Effects of a simulated system of straw phonation on the complete phonatory range of excised canine larynges

Abstract

Purpose

This study investigated the effects of straw phonation therapy on the aerodynamic and acoustic parameters of the vocal folds at different levels of elongation and subglottal pressure.

Methods

20 excised canine larynges were used in both experimental (straw phonation therapy simulation) and control conditions. Aerodynamic parameters, including phonation threshold pressure (PTP), phonation instability pressure (PIP), phonation pressure range (PPR), phonation threshold flow (PTF), phonation instability flow (PIF), phonation flow range (PFR), were obtained at different levels of vocal fold elongation (0%, 10%, 20%). Acoustic parameters, including fundamental frequency (F0), jitter, shimmer, signal noise ratio (SNR) were detected at different levels of vocal fold elongation (0%, 10%, 20%) and subglottal pressure (15 cmH₂O, 20 cmH₂O, 25 cmH₂O).

Results

Significant decreases in PTP and PTF and significant increases in PIP, PIF, PPR, and PFR occurred in experimental condition at all levels of elongation when compared with control condition. However, no significant changes of acoustic parameters were obtained between conditions at all levels.

Conclusion

At different levels of vocal fold elongation, straw phonation not only lowered the onset of normal voice, but also elevated the onset of chaotic voice, indicating a better voice economy and voice control. Moreover, the improved phonatory range demonstrated that straw phonation had the potential to prevent voice users who have high voice demand from voice fatigue and vocal damage.

http://bit.ly/2TIhscJ

Hauptsymptome und Elternerwartung bei Adenotomie und Adenotonsillotomie im Vorschulalter

Laryngo-Rhino-Otol
DOI: 10.1055/a-0816-5807

Hintergrund Um eine realistische Aufklärung vor Adeno(tonsillo)tomie zu leisten, wurden im Rahmen dieser Studie die kindliche Symptombelastung und die elterliche Erwartung an den Operationserfolg prospektiv erfasst. Material und Methoden Es wurden n = 111 Kinder (3–6 Jahre, ♂ 65 % ♀ 35 %) rekrutiert, welche an der HNO-Universitätsklinik Ulm eine Adenotomie (AT 66 %) oder Adenotonsillotomie (ATT 34 %) erhielten. In der fragebogenbasierten Befragung wurden die häufigsten Symptome und der Hauptgrund zur Operation aus Elternsicht erfasst (Operationstag, follow-up: 3,5 Mo.) und in Balkendiagrammen jeweils für Gesamtkollektiv und die Operationsgruppen AT und ATT visualisiert (Signifikanzniveau auf α = 5 %). Ergebnisse Am häufigsten wurden von den Eltern Zeichen einer Atemproblematik (Mundatmung 87 %, Nasenatmungsbehinderung 86 %, Schnarchen 78 %), Hörminderung (68 %) und vermehrter Infektneigung (66 %) beobachtet. Als Hauptgrund zur Operation wurden Nasenatmungsbehinderung (77,5 %) und Hörminderung (53,2 %) genannt. Bei reiner Rachenmandelhyperplasie dominierten Hörprobleme, während bei zusätzlich indizierter Tonsillotomie nächtlichen Apnoen als Operationsgrund am häufigsten genannt wurden. Bei allen abgefragten Symptomen konnte postoperativ eine wesentliche Verbesserung erzielt werden. Schlussfolgerungen Bei differenzierter Indikationsstellung ist es möglich, die Eltern über eine sehr gute und realistisch zu erwartende, effektive Symptomreduktion nach AT und ATT zu informieren.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://bit.ly/2VzO4qG

Nasofacial Anthropometric Study Among Students of Shiraz University of Medical Sciences, Iran: A Population Based Study

Abstract

Anthropometry is a scientific study of linear dimensions and angles of living subjects. Knowing the details and anthropometric properties of nasofacial for each specific ethnic group is important for cosmetic operation as well as identifying individuals. In this study, facial and nasal anthropometric factors were studied in students of Shiraz University of Medical Sciences. In a cross-sectional study, 200 students of Shiraz University of Medical Sciences (100 male and 100 female and age range of 18–30 years) were selected. Nasal width (NW), nasal length (NL), nasal height (NH), face height (FH) and face width (FW) were measured in and the nasal (NI) and facial index (FI) were calculated for each case. Then, the data were analyzed using SPSS-22. The mean age was 21.84 ± 3.18 years. There were significant differences in the facial and nasal measurements including FH (P = 0.0001), FW (P = 0.0001), FI (P = 0.0001), NL (P = 0.002), NH (P = 0.001), NW (P = 0.0001) and NI (P = 0.0001) of sex groups. The most common types of face were mesoprosopic (36%) and hyperleptoprosopic (38%) types and and platyrrhine (63%) were mostly frequent. Based on the findings, all students of Shiraz University of Medical Sciences had mesoprosopic (36%) and hyperleptoprosopic (38%) types of face and platyrrhine type of nose. As well, a sexual dimorphism was recorded according to the nasofacial measurements in Iranian population that should be considered in the cosmetic operations. Sexual dimorphism and differences between different populations were recorded.

http://bit.ly/2ACbgM0

Nasofacial Anthropometric Study Among Students of Shiraz University of Medical Sciences, Iran: A Population Based Study

Abstract

Anthropometry is a scientific study of linear dimensions and angles of living subjects. Knowing the details and anthropometric properties of nasofacial for each specific ethnic group is important for cosmetic operation as well as identifying individuals. In this study, facial and nasal anthropometric factors were studied in students of Shiraz University of Medical Sciences. In a cross-sectional study, 200 students of Shiraz University of Medical Sciences (100 male and 100 female and age range of 18–30 years) were selected. Nasal width (NW), nasal length (NL), nasal height (NH), face height (FH) and face width (FW) were measured in and the nasal (NI) and facial index (FI) were calculated for each case. Then, the data were analyzed using SPSS-22. The mean age was 21.84 ± 3.18 years. There were significant differences in the facial and nasal measurements including FH (P = 0.0001), FW (P = 0.0001), FI (P = 0.0001), NL (P = 0.002), NH (P = 0.001), NW (P = 0.0001) and NI (P = 0.0001) of sex groups. The most common types of face were mesoprosopic (36%) and hyperleptoprosopic (38%) types and and platyrrhine (63%) were mostly frequent. Based on the findings, all students of Shiraz University of Medical Sciences had mesoprosopic (36%) and hyperleptoprosopic (38%) types of face and platyrrhine type of nose. As well, a sexual dimorphism was recorded according to the nasofacial measurements in Iranian population that should be considered in the cosmetic operations. Sexual dimorphism and differences between different populations were recorded.

http://bit.ly/2ACbgM0

Outcome prediction for Bonebridge candidates based on audiological indication criteria

To re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.

http://bit.ly/2VH59Pp

SEVERE OSAS CAUSES SYSTEMIC MICROVASCULAR DYSFUNCTION. CLINICAL EVALUATION OF NINETY‐EIGHT OSAS PATIENTS

Abstract

Obstructive sleep apnea syndrome is described as "Sleep disorder characterized by recurrent episodes of upper respiratory tract obstruction (apnea) and decreased blood‐oxygen saturation occurring during sleep".

The assessment of systemic microvascular density and reactivity is important for cardiovascular disease pathophysiology and cardiovascular risk classification.

Cutaneous microcirculation which can be demonstrated via nailfold capillaroscopy is an easily accessible and acceptable non‐invasive method for the assessment of systemic microcirculation.

OSAS was also explained with various physiopathological mechanisms which may cause microvascular dysfunction.

Capillary density and reactivity in patients with severe OSAS (AHI≥30) are the predictors of systemic microvascular dysfunction and they should be considered as the cause of future cardiovascular events.

This article is protected by copyright. All rights reserved.

http://bit.ly/2H3M0nA

Issue Information

http://bit.ly/2sjb1Bi

Surgical management of suprastomal tracheal collapse in children

Publication date: Available online 8 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Ali Tawfik, Hisham Atef Ebada, Ahmed Musaad Abd El-Fattah, Elsharawy Kamal

Abstract

Objective

Suprastomal collapse is a complication of pediatric tracheotomy with a potential impact on decannulation success. The aim of this study was to review the experience in the management of pediatric suprastomal collapse in a tertiary-care center, detailing the surgical technique employed.

Methods

This study included 12 tracheotomised children with the diagnosis of suprastomal collapse in the last 5 years. All patients of the study underwent surgical intervention to manage suprastomal collapse to achieve tracheotomy decannulation. The surgical procedure entailed dissection of the pre-existing tracheotomy tract down to the trachea, then excision of the tract flush with the anterior tracheal wall. The tracheal opening was closed transversely with 3-4 interrupted absorbable sutures placed in craniocaudal direction.

Results

At the end of treatment all patients were decannulated successfully. No intraoperative complications were reported. Minor postoperative complications were reported in 3 children in the form of mild surgical emphysema (n=2) and wound infection (n=1). Those patients were successfully managed conservatively.

Conclusion

This technique is a simple and effective procedure enabling immediate decannulation with very low morbidity. In a long term follow up period, no recurrence has been reported and all patients returned to their usual quality of life.

http://bit.ly/2QyGJUt

Establishment of an immortalized human subglottic epithelial cell line

Objective

Translational research into subglottic disease is restricted by the availability of primary human tissue originating from this subsite. Primary epithelial cells are also limited by their inability to survive beyond several divisions in culture outside of the body. Specific subglottic cell lines, useful for in vitro studies, have not yet been described. We therefore demonstrate what we believe to be the first immortalized subglottic epithelial cell line.

Methods

Subglottic tissue was derived from a single adult patient's neoplasia‐free human subglottic brushing specimen. Cells were immortalized using a lentiviral vector expressing simian virus 40 T antigen. Karyotyping was performed on the transformed cells using single nucleotide polymorphism array comparative genomic hybridization. Transformed cells were phenotypically characterized by light microscopy, immunohistochemistry, and electrophysiology studies.

Results

The immortalized subglottic cell line (SG01) was able to divide successfully beyond 20 passages. Karyotyping demonstrated no significant genomic imbalance after immortalization. The cells demonstrated normal epithelial morphology and cytokeratin expression throughout. SG01 cells were also successfully cultured at air–liquid interface (ALI). At ALI cells demonstrated cilia, mucus production, and relevant ion channel expression.

Conclusion

The novel SG01 subglottic epithelial cell line has been established. This cell line provides a unique resource for researchers to investigate subglottic diseases, such as subglottic stenosis.

Level of Evidence

NA. Laryngoscope, 2018

http://bit.ly/2Fm0Raz

Tumor growth rate: A new prognostic indicator of hearing preservation in vestibular schwannoma surgery

Background

The management of small‐ to medium‐size (< 20 mm) sporadic vestibular schwannomas (VSs) continues to inspire debate. Preoperative pure tone thresholds and tumor size are recognized prognostic features of hearing preservation after surgery.

Objective

To investigate what preoperative characteristics were associated with nonserviceable hearing after surgery for VSs.

Methods

We retrospectively reviewed the audiological results of 92 patients treated with the middle cranial fossa (MCF) approach for resection of VSs (< 20 mm). Sex, age, symptoms, tumor site, tumor size, growth rate, and hearing class according to American Academy of Otolaryngology–Head and Neck Surgery guidelines were evaluated. Negative outcome was progression after surgery to nonserviceable hearing according to Gardner‐Robertson classification. We included only patients with preoperative serviceable hearing.

Results

After surgery, 48 patients (52.2%) had nonserviceable hearing. At univariate analysis, sex age, symptoms, tumor site, and size were not associated to hearing outcome. Tumor growth rate ≥ 2.16 mm/year (P = 0.02, odds ratio 8.5) and preoperative hearing class B (P = 0.03, OR 5.89) were statistically associated to nonserviceable hearing after VSs resection. Tumor growth rate ≥ 2.16 mm/year was also significantly associated to preoperative hearing class B (P = 0.01). At multivariate analysis, the only independent prognostic factor of progression to nonserviceable hearing in operated VSs was tumor growth rate ≥ 2.16 mm/year (P = 0.01, OR = 4.15).

Conclusion

We found a new prognostic indicator of hearing preservation after VS surgery with the MCF approach: the tumor growth rate. This feature should be further investigated before being considered in the decision‐making process of VS treatment.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2CZR4VW

Audiologic and surgical outcomes in endoscopic revision stapes surgery

http://bit.ly/2TBvNri

Laryngeal fracture presentation and management in United States emergency rooms

Objectives/Hypothesis

There are limited data on laryngeal fracture presentation and management in US emergency departments (EDs). We aimed to characterize patients who are diagnosed with laryngeal fractures in the ED and identify management patterns.

Study Design

Retrospective review of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Methods

The NEDS was queried for patient visits with a primary diagnosis of open or closed laryngeal fracture (International Classification of Diseases, Ninth Revision codes 807.5 and 807.6). Patient demographics, comorbidities, ED management, and hospital characteristics were extracted.

Results

There were 3,102 ED visits with a diagnosis of laryngeal fracture during the study period. Mean patient age was 40.9 years (range, 3–93 years). The majority of patients were male (85.5%) and sustained a closed (vs. open) fracture (91.4%), with an overall mortality rate of 3.8%. The majority of patients were treated for more than one injury during the same visit (76.2%). Most patients were evaluated at a trauma hospital (53.9%), and most patients were admitted to the hospital (71.9%). Emergent intubation or tracheostomy was rarely reported (2.6% and 0.1% of all cases), and a minority of patients underwent fiberoptic flexible laryngoscopy in the ED (1.9%). Laryngeal fractures occurred more frequently during summer months (28.2%). Mean charge for the entirety of the ED stay was $4,957.34.

Conclusions

Laryngeal fracture is rare and frequently associated with other injuries. The frequency of emergent airway procedure, imaging, and flexible fiberoptic laryngoscopy is lower than expected, raising concerns about appropriate workup and management or recognition of injury in the ED setting.

Level of Evidence

NA Laryngoscope, 2019

http://bit.ly/2CYCfmy

Evaluating the impact of adenotonsillectomy for pediatric sleep‐disordered breathing on parental sleep

Objectives/Hypothesis

To evaluate the impact of adenotonsillectomy for pediatric sleep‐disordered breathing (SDB) on parental sleep quality, daytime sleepiness, and child quality of life.

Study Design

Prospective cohort study.

Methods

Pediatric patients aged 2 to 10 years with SDB and suspected obstructive sleep apnea (OSA) requiring adenotonsillectomy were identified at a single tertiary‐care pediatric otolaryngology hospital. Parental daytime sleepiness and quality of sleep were evaluated pre‐ and postoperatively using the Epworth Sleepiness Scale (ESS) and Pittsburg Sleep Quality Index (PSQI), respectively. Child quality of life, in the context of suspected OSA, was evaluated by the Obstructive Sleep Apnea Quality of Life Survey (OSA‐18), pre‐ and postoperatively. Paired‐samples t tests were conducted to analyze data.

Results

Forty‐seven patients with a mean (standard deviation [SD]) age of 4.9 (2.2) years, participated. Mean (SD) parental age was 35.5 (4.6) years. Statistically significant decreases of 2.1 points were observed between preoperative and postoperative parental mean global ESS (P = .007; 95% confidence interval [CI]: 0.6‐3.6) and mean total PSQI (P = .001; 95% CI: 0.9‐3.1) scores. A statistically significant improvement (41.6 points) was observed between preoperative and postoperative on mean OSA‐18 scores (P < .0001; 95% CI: 35.7‐47.6).

Conclusions

Adenotonsillectomy performed in the pediatric population for SDB, with suspected OSA, can positively impact parental daytime sleepiness and sleep quality in addition to pediatric quality of life.

Level of Evidence

2 Laryngoscope, 2019

http://bit.ly/2TBvFrO

Is epiglottis surgery necessary for obstructive sleep apnea patients with epiglottis obstruction?

Objectives/Hypothesis

To examine the effect of epiglottis obstruction during drug‐induced sleep endoscopy (DISE) on the surgical results of multilevel sleep surgery without epiglottic intervention.

Study Design

Cross‐sectional study.

Methods

This investigation involved patients diagnosed with severe obstructive sleep apnea (OSA) based on preoperative polysomnography (PSG), who underwent DISE followed by multilevel OSA surgery without epiglottic intervention at Kyung Hee Medical Center (Seoul, South Korea) between March 2013 and July 2016. During DISE, obstruction patterns of the upper airway were evaluated using the velum, oropharynx, tongue base, epiglottis classification method. Follow‐up PSG was performed 3 months after surgery to determine the success rate of multilevel surgery without epiglottic intervention. A comparison was done between the group with epiglottis obstruction and the group without epiglottis obstruction.

Results

Epiglottis obstruction was observed during DISE in 43.7% of patients. After application of exclusion criteria, 54 subjects were included (27 with and 27 without epiglottis obstruction). DISE revealed an association between epiglottis obstruction and tongue base collapse (P = .02). Comparing pre‐ and postoperative PSG findings, both groups exhibited improvement postoperatively. The success rate was 44.4% in the epiglottis obstruction group and 40.7% in the non–epiglottis obstruction group (P = .80). There was no difference in surgical success rates between the two groups.

Conclusions

The prevalence of epiglottis obstruction requiring epiglottic surgery was lower than what was found during DISE. Sleep surgeons may consider staged epiglottic surgery in patients with epiglottis obstruction.

Level of Evidence

3b Laryngoscope, 2019

http://bit.ly/2FoMGBs

Recovery of olfaction after sinus surgery for chronic rhinosinusitis: A review

Objective

Investigation of the postoperative olfactory function after sinus surgery for chronic rhinosinusitis (CRS) with and without polyps in a review.

Data Sources

PubMed.

Review Methods

A comprehensive literature search was conducted through June 2018 using relevant keywords. The titles/abstracts were reviewed to identify studies evaluating the sense of smell in CRS‐patients pre‐ and postoperatively by either using the whole or parts of the University of Pennsylvania Smell Identification Test or the Sniffin' Sticks test. Study characteristics and outcome data of the included studies were extracted.

Results

In total, 106 studies were retrieved. Twenty‐four studies comprising 1,956 patients were included after quality assessment. The number of patients investigated per study was 19 to 206. In the 24 studies, 959 patients with nasal polyps and 516 without nasal polyps were described. The follow‐up times varied between 0.5 and 28 months. Twenty‐three studies reported an improved sense of smell, at least in certain subgroups. An overall improvement was seen in approximately 50% of the included patients. Nasal polyposis and preoperative anosmia were associated with a higher chance of improvement in olfaction. In those studies that commented on deterioration after sinus surgery, a decrease in olfaction was found in a range from 0% to 10% of cases.

Conclusion

Olfaction can be improved by sinus surgery in about every second patient, especially if the patient had chronic rhinosinusitis with polyps, was anosmic, and had no prior surgery. A deterioration of sense of smell after surgery is rare. Laryngoscope, 2019

http://bit.ly/2FfNny3

Outcome prediction for Bonebridge candidates based on audiological indication criteria

Publication date: Available online 8 January 2019

Source: Auris Nasus Larynx

Author(s): Wilhelm Wimmer, Moritz von Werdt, Georgios Mantokoudis, Lukas Anschuetz, Martin Kompis, Marco Caversaccio

Abstract

Objective

To re-evaluate current indication criteria and to estimate the audiological outcomes of patients with Bonebridge bone conduction implants based on preoperative bone conduction thresholds.

Methods

We assessed the outcome of 28 subjects with either conductive or mixed hearing loss (CMHL) or single-sided deafness (SSD) who were undergoing a Bonebridge implantation. We used linear regression to evaluate the influence of preoperative bone conduction thresholds of the better/poorer ear, indication group, and language (German- and French-speaking patients) on aided sound field thresholds. In addition, aided word recognition scores at 65 dB sound pressure level were fit with a logistic model that included preoperative bone conduction thresholds of the better/poorer ear, indication group, and language as effects.

Results

We found that both aided sound field thresholds and word recognition were correlated with the preoperative bone conduction thresholds of the better hearing ear. No correlation between audiological outcomes and the preoperative bone conduction thresholds of the poorer ear, language, or indication group was found.

Conclusion

Bone conduction thresholds of the better hearing ear should be used to estimate the outcome of patients undergoing Bonebridge implantation. We suggest the indication criteria for Bonebridge candidates considering maximal bone conduction thresholds of the better ear at 38 dB HL to achieve an aided sound field threshold of at least 30 dB hearing level and an aided word recognition score of at least 75% for monosyllabic words.

http://bit.ly/2SKFfbN

Non-infectious Granulomatous Lesions of the Orofacial Region

Abstract

Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.

http://bit.ly/2FhtsOp

Non-infectious Granulomatous Lesions of the Orofacial Region

Abstract

Granulomatous lesions of the orofacial region are a heterogeneous group of disorders characterized by a granulomatous reaction to a variety of stimuli. Infectious agents, foreign material, systemic inflammation and metabolic disorders can all be associated with granulomatous inflammation. In the orofacial region primary causes of granulomatosis include foreign body reaction, delayed hypersensitivity to topical agents and idiopathic orofacial granulomatosis. Secondary causes of granulomas include infectious agents, sarcoid, and Crohn disease. For this review, infectious causes of orofacial granulomatosis (OFG) including bacteria, parasites and fungi will not be discussed.

http://bit.ly/2FhtsOp

Oncolytic Sendai virus‐induced tumor‐specific immunoresponses suppress “simulated metastasis” of squamous cell carcinoma in an immunocompetent mouse model

Abstract

Background

The objectives of this study were to demonstrate anti‐metastatic effect of BioKnife, uPA activity‐dependent oncolytic Sendai virus, after BioKnife treatment for primary tumor, and analyze its mechanisms in a simulated metastasis mouse model of head and neck squamous cell carcinoma (HNSCC).

Methods

We established a simulated metastasis mouse model using a murine HNSCC cell line "SCCVII." We assessed a tumor size and an induction of tumor‐specific immunoresponses using cytotoxic T‐lymphocyte (CTL) assay, flow cytometry (FCM) in spleen and immunohistochemistry (IHC) in secondary tumor.

Results

Secondary tumors were significantly smaller in BioKnife‐treated group. CTL activities were significantly improved in BioKnife group. FCM revealed that induction of dendritic cells and CD4⁺/CD8⁺ lymphocytes was significantly higher in BioKnife group. IHC showed that CD8⁺ lymphocytes invaded secondary tumor.

Conclusion

Tumor‐specific immunoresponses induced by BioKnife has great potential to be a novel, safe, and less invasive option for control and prevention of metastasis.

http://bit.ly/2TH31FT

Histopathological features of juvenile‐onset laryngeal papillomatosis related to severity

Abstract

Background

Laryngeal papillomatosis (LP) is a disease that presents in both juvenile (JLP) and adult patients (ALP). This study correlated papillomatosis characteristics with the Derkay score.

Methods

Retrospective data and biopsies of 36 patients with JLP and 56 with ALP were collected and separated into groups according to their scores.

Results

The mean of the Derkay score, in the JLP group was 10.97 and in Group ALP was 8.26. The JLP group presented a more aggressive result than in the adult group (P = .02). In the JLP group, the respiratory difficulty (P = .01) and tracheostomy were correlated to a higher Derkay score (P < .05). Microscopically, the JLP samples presented a higher incidence of atypical mitosis and mitosis above the basal cells layer of the epithelium (P < .05) and these characteristics were correlated with a higher Derkay index (P = .03).

Conclusion

Findings suggest that ALP and JLP can present different clinical courses and histopathological features. There was a higher degree of LP severity in JLP.

http://bit.ly/2CZdyqb

Department of Veterans Affairs Consensus: Preradiation dental treatment guidelines for patients with head and neck cancer

Abstract

Few protocols have been published for the dental management of patients with head and neck cancer to prevent complications from head and neck radiation therapy. Radiation therapy not only affects the tumor cells targeted, but also the dentition, bone, salivary gland, and oral soft tissue structures. A comprehensive dental evaluation prior to head and neck radiation therapy can help prevent many complications. The following clinical guidelines were established by a workgroup of oral health providers within the Department of Veterans Affairs. This workgroup focused on developing a set of recommendations regarding dental care prior to the initiation of head and neck radiation therapy based on the best clinical evidence and expert consensus. A systematic algorithm was developed for the evaluation including pre‐exam data gathering, examination, education, and treatment, followed by maintenance and postradiation dental follow‐up. This document is evidence‐based, patient‐centered, consistent with accepted practices of care and safety, and in accordance with applicable statutes and regulations.

http://bit.ly/2TDRA1l

The prognostic value of volumetric reduction of the target lesions after induction chemotherapy in locoregionally advanced nasopharyngeal carcinoma

Abstract

Background

We explored whether the volumetric reduction ratio of target lesion after induction chemotherapy (IC) had any prognostic value in nasopharyngeal carcinoma (NPC).

Methods

From 2013 to 2016, 72 NPC patients treated with PCF (paclitaxel, cisplatin, 5‐fluorouracil) IC followed by cisplatin‐based concurrent chemoradiotherapy were analyzed. The volumes of target lesions before and after IC and survival conditions were assessed.

Results

For all cases, volumetric reduction ratios of the total tumor load ≥ optimal cutoff values were significantly associated with increased 2‐year progression‐free survival, locoregional failure‐free survival, and distant metastasis‐free survival (DMFS) rates, and for cervical lymph nodes, the volumetric reduction ratio ≥ optimal cutoff value was significant for DMFS (all P < .05). Accordingly, the optimal cutoff values were 24.56% (AUC = 60.5%), 23.91% (AUC = 57.7%), 29.77% (AUC = 75.8%), and 34.17% (AUC = 62.5%), respectively.

Conclusion

Volumetric reductions of target lesions after IC are independent survival predictors for NPC, especially for those with N2/N3 disease.

http://bit.ly/2CZtJ71

Determinants of long‐term survival in a population‐based cohort study of patients with head and neck cancer from Scotland

Abstract

Background

We investigated long‐term survival from head and neck cancer (HNC) using different survival approaches.

Methods

Patients were followed‐up from the Scottish Audit of Head and Neck Cancer. Overall survival and disease‐specific survival were calculated using the Kaplan–Meier method. Net survival was calculated by the Pohar‐Perme method. Mutually adjusted Cox proportional hazards models were used to determine the predictors of survival.

Results

A total of 1820 patients were included in the analyses. Overall survival at 12 years was 26.3% (24.3%, 28.3%). Disease‐specific survival at 12 years was 56.9% (54.3%, 59.4%). Net survival at 12 years was 41.4% (37.6%, 45.1%).

Conclusion

Determinants associated with long‐term survival included age, stage, treatment modality, WHO performance status, alcohol consumption, smoking behavior, and anatomical site. We recommend that net survival is used for long‐term outcomes for HNC patients—it disentangles other causes of death, which are overestimated in overall survival and underestimated in disease‐specific survival.

http://bit.ly/2TCdxOE

Impact of retropharyngeal lymph node dissection in the surgical treatment of hypopharyngeal cancer

Abstract

Objectives

To evaluate the impact of retropharyngeal lymph node (RPLN) dissection in the surgical treatment of hypopharyngeal cancer.

Methods

Between 2007 and 2016, 98 previously untreated patients with pathological diagnosed hypopharyngeal squamous cell carcinoma underwent total pharyngolaryngectomy and bilateral neck dissection at Kobe University Hospital. Bilateral dissection of RPLN was simultaneously performed in all patients. Pharynx was reconstructed with free jejunal transfer in 94 patients and primarily closed in 4 patients. Postoperative chemoradiotherapy was performed in patients with high risk factors including metastasis to RPLN, multiple lymph node metastasis, extranodal invasion, and/or positive/close surgical margins.

Results

The median follow‐up period was 25 months ranging from 1 to 105 months. RPLN adenopathy was preoperatively identified in 9 patients in FDG‐positron emission tomography. All of them had pathologically diagnosed RPLN metastases, which had been controlled in all patients during the observation periods. Among the other 89 patients, 7 patients had RPLN metastasis. The 2‐year overall survival rates of the patients with and without RPLN metastasis were 65.7% and 69.8% (P = .61), respectively.

Conclusions

In the present study, patients with RPLN metastasis showed equally favorable oncological outcome compared with patients without RPLN metastasis. At least, ipsilateral RPLN dissection should be considered in the surgical treatment of advanced hypopharyngeal cancer and multiple neck lymph node metastasis regardless of primary subsite.

http://bit.ly/2CYLm72

Prognostic significance of tumor budding, tumor‐stroma ratio, cell nests size, and stroma type in laryngeal and pharyngeal squamous cell carcinomas

Abstract

Background

Despite immune microenvironment of head and neck squamous cell carcinoma (HNSCC) has been studied, there are no sufficient data on the role of tumor stroma factors. The aim of the study was to explore the prognostic and predictive role of these factors in a large series of HNSCC.

Methods

This is a retrospective study of 266 patients with laryngeal and pharyngeal SCC. Clinical data were correlated with the following histological parameters: tumor‐stroma ratio (TSR), tumor budding activity (BA), cell nests size (CNS), and stroma type.

Results

Stroma‐rich tumors, tumor budding, smaller CNS at core and front area, and fibroblastic stroma type, were all adverse prognostic factors (P < 0.0001, 0.001, 0.003, 0.001, 0.007, respectively). Stroma‐poor tumors and with larger CNS showed good response to induction chemotherapy (P = 0.009 and 0.02, respectively).

Conclusions

TSR, tumor budding, CNS, and stroma type are important prognostic and predictive factors in laryngeal and pharyngeal SCC.

http://bit.ly/2TDf9HE

IMRT‐based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

Abstract

Background

Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence.

Methods

Retrospective analysis of 58 patients with head and neck CUP treated with intensity‐modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013.

Results

There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx‐sparing approach was associated with improved outcomes for strictures and PEG use.

Conclusion

In this single institution study, a 56 Gy IMRT‐based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx‐sparing IMRT.

http://bit.ly/2CZtzMX

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Abstract

Background

Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed "sensory dysphagia" and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia.

Methods and Results

Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation.

Conclusions

Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.

http://bit.ly/2TCdhiE

Impact of lymph node sampling on survival in cN0 major salivary gland adenoid cystic carcinoma

Abstract

Background

The role of elective neck dissection in the management of major salivary gland adenoid cystic carcinoma is unclear.

Methods

Data were retrospectively extracted from the National Cancer Center Database. The study cohort included 1504 patients with adenoid cystic carcinoma of major salivary glands with clinical N0 necks who were treated with surgery between 2004 and 2014. The cohort was divided into four groups based on number of lymph nodes (LNs) examined on pathology: 0, 1‐8, 9‐17, and ≥18 LNs.

Results

The rate of occult nodal metastasis was 9.0%. Number of LNs removed was not associated with survival (Reference, 0 LNs; HR = 0.98, 95% CI 0.73‐1.32 for 1‐8 LNs; HR = 1.22, 95% CI 0.80‐1.88 for 9‐17 LNs; HR = 0.94, 95% CI 0.61‐1.46 for ≥18 LNs) after adjusting for important covariates.

Conclusions

LN sampling is not associated with survival in cN0 major salivary gland ACC.

http://bit.ly/2CZ0scw

A flexible model for patient engagement: Achieving quality outcomes and building a research agenda for head and neck cancer

Abstract

Background

This article describes the benefits of patient‐driven research in the field of head and neck oncology, reviews lessons learned from establishing partnerships with patients and caregivers, and serves as a model for further patient‐driven research endeavors.

Methods

Head and neck cancer survivors underwent training including that of effective communication and the basics of research methodology. They then drove the agendas for monthly meetings that included a multidisciplinary team of providers, facilitated by a physician champion (S.S.C.).

Results

The advisors reported concrete areas for improvement of the clinical flow, including the formation of a dental oncology clinic and a post‐treatment survivorship clinic. They also refined research topics of interest, such as treatment regret. The advisors have also driven efforts to increase public awareness and have participated in cancer symposiums and local presentations.

Conclusion

Patient‐driven research improves the relevance and implementation of head and neck oncology research and clinical processes.

http://bit.ly/2TCdd2o

Classification of tumors by imaging diagnosis and preoperative fine‐needle aspiration cytology in 120 patients with tumors in the parapharyngeal space

Abstract

Background

Tumors in the parapharyngeal space are rare, and preoperative diagnosis is difficult because of anatomical and histological complexity.

Methods

To evaluate the usefulness of preoperative diagnosis, we compared the classification of tumor localization in the prestyloid and retrostyloid compartments by imaging and preoperative cytological diagnosis by fine‐needle aspiration cytology with the postoperative histopathological diagnosis in 120 patients with tumors in the parapharyngeal space.

Results

Tumors were located in the prestyloid and retrostyloid compartments in 68 and 52 patients, respectively. The majority of histopathological diagnoses in the prestyloid and retrostyloid compartments were pleomorphic adenoma and schwannoma, respectively. All malignant tumors were in the prestyloid compartment. The preoperative cytological diagnostic rate for benign or malignant tumor was 95.2%, which was not inferior to that for other head and neck lesions.

Conclusion

Our results suggested that the preoperative classification of tumor localization and cytological diagnosis improved the accuracy of presumptive diagnosis.

http://bit.ly/2CZUf01

Adjuvant external beam radiotherapy for locally invasive papillary thyroid cancer

Abstract

Background

The goal of this study was to assess the impact of adjuvant external beam radiotherapy (EBRT) on survival in patients with locally invasive papillary thyroid carcinoma.

Methods

Propensity score analysis was performed on 870 patients with surgically resected T4 papillary thyroid carcinoma, identified in the Surveillance, Epidemiology, and End Results Database between 1988 and 2013.

Results

EBRT was associated with worse overall survival (OS) (HR 1.60, 95% CI 1.18‐2.16) and disease‐specific survival (DSS) (HR 1.58, 1.09‐2.30). Subset analysis of patients with major extrathyroidal invasion showed that EBRT was associated with worse OS (HR 1.53, 95% CI 1.04‐2.25), but not with DSS (HR 1.57, 95% CI 0.99‐2.50).

Conclusion

Adjuvant EBRT, in the initial management of locally invasive papillary thyroid cancer, was not associated with a survival benefit. Future studies are needed to determine which subset of patients may benefit from adjuvant EBRT.

http://bit.ly/2TCouzo