submandibular sialolithiasis. Transoral stone removal alone may have equivalent symptomatic outcomes in the management of select sialoliths. Level of evidence III Laryngoscope, 2021.

Duct scar in the form of stenoses or stricture is the second leading cause of obstructive sialadenitis after stone. Over the past decade, there has been a growing experience demonstrating the effectiveness of endoscopic techniques in the minimally invasive management of salivary duct stenosis. Less information, however, is available with regard to open approaches for recurrent or complex ductal stenoses. This article reports on a case of gland preservation using an open ductal technique that originally was applied in cases of traumatic Stensen's duct injury.

OBJECTIVE/HYPOTHESIS The objective of this study was to perform a systematic review and meta-analysis to determine the impact of dental care on head and neck (H&N) cancer survival. METHODS A comprehensive literature search was performed using PubMed, MEDLINE, and CINAHL to find all relevant studies from the date of inception to March 2020. Systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using the random effects logistic regression model. Primary outcomes of interest were 5-year survival and hazard ratios comparing survival between dental care subgroups. RESULTS H&N cancer survival rates strongly correlate with dental care adherence. Patients with good dental care had significantly better survival than patients with poor dental care (HR = 0.67, 95% CI: 0.55-0.83), with similar improved survival among patients with moderate versus poor dental care (HR = 0.67, 95% CI: 0.57-0.80). In addition, patients with good dental care had significantly decreased mortality than those with moderate dental care (HR = 0.81, 95% CI: 0.69-0.96), indicating an exposure-response gradient. CONCLUSIONS For patients with H&N cancer, survival is significantly higher in those who receive recommended dental care compared with those who do not. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.

The prevalence of sleep-disordered breathing has greatly increased in the geriatric population. The pathophysiology of sleep-disordered breathing for this population varies from younger populations due to consequences of aging such as loss of neuromuscular tone, soft tissue hypertrophy, and tissue laxity. The importance of treating obstructive sleep apnea is obvious as it is linked to detrimental cardiovascular and cerebrovascular risks with additional effects on quality of life. Treatment of older patients is best met by evaluating their goals of treatment and meeting it with options that are minimally invasive, cost-effective, and with low pain and morbidity. Non-surgical options such as continuous positive airway pressure and oral appliances are beneficial to those who can tolerate them, but for those that cannot, various surgical options including nasal surgery, palatal stiffening procedures, hyoid suspension, radiofrequency ablation, and upper airway stimulation can provide improvement in their disease and meet their expectations for treatment.

Objective Demonstrate the safety and effectiveness of palatal foreshortening and stiffening in reducing snoring severity in nonobstructive sleep apnea (non‐OSA) patients complaining of chronic disruptive snoring. Methods In a US‐based 8‐center, open‐label, prospective, single‐arm cohort study, 52 consenting adults with chronic disruptive snoring (snoring impacting a patient's life and causing patient or bed partner to seek medical intervention) were treated via office‐based placement of resorbable, bidirectional, barbed suture implants into the soft palate under local anesthesia. Prior to intervention, home sleep tests (HSTs) were performed to rule out OSA and to document snoring noise level. Both subject and their bed/sleep partners (also consented) completed questionnaires including: bed/sleep partner's scored visual analog scale (VAS) for subjects' snoring severity, and subject scoring for Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Following intervention, HSTs, VAS, ESS and PSQI were repeated at 30, 90 and 180 days. Results Mean baseline bed/sleep partner VAS was 7.81 ± 1.59. Mean postimplant VAS scores decreased significantly at each measured interval; to 5.77±2.35 (P

Background: Primary management of advanced head/neck cancers involves concurrent chemoradiotherapy . Subsequently, regional and local failures are managed with resection but there have been few reports that describe the morbidity and disease control outcomes of surgical salvage in this setting. Methods: Retrospective analysis describes complications, survival, and patterns of failure after salvage resection of isolated local and/or regional failures of head/neck cancer following definitive concurrent chemoradiotherapy. Results: Sixteen patients were identified for inclusion: laryngectomy in 11 patients, oral cavity/oropharynx resection in 2 patients, and neck dissection alone in 4 patients. Ten patients required graft tissue reconstruction (6 pedicle and 4 free flap). Median post-operative hospitalization was 7 days (range 3-19), and 4 patients required hospital re-admission. At a median survivor follow-up of 15.8 months (range 4.3-34.9), 10 patients were alive (6 without evidence of disease). Seven patients experienced disease recurrence at a median 6.7 months (range 0-12.6) following salvage resection (2 with isolated distant failures). Estimated 2-year local/regional control, freedom from failure, and overall survival were 58%, 39%, and 58%, respectively. Conclusions: Surgical salvage after primary definitive concurrent chemoradiotherapy is feasible with toxicity and outcomes similar to prior radiotherapy alone or sequential chemotherapy and radiation. Local andregional recurrence remains the predominant pattern of failure.

To compare the effectiveness of transoral robotic surgery (TORS) versus plasma ablation (PA) in tongue base reduction surgery for obstructive sleep apnea (OSA).PubMed, Scopus, Cochrane Library, OVID.Keywords searched included OSA, tongue base surgery, TORS, and coblation. Outcomes included pre- to postoperative apnea-hypopnea index, Epworth Sleepiness Scale (ESS), and lowest oxygen saturation. Additional outcomes included surgical success rate, postoperative bleeding, operative time, and length of stay.A total of 690 unique articles were identified, of which 60 underwent full-text review. Twenty-six articles were included in final analysis, comprising 18 studies on TORS (834 patients) and 11 studies on PA (294 patients). Mean differences of apnea-hypopnea index, ESS, and lowest oxygen saturation for TORS were -23.92, -7.6, and 5.83% (allTongue base reduction with TORS or PA each effectively treats OSA and provides comparable results. The choice between techniques might depend on patient factors, availability of technology, and associated costs.

Objectives/hypothesis Obstructive sleep apnea (OSA) and sickle cell disease (SCD) represent two complex disease processes. Current guidelines recommend that children with SCD receive polysomnography (PSG) after presenting with signs or symptoms of sleep-disordered breathing (SDB). Recent studies suggest a disproportionately elevated prevalence of SDB in the population of children with SCD, and traditional risk factors may not be evident within these patients. Further objective testing might be needed to screen all pediatric patients with SCD, even in the absence of overt signs or symptoms of OSA to prevent complications of both conditions. Study design Prospective cohort study. Methods Institutional review board approval was obtained. An eight-question OSA risk assessment screening questionnaire was presented prospectively to 100 consecutive patients with SCD in the pediatric hematology clinic regardless of complaints of SDB. Results Out of 100 patients, 51 were female. The average age, body mass index (BMI), BMI percentile, and I'M SLEEPY score of the entire cohort were 3.97 years, 15.97%, 55.4%, and 1.63%, respectively. Nineteen patients had a positive sleep apnea screening score and were referred for PSG. The average age BMI, BMI percentile, and I'M SLEEPY score for those 19 patients were 3.77%, 16.67%, 65%, and 3.95%, respectively. Ten patients completed PSG, with seven diagnosed with OSA. Conclusions This pilot study demonstrates a higher incidence of SDB and OSA in children with SCD relative to the general pediatric population. Although more PSG reports and further testing is needed to determine whether the results hold, preliminary data indicate that children with SCD should at least undergo OSA screening in the office regardless of overt symptoms. Level of evidence 3 Laryngoscope, 131:E1022-E1028, 2021.

Objective To evaluate the association between findings of blinded reviews of preoperative drug-induced sleep endoscopy (DISE) examinations using the VOTE Classification and obstructive sleep apnea (OSA) surgical outcomes in a large multicenter, international cohort. Methods Retrospective, multi-center cohort study of adults without tonsillar hypertrophy who underwent pharyngeal surgery for OSA. The study included only participants without enlarged tonsils. Four independent reviewers performed blinded review of preoperative DISE videos using the VOTE Classification system and scoring of a primary structure contributing to airway obstruction. DISE findings were examined for an association with surgical outcomes with univariate analyses and multiple regression. Results Two hundred seventy-five study participants were included from 14 centers. Mean age was 51.4 ± 11.8 years, and body mass index was 30.1 ± 5.2 kg/m2 . There was moderate interrater reliability (kappa = 0.40-0.60) for DISE findings. Oropharyngeal lateral wall-related obstruction was associated with poorer surgical outcomes (adjusted odds ratio (AOR) 0.51; 95% CI 0.27, 0.93). Complete tongue-related obstruction was associated with a lower odds of surgical response in moderate to severe OSA (AOR 0.52; 95% CI 0.28, 0.98), with findings that were similar but not statistically significant in other analyses. Surgical outcomes were not clearly associated with the degree and configuration of velum-related obstruction or the degree of epiglottis-related obstruction. Surgical response was associated with tonsil size and body mass index (inversely). Conclusion DISE findings concerning the oropharyngeal lateral walls and tongue may be the most important findings of this evaluation technique. Level of evidence 2B Laryngoscope, 129:761-770, 2019.

Objective: To present 5-year outcomes from a prospective cohort of patients with obstructive sleep apnea (OSA) who were treated with upper airway stimulation (UAS) via a unilateral hypoglossal nerve implant. Study Design: A multicenter prospective cohort study. Setting: Industry-supported multicenter academic and clinical trial. Methods: From a cohort of 126 patients, 97 completed protocol, and 71 consented to a voluntary polysomnogram. Those having continuous positive airway pressure failure with moderate to severe OSA, body mass index 2, and no unfavorable collapse on drug-induced sleep endoscopy were enrolled in a phase 3 trial. Prospective outcomes included apnea-hypopnea index (AHI), oxygen desaturation index, and adverse events, as well as measures of sleepiness, quality of life, and snoring. Results: Patients who did and did not complete the protocol differed in baseline AHI, oxygen desaturation index, and Functional Outcomes of Sleep Questionnaire scores but not in any other demographics or treatment response measures. Improvement in sleepiness (Epworth Sleepiness Scale) and quality of life was observed, with normalization of scores increasing from 33% to 78% and 15% to 67%, respectively. AHI response rate (AHI 50% reduction) was 75% (n = 71). When a last observation carried forward analysis was applied, the responder rate was 63% at 5 years. Serious device-related events all related to lead/device adjustments were reported in 6% of patients. Conclusions: Improvements in sleepiness, quality of life, and respiratory outcomes are observed with 5 years of UAS. Serious adverse events are uncommon. UAS is a nonanatomic surgical treatment with long-term benefit for individuals with moderate to severe OSA who have failed nasal continuous positive airway pressure.

To determine the incidence, duration, and predictors of swallowing-related symptoms following upper airway surgery for obstructive sleep apnea.Adults (age 18 years or older) who underwent surgery for obstructive sleep apnea at a tertiary care institution from January 2012 to December 2015 were retrospectively reviewed. The incidence, duration, and associated factors of postoperative swallowing complaints were evaluated.A total of 130 patients (135 surgical encounters) met criteria for inclusion. There were 91 men (70.0%) and 39 women (30.0%) with a median age of 60 years (range: 19-79). Presurgical diagnosis of gastroesophageal reflux disease was present in 57 patients (43.8%). An average of 2.1 procedures (± 0.8) were conducted at each encounter. Uvulopalatopharyngoplasty (54.8%) was the most common followed by radiofrequency ablation of the soft palate (34.8%) and tongue base (29.6%). Postoperatively, 25 patients (19.8%) complained of dysphagia, 14 (10.9%) of globus, and 9 (6.7%) of odynophagia. Preoperative gastroesophageal reflux (odds ratio [OR] 4.09, 95% confidence interval [CI] 1.41-11.91) and hyoid myotomy with suspension (OR 4.88, 95% CI 1.34-17.77) were significant predictors for dysphagia. Radiofrequency ablation of the tongue base (OR 5.00, 95% CI 1.28-19.50) was a predictor for globus sensation. Median symptom durations, in months, were 4.0 for dysphagia, 7.3 for globus, and 3.0 for odynophagia.Preoperative gastroesophageal reflux and hyoid myotomy with suspension procedure were associated with postoperative dysphagia whereas radiofrequency ablation of the tongue base was associated with globus. These findings can assist surgeons in providing preoperative counseling and postoperative supportive measures regarding dysphagic symptoms following sleep surgery.

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 12 recommendations developed emphasize reducing delays in diagnosis of head and neck squamous cell carcinoma; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected.

Objectives: Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial. Methods: Moderate-severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial. Self-reported history on prior OSA medical therapy was collected at enrollment, including OSA diagnosis date, CPAP start and stop dates, oral appliance trial, and reasons for discontinuation or non-adherence. Results: The cohort consisted of 929 participants, 83% male, with a mean age (53.9 ± 10.5) years. Ninety percent (n = 835) had complete CPAP information including 47% (n = 435) who discontinued therapy prior to enrollment and 43% (n = 400) who were still attempting CPAP but had inadequate adherence. Abandonment rates were 60% at 1-year, 73% at 3-years, and 86% at 5-years. Oral appliance therapy was attempted by 171 patients for mean (1.8 ± 2.3) years, with 81% abandonment at 1 year, 89% at 3-years, and 94% at 5-years. Conclusions: In this CPAP-refractory cohort, high rates of CPAP abandonment were reported in the first several years with approximately half of the participants not receiving any treatment despite being diagnosed for >5 years. Close clinical follow-up and consideration of alternative treatment options is indicated in all OSA patients in order to ensure adequate longitudinal care. Keywords: Upper airway stimulation, Hypoglossal nerve stimulation, STAR trial, Obstructive sleep apnea, CPAP failure

Objective: Determine the effects of hyoid myotomy and suspension (HMS) without concurrent palatal or tongue base sleep surgery for obstructive sleep apnea (OSA). Method: Patients with OSA treated with HMS were identified using CPT code (21685) at an academic and private sleep surgery clinic. Those who underwent concurrent palatal or tongue base sleep surgery were excluded. Outcomes included simultaneous procedures, apnea-hypopnea index (AHI), lowest oxyhemoglobin saturation (LSAT), and Epworth Sleepiness Scale (ESS). Results: Nineteen patients with OSA underwent HMS without palatal or tongue base sleep surgery. The average age at surgery was (55.3 ± 13.5) years with a majority of patients being male (71%). Concurrent procedures included the following: torus mandibularis excision (n = 1), endoscopic sinus surgery (n = 4), septoplasty (n = 10), inferior turbinate reduction (n = 12), and nasal valve repair (n = 2). AHI improved significantly from (39.7 ± 21.2) events/h to (22.6 ± 22.7) events/h after HMS (P 30 events/h) had an improvement in AHI from (49.9 ± 16.6) events/h to (29.1 ± 24.9) events/h, P

Objective: To determine the level of agreement among experienced operators of candidacy for upper airway stimulation (UAS) based on evaluation of drug-induced sleep endoscopy (DISE). Methods: The trial was designed as a single-blinded cross-sectional study. Four otolaryngologists with extensive DISE experience were given 63 video clips from the STAR trial video library. These videos were graded using the VOTE classification. Percentage agreement and Cohenâs κ (for inter-rater reliability) were calculated between pairs of reviewers, assessing palatal complete concentric collapse (CCC) and determining UAS eligibility. Subjects were also grouped based on collapse severity for each reviewer. Results: The reviewers had excellent (approximately 90%) agreement on findings at the level of the soft palate and tongue base. The inter-rater reliability for palatal CCC ranged from moderate to substantial. The agreement on determining the criteria for UAS implantation ranged from poor to moderate. All 4 upper airway structures as classified by the criteria of the VOTE were graded by all the reviewers as contributing to obstruction in a majority of subjects who were performed via application of DISE. Conclusion: Application of DISE remains a subjective examination, even among those experienced operators, therefore more studies need to be performed for evaluation of improvement in inter-rater reliability after implantation of training videos. Keywords: Drug-induced sleep endoscopy, Drug-induced sedation endoscopy, Upper airway stimulation, Sleep-disordered breathing, Obstructive sleep apnea, Inter-rater reliability

Objective: To assess patient-based outcomes of participants in a large cohort study—the STAR trial (Stimulation Therapy for Apnea Reduction)—48 months after implantation with an upper airway stimulation system for moderate to severe obstructive sleep apnea.Study Design: A multicenter prospective cohort study. Setting: Industry-supported multicenter academic and clinical setting. Subjects: Participants (n = 91) at 48 months from a cohort of 126 implanted participants. Methods: A total of 126 participants received an implanted upper airway stimulation system in a prospective phase III trial. Patient-reported outcomes at 48 months, including Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), and snoring level, were compared with preimplantation baseline.Results: A total of 91 subjects completed the 48-month visit. Daytime sleepiness as measured by ESS was significantly reduced (P =.01), and sleep-related quality of life as measured by FOSQ significantly improved (P =.01) when compared with baseline. Soft to no snoring was reported by 85% of bed partners. Two patients required additional surgery without complication for lead malfunction. Conclusion: Upper airway stimulation maintained a sustained benefit on patient-reported outcomes (ESS, FOSQ, snoring) at 48 months in select patients with moderate to severe obstructive sleep apnea.

To demonstrate the effect of drug induced sleep endoscopy (DISE) on intra-operative decision making during pediatric sleep surgery for obstructive sleep apnea (OSA).A retrospective chart review was performed on pediatric (3-17 years) patients with moderate-to-severe OSA (7.2-71.8) who underwent drug induced sleep endoscopy at the time of initial sleep surgery. The characteristics evaluated included age, race, gender, site of obstruction, type of surgical intervention, pre- and post-operative apnea and hypopnea index. Of the 26 patients that were identified, 18 had both a pre- and post-operative polysomnograms result.All patients underwent DISE immediately prior to surgical treatment. The mean pre-operative AHI for the 18 patients with post-operative polysomnogram results was 21.3 (7.2-71.8). The mean post-operative AHI for the 18 patients was 7.6 (0.7-25.1). There was a significant difference between pre- and post-operative AHI (p 0.001). Of the 26 patients, the most common area of collapse was the soft palate, occurring in 17/26 (65.4%) patients. Base of tongue involvement was found to be present in 11/26 (42.3%) patients, and the epiglottis was involved in 4/26 (15.4%). Evidence of multilevel collapse was observed in 6/26 (23.1%) patients. Patients observed to have palatal collapse underwent a pharyngoplasty (20/26; 76.9%) at the time of adenotonsillectomy. Three (11.5%) patients underwent a tongue reduction.This study provides additional evidence that DISE can affect intra-operative decision making, with the potential for improved post-operative outcomes. A randomized controlled study is needed to determine if these outcomes are better than what can be achieved without DISE.

Objectives Review the role of upper airway stimulation (UAS) therapy in the management of moderate to severe obstructive sleep apnea (OSA). Data Sources A literature search was performed of PubMed and Medline using the search terms clinical trial; obstructive sleep apnea; upper airway stimulation; hypoglossal stimulation; hypoglossal nerve; Inspire; and ImThera. Review Methods All published clinical trials of currently available devices were reviewed. Unpublished data were excluded. Results UAS therapy results in surgical success (AHI decrease of >50% and overall AHI

Objective This study sought to systematically review the international literature for articles evaluating maxillary expansion and maxillomandibular expansion as treatments for obstructive sleep apnea (OSA) in adults and to perform a meta-analysis. Data sources Nine databases (including MEDLINE/PubMed). Review methods Searches were performed through January 8, 2016. The PRISMA statement was followed. Results Eight adult studies (39 patients) reported polysomnography and/or sleepiness outcomes. Six studies reported outcomes for maxillary expansion (36 patients), and the apnea-hypopnea index (AHI) decreased from a mean (M) ± standard deviation (SD) of 24.3 ± 27.5 [95% CI 15.3, 33.3] to 9.9 ± 13.7 [95% CI 5.4, 14.4] events/hr (relative reduction: 59.3%). Maxillary expansion improved lowest oxygen saturation (LSAT) from a M ± SD of 84.3 ± 8.1% [95% CI 81.7, 87.0] to 86.9 ± 5.6% [95% CI 85.1, 88.7]. Maxillomandibular expansion was reported in two studies (3 patients) and AHI decreased from a M ± SD of 47.53 ± 29.81 [95% CI −26.5 to 121.5] to 10.7 ± 3.2 [95% CI 2.8, 18.6] events/hr (relative reduction: 77.5%). Maxillomandibular expansion improved LSAT from a M ± SD of 76.7 ± 14.5% [95% CI 40.7, 112.7] to 89.3 ± 3.1 [95% CI 81.6, 97]. Conclusion The current literature demonstrates that maxillary expansion can improve and maxillomandibular expansion can possibly improve AHI and LSAT in adults; however, given the paucity of studies, these remain open for additional research efforts.

Background /Aims: The aim of this study was to determine the effect of upper airway surgery (UAS) on continuous positive airway pressure (CPAP). A secondary objective was to determine if a decrease in CPAP from UAS increases CPAP adherence. Methods: Studies were eligible for inclusion if a CPAP titration was performed both prior and following UAS in patients with obstructive sleep apnea (OSA). Studies that compared adherence to CPAP before and after UAS were included to evaluate the secondary objective. Results: A total of 11 articles involving 323 patients were included in the review. The results show that there was a mean reduction in CPAP of 1.40 cm H2O (95% CI -2.08 to -0.73). Four of the 11 papers, with a total of 80 patients, evaluated CPAP adherence and found a significant 0.62-hour improvement on average (95% CI 0.22-1.01). Conclusion: Due to high levels of nonadherence, surgical intervention will play a role even in patients who are unlikely to be fully cured by surgery. UAS decreases the apnea-hypopnea index and modestly reduces CPAP while improving CPAP adherence in the majority of patients. The evidence suggests that UAS may have an adjunctive role in the management of OSA.

Objectives/Hypothesis Determine safety and efficacy of the TranQuill Sling Snoreplasty (TSS) (Surgical Specialties Corp., Vancouver, BC, Canada) for the treatment of snoring in adults with benign snoring or mild obstructive sleep apnea. Study Design Prospective, unblinded, single-center pilot study. Methods From February 2014 to July 2014, 20 adult patients with chronic, disruptive snoring assessed by bed partner were recruited to undergo TSS. Subjects with apnea hypopnea index 85%, and body mass index (BMI)

The patient is a 62-year-old man with continuous positive airway pressure-intolerant obstructive sleep apnea who was enrolled in a study for a hypoglossal nerve upper airway stimulation device (UAS). Nearly 2.5 years later, he was admitted to the hospital for unstable angina. Diagnostic workup revealed a prior myocardial infarction, an ejection fraction of 30% on maximal medical therapy, and episodes of nonsustained ventricular tachycardia. During hospitalization, the patient received an implantable cardioverter defibrillator (ICD). This is the first reported case of simultaneous use of a UAS and an ICD, and we report no untoward device interference between the two implantable devices.

Objectives/Hypothesis To determine the effect of surgeon experience with an upper airway stimulation (UAS) system on surgical time and complication rates. Study Design Retrospective review. Methods Surgical procedure times and complication rates observed in patients implanted at 22 study centers as part of a phase III, multicenter surgical trial of upper airway nerve stimulation therapy for obstructive sleep apnea were reviewed. Results The study included 126 subjects who were predominantly male (83%), with a mean age of 54.5 years (range = 31–80 years), and the mean body mass index was 28.4 ± 2.6. There were an average of 5.7 (range = 1–22) surgical implants per site, with an average surgical time of 2.52 ± 0.98 hours (range = 1.08–6.0 hours). The surgical implant time decreased significantly with surgeon experience, from 2.98 ± 1.18 hours for a surgeon's first implant (n = 22) to 2.08 ± 0.55 hours for the fifth implant (n = 10, P = .025). Surgical time was inversely correlated with the site implant number (rho = −0.334, P

Determine the effect of glossectomy as part of multilevel sleep surgery on sleep-related outcomes in patients with obstructive sleep apnea.PubMED, Scopus.Two independent researchers conducted the review using PubMed-NCBI and Scopus literature databases. Studies on glossectomy for obstructive sleep apnea that reported pre- and postoperative apnea-hypopnea index (AHI) score with 10 or more patients were included.A total of 18 articles with 522 patients treated with 3 glossectomy techniques (midline glossectomy, lingualplasty, and submucosal minimally invasive lingual excision) met inclusion criteria. Pooled analyses (baseline vs post surgery) showed a significant improvement in AHI (48.1 ± 22.01 to 19.05 ± 15.46, P.0001), Epworth Sleepiness Scale (ESS; 11.41 ± 4.38 to 5.66 ± 3.29, P.0001), snoring visual analog scale (VAS; 9.08 ± 1.21 to 3.14 ± 2.41, P.0001), and Lowest O2 saturation (76.67 ± 10.58 to 84.09 ± 7.90, P.0001). Surgical success rate was 59.6% (95% CI, 53.0%-65.9%) and surgical cure was achieved in 22.5% (95% CI, 11.26%-36.26%) of cases. Acute complications occurred in 16.4% (79/481) of reported patients. Glossectomy was used as a standalone therapy in 24 patients. In this limited cohort, significant reductions in AHI (41.84 ± 32.05 to 25.02 ± 20.43, P = .0354) and ESS (12.35 ± 5.05 to 6.99 ± 3.84, P.0001) were likewise observed.Glossectomy significantly improves sleep outcomes as part of multilevel surgery in adult patients with OSA. Currently, there is insufficient evidence to analyze the role of glossectomy as a standalone procedure for the treatment of sleep apnea, although the evidence suggests positive outcomes in select patients.

Background Disparities in prevalence, human papillomavirus (HPV) status, and mortality rates for head and neck cancer have been described between African American and European American patients. Methods We studied the HPV status and gene expression profiles in 56 oropharyngeal/oral cavity tumors and 9 normal tissue samples from European American and African American patients treated in South Carolina between 2010 and 2012. Results Overall, 59% of tumors were HPV DNA-positive, but only 48% of those expressed E7 mRNA (HPV-active). The prevalence of HPV-active tumors was 10% in African American patients and 39% in European American patients. Tumors positive for HPV DNA but negative for HPV mRNA exhibited gene expression profiles distinct from those of both HPV-active and HPV-negative cancers, suggesting that HPV DNA-positive/RNA-negative tumors may constitute a unique group. Conclusion This study provides a direct assessment of differential expression patterns in HPV-related oropharyngeal cancer arising from African American and European American patients, for which there is a paucity of data. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

account for 15 – 25% of obstructive salivary disease.. The presence of fibrous intraductal circular or web-like inclusions and moderate luminal narrowing have a higher tendency to form megaducts due to a reservoir effect. Megaducts are defined as a Stensen’s ducts with diameters exceeding 10mm, often with thin walls that contribute to the gland’s weak excretory force. In addition to the obstructive symptoms, megaducts pose a cosmetic problem as they frequently appear as a bulge on the patient’s cheek. Besides interventional sialendoscopy, no other effective and glandpreserving treatment has been described in the literature. The purpose of this report is to describe a novel approach to patients with symptomatic Stensen’s ductal stenosis with concurrent megaducts. Introduction

Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes. Purpose The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected. The target patient for this guideline is anyone ≥18 years old with a neck mass. The target clinician for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses the initial broad differential diagnosis of a neck mass in an adult. However, the intention is only to assist the clinician with a basic understanding of the broad array of possible entities. The intention is not to direct management of a neck mass known to originate from thyroid, salivary gland, mandibular, or dental pathology as management recommendations for these etiologies already exist. This guideline also does not address the subsequent management of specific pathologic entities, as treatment recommendations for benign and malignant neck masses can be found elsewhere. Instead, this guideline is restricted to addressing the appropriate work-up of an adult patient with a neck mass that may be malignant in order to expedite diagnosis and referral to a head and neck cancer specialist. The Guideline Development Group sought to craft a set of actionable statements relevant to diagnostic decisions made by a clinician in the workup of an adult patient with a neck mass. Furthermore, where possible, the Guideline Development Group incorporated evidence to promote high-quality and cost-effective care. Action Statements The development group made a strong recommendation that clinicians should order a neck computed tomography (or magnetic resonance imaging) with contrast for patients with a neck mass deemed at increased risk for malignancy. The development group made the following recommendations: (1) Clinicians should identify patients with a neck mass who are at increased risk for malignancy because the patient lacks a history of infectious etiology and the mass has been present for ≥2 weeks without significant fluctuation or the mass is of uncertain duration. (2) Clinicians should identify patients with a neck mass who are at increased risk for malignancy based on ≥1 of these physical examination characteristics: fixation to adjacent tissues, firm consistency, size1.5 cm, or ulceration of overlying skin. (3) Clinicians should conduct an initial history and physical examination for patients with a neck mass to identify those with other suspicious findings that represent an increased risk for malignancy. (4) For patients with a neck mass who are not at increased risk for malignancy, clinicians or their designees should advise patients of criteria that would trigger the need for additional evaluation. Clinicians or their designees should also document a plan for follow-up to assess resolution or final diagnosis. (5) For patients with a neck mass who are deemed at increased risk for malignancy, clinicians or their designees should explain to the patient the significance of being at increased risk and explain any recommended diagnostic tests. (6) Clinicians should perform, or refer the patient to a clinician who can perform, a targeted physical examination (including visualizing the mucosa of the larynx, base of tongue, and pharynx) for patients with a neck mass deemed at increased risk for malignancy. (7) Clinicians should perform fine-needle aspiration (FNA) instead of open biopsy, or refer the patient to someone who can perform FNA, for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain. (8) For patients with a neck mass deemed at increased risk for malignancy, clinicians should continue evaluation of patients with a cystic neck mass, as determined by FNA or imaging studies, until a diagnosis is obtained and should not assume that the mass is benign. (9) Clinicians should obtain additional ancillary tests based on the patient's history and physical examination when a patient with a neck mass is deemed at increased risk for malignancy who does not have a diagnosis after FNA and imaging. (10) Clinicians should recommend evaluation of the upper aerodigestive tract under anesthesia, before open biopsy, for patients with a neck mass deemed at increased risk for malignancy and without a diagnosis or primary site identified with FNA, imaging, and/or ancillary tests. The development group recommended against clinicians routinely prescribing antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.

Background Implantable hypoglossal nerve upper airway stimulation (HNS) is a novel strategy approved by the US Food and Drug Administration for the management of moderate-to-severe obstructive sleep apnea (OSA) in patients with continuous positive airway pressure therapy intolerance or failure. Because of the proximity of a cardiac implantable electronic device (CIED) to this stimulator, interaction between these devices is theoretically possible. Objective The purpose of this study was to assess interactions between an implantable HNS device and a CIED. Methods We retrospectively analyzed 14 ad hoc patients with continuous positive airway pressure-intolerant, moderate-to-severe OSA and pre-existing transvenous CIEDs undergoing HNS implantation (Inspire II, Inspire Medical Systems). We assessed these devices for their pre and postimplant OSA outcomes and for possible device–device interaction. All patients were followed up for 1 year. Results Of the 14 patients, 9 had a pacemaker (8 dual-chamber, 1 single-chamber), 4 had an implantable cardioverter-defibrillator (2 dual-chamber, 1 single-chamber), and 1 had a cardiac resynchronization therapy device. All the HNS devices were implanted on the opposite side of the CIED. All CIEDs were programmed bipolar. HNS were programmed either unipolar or bipolar. During implant, intraoperative testing was performed to confirm that bipolar and unipolar HNS stimulation did not impact CIED sensing. During the follow-up period, no oversensing episodes were noted on the CIEDs. Conclusion In this early experience, simultaneous use of a novel hypoglossal nerve upper airway stimulation device with transvenous CIEDs seems to be safe, effective, and without any device–device interactions.

BACKGROUND The purpose of this clinical review was to analyze the effectiveness of nonsurgical management options for human immunodeficiency virus (HIV)-associated parotid cysts. METHODS We conducted systematic and meta-analysis reviews. Primary outcomes were complete or partial responses. RESULTS Systematic review identified 12 relevant studies. The average rates of complete response for antiretroviral therapy (ART), sclerotherapy, and fine-needle aspiration (FNA) were 52.8%, 55.5%, and 33.3%, respectively. Three radiotherapy studies, totaling 104 patients, were included in a meta-analysis. Patients receiving high-dose therapy achieved complete and partial response rates of 65.8% (95% confidence interval [CI] 54.3%-76.2%) and 25.2% (95% CI 16.1%-36.3%), respectively. Patients receiving low-dose therapy achieved complete and partial response rates of 23.2% (95% CI 1.2%-60.9%) and 22.3% (95% CI 5.2%-87.8%), respectively. The rate of complete response was significantly greater for high-dose radiotherapy compared to low-dose (P < .001). CONCLUSION Among nonsurgical treatment modalities for HIV-associated parotid cysts, radiotherapy has the highest number of reported outcomes in the literature and our analysis suggests that higher dose radiotherapy has higher rates of achieving complete response.

Objectives/Hypothesis Gland-preserving salivary surgery utilizing salivary endoscopy has been proposed as a treatment alternative in the management of chronic sialadenitis. This study seeks to determine medium-term clinical and quality-of-life (QOL) outcomes following a gland-preserving approach for chronic sialadenitis. Study Design Cross-sectional survey with retrospective chart review. Methods All patients undergoing attempted gland-preserving salivary surgery with salivary endoscopy for chronic sialadenitis at a tertiary, academic salivary referral center between October 2008 and April 2013 were identified from a quality assurance database. A research database was constructed to examine clinical factors of interest. A clinical outcomes and QOL survey was mailed to all eligible patients in order to obtain long-term follow-up data. Results A total of 206 of 306 (67%) eligible patients returned the survey. The median length of follow-up was 17 months (3–54 months). The majority of patients (89%) endorsed symptom improvement after gland-preserving therapy. Surgical excision was performed on 8% of affected glands. Patients with chronic sialadenitis due to stones reported a greater incidence of symptom resolution (P = 0.0004) and more favorable QOL outcomes (P = 0.0001) than patients with nonstone etiologies. Conclusions Patients undergoing gland-preserving salivary surgery with salivary endoscopy for chronic sialadenitis have favorable long-term symptom improvement and gland retention rates. Although patients with stones demonstrated the best outcomes, improvement was documented for all etiologies of chronic sialadenitis. Level of Evidence 4. Laryngoscope, 125:1340–1344, 2015

Objectives/Hypothesis The aim of this study was to systematically review available literature on the outcomes of children treated with balloon laryngoplasty (BLP) as a primary or adjuvant treatment for subglottic or laryngeal stenosis, as well as briefly report on a new series of 60 children treated at the Medical University of South Carolina from 2007 to 2013. Study Design Review of published case series and retrospective chart review. Methods A literature search was performed in PubMed and MEDLINE to identify trials that reported clinical outcomes of BLP in human patients under the age of 18 with subglottic or laryngeal stenosis. Single case reports and series studying the dilation of tracheal or bronchial stenosis alone were excluded. Hospital billing codes were used to identify appropriate patients for retrospective chart review. A successful outcome for chart review was determined to be decannulation of previous tracheostomy or avoidance of open laryngotracheoplasty or tracheostomy. Results Seven studies published between 1991 and 2012 met inclusion criteria and reported outcomes with success defined through improvement of symptoms, decrease in Myer-Cotton level of stenosis, decannulation, or avoidance of reconstructive procedures. Including 60 children from our institution, 202 patients between 1 day and 22 years of age (average 35 months) underwent 457 dilations, with an average of 2.26 dilations per patient (2.25 in our population). The overall success rate was 64% (77% in our population). No complications were reported with subglottic or laryngeal dilations. Conclusions BLP is a highly effective, low-risk alternative or adjunct to traditional reconstructive procedures in children with subglottic or laryngeal stenosis. Level of Evidence 4 Laryngoscope, 124:1707–1712, 2014

Objective Review the current literature on the use of sialendoscopy in the treatment of non-stone disorders of the major salivary glands. Data Sources Eligible articles that reported on the use of sialendoscopy in the treatment of non-stone disorders were identified using MEDLINE, Embase, and Google Scholar through May 2016. The search used key words sialendoscopy, salivary endoscopy, salivary scope, salivary duct stenosis, salivary duct stricture, Sjogren's disease, radioiodine sialadenitis, salivary duct obstruction, sialadenitis, chronic sialadenitis, juvenile recurrent parotitis, parotitis, and radiation sialadenitis. Review Methods Full-length prospective and retrospective original articles; systemic reviews; and meta-analysis, including adults and children with adequate data for evaluating the sialendoscopy for non-stone disorders, were included. Individual case reports were excluded. Results There is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non-stone disorders worldwide. The studies of sialendoscopy for non-stone disorders are often retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjogren syndrome, respectively. Conclusion Although the initial evidence for the use of sialendoscopy for non-stone disorders is not as established as that for stones, it remains a promising gland-preserving tool in the management of non-stone disorders of major salivary glands.

Importance Surgical intervention is the main treatment alternative for patients with severe laryngomalacia. Supraglottoplasty offers effective treatment results not only for laryngomalacia but also for concurrent obstructive sleep apnea (OSA). Objective To quantify the objective outcomes of supraglottoplasty for laryngomalacia with OSA via polysomnography data in the pediatric population. Data Sources A comprehensive literature search of the PubMed database was performed on May 20, 2015, using the search terms supraglottoplasty, epiglottoplasty, aryepiglottoplasty, laryngomalacia, obstructive sleep apnea, Apnea-Hypopnea Index (AHI), children, and polysomnography. There were no date restrictions. Study Selection The literature search identified English-language studies that used polysomnography to evaluate patients with laryngomalacia and OSA after supraglottoplasty. Two reviewers screened titles and abstracts of the studies. The full texts of the studies were examined to assess their relevance to the meta-analysis. Data Extraction Numerical polysomnography data were extracted and compared among studies where appropriate. A fixed- or random-effects model was used, when appropriate, to analyze the data and calculate effect sizes. Results Four studies were included in various subsets of the meta-analysis. After supraglottoplasty, the Apnea-Hypopnea Index (AHI) improved by a mean of 12.5 points in 4 studies (95% CI, −21.14 to −3.78; P = .005), oxygen saturation as measured by pulse oximetry nadir by 9.49 in 4 studies (95% CI, 4.87–14.12; P P = .16). Twenty-nine of 33 children (88%) had residual disease. Patients 7 months and older had significant improvement in the AHI ( P = .03). Conclusions and Relevance Supraglottoplasty is an effective treatment modality for patients with laryngomalacia and OSA with objectively measurable benefits; however, patients will frequently have residual disease. Additional polysomnography after treatment is advised to ensure adequate resolution of the disorder.

To determine the effect of transoral robotic surgery (TORS) base of tongue (BOT) reduction on sleep-related outcomes in patients with obstructive sleep apnea (OSA).PubMed, Scopus, EMBASE, CINAHL, Cochrane, and Ovid.Literature search by two independent authors was conducted using the abovementioned databases. Studies on TORS BOT reduction as part of OSA treatment in adult patients with pre- and postoperative apnea-hypopnea index (AHI) scores were included. Studies on TORS as treatment for diseases other than OSA were excluded.A total of six articles with 353 patients treated with TORS BOT reduction met inclusion criteria. Pooled analyses (baseline vs. postsurgery) showed significant improvement in the following: AHI (44.3 ± 22.4 to 17.8 ± 16.5, P.01), Epworth Sleepiness Scale (12.9 ± 5.4 to 5.8 ± 3.7, P.01), lowest oxygen saturation (79.0 ± 9.5 to 84.1 ± 6.5, P.01), and snoring visual analog scale (9.3 ± 0.8 to 2.4 ± 2.43, P.01). Surgical success rate, defined as a50% reduction of AHI with a postoperative AHI20, was 68.4% (95% confidence interval [CI] = 63.0%-73.5%). Cure rate (postoperative AHI5) was 23.8% (95% CI = 19.1%-29.2%).TORS BOT reduction decreases AHI and symptoms of sleepiness in adult patients with OSA. It is considered successful in a majority of cases; however, further studies must be performed to optimize patient selection criteria to achieve higher rates of success. Laryngoscope, 127:258-265, 2017.

Objective To describe upper airway collapse patterns observed on drug-induced sedation endoscopy (DISE) during screening for a clinical trial and to evaluate the impact of collapse patterns found on preoperative DISE on response rates to upper airway stimulation (UAS) therapy. Study Design Retrospective review of an ongoing prospective multi-institutional cohort study. Setting Twenty-two participating institutions of the STAR trial. Subjects and Method In total, 222 subjects were screened with DISE to determine eligibility for an implantable UAS device. Supine laryngoscopy was performed during moderate sedation (propofol and/or midazolam). Airway collapse pattern and severity were graded at 4 levels, including velum, oropharynx, tongue base, and epiglottis (VOTE classification). Patients with complete concentric collapse (CCC) at the velum were excluded from implantation. Results The CCC at the velum was observed in 52 (23%) of screened subjects, and these subjects were subsequently excluded from implantation. Of the 170 subjects without CCC at the velum, 126 (77%) underwent implantation: 121 (96%) had multilevel collapse and 5 (4%) had single-level collapse. When comparing preimplantation DISE findings, UAS responders at 12 months had lower baseline VOTE scores compared with therapy nonresponders. Conclusion Drug-induced sedation endoscopy is an efficient and safe method for determining UAS eligibility and has the potential to identify UAS nonresponders. Most patients had multilevel airway collapse, illustrating the limitations of single-level upper airway surgery in treating obstructive sleep apnea. Upper airway stimulation is effective therapy for most patients with multilevel airway collapse; however, patients with complete anterior-posterior or lateral soft palate and/or epiglottic collapse may be at increased risk of therapy failure.

Objective: To describe the long term (36 month) clinical and polysomnographic outcomes in an OSA cohort treated with cranial nerve upper airway stimulation. Methods: 126 participants were enrolled in a prospective phase III trial evaluating the efficacy of Inspire II (Inspire Medical Systems, Minnesota, USA). Prospective outcomes included AHI, ODI, side effects and self-reported measures including sleepiness (ESS), sleep related quality of life (FOSQ), and snoring, .Data was collected at baseline and t select time points post-device activation. . Results: 116 of 126 enrolled patients completed 36 month follow up evaluation per protocol. 98 patients additionally agreed to an interval 36 month PSG. Daily device usage was 81%. In the interim PSG group, 74% met the a priori definition of success with the primary outcomes of AHI and ODI improved from baseline to 12 and 36 months (32.0±11.8 to 15.3±16.1 and 11.5±13.9 and 28.9±18.2 to 14.0±15.6 and 9.1±11.7, all p

Objectives/Hypothesis: To determine the reliability and validity of drug-induced sleep endoscopy (DISE) for patients undergoing surgery for sleep-disordered breathing (SDB). Study Design: Non-randomized, prospective clinical trial. Methods: Patients with sleep-disordered breathing were evaluated for multi-level upper airway surgery by awake and drug-induced sleep endoscopy to identify levels and degree of airway collapse. The reliability of a drug-induced sleep endoscopy rating index was assessed by comparing scores of three blinded investigators. The validity was assessed by comparison of drug-induced sleep endoscopy index scores from awake and drug-induced sleep endoscopy; correlation between drug-induced sleep endoscopy scores and Apnea-Hypopnea Index; and determination whether drug-induced sleep endoscopy affected the original surgical plan. Results: Thirty-eight patients (22 M, 16 F) underwent preoperative assessment with awake and drug-induced sleep endoscopy. Drug-induced sleep endoscopy was successfully performed in all but one patient (97%) who became combative during propofol infusion. Using an internal airway grading scale, drug-induced sleep endoscopy demonstrated more severity of collapse than awake endoscopy (P = 0.0001). The surgical plan was changed after drug-induced sleep endoscopy in 23 (62%) cases and unchanged in 14 (38%). The majority (73%) had multi-segmental airway collapse with fewer having single-level palatal (16%) or tongue base (11%) collapse. Scoring of drug-induced sleep endoscopy videos demonstrated good intrarater (κ 0.61) and interrater (κ 0.65) correlation. Conclusions: Drug-induced sleep endoscopy provides more clinical information to assess airway function and collapse than awake endoscopy alone and assists in the surgical planning. Additional investigation is needed to standardize drug-induced sleep endoscopy techniques, training, and interpretation. Laryngoscope, 2013

Objectives/Hypothesis: Recent studies suggest that extracapsular dissection (ECD) is an option for the resection of certain benign parotid tumors. This study investigates complication rates and effectiveness of ECD versus superficial parotidectomy (SP) for the treatment of primary benign parotid neoplasms. Study Design: Systematic literature review with meta-analysis. Methods: Studies available for inclusion evaluated the complications and effectiveness of ECD and SP as surgical techniques for the treatment of solitary, benign parotid tumors. An Ovid/Medline search revealed nine articles that met inclusion criteria. A critical review and meta-analysis of these articles was performed. Results: The included studies evaluated a total of 1,882 patients. There was no observed difference in tumor recurrence between the ECD and SP groups (odds ratio [OR], 0.557; 95% confidence interval [CI], 0.271-1.147). There was a significantly lower rate of transient facial nerve paresis (OR, 0.256; 95% CI, 0.174-0.377) in the ECD group (59 of 741; 8.0%) compared to the SP group (81 of 397; 20.4%); however, there was no observed difference in permanent facial paralysis between the ECD and SP groups (OR, 0.878; 95% CI, 0.282-2.730). Frey's syndrome was less often observed (OR, 0.117; 95% CI, 0.071-0.191) after ECD (27 of 602; 4.5%) compared to SP (75 of 287; 26.1%). Conclusions: This systematic review with meta-analysis suggests that ECD has a similar recurrence rate as SP with fewer postoperative complications. ECD may be considered an alternative surgical modality for select benign parotid neoplasms.

OBJECTIVES/HYPOTHESIS Compressive symptoms are common in thyroid disease, but few studies have focused on the presence, associated factors, and etiology of compressive symptoms. STUDY DESIGN Retrospective review. METHODS Patients who underwent thyroidectomy from 2005 through 2009 were reviewed. The data included demographics, indication for surgery, compressive symptoms, complications, diagnosis, volume of thyroid gland, presence of inflammation, and follow-up. RESULTS Three hundred thirty-three patients were identified. The mean age was 51 years, and 82% were female. Fifty-two percent (n=172) of patients experienced compressive symptoms preoperatively, including dysphagia (n=131) and shortness of breath (n=83). Twenty-six percent (n=86) of patients presented with voice changes, and 8% (n=27) complained of odynophagia. Postoperatively, 25 patients (8%) continued to have compressive symptoms (P

Purpose: Here we report a phase II clinical trial, which was designed to test a novel hypothesis that treatment with gemcitabine (GEM)/doxorubicin (DOX) would be efficacious via reconstitution of C18-ceramide signaling in head and neck squamous cell carcinoma (HNSCC) patients for whom first-line platinum-based therapy failed. Experimental Design: Patients received GEM (1,000 mg/m2) and DOX (25 mg/m2) on days 1 and 8, every 21 days, until disease progression. After completion of 2 treatment cycles, patients were assessed radiographically, and serum samples were taken for sphingolipid measurements. Results: We enrolled 18 patients in the trial, who were evaluable for toxicity, and 17 for response. The most common toxicity was neutropenia, observed in 9 of 18 patients, and there were no major nonhematologic toxicities. Of the 17 patients, 5 patients had progressive disease (PD), 1 had complete response (CR), 3 exhibited partial response (PR), and 8 had stable disease (SD). The median progression-free survival was 1.6 months (95% CI: 1.4–4.2) with a median survival of 5.6 months (95% CI: 3.8–18.2). Remarkably, serum sphingolipid analysis revealed significant differences in patterns of C18-ceramide elevation in patients with CR/PR/SD in comparison with patients with PD, indicating the reconstitution of tumor suppressor ceramide generation by GEM/DOX treatment. Conclusions: Our data suggest that the GEM/DOX combination could represent an effective treatment for some patients with recurrent or metastatic HNSCC, and that serum C18-ceramide elevation might be a novel serum biomarker of chemotherapy response. Clin Cancer Res; 17(18); 6097–105. ©2011 AACR.

To review the current state of the data on the use of cetuximab in head and neck squamous cell carcinoma (HNSCC).The National Center for Biotechnology Information's PubMed and the Cochrane collection.Search terms included cetuximab and head and neck cancer. These results were reviewed, and a second search was performed using limits: meta-analysis, randomized controlled trial, and clinical trial.The literature search yielded 412 articles. Fifteen were identified for analysis. For patients with recurrent/metastatic disease who received combination chemotherapy in phase I/II trials, the overall response (OR) was 18.7% (95% confidence interval [CI], 10.4%-27.0%). Phase III trial data for combination chemotherapy in recurrent/metastatic disease showed OR to be 17.0% (95% CI, 12.6%-21.4%) for platinum-based regimens and 34.2% (28.6%-39.7%) for platinum-based regimens with cetuximab. For this same group, the estimated aggregate hazard ratio comparing platinum-based therapy plus cetuximab to platinum therapy alone was 1.10 (95% CI, 0.78- 1.54), indicating no significant improvement in overall survival in the aggregate analysis. Combination chemoradiation with cetuximab in both phase I/II trials and the single phase III trial shows enhanced responsiveness, but the data are difficult to interpret because it is not used with standard-of-care regimens for advanced-stage disease.Early evidence has shown cetuximab to be effective in the treatment of HNSCC, and it should be used to enhance, but not replace, current treatment paradigms until further phase III data are available.

Background Chronic sialadenitis is a relatively common disorder that is frequently referred to head and neck surgeons for diagnosis and management. The management of the disorder is rapidly evolving with the introduction of salivary endoscopy. The purpose of the present study was a review of the indications and techniques of endoscopic-assisted management of chronic sialadenitis at a single U.S. institution. Methods This study is a retrospective case series of patients undergoing salivary endoscopy for chronic sialadenitis. Patient clinical information was reviewed to determine endoscopic findings, associated procedures, complications, rate of gland preservation, and early symptom control. Results A total of 51 patients underwent endoscopic-assisted salivary surgery over a 24-month period. Treatment indications included sialadenitis of unclear etiology (49%), sialadenitis with sialolithiasis (47%), and Sjogren syndrome (4%). Findings included obstructive stricture formation in 22 patients (43%). Associated procedures included sialodochoplasty (41%), steroid infusion (39%), and ductal stenting (8%). Gland preservation was achieved in 40 patients (78%). Of those who were treated with endoscopic-assisted techniques alone, 38 patients (84%) had symptomatic improvement whereas 7 patients (16%) did not improve. Minor complications were observed in 12% of the patients. Conclusion Endoscopic-assisted management of chronic sialadenitis is both safe and effective and allows gland preservation with symptom control in the majority of patients. © 2011 Wiley Periodicals, Inc. Head Neck, 2011

Prior studies have shown that treatment of head and neck squamous cell carcinoma (HNSCC) patients with 1alpha,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)] reduced intratumoral levels of immune inhibitory CD34(+) progenitor cells while increasing levels of mature progeny dendritic cells. This finding was extended to a pilot study to determine whether 1,25(OH)(2)D(3) treatment concurrently increases levels of intratumoral CD4(+) and CD8(+) T cells, increases intratumoral levels of immune cells expressing the early activation marker CD69, and prolongs time to HNSCC recurrence. The clinical trial comprised 16 patients with newly diagnosed HNSCC being untreated and 16 patients being treated with 1,25(OH)(2)D(3) during the 3-week interval between cancer diagnosis and surgical treatment. Immunologic effects of treatment were monitored by immunohistochemical analyses of surgically removed HNSCC. Clinical effectiveness of 1,25(OH)(2)D(3) treatment in this study was measured by the time to HNSCC recurrence. HNSCC tissues of patients who received treatment with 1,25(OH)(2)D(3) contained increased levels of CD4(+) cells and, more significantly, CD8(+) T cells. Also prominent was an increase in cells expressing the lymphoid activation marker CD69. Results of this pilot study suggest that patients treated with 1,25(OH)(2)D(3) had a lengthier time to tumor recurrence compared with patients who were not treated before surgery.

Objectives/Hypothesis: The optimal concurrent chemoradiotherapy regimen for definitive treatment of locoregionally advanced head and neck cancer remains to be determined. The present investigation reports toxicities, disease control, patterns of failure, and survival outcomes in a large mature cohort of patients treated with low-dose weekly platinum-based concurrent chemoradiotherapy. Study Design: Retrospective single-institution series. Methods: Toxicity and outcome data for locoregionally advanced head and neck cancer patients treated with low-dose weekly platinum-based chemotherapy concurrent with standard fractionation radiotherapy were retrospectively collected and analyzed from a clinical database. Survival analysis methods, including Kaplan-Meier estimation and competing risks analysis, were used to assess locoregional disease control, freedom from failure, and overall survival. Results: Ninety-six patients were eligible for the present analysis. Nearly all patients had American Joint Committee on Cancer clinical stage III to IVB disease (99%). Severe acute toxicities included grade 3 mucositis (61%), grade 3/4 nausea (27%/1%), and grade 3 neutropenia (8%). Thirty-seven patients (38%) required hospitalization for a median of 7 days (range, 1–121). Ninety-two percent of patients completed the fully prescribed course of radiotherapy, and 87% completed ≥6 cycles of chemotherapy. At a median survivor follow-up of 40 months (range, 8–68), 47% of patients were without evidence of disease recurrence. The estimated 4-year freedom from failure and overall survival were 48% and 58%, respectively. Initial site(s) of disease failure were locoregional for 22 patients, locoregional and distant (five patients), and distant only (14 patients). Conclusions: Weekly low-dose platinum-based chemotherapy with full-dose daily radiotherapy is a tolerable alternative regimen for locoregionally advanced head and neck cancers, with comparable efficacy and patterns of failure to alternative regimens. Laryngoscope, 2010

Background. Reirradiation of locoregionally recurrent, previously irradiated head/neck cancer may be considered in situations of unresectability, medical inoperability, or adverse pathologic features found at salvage resection. Methods. Retrospective cohort analysis of toxicity and survival outcomes in locoregionally recurrent, previously irradiated patients with head/neck cancer treated with hyperfractionated split-course radiotherapy and concurrent chemotherapy. Results. Between March 1998 and September 2006, 39 patients initiated reirradiation at median of 2.3 years (range, 0.5–19) following prior radiotherapy. At median survivor follow-up of 24.5 months (range, 3–63.9), 10 patients are alive without evidence of disease. Median survival is 19.0 months, with estimated 1-, 2-, and 3-year overall survivals of 60.1%, 45.1%, and 22.7%, respectively. Locoregional failure was the predominant site of postreirradiation recurrence. Male sex, total radiotherapy dose, cycles of chemotherapy completed, and clinical response were associated with improved overall survival. Conclusions. Reirradiation can offer long-term survival for patients with recurrent, previously irradiated head/neck cancers. © 2009 Wiley Periodicals, Inc. Head Neck, 2009

Recent studies suggest that radiofrequency ablation (RFA) is a treatment option for patients with obstructive sleep apnea (OSA). This study investigates the effectiveness of RFA in treating OSA using a critical literature review and meta-analysis.Critical literature review and meta-analysis.Two independent searches of PubMed 1966-present were performed to identify publications pertaining to RFA and OSA. Effectiveness of the procedure was measured by comparing the Epworth Sleepiness Scale (ESS), respiratory disturbance index (RDI), and lowest O2 saturation before and after tissue ablation.Sixteen studies met the inclusion criteria. The study found a 31% reduction in short-term ESS (odds ratios (OR) 0.69, 95% confidence interval (CI) 0.63-0.75), which was maintained beyond 12 months (OR 0.68, 95% CI 0.43-0.73). Likewise, RFA resulted in a 31% reduction in short term (12 month) (OR 0.69, 95% CI 0.61-0.77) and 45% reduction (OR 0.55, 95% C.I. 0.45-0.72) in long-term (24 month) RDI levels. Short-term results of the lowest O2 saturations failed to demonstrate improvement (OR 1.03, 95% CI 0.88-1.20).RFA seems to be a clinically effective tool that reduces ESS scores and RDI levels in patients with OSA syndrome. The procedure should be considered a valid treatment option for patients who refuse or are unable to tolerate continuous positive airway pressure.

Seven head and neck cancer patients participated in a driving evaluation in a driving simulator. Radiation dose on the temporal lobes was moderately associated with time to complete a cognitive test and with driving performance. Results indicated that incidental irradiation may contribute to a decrease in cognition and in unsafe driving performance, which seems to be time-dependent.

Background: There has been an increasing focus on late functional effects of head and neck cancer (HNC) treatment. This study was undertaken to evaluate the incidence of late proximal esophageal stricture in patients undergoing total laryngectomy (TL) and radiation therapy (RT). Material and Methods: An institutional retrospective review of HNC patients treated between 1995 and 2003 with TL and RT was undertaken. Thirty-three patients with stage II–IV disease were included; 25 patients had TL and postoperative RT (group 1), while 8 patients had definitive RT with salvage laryngectomy (group 2). Results: The median follow-up was 28 months. At the last follow-up, 25 patients (76%) were alive and disease free. Four had died and 3 developed distant metastasis. Dysphagia or stenosis developed in 40% in group 1 and 75% in group 2 patients. The median time to dysphagia was 5.5 months for all patients. Conclusions: The incidence of esophageal stenosis was 33% for all patients. Contributing factors for esophageal stenosis after TL and RT include continued alcohol and tobacco use, the dose-volume relationship of the RT and normal tissue damage from the tumor and the treatment.