Dermoid Cyst of the Parotid Gland: A Rare Entity

Abstract

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

http://bit.ly/2QRnJpq

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

Abstract

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

http://bit.ly/2BEiVt4

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

Abstract

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

http://bit.ly/2QVkFJ1

Metaplastic carcinoma of breast

: A series of nine cases from a regional cancer center in Northeast India

p. 69

Srigopal Mohanty, Yumkhaibam Sobita Devi, Daffilyne Lyngdoh Nongrum, Laishram Jaichand Singh, Vimal Sekar, Deep Sikha Das DOI:10.4103/oji.oji_39_18   Background: Metaplastic carcinoma of the breast (MCB) is a rare histological subtype of breast carcinoma containing glandular and nonglandular components with mixed epithelial and mesenchymal differentiations. Aim of the Study: The study aimed to report clinical, radiological and pathological profiles, treatment and outcome of patients diagnosed with MCB from a tertiary care institute along with literature review. Materials and Methods:Diagnosed cases of MCB were obtained from the record over a period of January 2010 to December 2017, and data were recorded in a structured pro forma. Results: A total of 9 (0.9%) cases of MCB were identified out of 1031 breast cancer patients with the median age of presentation of 53 years. The palpable lump was the most common presentation (77.78%). The mean tumor size was 4.9 cm in greatest dimension. Sonographically, most of the lesions were solid (44.44%) followed by cystic (33.33%). Mammographically, microcalcifications were absent in eight cases. Histologically, 55.56% of cases were purely epithelial subtype (3: pure squamous and 2: adenosquamous) and 4 (44.44%) cases were mixed epithelial and mesenchymal subtypes (3: carcinosarcoma and 1: invasive lobular carcinoma with sarcomatous component and osseous metaplasia). All the cases were having triple-negative receptor status. Modified radical mastectomy (MRM) was performed in all cases and 33.33% of cases had axillary node positive. About 77.88% and 88.89% of cases received adjuvant chemotherapy and adjuvant radiotherapy, respectively. At median follow-up of 27 months, local recurrence and distant metastases were seen in 1 and 3 cases, respectively. At present, 33.33%, 22.22%, and 44.45% of patients were died, alive, and lost for follow-up, respectively. Conclusion: MCB is a rare histologic subtype of breast cancer with larger tumor size at presentation and MRM is the preferred surgical procedure over breast conservation surgery. Long-term and regular follow-up is necessary to know the outcome.

http://www.ojionline.org/articles/2018/2/4/images/OncolJIndia_2018_2_4_69_248535_f1.jpg

Anti-cancer and anti-inflammatory activities of aronia (Aronia melanocarpa) leaves

p. 586

Nhuan Do Thi, Eun-Sun Hwang

DOI:10.4103/2221-1691.248095  

Objective: To determine the anti-cancer effect of aronia leaf extract on SK-Hep1 cells using migration, metallo metrix proteinase-2/-9 (MMP-2/-9) and MT-1 MMP expression and to evaluate the anti-inflammatory activities of the leaf extract. Methods: The effect of aronia leaf extract on cancer prevention was investigated. SK-Hep1 human liver cancer cell line was treated with aronia leaf extract at various concentractions. MTT assay was used to measure cancer cell growth inhibition, and wound migration assay was used for metastasis determination. The expression of MMP-2/-9 was measured at the protein level using zymography and the expression of MMP-2/-9 and MT-1 MMP was examined at the gene level by RT-PCR. Raw 264.7 macrophage cells were stimulated with lipopolysaccharides to induce inflammation, and then the inhibition of inflammation was evaluated by treatment of aronia leaf extract. Expressions of interleukin-6, tumor factor-α, and nitric oxide (NO) were also determined. Results: SK-Hep1 cell growth was inhibited in proportion to the concentration of aronia leaf extract. In migration assay, aronia leaf extract showed 61.3%-96.3% wound size inhibtion after treating 50-200 μg/mL of aronia leaf extract for 24 h. At the protein level, the expression of MMP-2 and MMP-9 decreased as the concentration of aronia leaf extract treated with SK-Hep1 cells increased. In addition, the same pattern as in the protein was also observed in the mRNA levels. The expressions of MMP-2 and MMP-9 protein were inhibited by 92.2% and 53.8%, respectively after treatment with 200 μg/mL aronia leaf extract. In addition, Raw 264.7 cells treated with aronia leaf extract did not affect cell survival. There was dose dependent inhibition of interleukine-6, tumor necrosis factor-α and nitric oxide after treating aronia leaf extract in lipopolysaccharides-treated Raw 264.7 cell. Conclusions: The results show that aronia leaf has anticancer and and antimetastatic properties in SK-Hep1 and Raw 264.7 cells.

Effects of phototherapy on outer hair cell function in infants with hyperbilirubinemia

 p. 52
Vikas Mysore Dwarakanath, Pavana Mohan, Sapthami Patel
DOI:10.4103/jisha.JISHA_8_17  
Introduction: Hyperbilirubinemia in newborns has been hypothesized to cause damage to inner ear, thus leading to sensorineural hearing loss. Phototherapy is treatment protocol in most of the hospitals for newborns with high bilirubin levels. The present study aimed to determine the effects of phototherapy on outer hair cell (OHC) function of cochlea. Methods: Twenty-two neonates with hyperbilirubinemia undergoing phototherapy and 22 neonates without any high-risk registers were included in the study. Distortion product otoacoustic emission (DPOAE) was administered before and after phototherapy. Auditory brainstem response (ABR) evaluation was done during the postphototherapy recording. Results: Results showed that DP amplitude and signal-to-noise ratio improved significantly after phototherapy. ABR evaluation revealed; 19 neonates had significantly prolonged wave V latency compared to normal, whereas no peaks were identified among three neonates. Most of the infantile hyperbilirubinemia are found to be harmless until and unless treatment is not initiated at the earliest, but still it is found that short-term increase in bilirubin level can induce temporary changes in OAEs and ABR measures. ABR needs to be repeated over a period of time for these three neonates to rule out auditory dyssynchrony (AD). Conclusion: The results indicate that phototherapy has temporary effects on OHC function and can improve as the bilirubin levels reduce. Follow-up testing over a period of time helps in discriminating the sensory pathology and AD.
http://www.jisha.org/currentissue.asp?sabs=y

Long-term exposure to traffic noise

Effect of long-term exposure to traffic noise on acceptable noise level measures in traffic police officers p. 47
PG Vipin Ghosh, D Nagashreeya, V Hemavathi
DOI:10.4103/jisha.JISHA_24_18  
Introduction: The acceptable noise level (ANL) measure is a subjective way of identifying how much of noise a person is able to put up with while listening to speech. Individuals with low ANL were observed to be satisfied hearing users than the individuals with high ANL. However, the reason for large individual variations of the measure is still not well understood. Exposure to noise may be one such factor that would affect the ANL which was never explored. Among the individuals who are exposed to noise, majority are exposed to occupational noise. Traffic police is such a working population who is exposed continuously to traffic noise during their duty hours. Hence, the present study was planned to investigate ANL measures in traffic police officers that might further provide insight toward the heterogeneity of the measure. Methods: A total of 38 participants were divided into two groups. Group 1 consisted of 19 traffic police officers with minimum of 5 years of job experience and Group 2 consisted of normal hearing individuals without any noise exposure. All the participants underwent routine audiological evaluations followed by ANL testing. Results: The mean ANL obtained in both the groups was statistically compared. The results revealed that the traffic police officers yielded better ANLs than participants in Group 2. Conclusion: This ability of traffic police officers to put up with more noise while listening to speech may be attributed to their long-standing experience in listening to wanted signals in noise.
http://www.jisha.org/currentissue.asp?sabs=y

“Slime” dermatitis, a fad‐associated chronic hand dermatitis - Kondratuk - - Pediatric Dermatology - Wiley Online Library

"Slime" is the colloquial name for a non‐Newtonian viscoelastic putty‐like substance that is currently a popular plaything among pre‐teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime‐associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13729

The impact of pediatric atopic dermatitis on families: A review - Yang - - Pediatric Dermatology - Wiley Online Library

Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well‐documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance.

Objective
This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD.

Methods
A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD.

Results
Caring for children affected by AD can be an extremely time‐consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement.

Conclusions
Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13727

Successful treatment of hemorrhagic bullous Henoch‐Schonlein purpura with intravenous immunoglobulins - Mauro - - Pediatric Dermatology - Wiley Online Library

Henoch‐Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. There is no consensus about the management for isolated cutaneous manifestations in HSP. We describe a case of HSP presenting with severe skin lesions that did not respond to standard therapy with corticosteroids. The 11‐year‐old child was treated with intravenous immunoglobulins, which induced rapid and persistent resolution of symptomatology.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13715

Biology of human melanocyte development, Piebaldism, and Waardenburg syndrome - Saleem - - Pediatric Dermatology - Wiley Online Library

Melanocyte development is orchestrated by a complex interconnecting regulatory network of genes and synergistic interactions. Piebaldism and Waardenburg syndrome are neurocristopathies that arise from mutations in genes involved in this complex network. Our understanding of melanocyte development, Piebaldism, and Waardenburg syndrome has improved dramatically over the past decade. The diagnosis and classification of Waardenburg syndrome, first proposed in 1992 and based on phenotype, have expanded over the past three decades to include genotype. This review focuses on the current understanding of human melanocyte development and the evaluation and management of Piebaldism and Waardenburg syndrome. Management is often challenging and requires a multidisciplinary approach.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13713

Focal facial dermal dysplasia type 4.Bilateral preauricular scarlike defects surrounded by a hair collar, resembling membranous aplasia cutis congenita.

We present a rare case of focal facial dermal dysplasia type 4 (FFDD4) in an otherwise healthy boy infant, presenting as bilateral preauricular scarlike defects surrounded by a hair collar, resembling membranous aplasia cutis congenita. The presence of a hair collar supports the hypothesis that FFDD is caused by abnormal closure at facial embryonic fusion lines, but unlike midline scalp defects is not associated with neurological compromise. Other types of FFDD occur at different sites and can be associated with cranial dysgraphism. Awareness of this rare condition by dermatologists is imperative to enable prompt recognition and minimize diagnostic delay.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13730

Bullous pemphigoid in adolescence - Patsatsi - - Pediatric Dermatology - Wiley Online Library

Bullous pemphigoid (BP) is the most common autoimmune blistering disease affecting the elderly but is quite rare in childhood. The majority of pediatric cases have been reported during early childhood. Adolescence is divided into three phases: early (10‐13 years), middle (14‐17), and late (18‐21). This review aimed to identify BP cases in adolescence and demonstrate their clinical features and course. Our literature search was performed in Medline with the terms "bullous pemphigoid in childhood and adolescence," "childhood bullous pemphigoid," "juvenile bullous pemphigoid," and "autoimmune blistering and autoimmune bullous diseases in childhood." The data extraction for late adolescence was limited by the fact that this age group is included in adult BP registries. We identified nine cases in early adolescence. Mucosa were affected in 5 of 9 cases. Treatment consisted of systemic prednisone (8/9), in combination with dapsone (2/9), azathioprine (2/9), or erythromycin/nicotinamide (1/9). Relapses were reported in 3 of 9 cases. We identified five cases occuring in middle adolescence. Mucosa were not affected. Treatment consisted of systemic prednisone (5/5), in combination with dapsone (3/5), azathioprine (2/5), doxycycline/nicotinamide (1/5), or mycophenolate mofetil (1/5). Relapses were reported in two of five cases. No case of BP in the late adolescence was included in the results, as only one case met the search criteria, and overlapped with pemphigus vulgaris. With only 14 cases found in our review, BP in adolescence appears even rarer than in earlier childhood. Despite its low prevalence, BP should be included in the differential diagnosis of autoimmune blistering diseases in adolescents.
https://onlinelibrary.wiley.com/doi/10.1111/pde.13717

Quantitative Evaluation of Nasolabial Alterations following Nasoalveolar Molding (NAM) Therapy in Patients with Unilateral Cleft Lip

Facial plast Surg
DOI: 10.1055/s-0038-1675633

The clinical benefit of nasoalveolar molding (NAM) is actively debated between cleft centers without clear consensus. Nasolabial measurements were performed on pediatric patients with unilateral clefts of the lip, with or without cleft palate, at an academic cleft/craniofacial center prior to and following NAM therapy between June 2015 and August 2016. The parameters of interest were: columella height and width, cleft nostril height and width, and lip width. Measurements were performed using photographs taken alongside a reference object. The image output was then scaled to the size of the reference object and the capture angle. Intraclass correlation coefficient was calculated to assess reliability of the photographic measurements. Descriptive statistics (mean, standard deviation [SD]) were calculated to characterize the pre- and post-NAM measurements. Student's t-tests were performed to compare the pre-NAM versus post-NAM measurements. The primary objective was to measure the effect of NAM on the nasal aesthetic units that are known to be anatomically aberrant in the cleft lip patient. Nine patients were included in this study. Average pre-NAM age was 2.5 weeks, and average post-NAM age was 13 weeks. Average columellar height increased from 3.70 mm (SD = 0.14) pre-NAM to 5.85 mm (SD = 1.96) post-NAM (p < 0.01); average columellar width increased from 4.71 mm (SD = 0.49) to 5.93 mm (SD = 0.71) (p < 0.01); average cleft nostril height increased from 3.54 mm (SD = 2.97) to 6.81 mm (SD = 2.98) (p = 0.01); and average cleft nostril width decreased from 15.46 mm (SD = 2.91) to 11.05 mm (SD = 1.01) (p = 0.01). Average lip width decreased from 34.61 mm (SD = 1.73) to 33.87 mm (SD = 3.67); however, this change was not statistically significant (p = 0.16). This study objectively quantifies positive changes in nasal aesthetics associated with NAM therapy, providing further evidence for its utility as a presurgical treatment modality for optimal aesthetic nasal results in the unilateral cleft lip patient. The major limitation of this study was a lack of control group, as our center universally treats complete unilateral cleft lip patients with NAM therapy. However, the authors strongly believe that the positive aesthetic nasal findings would persist if compared with a non-NAM control group.
[...]

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

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

http://bit.ly/2QOBzZA

Diffusion-Weighted Magnetic Resonance Imaging in the Detection of Residual and Recurrent Cholesteatoma in Children: A Systematic Review and Meta-Analysis

Publication date: Available online 26 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Khalil Bazzi, Eugene Wong, Nicholas Jufas, Nirmal Patel

Abstract

Objective

To examine the performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in the detection of residual and recurrent cholesteatoma in children.

Methods

A systematic review and meta-analysis was conducted as per PRISMA guidelines using the following databases from their date of inception: MEDLINE, PubMed, Embase, Cochrane Library, Web of Science. Bivariate meta-analysis using a random effects model was used to calculate summarized pooled estimates of sensitivity, specificity, and diagnostic odds ratios, using second-look surgery as the gold standard comparison.

Results

A total of ten articles (141 cases) were included for qualitative and quantitative analysis. Pooled sensitivity and specificity of non-echo planar imaging (non-EPI) DW-MRI were 89.4% (95%CI 51.9%-98.5%) and 92.9% (95%CI 81.4%-97.5%) respectively. DW-MRI appears limited in its ability to detect lesions less than 3mm in size.

Conclusion

Non-EPI DW-MRI is highly specific but carries uncertain sensitivity in the detection of residual and recurrent cholesteatoma in children. Further research is warranted to determine the specific role of DW-MRI in this patient group, namely when and how often children should be referred for imaging and in which cases the method can be used to completely replace second-look surgery.

http://bit.ly/2VaZPne

Deep interarytenoid notch in young children managed with systematic thickener wean and injection laryngoplasty

Publication date: Available online 26 December 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Usmaan Basharat, Scott Schraff, Lindsay M. Stevens, Pamela Y. Clarke, Paul Kang, Jim Woodward, Shauna R. Schroeder, Aparna Rao, Nathan Page, Dana I. Williams

Abstract

Objectives

Deep interarytenoid notch (DIN) is a congenital variation of the larynx often associated with dysphagia and aspiration (DA) in young children. Feeding therapy with thickeners and surgical management with injection larygoplasty (IL) are used with various efficacies. Thickeners address the functional domain and IL addresses the anatomical domain of treatment. Our objective was to evaluate DIN patients managed with both interventions.

Methods

We conducted a retrospective pilot descriptive study of DIN patients with DA aged 1-3 years receiving thickeners and IL. Patients received a systematic weekly reduction of thickeners, referred to as the Thickener Weaning Protocol (TWP), based on clinical signs and symptoms of DA. The outcomes were assessed by the rate of thickener level reduction and DA-related sign/symptom frequency achieved at 6 months post-treatment.

Results

Thirteen patients with DIN associated DA were analyzed. The TWP was initiated within 2 months in 77% of patients, and within 4 months in 100% of patients. Thickener scores improved from an average of 5.76 (3/4 honey) to 2.15 (thin) (p = 0.001). DA-related signs/symptoms frequency improved from an average of 3.3 to 0.84 (p = 0.05).

Conclusions

These findings suggest that treatment of DIN associated DA with a combination of thickeners and IL results in significant clinical improvements in young children.

http://bit.ly/2Q3mRsx

Updates in management of acute invasive fungal rhinosinusitis

Purpose of review Acute invasive fungal rhinosinusitis (AIFRS) is a rare and often fatal disease, that remains incompletely understood. Case series and literature reviews constitute most of the literature on AIFRS, and act as the standards by which we treat these extremely complex patients. This review discusses management of AIFRS, with focuses on optimal diagnostic and therapeutic strategies. Recent findings Mortality rates remain high, around 50% overall, though some recent studies have shown higher survival rates with early diagnosis and complete surgical resection. Some recent publications on AIFRS have focused on the utility of frozen section analysis both to diagnose and potentially guide the completeness of endoscopic surgical debridement. It was also recently shown that complete endoscopic resection of disease leads to higher survival than when disease was incompletely resected. Additionally, a new antifungal agent was recently approved by the FDA, which has a more favorable pharmacologic and side effect profile, though more studies are necessary to determine its utility. Summary Early diagnosis requires identification of sinusitis symptoms in immunocompromised patients, followed by intranasal biopsy and frozen section analysis. Early surgical debridement and antifungal therapy then remain the cornerstones of AIFRS management. Video abstract See Video, Supplemental Digital Content 1, http://bit.ly/2BKeblx. Correspondence to John R. Craig, MD, Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA. Tel: +1 313 971 9320; fax: +1 313 916 7263; e-mail: JCraig1@hfhs.org. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2QPN9Uo). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2BGEFVj

Analysis of neuromonitoring signal loss during retroauricular versus conventional thyroidectomy

Objective

Loss of signal (LOS) during intraoperative neuromonitoring (IONM) of robotic or endoscopic thyroidectomy via a retroauricular approach (RAT) and during conventional open thyroidectomy (COT) was investigated to compare the risk of recurrent laryngeal nerve (RLN) injury between the two groups.

Study Design

Original article.

Methods

This is a retrospective case series study performed between May 2014 and September 2016. IONM using the NIM 3.0 system (Medtronic Xomed, Inc., Jacksonville, FL) was used for this study. Pre‐ and postoperative vocal cord functions were assessed using a flexible laryngoscope. LOS types noted intraoperatively and their associations with postoperative vocal cord palsy (VCP) were evaluated. LOS rate and temporary and permanent VCP rates were compared between the two groups. The surgical events associated with LOS were also documented and analyzed in this study.

Results

In total, 153 patients were recruited, and 111 patients were enrolled in the RAT group; the remaining 42 patients were enrolled in the COT group. No statistically significant differences in intraoperative LOS (P = 0.812) and postoperative VCP rates (early, permanent; P = 0.259 and P = 0.577, respectively) between the two groups were observed. IONM accuracy of predicting postoperative VCP was 99.1% in our case series.

Conclusion

On the basis of IONM findings, the risks of injury to RLN were similar between the two groups. Comparison of LOS was an objective method for verifying the novel RAT approach. We applied our IONM protocol and troubleshooting algorithm during RAT with acceptable accuracy, but the international standardized method of IONM is applicable and recommended for reducing false results using vagal nerve stimulation.

Level of Evidence

3b. Laryngoscope, 2018

http://bit.ly/2ENJJtX

Prevention of tracheal stenosis with pirfenidone after tracheotomy: An experimental study

Objectives

In this study, pirfenidone's role about reducing tracheal stenosis by suppressing fibrosis and inflammation was examined.

Methods

Tracheotomy was performed on 14 rats, and their cannulas were fixed to tracheotomy area by stoma suture. Two working groups were established. Rats in the first group were given 15 mg/kg/day (1 mL pirfenidone solution) pirfenidone intraperitoneally for 10 days. In the second group as a control group, 1 mL saline solution was applied intraperitoneally. Ten days later, rats were decanulated and kept alive for 3 more weeks.

Anesthetized rats were sacrificed on day 30. All rat tracheas were resected between the first and seventh rings. Epithelial damage, inflammation, and fibrosis were determined histopathologically; diameters of intratracheal lumen and their mucosal thickness parameters were determined histomorphometrically; and TGFβ‐1 (the growth factor beta), TNFα (tumor necrosis factor alpha), and IL‐1β (Interleukin‐1 beta) values were determined immunohistochemically.

Results

According to the parameters of the control group, fibrosis; diameters of intratracheal lumen; and values of TGFβ‐1, TNFα, and IL‐1β were found to be statistically significant.

Conclusion

In our study, it was found that pirfenidone reduces fibrosis and narrowing of intratracheal lumen diameter significantly.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2EOwhXK

Factors associated with epiglottic petiole prolapse repositioning success

Objective

Epiglottic petiole prolapse is an overlooked entity that could lead to supraglottic airway obstruction for patients with complex airway history. Classical symptoms include exercise intolerance, obstructive sleep apnea, and difficulty with decannulation. The goal of this project was to evaluate the factors associated with epiglottic petiole repositioning success.

Methods

Retrospective case series of patients with a complex history of airway reconstruction evaluated by the aerodigestive team at a tertiary pediatric hospital from May 2003 to August 2017. All patients underwent repositioning for petiole prolapse.

Results

We had a total of 59 patients (14 females, 23.7%) with complex airway anomalies with petiole prolapse noted during a microlaryngoscopy and bronchoscopy. Mean age was 12.9 ± 6.1 year old (range 1.3–35.9). Patients had a history of 2.2 (1–5) open airway surgeries, and 51 of 58 (87.9%) of them had a prior complete laryngofissure. Laryngotracheoplasty and petiole repositioning were performed as a double‐stage surgery for 54 of 58 (91.5%) patients. Epiglottic petiole prolapse was persistent in 20 patients (33.9%) and became symptomatic for 14 of them (23.7%). The main preventive factor of petiole prolapse recurrence was pre‐epiglottic fat debulking at the time of the repositioning, with an odds ratio of 0.06 (95% confidence interval 0.007–0.6, P = 0.01). Stent placement, longer duration of stent placement, and double‐stage procedure also increased the likelihood of success (all P < 0.05).

Conclusion

Patients with petiole prolapse have a history of complete laryngofissure and multiple open airway surgeries. Pre‐epiglottic fat debulking and longer stent placement at the time of the repositioning surgery appear to significantly increase the long‐term success rate.

Level of Evidence

4. Laryngoscope, 2018

http://bit.ly/2EJ6RKl

Laryngeal reconstruction for recurrent desmoid tumor using three‐dimensional modeling: A unique approach for a rare tumor

Desmoid tumors are exceedingly rare within the larynx and cause significant morbidity due to their locally aggressive and infiltrative nature. Surgery is the mainstay of treatment with previous reports describing total and near‐total laryngectomy for cure. We present a case of recurrent glottic desmoid tumor managed with hemilaryngectomy and reconstructed with temporoparietal free tissue, rib, and buccal grafts. Three‐dimensional modeling was utilized to optimize aerodigestive function after laryngeal reconstruction. Laryngoscope, 2018

http://bit.ly/2ESO6VA

Diode laser thermal effect on the paranasal sinus osteoma

http://bit.ly/2EMkF6E

Pharyngobasilar fascia as a landmark in endoscopic skull base surgery: The triangulation technique

http://bit.ly/2EQazm6

Over‐the‐Counter Tinnitus “Cures”: Marketers’ Promises Do Not Ring True

Objectives

The Clinical Practice Guideline of the American Academy of Otolaryngology–Head & Neck Surgery (2014) stated that clinicians should not recommend dietary supplements for the treatment of tinnitus. The aim of this study is to characterize over‐the‐counter tinnitus remedies (OTCTR) on the U.S. market, describe the ingredients and prices, and characterize the methods of promoting these products.

Methods

OTCTR were identified via Web search and visits to retail establishments. Information was collected regarding OTCTR chemical composition, product labeling, advertisements and marketing, price, and customers reviews.

Results

A wide array of unproven OTCTR exist on today's market. All make unfounded claims of relief from ear ringing. Most of the products considered in this study consist of mixtures of inexpensive and common vitamins, minerals, and/or herbs sold at a premium compared to similar preparations not expressly advertised for tinnitus. Certain brands, most notably Arches Tinnitus Formula (Arches Natural Products Inc., Salt Lake City, UT) and Lipo‐Flavonoid (Clarion Brands Inc., Solon, OH), target otolaryngologists by advertising in specialty journals and prominently featuring supposed endorsement by "Ear‐Nose‐and‐Throat Doctors" in their marketing.

Conclusion

It is important for otolaryngologists who are caring for tinnitus sufferers to be aware that a robust and diverse market exists for unproven OTC tinnitus remedies. It is troubling that heavily advertised brands profess support by otolaryngologists. Responsible specialty organizations in the field should consider opposing such commercially motivated representations. Otolaryngology journals may wish to adopt a policy along the lines of The Journal of the American Medical Association publications to decline advertisements of dietary supplements that make unproven therapeutic claims.

Level of Evidence

5. Laryngoscope, 2018

http://bit.ly/2EQ0QeC

The Impact of Nasalance on Cepstral Peak Prominence and Harmonics‐to‐Noise Ratio

Objectives/Hypothesis

Cepstral peak prominence (CPP) has been reported as a reliable measure of dysphonia and a preferred alternative to harmonics‐to‐noise ratio (HNR). However, CPP has been observed to be sensitive to articulatory variation and vocal intensity. The aim of this study was to examine the impact of nasalance on CPP and HNR of voice signals. It was hypothesized that increased nasalance would be associated with decreased CPP.

Study Design

Within‐subject correlation design.

Methods

Thirty vocally healthy female participants were recorded reading and producing a vowel in alternation with a nasal consonant while wearing a nasometer for calculation of nasalance. Recorded vowel, nasalized, and nasal segments of speech were used to calculate CPP using Analysis of Dysphonia in Speech and Voice software, and HNR and vocal intensity using Praat software.

Results

Significant main effects of conditions were observed for CPP. CPP values decreased significantly when phonation changed from vowel to nasalized vowel and to nasal. There was correlation between CPP and nasalance and between CPP and intensity. HNR was slightly higher in the nasal condition than in vowel. There was a weak correlation between HNR and nasalance. No correlation was found between HNR and intensity.

Conclusions

CPP is sensitive to changes in vocal tract configuration caused by nasalization as well as intensity, whereas HNR is not. Therefore, CPP may reflect the periodicity in source signal or the filtering effects of vocal tract. Further research is needed to clarify the application and interpretation of CPP in clinical practice.

Level of Evidence

4 Laryngoscope, 2018

http://bit.ly/2EPZXn9

CT Navigation and sialendoscopy‐assisted transfacial removal of a parotid stone: A technical note

http://bit.ly/2EMkEQ8

Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

Objectives/Hypothesis

Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non‐opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty.

Study Design

Evidence‐based systematic review.

Methods

PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included.

Results

Thirty‐seven studies met inclusion criteria for this evidence‐based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti‐inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution.

Conclusions

Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α‐agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost‐effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large‐scale, multi‐institutional, controlled studies are needed to provide definitive recommendations.

Level of Evidence

NA Laryngoscope, 2018

http://bit.ly/2EOwfiA

The Effect of Octanoic Acid on Essential Voice Tremor: A Double‐Blind, Placebo‐Controlled Study

Objectives/Hypothesis

The purpose of this study was to determine the effects of octanoic acid on acoustic, perceptual, and functional aspects of essential voice tremor (EVT).

Study Design

Prospective, double‐blind, placebo‐controlled, crossover study.

Methods

Sixteen participants with a diagnosis of EVT were randomized to a 3‐week dosing condition of octanoic acid or placebo, followed by a 2‐week washout period and crossover to the other condition for an additional 3 weeks. Baseline and post‐testing sessions were completed before and at the completion of each condition. Primary outcome measures were the magnitude of amplitude and frequency tremor, measured from the acoustic signal. Secondary outcomes were auditory‐perceptual ratings of tremor severity and self‐ratings of voice handicap.

Results

Magnitude of amplitude and frequency tremor were significantly lower after 3 weeks of octanoic acid dosing as compared to the placebo condition. Auditory‐perceptual ratings of tremor severity did not show significant differences between conditions. A trend toward better voice was seen for the sustained vowel ratings, but not the sentence‐level ratings. No significant differences between conditions were seen on self‐reported voice disability as assessed on the Voice Handicap Index‐10.

Conclusions

The results of this controlled investigation support the potential utility of octanoic acid for reducing the magnitude of tremor in people with EVT. Further research is needed to determine whether different dosing or treatment combinations can improve functional communication in EVT.

Level of Evidence

1 Laryngoscope, 2018

http://bit.ly/2EKi4u6