Role of Frailty and Comorbidity in Determination of Operability for Patients With Oral and Oropharyngeal Squamous Cell Carcinoma

Abstract

Purpose of Review

To review the role of frailty and comorbidities in determining operability and associated outcomes in patients with oral and oropharyngeal squamous cell carcinoma.

Recent Findings

Frailty and comorbidity have been linked to multiple adverse outcome measures including risk of mortality, surgical complications, length of stay, intensity of care needs, discharge disposition, risk of readmission, and cost of healthcare delivery. There are diverse objective and validated measures of comorbidity and frailty. Addition of comorbidity and objective frailty measurements has been demonstrated to improve predictive power of nomograms and clinical staging systems for patients with oral and oropharyngeal squamous cell carcinoma. The use of predictive tools that assess frailty may contribute to shared decision making, realistic expectations, and facilitation of appropriate level of care. While emerging literature supports the role of prehabilitation, there is paucity of data in support of such interventions for patients afflicted by oral and oropharyngeal cancer.

Summary

Frailty assesses operability beyond anatomic resectability and incorporates key determinants of physical, nutritional, and cognitive well-being. Objective measurements of frailty predict meaningful outcomes following surgery for cancers of the oral cavity and oropharynx. This paper suggests that clinicians should objectively and routinely assess frailty, which may facilitate patient counseling, improved risk stratification, informed decision making, and further research to elucidate relationship of frailty with outcomes in head and neck specific populations.

http://bit.ly/2HleOID

Tonsillectomy plus steroid pulse therapy is the most effective treatment in adult patients with C-Grade I IgA nephropathy, and the weight of the extracted palatine tonsils and Yamamoto scale have no significant correlation with the effects of this treatment

We studied patients who underwent tonsillectomy plus steroid pulse therapy (TSP) for immunoglobulin A nephropathy (IgAN), in order to investigate the clinical factors associated with a positive response to this treatment.

http://bit.ly/2RQFFAg

Air Methods’ airway management tool published in leading trauma textbook

Air Methods' HEAVEN Criteria was established as the gold standard process for airway management in a book for NAEMT's CE program

http://bit.ly/2FH0VSw

Competence of final year otolaryngology residents with the bedside head impulse test

Abstract

Background

The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acute stroke from vestibular neuritis. However, there is evidence showing the bHIT is often not performed in appropriate clinical settings or is performed poorly. To date, there have been no studies evaluating the bHIT competence of graduating physicians.

Methods

23 final year Otolaryngology –Head &Neck Surgery (OTL-HNS) residents in Canada were evaluated on the use of bHIT using a written multiple-choice examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of subject bHIT performance were completed by two expert examiners (DT, DL) using the previously published Ottawa Clinic Assessment Tool (OCAT).

Results

Using a cut-off of an OCAT score of 4 or greater, only 22% (rater DT) and 39% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was fair (0.51, interclass correlation). The mean scores were 65% (14.1% standard deviation) on the video interpretation and 71% (20.2% standard deviation) on the multiple-choice questions. The scores on multiple choice examination did not correlate with bHIT ratings (Pearson r = 0.07) but there was fair correlation between video interpretation and bHIT ratings (Pearson r = 0.45).

Conclusion

Final year OTL-HNS residents in Canada are not adequately trained in performing the bHIT, though low interrater reliability may limit the evaluation of this bedside skill. Multiple choice examinations do not reflect bHIT skill. These findings have implications for development of competency-based curricula and evaluations in Canada in critical physical exam skills.

http://bit.ly/2Cxe0dO

Pediatric Laryngeal Electromyography Technique for Vocal Fold Immobility Using Bipolar Double Hookwire Electrodes

Publication date: Available online 18 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Sarah N. Bowe, Carissa J. Wentland, Christopher J. Hartnick

Abstract

Vocal fold immobility (VFI) is a common cause of dysphonia and dysphagia in children. Laryngeal electromyography (LEMG) is an important adjunctive test in its diagnosis and treatment. In this study, we present an alternative technique in which bipolar double hookwire electrodes allow simultaneous placement and recordings from the bilateral thyroarytenoid and posterior cricoarytenoid muscles. Details of the technique are shown for a 5 y/o F with history of Neurofibromatosis Type 2 with left VFI and aspiration and dysphonia. This modified technique for pediatric LEMG has the potential to be a useful tool in predicting return of laryngeal function.

http://bit.ly/2FMuv90

Caregiver perception of speech quality in patients with ankyloglossia: comparison between surgery and non-treatment

Publication date: Available online 18 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Srihari Daggumati, Jason E. Cohn, Matthew J. Brennan, Marissa Evarts, Brian J. McKinnon, Alyssa R. Terk

Abstract

Objectives

Our objective was to determine if there are differences in caregiver perception of speech for patients that undergo frenulectomy compared to patients that were not surgically treated.

Introduction

Ankyloglossia is a controversial topic without standardized treatment guidelines. Although there have been several studies suggesting that breastfeeding does improve after frenulectomy, there is a paucity of literature that investigates the relationship between ankyloglossia and speech.

Methods

A retrospective chart review was conducted to identify patients with ankyloglossia. Patients were categorized into surgical treatment (frenulectomy) and non-treatment groups. Caregivers of both groups were contacted by phone and surveyed on speech quality and tongue mobility using Likert scores. Mann Whitney-U testing was used to determine if there were significant differences in perceived speech quality between the surgical and non-surgical groups.

Results

The caregivers of seventy-seven patients participated in the phone survey: 46 (60%) children in the surgical group and 31 (40%) children in the non-surgical group who participated in the phone survey. There were no differences in difficulty with speech (p=0.484) and tongue mobility (p=0.064) between the two groups. However, patients that underwent surgical intervention for ankyloglossia reported less difficulty with tongue tasks (p<0.001) compared to those who were not surgically treated. Additionally, 50% of patients that underwent surgery had a documented family history of ankyloglossia which was significantly higher than 16.1% in the non-surgical group (p=0.002).

Conclusions

It appears that children with ankyloglossia might have similar speech quality following frenulectomy in comparison to speech quality without treatment. Children who undergo frenulectomy may experience improvements in tongue tasks. This data should encourage further research on the management of speech concerns in children with ankyloglossia.

http://bit.ly/2Fzbyro

Editorial Board

Publication date: February 2019

Source: Archives of Oral Biology, Volume 98

Author(s):

http://bit.ly/2CwfOnD

Effect of Er,Cr:YSGG Laser Associated with Fluoride on the Control of Enamel Erosion Progression

Publication date: Available online 17 January 2019

Source: Archives of Oral Biology

Author(s): Vilmara Rocha Mendes da Silva, Ítallo Emídio Lira Viana, Raquel Marianna Lopes, Denise Maria Zezell, Taís Scaramucci, Ana Cecília Corrêa Aranha

Abstract

Objective

To evaluate the effect of Er,Cr:YSGG laser associated or not with acidulated phosphate fluoride (APF) on the control of enamel erosion progression. Design: Enamel slabs (4 mm × 4 mm×2 mm) from bovine incisors were flattened, polished, and received a tape on their test surfaces, leaving a 4 mm x 1 mm area exposed. Specimens were eroded (10 min in 1% citric acid solution) and randomly assigned into 8 experimental groups (n = 10): Control (no treatment); F (APF gel, 1.23% F, pH 3.6-3.9); Er,Cr:YSGG laser irradiation (P1: 0.25 W, 20 Hz, 2.8 J/cm², 56 W/cm²); Er,Cr:YSGG laser irradiation (P2: 0.50 W, 20 Hz, 5.7 J/cm², 113,6 W/cm²); Er,Cr:YSGG laser irradiation (P3: 0.75 W, 20 Hz, 8.5 J/cm², 170,4 W/cm²); F + Laser P1; F + Laser P2; F + Laser P3. Specimens were then subjected to erosive cycling (5 min immersion in 0.3% citric acid solution, followed by immersion in artificial saliva for 60 min; 4×/day for 5 days). At the end of cycling, surface loss (SL, in μm) was determined with optical profilometry. Selected specimens were further evaluated by environmental scanning electron microscopy (n = 3). Data were analyzed using Kruskal-Wallis and Tukey tests (α = 0.05). Results: Group F + Laser P2 had the lowest SL value, differing significantly from the control; however, with no significant difference from the other groups. All groups, except F + Laser P2, showed no significant difference in SL when compared with the control. An irregular and rough surface, suggestive of a melting action of laser, was observed on enamel in Laser P2 and F + Laser P2 groups. Conclusions: Association of the Er,Cr:YSGG laser in parameter 2 with fluoride was the only treatment capable of controlling the progression of enamel erosion.

http://bit.ly/2RAaGcu

Cellular senescence in dental pulp stem cells

Publication date: Available online 17 January 2019

Source: Archives of Oral Biology

Author(s): Christian Morsczeck

Abstract

Objective

This short review summarizes our current knowledge about dental stem cell aging and about possible targets for the regulation of cellular senescence.

Design

A literature search was performed using a combination of keywords, e.g., stem cells, replicative senescence, differentiation potential, dental pulp, dental follicle and periodontal ligament

Results

Previous studies have shown that cellular senescence occurs while the proliferation of dental stem cells. Moreover, the differentiation potential was significantly decreased in senescent stem cells and senescent cells secrete also factors that are harmful to the adjacent tissue cells. Moreover, many targets for the regulation of cellular senescence are considered; for example pathways related to the nutrient sensing such as the 5' adenosine monophosphate-activated protein kinase (AMPK) pathway.

Conclusions

The regulation of cellular senescence will play a crucial role in the clinical use of stem cells. However, there is no cell culture protocol available that prevents dental stem cell senescence. Therefore, more knowledge about molecular processes in stem cells is needed before and after the induction of senescence.

http://bit.ly/2CxT3iP

Ewing’s Sarcoma of the Sinonasal Tract: A Report of Two Challenging Cases

Abstract

Ewing's sarcoma (ES) is a malignant small round cell tumor that belongs to the primitive neuroectodermal tumor class. ES generally arises in the long bones of the extremities (skeletal form) and less frequently in the soft tissue of the trunk and extremities (extra-skeletal form). Sinonasal localization of ES is an extremely rare event. About 80% of the patients are less than 20 years old with the highest incidence in the second decade of life. The combination of histopathological examination and ancillary methods (such as immunohistochemistry and molecular genetics) is extremely important to establish the diagnosis of ES. The most effective treatment plan for ES includes a multidisciplinary approach with surgery, radiotherapy and chemotherapy. This is a report of two challenging cases of sinonasal ES in two different age groups. The first case is a 13-years old female patient who presented with right nasal obstruction, anosmia, intermittent epistaxis and hearing loss. The second case is a 24-years old male patient who presented with a history of right nasal obstruction, right eye pain and periorbital edema. We present these cases due to the rarity of the disease and the difficulty of diagnosis.

http://bit.ly/2ARXrcJ

Perioperative Teaching and Feedback: How are we doing in Canadian OTL-HNS programs?

Discrepancies between resident and faculty perceptions regarding optimal teaching and feedback during surgery are well known but these differences have not yet been described in Otolaryngology - Head and Neck ...

http://bit.ly/2TWAmN2

Perimarginal lymph nodes: an undervalued entity in oral cancer

Abstract

Purpose

In a previous study, we gave a surgical description of a group of lymph nodes in the submandibular area at risk of remaining undissected during neck dissection (ND) for which we have proposed the term "perimarginal nodes" (PMNs) due to their proximity to marginal mandibular nerve (MMN). The aim of this study is to evaluate prevalence of PMNs involvement in oral cavity squamous cell cancer (OCSCC) and to verify if metastases are related to primary tumor characteristics or to the state of the neck.

Methods

We recruited a total of 39 consecutive patients diagnosed with OCSCC candidate to ND. Histological characteristics of PMNs were analyzed and the incidence of metastases in relation to the primary tumor characteristics were noted.

Results

PMNs were found to be involved with metastases in 8 patients (20.5%). No characteristic of the primary tumor seems to influence the metastatic involvement of the PMNs.

Conclusions

PMNs represent a frequent site of micro-metastases in patients diagnosed with OCSCC regardless of other characteristics of the primary tumor.

http://bit.ly/2QTowRW