Low-Income Children with Neonatal Hypothyroidism Are at Increased Risk for Intellectual Disability

Clinical Thyroidology, Volume 31, Issue 1, Page 14-16, January 2019.


http://bit.ly/2sAVAEo

How Can Levothyroxine Overuse Be Reduced?

Clinical Thyroidology, Volume 31, Issue 1, Page 5-7, January 2019.


http://bit.ly/2Mlx0ke

An Increased Relative but Small Absolute Risk of Leukemia Can Be Attributed to I-131 Ablation

Clinical Thyroidology, Volume 31, Issue 1, Page 30-32, January 2019.


http://bit.ly/2szTJ2L

New miRNA-Based Classifier Test Uses FNA Cytology to Evaluate Cytologically Indeterminate Thyroid Nodules

Clinical Thyroidology, Volume 31, Issue 1, Page 23-26, January 2019.


http://bit.ly/2MoRQ28

Fear of Recurrence Affects Health-Related Quality of Life in Thyroid Cancer Patients

Clinical Thyroidology, Volume 31, Issue 1, Page 27-29, January 2019.


http://bit.ly/2sB9DtN

Clinical Validation of ThyroSeq V3 Shows High Sensitivity and Specificity

Clinical Thyroidology, Volume 31, Issue 1, Page 20-22, January 2019.


http://bit.ly/2MioqT4

A Mild Risk of Neonatal Hyperthyroidism Follows Preconception Radioactive Iodine Treatment for Graves’ Disease

Clinical Thyroidology, Volume 31, Issue 1, Page 11-13, January 2019.


http://bit.ly/2sKl2Yt

More Hürthle-Cell Aspirations Will Be Identified as Benign by the New Afirma GSC Test

Clinical Thyroidology, Volume 31, Issue 1, Page 17-19, January 2019.


http://bit.ly/2MmKaNz

Dyslipidemia Is Common in Patients with Hypothyroidism Despite Correction of Abnormal TSH: A Systematic Review and Meta-Analysis

Clinical Thyroidology, Volume 31, Issue 1, Page 8-10, January 2019.


http://bit.ly/2sB3ein

The Difficult to Access “Right-To-Try” U.S. Health Care Law

Clinical Thyroidology, Volume 31, Issue 1, Page 33-36, January 2019.


http://bit.ly/2MoJ5VS

Greetings From the New Editor of Clinical Thyroidology

Clinical Thyroidology, Volume 31, Issue 1, Page 4-4, January 2019.


http://bit.ly/2szOb8B

A Systematic Review of Radiofrequency Treatment of the Ankle for the Management of Chronic Foot and Ankle Pain

Abstract

Background

Chronic pain of the lower extremity remains challenging to manage. Radiofrequency treatment applies heat to nerve fibers with the goal of mitigating chronic pain conditions. The clinical efficacy has not yet been adequately established for pathologies of the ankle and foot. In this review paper, we report the use and efficacy of radiofrequency treatment applied to foot and ankle pain.

Recent Findings

PubMed and the Cochrane Controlled Trials Register were searched (final search 30 March 2018) using the MeSH terms "radiofrequency ablation," "neurolysis," "radiofrequency therapy," "pain syndrome," "analgesia," "plantar heel pain," "plantar fascitis," and "chronic pain" in the English literature. Of the 23 papers screened, 18 were further investigated for relevance. Our final search methodology yielded 15 studies that investigated the use of radiofrequency treatment at the ankle. Of these 15 studies, there were three randomized control trials, four prospective studies, three retrospective studies, and five case reports. The quality of selected publications was assessed using the Cochrane risk of bias instrument.

Summary

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

Conclusion

The evidence from our studies suggests that radiofrequency treatment can be used safely for the management foot and ankle pain. The technique (continuous vs pulsatile), temperature, location of treatment, and duration of administration need more thorough evaluation. Randomized control trials are needed to establish the efficacy and safety profile of radiofrequency ablation and its long-term benefits in patients with chronic pain of the foot and ankle.

http://bit.ly/2MldDro

Adherence to Behavioral Therapy for Migraine: Knowledge to Date, Mechanisms for Assessing Adherence, and Methods for Improving Adherence

Abstract

Purpose of Review

In other disease states, adherence to behavioral therapies has gained attention, with a greater amount of studies discussing, defining, and optimizing adherence. For example, a meta-analysis formally discussed adherence in 25 studies of CBT for 11 different disorders, with only 6 of the 25 omitting addressing or defining adherence. Many studies have discussed the use of text messages, graph-based adherence rates, and email/telephone reminders to improve adherence. This paper examined the available literature regarding adherence to behavioral therapy for migraine as well as adherence to similar therapies in other disease states. The goal of this research is to apply lessons learned from adherence to behavioral therapy for other diseases in better understanding how we can improve adherence to behavioral therapy for migraine.

Recent Findings

Treatment for migraine typically includes both pharmacologic and non-pharmacologic therapies, including progressive muscle relaxation (PMR), cognitive behavioral therapy (CBT), and biofeedback. Behavioral therapies have been shown to significantly reduce headache frequency and intensity, but high attrition rates and suboptimal adherence can undermine their efficacy. Traditionally, adherence to behavioral therapy has been defined by self-report, including paper headache diaries and assignments. In person attendance has also been employed as a method of defining and monitoring adherence. With the advent of personal electronics, measurements of adherence have shifted to include electronic-based methods such as computer-based programs and mobile-based therapies. Furthermore, some studies have taken advantage of electronic methods such as email reminders, push notifications, and other mobile-based reminders to optimize adherence. The JITA-I, a novel method of engaging individual patient adherence, has also been suggested as a possible method to improve adherence by tailoring engagement with a mobile health app-based on patient input. These novel methods may be utilized in behavioral therapy for migraine for further optimizing adherence.

Summary

Few intervention studies to date have addressed the optimal ways to impact adherence to migraine behavioral therapy. Further research is required regarding adherence with behavioral therapies, specifically via mobile health interventions to better understand how to define and improve adherence via this novel forum. Once we are able to understand optimal methods of tracking adherence, we will be better equipped to understand the role of adherence in shaping outcomes for behavioral therapy in migraine.

http://bit.ly/2szdOGz

The Status of Pain Research in Academia and how We Are Doing in the United States

http://bit.ly/2MoRPv6

Imaging of Carotid Dissection

Abstract

Purpose of Review

Here, we describe the four primary imaging modalities for identification of carotid artery dissection, advantages, limitations, and clinical considerations. In addition, imaging characteristics of carotid dissection associated with each modality will be described.

Recent Findings

Recent advances in etiopathogenesis describe the genetic factors implicated in cervical artery dissection. MRI/MRA (magnetic resonance angiography) with fat suppression is regarded as the best initial screening test to detect dissection. Advances in magnetic resonance imaging for the diagnosis of dissection include the use of susceptibility-weighted imaging (SWI) for the detection of intramural hematoma and multisection motion-sensitized driven equilibrium (MSDE), which causes phase dispersion of blood spin using a magnetic field to suppress blood flow signal and obtain 3D T1- or T2*-weighted images. Digital subtraction angiography (DSA) remains the gold standard for identifying and characterizing carotid artery dissections.

Summary

Carotid artery dissection is the result of a tear in the intimal layer of the carotid artery. This leads to a "double lumen" sign comprised of the true vessel lumen and the false lumen created by the tear. The most common presentation of carotid artery dissection is cranial and/or cervical pain ipsilateral to the dissection. However, severe neurological sequelae such as embolic ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage can also result from carotid artery dissection. Carotid artery dissection can be identified by a variety of different imaging modalities including computed tomographic angiography (CTA), MRI, carotid duplex imaging (CDI), and digital subtraction angiography (DSA).

http://bit.ly/2szdKGP

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

Publication date: Available online 18 January 2019

Source: Auris Nasus Larynx

Author(s): Norio Kondo, Takahito Moriyama, Mayako Tachikawa, Erika Tomita, Ai Hattori, Yukie Yamamura, Manabu Nonaka

Abstract

Objective

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.

Methods

We analyzed 118 IgAN patients who underwent TSP. We collected patients' data retrospectively, including age, sex, blood pressure, onset of IgAN, pathological findings of a renal biopsy, serum concentration of creatinine, estimated glomerular filtration rate, serum concentration of protein, urinary protein, hematuria, past history of tonsillitis, the Yamamoto scale, the weight and pathological findings of the extracted palatine tonsils, and the presence or absence of anti-platelet drugs and renin-angiotensin system inhibitors (RAS-I) usage. This study included participants who were over 18 years of age, had undergone tonsillectomy within three months of steroid pulse therapy administered thrice, in whom renal biopsy was performed within a year before treatment, and with follow-up period of over 3 years. Clinical remission (CR) of urinary abnormalities was defined as remission of both proteinuria and hematuria: three consecutive negative results over a 6-month period, with a urinary sediment red blood cell count of <5/HPF, and a proteinuria qualitative reaction of (−) to (±).

Results

The CR rate of all cases was 56.8% and statistical significance was observed with respect to the C-Grade (P =  0.0003, P =  0.028) using both univariate and multivariate analysis. The CR rate of C-Grade І (73.4%) patients was significantly higher than that of C-Grade II patients (39.0%; P =  0.0004) and C-Grade III patients (30.8%; P =  0.003). We analyzed clinical factors in each C-Grade patient. No statistical significance was observed with respect to any of the factors using univariate analysis in C-Grade I patients. The weight of the extracted palatine tonsils and Yamamoto scale showed no statistical significance in every analysis. Fibrosis or hyalinization of the stroma of the palatine tonsils showed statistical significance (P =  0.026) only in the univariate analysis of C-Grade III patients. However, the patient number of C-Grade III was small.

Conclusion

Our results indicate that TSP is mostly effective in patients with of C-Grade I IgAN and that the C-Grade reflects the clinical indication for TSP. The weight of the extracted palatine tonsils and Yamamoto scale did not show obvious correlations with the clinical effect of TSP.

http://bit.ly/2T4QDiO

First in Houston to Offer a New Treatment for Obtructive Sleep Apnea

UT Physicians is now offering an alternative therapy for obstructive sleep apnea (OSA) when traditional approaches fail. The first six...

http://bit.ly/2ASN74f

Head and Neck Surgical Oncology: How Do We Make the Experience Better for the Patient?

By asking cancer patients what they want, physicians in the Head and Neck Surgical Oncology Program at Memorial Hermann and...

http://bit.ly/2T68Bl6

On a Mission: Dr. Yuksel Returns to Nicaragua

Pediatric otolaryngologist Sancak Yuksel, MD joined a team of otolaryngologists, nurses, audiologists, and speech pathologists supported by Oklahoma-based Mayflower Medical Outreach...

http://bit.ly/2ATqkFk

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

http://bit.ly/2R1fN0a

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

http://bit.ly/2DjX8ZQ

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

http://bit.ly/2Mjur1U

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

http://bit.ly/2RCF8Cv

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

http://bit.ly/2sz246Z

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

Eine seltene Ursache der peripheren Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/a-0821-5850

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

http://bit.ly/2sEtesQ

Radioguided Surgery of Non-palpable Neck Lymph Node in Lymphoma Patients

Abstract

Lymphomas have frequent relapses; early diagnosis is important to treat and improve outcomes. Clinical exam and imaging are useful but confirmation with biopsy is always required. Minimally exploratory surgery is a tool to take good samples with precision and safety. Evaluate the use of ROLL technique to track non-palpable lesions on the neck which were suspicious of recurrence in lymphoma patients. A retrospective review of the patients with high probability of lymphoma relapse who were biopsied using ROLL technique. Suspicious lesions on the neck where identified on the follow up of five lymphoma patients. Roll technique was used successfully to guide the biopsy. There were no complications. Relapse was confirmed in two patients; the other three was reactive follicular hyperplasia. Management was redirected on relapsing patients. ROLL technique proved to be a simple, safe and effective method to detect and biopsy non- palpable lesions on the neck of patients with suspicious relapsing lymphoma.

http://bit.ly/2R1fN0a

Frequency characteristics and speech recognition in cartilage conduction

Cartilage conduction (CC) is a new transduction form, and hearing devices that utilize CC present a new option for patients with aural atresia. However, in occluded ears, low-tone sounds are transmitted very effectively, resulting in excessive low-tone sound emphasis and speech recognition reduction. This study aimed to clarify low-tone speech recognition for CC in occluded ears, and determine if excessive low-tone sound emphasis decreases maximum speech recognition scores.

http://bit.ly/2U0GzHG

A critical analysis of the prognostic performance of the 8th edition American Joint Committee on Cancer staging for metastatic cutaneous squamous cell carcinoma of the head and neck

Abstract

Background

The 8th edition AJCC staging of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) incorporated extranodal extension (ENE) for the first time. This study compared the prognostic performance of the 7th and 8th edition staging for cSCCHN with nodal metastases.

Methods

Retrospective analysis of 96 patients with metastatic cSCCHN, comparing the ability of staging systems to predict disease‐specific and overall survival (OS) using the proportion of variation explained and Harrell's C‐index.

Results

In AJCC8, the N classification was upstaged in 77% of patients due to the presence of ENE and 88% of patients were classified as TNM stage IV. AJCC8 was inferior to AJCC7 in predicting disease‐specific survival for both N and TNM stages, and OS by TNM stage.

Conclusions

The majority of patients with metastatic cSCCHN have ENE and are classified as TNM stage IV based on the 8th edition staging, resulting in poor prognostic performance.

http://bit.ly/2szpIQD

Impact of tumor‐associated macrophages and BRAFV600E mutation on clinical outcomes in patients with various thyroid cancers

Abstract

Background

Tumor‐associated macrophages (TAMs) play a role in thyroid cancer tumor progression and metastasis. This study aimed to investigate the association of TAM density and cluster of differentiation 68 (CD68) expression with thyroid tumors as a prognostic marker and the relationship of these factors with BRAF^V600E mutations.

Methods

This study included 275 thyroid specimen tissues, including benign and malignant lesions. We compared the clinicopathological features according to thyroid tumor types and evaluated the presence of CD68 expression and BRAF^V600E mutations.

Results

CD68 positive expression increased with aggressiveness of thyroid tumor histologic grades (P < 0.001). In patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), CD68 positivity was associated with aggressive adverse clinical outcomes such as extrathyroidal extension, cervical lymph node metastases, and distant metastases (P < 0.05).

Conclusions

CD68 positivity was more frequent in advanced and aggressive thyroid cancer types such as PDTC/ATC.

http://bit.ly/2MizKi5

Bilateral vs ipsilateral adjuvant radiotherapy in patients with cancer of unknown primary of the head and neck: An analysis of the clinical outcome and radiation‐induced side effects

Abstract

Background

The purpose of this study was to analyze and compare ipsilateral and bilateral adjuvant radiotherapy in patients with cancer of unknown primary (CUP) of the head and neck.

Methods

Overall survival, recurrence‐free survival, and radiation‐induced side effects were assessed in 76 patients with CUP who underwent ipsilateral (n = 29) or bilateral (n = 47) radiotherapy.

Results

At a median follow‐up of 41 months, the 5‐year overall survival and recurrence‐free rate were 67.9% and 71.5%, respectively. No statistically significant difference between ipsilateral and bilateral radiotherapy could be found regarding 5‐year overall survival, recurrence‐free survival, occurrence of a primary tumor, and distant metastasis. The analysis of radiation‐induced acute side effects showed a significant benefit of ipsilateral radiotherapy.

Conclusion

As the main parameters of the study regarding the outcome and radiation‐induced side effects showed no advantages of bilateral radiotherapy, the strategy of ipsilateral radiotherapy can be recommended for the adjuvant treatment of CUP patients.

http://bit.ly/2szpHfx

Issue Information

http://bit.ly/2MizDDb

Cover Image

The cover image, by David H. Yeh et al., is based on the Original Article Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap, DOI: 10.1002/hed.25342.

http://bit.ly/2sAB0UJ

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

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 acut...

http://bit.ly/2sAfW0A

CNPAS: A Differential to Choanal Atresia

Abstract

A case of 7 day old male child, born at 36 weeks, presented with feeding difficulties, hypothermia and failure to thrive. After clinical examination to rule out any gross congenital anomalies, CT scan was done which was suggestive of pyriform aperture stenosis. It was surgically dilated and stented successfully.

http://bit.ly/2Mjur1U

Reconstruction of Orbital Suprastructure Maxillectomy Defects by Temporalis Myofascial Flap

Abstract

Oncological surgery being radical is often mutilating in form and function especially in the maxillary/orbit region reconstruction of maxillo-orbit defects are challenging due to the complex three dimensional anatomy. Free flaps are de-rigueur but a technical resource with constraints. The temporalis myofascial flap (TMFF) is a locally available, safe and reliable flap which can be used for the reconstruction of various orbital and supramaxillary facial defects. To study the use of the temporalis myofascial flap in the reconstruction of various orbital and supramaxillary facial defects. Temporalis myofascial flap was harvested and successfully used in reconstruction of three patients who had undergone orbital exenteration with or without suprastructural maxillectomy. There was no morbidity related to flap loss. Temporalis flap (TMFF) can be considered as a first line reconstructive option for limited resection of upper maxilla with palatal preservation. Its proximity to the oral cavity, palate and mid third face and the technical ease makes the TMFF valuable for reconstruction. The techniques and outcomes of TMFF are discussed.

http://bit.ly/2sz246Z

Spontaneous Resolution of Fourth Branchial Fistula Following Thyroid Surgery: Case Report

Abstract

Fourth branchial pouch anomalies represent one of the rarest types of all branchial apparatus anomalies. They appear in the first lifedecade in a form of recurrent left-sided neck masses which demands surgical treatment. Accidental finding, appearance later in life and spontaneous resolving are really rare. We present a case of a 43-year-old man with accidental finding of asymptomatic fourth pouch cyst and fistula following follicular thyroid cancer surgery. The day after the surgery, suction bottle was filled with little white crumbs and the wound started to suppurate. Barium swallow revealed the presence of a fistulous canal that arose from the left pyriform sinus. Meanwhile, the pathologist confirmed the presence of a lateral neck cyst within this thyroid lobe. The patient was operated on but fistulous canal was not visualized. In the meantime, wound discharge ceased spontaneously. At 1-year follow up, the patient was still well and free from any symptoms. These anomalies may manifest not only in childhood but may stay asymptomatic for a long time. It seems that the fistula can resolve spontaneously and that conservative approach is an alternative to multiple surgical procedures.

http://bit.ly/2DjX8ZQ

Quality assurance in head and neck cancer surgery: where are we, and where are we going?

Purpose of review The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated. Recent findings Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC. Summary Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level. Correspondence to Christian Simon, MD, Service d'Oto-rhino-laryngologie – Chirurgie cervico-faciale, Centre Hospitalier Universitaire Vaudois (CHUV), Université de Lausanne (UNIL), Rue du Bugnon 21, 1011 Lausanne, Switzerland. Tel: +41 21 314 11 11; fax: +41 21 314 27 06; e-mail: Christian.Simon@chuv.ch Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2TYm6mU

Radiation-induced papillary thyroid cancer: is it a distinct clinical entity?

Purpose of review To present the current status of knowledge regarding radiation-induced papillary thyroid cancer (RIPTC), defining its epidemiologic, pathologic, and clinical characteristics, with ensuing possible therapeutic and prognostic consequences. Recent findings Cumulative evidence shows that RIPTC resembles sporadic papillary thyroid cancer (PTC) of comparable age, both in terms of clinical-pathological features and prognosis. Therefore, more aggressive treatment does not seem to be required when managing RIPTC as its prognosis is comparable to that of never-irradiated patients. Summary Radiation exposure in childhood is a well-documented risk factor for development of PTC. Therefore, increased exposure to medical or environmental radiation may be in part responsible, along with increased screening, of the recent burgeoning incidence of PTC. A specific morphological and molecular portrait of RIPTC is unlikely to exist. The more aggressive histologic and clinical features initially reported in radiation-induced cases are consistent with the expectations in nonradiation-related PTC of a comparable age. Aggressive histology, nodal, and distant metastases correlate with early age at onset rather than with radiation exposure. Although relapses are frequent in children, long-term cancer-specific mortality is approximately 1%, lower than that observed for adults and comparable between irradiated and nonirradiated cohorts. RIPTC does not require more aggressive surgery or more adjuvant treatments, as prognosis is as good as that of sporadic PTC when matched for stage and treatment received. Correspondence to Lorenzo Bresciani, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, 20133 Milan, Italy. Tel: +390223902793; fax: +390223902760; e-mail: lorenzo.bresciani@istitutotumori.mi.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DlH3CQ

Management of the marginal mandibular nerve during and after neck dissection

Purpose of review Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options. Recent findings A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer. Summary When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered. Correspondence to Deepak Balasubramanian, MCh, Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India 682041. Tel: +91 8089089887; e-mail: dr.deepak.b@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2U11Pgp

“Sinus Headache”: Diagnosis and Dilemma?? An Analytical and Prospective Study

Abstract

To evaluate the type, location, severity of headache and their relation to various nasal and sinus related pathological conditions. All the patients presenting with acute and chronic sinus and nasal infections along with headache were included in the study. The diagnostic confirmation was done with clinical along with radiological and endoscopic evaluation. Various parameters categorized accordingly. Chronic rhinosinusitis/chronic recurrent rhinosinusitis are the most common nasal condition seen in oto-rhino-laryngology OPD which has enormous economic burden and significant morbidity on general population. The headache is the commonest associated symptom which is needed to be given attention. The location, variation, pattern of the headache can guide us towards the correct diagnosis.

http://bit.ly/2RCF8Cv