Cartilage conduction as the third pathway for sound transmission

It has been long considered that air and bone are the two major mediators that conduct sounds to the inner ear. In 2004, Hosoi found that vibration of aural cartilage, generated by placing gently a transducer on it, could create audible sound with the same level of clarity as air- and bone-conduction sound. He thus proposed the term "cartilage conduction" for this concept. This research identified a third mediator for sound conduction to the inner ear. Hosoi also proposed the development of novel communication devices, such as hearing aids, telephones, etc.

http://bit.ly/2Rwm1Fu

Severe deviated nose treatment: importance of preserving the dorsal septal remnant

Abstract

Purpose

To compare the surgical outcomes of modified extracorporeal septoplasty and anterior septal reconstruction for the management of the severe deviated nose.

Methods

In a prospective cohort study, we selected 86 patients referred for septorhinoplasty to a tertiary center in May 2015–April 2017 with a primary complaint of nasal obstruction and deformity. They had moderate-to-severe septal deviation and severely deviated noses, particularly in the dorsum. Forty-three patients underwent each procedure. The cohorts were age- and sex-matched, and were operated at a similar time point. Surgical outcome was assessed and compared using anthropometric measurement of photographs, acoustic rhinometry, and The Nasal Obstruction Septoplasty Effectiveness questionnaire (including a visual analog scale).

Results

In all patients, MCA1 (initial minimum cross-sectional area) and MCA2 (minimum cross-sectional area after topical decongestion of the nasal mucosa), anthropometric angles (nasolabial, nasofacial and tip projection), and The Nasal Obstruction Septoplasty Effectiveness questionnaire significantly improved after surgery in both groups (p = 0001), with no significant difference in improvement between two groups. However, anthropometric angles and minimal cross-sectional area were better in anterior septal reconstruction group.

Conclusion

Both methods are effective in patients with a severely deviated nose for correction of deviation and obstruction. Anterior septal reconstruction is the preferable method in patients with more deviation.

http://bit.ly/2Gl913t

Is Day Care Tonsillectomy a Safe Procedure?

Abstract

Tonsillectomy with or without adenoidectomy is the commonest procedure performed by an otolaryngologist. It has been performed as an in-patient procedure. To present our experience of 15 years of day care tonsillectomy with or without adenoidectomy and to assess the safety of tonsillectomy as a day care procedure. Design: retrospective study. A retrospective study of all day care tonsillectomies with or without adenoidectomies operated at a Secondary care ENT Hospital from 2002 to 2016 has been carried out. In last 15 years, we have operated 1207 tonsillectomies with or without adenoidectomies as a day care procedure. Postoperatively, the patients were discharged after observing for 6 to 8 h. Out of 1207 patients, 3 patients required readmission due to bleeding and 5 due to pain. Hence the overall readmission rate following tonsillectomy was 8/1027, which equals to 0.778 percent. Two patients with postoperative bleeding within 6 h were taken up for exploration and control of hemostasis. One patient of secondary haemorrhage was managed conservatively. None of the patients required blood transfusion. Day care tonsillectomy with or without adenoidectomy is a safe procedure as long as the patients are carefully selected. It is also cost effective. Level of evidence: Level 4.

http://bit.ly/2Wx41i1

What is a pituitary adenoma? A pituitary adenoma is a fairly common benign growth that occurs in the...

What is a pituitary adenoma? A pituitary adenoma is a fairly common benign growth that occurs in the pituitary gland....

http://bit.ly/2t0T0aX

Is Day Care Tonsillectomy a Safe Procedure?

Abstract

Tonsillectomy with or without adenoidectomy is the commonest procedure performed by an otolaryngologist. It has been performed as an in-patient procedure. To present our experience of 15 years of day care tonsillectomy with or without adenoidectomy and to assess the safety of tonsillectomy as a day care procedure. Design: retrospective study. A retrospective study of all day care tonsillectomies with or without adenoidectomies operated at a Secondary care ENT Hospital from 2002 to 2016 has been carried out. In last 15 years, we have operated 1207 tonsillectomies with or without adenoidectomies as a day care procedure. Postoperatively, the patients were discharged after observing for 6 to 8 h. Out of 1207 patients, 3 patients required readmission due to bleeding and 5 due to pain. Hence the overall readmission rate following tonsillectomy was 8/1027, which equals to 0.778 percent. Two patients with postoperative bleeding within 6 h were taken up for exploration and control of hemostasis. One patient of secondary haemorrhage was managed conservatively. None of the patients required blood transfusion. Day care tonsillectomy with or without adenoidectomy is a safe procedure as long as the patients are carefully selected. It is also cost effective. Level of evidence: Level 4.

http://bit.ly/2Wx41i1

Thank you!

Publication date: March 2019

Source: International Journal of Pediatric Otorhinolaryngology, Volume 118

Author(s):

http://bit.ly/2BiRANA

Erratum to “Population-based cross-sectional study to assess newborn hearing screening program in Central Germany” [Int. J. Pediatr. Otorhinolaryngol., 107 (2018) 110–120]

Publication date: Available online 2 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Anke Rissmann, Andrea Koehn, Marja Loderstedt, Cornelia Schwemmle, Gerrit Goetze, Sylva Bartel, Stefan K. Plontke, Joerg Langer, Klaus Begall, Peter Matulat, Friedrich-Wilhelm Roehl, Ulrich Vorwerk

http://bit.ly/2TnVpZ6

Risk of occurrence and recurrence of otitis media with effusion in children suffering from cleft palate

Publication date: Available online 1 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Caroline Rieu-Chevreau, Nolwenn Lavagen, Cica Gbaguidi, Stéphanie Dakpé, Nathalie Klopp-Dutote, Cyril Page

http://bit.ly/2BiRxBo

Evaluation of hearing in pediatric familial Mediterranean fever patients during attack period and attack-free period

Publication date: Available online 1 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Asif Salimov, Umut Akyol, Bunyamin Cildir, Ezgi Deniz Batu, Seza Ozen

http://bit.ly/2TnVlbO

The prevalence and impact of cervical spine pathologies in patients with nasopharyngeal carcinoma

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Colin Shing-Yat Yung, Dennis Kwok Chuen Leung, Jason Pui Yin Cheung

Abstract

Objectives

Nasopharyngeal carcinoma (NPC) and its treatment can lead to cervical spine pathologies such as metastases, osteoradionecrosis (ORN) and infection. However, the occurrence rate and relationship between timing of diagnosis and outcomes of the ever-advancing technology of radiation therapy is largely unknown. Hence, the aim of this study is to determine the prevalence and impact of cervical spine pathologies in patients with NPC.

Materials and methods

This was a cross-sectional study of all newly diagnosed cases of NPC from 2007 to 2016 at a tertiary referral oncology and spine centre with minimum 1-year post-treatment follow-up. All cervical spine pathologies, their treatment and outcomes were determined. Presentation, onset time and correlations of the cervical spine pathologies with mortality and risk factors were also analysed.

Results

Out of 605 cases of verified cases of NPC, cervical spine pathologies were seen in 8.9% of patients. New onset neck pain was seen in 5.3%, symptomatic cervical spondylosis in 4.8%, cervical spine metastases in 2.5%, local tumour invasion in 0.8%, cervical ORN in 0.7%, osteomyelitis in 0.7%, radiculopathy in 0.3%, and myelopathy in 0.3%. Cervical spine pathologies were associated with an increased risk (odds ratio: 2.73) in overall mortality. Cervical spine metastases, invasion, ORN and infection were associated with significantly higher risk of mortality (p = 0.01–0.02).

Conclusion

Cervical spine pathologies in patients with NPC are heterogenous but not uncommon. Neck pain is prevalent but is often benign. ORN and osteomyelitis of the cervical spine is uncommon but have large clinical implications including higher mortality with subtle presentations.

http://bit.ly/2WCrhLx

Direct and antibody-dependent cell-mediated cytotoxicity of head and neck squamous cell carcinoma cells by high-affinity natural killer cells

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Jay Friedman, Michelle Padget, John Lee, Jeffrey Schlom, James Hodge, Clint Allen

Abstract

High affinity natural killer cells (haNKs) are a cell therapy product capable of mediating both direct and antibody-dependent cell-mediated cytotoxicity (ADCC). These cells may be particularly useful in tumors that escape T-cell anti-tumor immunity by harboring antigen processing and presentation defects. Here, we demonstrated that haNKs directly kill both HPV-positive and negative head and neck squamous cell carcinoma cells. Variable tumor cell sensitivity to haNK direct cytotoxicity did not correlated with MHC class I chain-related protein A or B (MICA or MICB) expression. Importantly, haNK killing was significantly enhanced via ADCC mediated by cetuximab or avelumab in cells with higher baseline EGFR or PD-L1 expression, respectively. The ability of IFNγ to induce tumor cell PD-L1 expression correlated with enhanced PD-L1-specific ADCC. IFNγ induced neither tumor cell EGFR expression nor EGFR-specific ADCC. Although a single dose of 8 Gy IR did not appear to directly enhance susceptibility to haNK killing alone, enhanced PD-L1- and EGFR-mediated ADCC after IR correlated with increased PD-L1 and EGFR expression in one of four models. This pre-clinical evidence supports the investigation of haNK cellular therapy in combination with ADCC-mediating mAbs, with or without IR, in the clinical trial setting for patients with advanced HNSCCs. Given the MHC-unrestricted nature of this treatment, it may represent an opportunity to treat patients with non-T-cell inflamed tumors.

http://bit.ly/2Rwfqux

Prognostic value of programed death ligand-1 and ligand-2 co-expression in salivary gland carcinomas

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Takafumi Nakano, Katsumi Takizawa, Azusa Uezato, Kenichi Taguchi, Satoshi Toh, Muneyuki Masuda

Abstract

Objectives

The aim of the present study was to investigate the molecular basis for the use of immune checkpoint inhibitors to treat salivary gland carcinomas (SGC).

Materials and methods

We examined the clinical and prognostic significance of programed death ligands 1 and 2 (PD-L1 and -L2) expression using immunohistochemistry and in situ hybridization, as well as microsatellite instability (MSI) status using polymerase chain reaction, along with tumor-infiltrating lymphocytes (TILs) in 30 cases of SGC.

Results

The SGC cases studied included adenoid cystic carcinoma (AdCC, 36.7%), salivary duct carcinoma (SDC, 26.7%), mucoepidermoid carcinoma (MEC, 23.3%), and carcinoma ex pleomorphic adenoma (CxPA, 13.3%). Either PD-L1 or PD-L2 overexpression was observed in 36.7% patients. PD-L2 expression was associated with reduced disease-specific survival (DSS) and disease-free survival (DFS) (P = 0.0266 and P = 0.0209, respectively). Simultaneous PD-L1 and PD-L2 overexpression was detected in 13.3% of cases, and was correlated with reduced DSS (P = 0.0113). Among non-AdCCs, all cases that developed distant metastasis were positive for PD-L2 (P = 0.001). Cases showing low-TILs that were positive for either PD-L1 or L2 were associated with poor DFS. No MSI was detected in the SGC cases studied.

Conclusion

To our knowledge, this is the first comprehensive study examining PD-L1 and PD-L2 status, MSI status, and TILs in SGC. Our results indicate that the PD-1/PD-L1 or PD-L2 pathway, which is associated with poor clinical outcomes, may provide promising therapeutic targets against SGC in selected patients. Further experimental and clinical studies are encouraged.

http://bit.ly/2WBgJfs

Effect of prior cancer on trial eligibility and treatment outcomes in nasopharyngeal carcinoma: Implications for clinical trial accrual

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Ya-Qin Wang, Jia-Wei Lv, Ling-Long Tang, Xiao-Jing Du, Lei Chen, Wen-Fei Li, Xu Liu, Ying Guo, Ai-Hua Lin, Yan-Ping Mao, Ying Sun, Yu-Pei Chen, Jun Ma

Abstract

Objective

In cancer trials, prior cancer is a common exclusion criterion. We evaluated the characteristics of prior cancer exclusion criteria in nasopharyngeal carcinoma (NPC) trials and determined its prognostic effect on patients with NPC.

Methods

We reviewed NPC trials for prior cancer exclusion criteria. Then we estimated the effect of prior cancer among NPC patients using the Surveillance, Epidemiology, and End Results database. Propensity score-matching was used to compensate for differences in baseline characteristics between patients with and without prior cancer.

Results

There were 109 clinical trials involving 10,437 patients; 49 trials (45%) excluded patients with prior cancer. Prior cancer exclusion was more common in recent or phase III trials. We identified 10,195 NPC patients; 6.2% had prior cancer. More than 70% of these cancers were in situ/localized/regional and diagnosed relatively close to the NPC diagnosis (median 3.3 years). Patients with certain prior cancer type (prostate, breast, gynecological, hematological), time of diagnosis (>5 years ago), or stage (in situ/localized) did not have inferior survival compared with patients with no prior cancer. We tested one form of prior cancer exclusion criteria in an NPC cohort resembling a modern trial population: it did not adversely affect overall and NPC-specific survival.

Conclusions

Many NPC trials excluded patients with prior cancer, which impacts trial accrual and generalizability. Our findings suggest that broader inclusion in trials of patients with NPC with prior cancer might not affect trial outcomes. More research is needed to understand the appropriateness of this exclusion policy across cancer types and trials.

http://bit.ly/2Rwfqe1

Cervical nodal metastasis after malignant conversion of sinonasal inverted papilloma: Report of a rare case and literature review

Publication date: March 2019

Source: Oral Oncology, Volume 90

Author(s): Daniel Sharbel, Vipawee Chat, Daniel Blumenthal, Paul Biddinger, J. Kenneth Byrd

Abstract

Malignant conversion of sinonasal inverted papilloma (SNIP) occurs in approximately ten percent of cases. These tumors are classically described as locally destructive, but without metastatic potential. Only four cases of malignant conversion with cervical nodal metastases have been described in the English literature. We present the rare case of a 61-year-old Caucasian male with a nasopharyngeal recurrence of malignant SNIP with cervical and retropharyngeal nodal metastases. The patient underwent endoscopic transpterygoid with nasoseptal flap reconstruction, followed by staged bilateral and retropharyngeal node dissection. Histopathology of the specimens demonstrated poorly differentiated invasive nonkeratinizing squamous cell carcinoma with inverted-type features. Three months after surgery, the patient suffered from C1-C2 fractures consistent with osteoradionecrosis and expired. Although the rate of malignant conversion of SNIP is low, this case highlights the need for aggressive, definitive treatment and surveillance.

http://bit.ly/2WBeJnz

Cartilage conduction as the third pathway for sound transmission

Publication date: Available online 2 February 2019

Source: Auris Nasus Larynx

Author(s): Hiroshi Hosoi, Tadashi Nishimura, Ryota Shimokura, Tadashi Kitahara

Abstract

It has been long considered that air and bone are the two major mediators that conduct sounds to the inner ear. In 2004, Hosoi found that vibration of aural cartilage, generated by placing gently a transducer on it, could create audible sound with the same level of clarity as air- and bone-conduction sound. He thus proposed the term "cartilage conduction" for this concept. This research identified a third mediator for sound conduction to the inner ear. Hosoi also proposed the development of novel communication devices, such as hearing aids, telephones, etc. using his findings.

For cartilage conduction, three sound pathways can be assumed. The transducer vibration may cause airborne sound which passes into the external auditory canal through the canal entrance (direct air pathway). Alternatively, the vibration at the cartilage may generate audible sound in the external auditory canal (cartilage-air pathway), or propagate directly to the inner ear through the skull bone (cartilage-bone pathway). A series of studies has illustrated that the cartilage-air pathway is dominant for hearing sensations in listeners with normal ears. The cartilage-bone pathway works for patients with bony aural atresia. A fourth pathway, the fibrotic-tissue pathway, is considered to act in the case of fibrotic aural atresia.

In this review, we summarize this series of studies and discuss the nature of cartilage conduction.

http://bit.ly/2G85PJ6

Remerciements aux lecteurs

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s):

http://bit.ly/2SsuZIx

Thrombose post-traumatique du sinus sigmoïde par corps étranger transmastoïdien

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): G. Badidi, S. Chabrier, J.M. Prades, A. Karkas

http://bit.ly/2GiBWoO

Infection nasosinusienne à burkholderia gladioli

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): C. Zanotti, S. Munari, G. Brescia, U. Barion

Résumé

Introduction

Burkholderia gladioli est une bactérie aérobie gram-négative en bâtonnets, et non fermentaire, qui a été identifiée la première fois comme pathogène pour les plantes. La plupart des infections à B. gladioli rapportées dans la littérature concernent des adultes et des nouveau-nés immunodéprimés. Chez l'homme, B. gladioli est souvent associée à un pronostic défavorable.

Cas clinique

Nous décrivons le premier cas d'infection nasosinusienne due à B. gladioli et Staphylococcus aureus chez une patiente immunocompétente ayant fait un voyage récent au Congo.

Discussion

Comme dans les quelques autres cas rapportés impliquant des patients immunocompétents, la prise en charge adaptée pour cette infection à B. gladioli multirésistante était une combinaison de chirurgie et d'antibiotiques adaptés à l'antibiogramme.

http://bit.ly/2SnlJoT

Coloration noire récidivante de la langue et des dents

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Hervochon, Q. Lisan, F. Rubin

http://bit.ly/2GiBSFA

Une masse nasale atypique

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): E. Drapier, M. Makeieff, X. Dubernard

http://bit.ly/2SjGrGi

Une localisation épiglottique asymptomatique inattendue dans le cadre d’une maladie de Kimura

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): F. Dezoteux, R. Dubois, G. Lefèvre, J.P. Lecoutre, D. Staumont-Sallé, O. Carpentier

Résumé

Introduction

La maladie de Kimura est un syndrome lymphoprolifératif chronique d'étiologie inconnue qui affecte la peau et les ganglions lymphatiques. Il survient principalement chez les jeunes hommes d'origine asiatique. L'histoire naturelle de l'atteinte épiglottique asymptomatique n'est pas connue. Cette atteinte rare n'est souvent diagnostiquée que lorsque la croissance de la tumeur commence à obstruer les voies respiratoires supérieures.

Observation

Il s'agit d'un homme d'origine nord-africaine âgé de 34 ans présentant un tableau associant fatigue et multiples nodules cutanés fluctuants lentement progressifs dans les régions mandibulaires et rétroauriculaires droites. Un scanner cervical a confirmé une tumeur des tissus mous du corps mandibulaire droit et a également révélé un épaississement inattendu de l'épiglotte. La nasofibroscopie a confirmé les résultats de la tomodensitométrie et a montré un épaississement de l'épiglotte. Notre diagnostic de maladie de Kimura était basé sur l'examen histologique d'échantillons de biopsie prélevées sur la tumeur mandibulaire droite, un ganglion lymphatique cervical et l'épiglotte.

Discussion

La plupart des cas de maladie de Kimura avec atteinte épiglottique sont révélés par dysphonie et dysphagie. Il n'y a pas de consensus sur les examens complémentaires à effectuer. Cette observation soulève la question dépistage systématique des lésions dans des sites anatomiques inhabituels et potentiellement dangereux au cours de cette affection.

http://bit.ly/2Giybjm

Sinusalgies maxillaires radiotransparentes par agenesie de l’ostium membraneux

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): R. Jankowski, C. Rumeau, D.T. Nguyen, P. Gallet

Résumé

Introduction

L'absence d'opacité scanographique lors du bilan de douleurs faciales conduit classiquement à éliminer une étiologie sinusienne. Nous rapportons une observation qui contredit cet adage et révèle une nouvelle cause de sinusalgie.

Observation

Un homme de 16 ans présentait un tableau de « sinusites aiguës hyperalgiques » récidivantes déclenchées par les changements de pression (altitude, plongée, surf), sans opacité sinusienne au scanner. Pourtant l'exploration chirurgicale a permis de constater l'absence de tout ostium maxillaire (principal ou accessoire). Une antrostomie chirurgicale a mis fin aux douleurs.

Discussion

La physiopathologie de ce faux tableau de « sinusites aiguës récidivantes » et l'efficacité de l'antrostomie s'expliquent par la théorie évo-dévo de la formation et du rôle des sinus paranasaux. Ce cas illustre une absence d'abouchement dans l'ethmoïde du sac membranaire tapissant la cavité sinusienne, formée après dégénérescence de la moelle érythropoïétique dans l'os maxillaire. La production permanente de monoxyde d'azote par l'épithélium sinusien est éliminée par simple diffusion transmembranaire en condition environnementale stable, mais insuffisamment lors des changements pressionnels rapides, provoquant des sinusalgies parfois hyperalgiques. Cette observation ouvre la voie à de plus amples études sur le rôle des sinus dans la pathologie faciale et la physiologie respiratoire.

http://bit.ly/2ShjF1G

Dacryocystocèle congénitale bilatérale

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): P.C. de Sousa, M. Neves, D. Duarte, P. Azevedo

Résumé

Introduction

Les nouveau-nés respirent exclusivement par le nez. Une obstruction nasale peut donc entraîner une cyanose et une désaturation. Malgré le fait qu'elle soit très rare, la dacryocystocèle congénitale bilatérale est une étiologie possible du syndrome de détresse respiratoire chez le nouveau-né.

Résumé du cas clinique Il s'agit d'un nouveau-né de sexe masculin présentant une détresse respiratoire due à une lésion nasale polypoïde et bleuâtre bilatérale occupant la quasi-totalité des méats inférieurs. L'imagerie a confirmé une dacryocystocèle bilatérale. Le traitement a été symptomatique et une évacuation spontanée est survenue, améliorant la détresse respiratoire.

Discussion

Le diagnostic de dacryocystocèle congénitale est clinique bien que des examens d'imagerie puissent être demandés pour le confirmer. Le traitement est controversé en raison de l'évolution spontanément variable de la maladie. Une prise en charge symptomatique initiale peut être recommandée mais, en l'absence d'amélioration spontanée de l'obstruction des voies aériennes, une prise en charge chirurgicale est obligatoire.

http://bit.ly/2GgOQDT

Fraisage et contrôle du méat auditif interne par endoscope fixé

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): X. Dubernard, J.-C. Kleiber, M. Makeieff, A. Bazin, A. Chays

Résumé

En cas de résection chirurgicale d'un schwannome vestibulaire par voie rétro sigmoïde, le contrôle des structures vestibulaires en particulier du canal semi-circulaire postérieur est impératif si l'objectif de conservation de l'audition s'ajoute à celui d'une exérèse tumorale totale. Le fraisage du méat acoustique interne (MAI) est une étape délicate au cours de laquelle les structures vestibulaires peuvent être involontairement ouvertes. L'orientation du MAI explique la formation de zone d'ombre propice à leur ouverture si le fraisage est réalisé au microscope. L'endoscopie portée expose en totalité la zone opératoire mais bloque l'une des mains du chirurgien rendant la chirurgie délicate. L'endoscopie fixée est une solution permettant de rendre au chirurgien sa liberté opératoire tout en garantissant un contrôle précis de son geste. Elle permet le repérage et le contournement des structures vestibulaires tout en étant au plus près de la tumeur. Le schwannome peut se laisser cliver en totalité, le fond du MAI étant correctement contrôlé tout en respectant le nerf facial et le nerf cochléaire.

http://bit.ly/2SjGge6

Reconstruction de la paroi antérieure du sinus frontal par prothèse en titane sur-mesure après exérèse d’un ostéome géant du sinus frontal

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): J. Fanchette, B. Faucon, F. Cartry, M. Ratajczak

Résumé

L'ostéome est une tumeur osseuse bénigne, fréquemment rencontrée au niveau naso-sinusien, le plus souvent asymptomatique. Le traitement est chirurgical et s'impose lorsque le patient devient symptomatique ou présente des complications opthalmologiques ou neurologiques. Bien que l'approche endoscopique soit de plus en plus utilisée si la localisation et/ou la taille de l'ostéome le permettent, la chirurgie par voie ouverte peut être préférable et reste encore la référence. Nous présentons dans cette note technique un cas d'ostéome géant du sinus frontal ayant nécessité une exérèse par voie bicoronale, avec reconstruction par une prothèse en titane réalisée sur-mesure.

http://bit.ly/2GnaGW6

Quelle place pour l’ambulatoire en chirurgie plastique et reconstructrice de la face et du cou en France ?

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): O. Malard, G. Michel, F. Espitalier

Résumé

Cette mise au point propose d'expliciter des grands principes qui régissent en 2018 la réalisation des soins ambulatoires dans le système de santé français, spécifiquement dans le domaine de la chirurgie plastique et esthétique de la face et du cou. Les aspects réglementaires historiques et l'évolution au cours des dernières années sont exposés, ainsi que les tendances et les attentes des autorités sanitaires pour les années à venir. L'essentiel des contraintes liées à l'exécution des actes en ambulatoire sont communs aux différentes spécialités chirurgicales. La chirurgie plastique et esthétique de la face et du cou n'y déroge pas. Parmi ces contraintes, outre les aspects purement techniques liés à l'acte chirurgical et anesthésique, il faut compter sur l'autorisation du site, l'organisation de la continuité des soins, l'environnement du patient… Dans son rapport de 2012 sur l'évaluation de la tarification des soins hospitaliers et des actes médicaux, l'IGAS, rappelle que : « La chirurgie ambulatoire devient la norme, l'hospitalisation traditionnelle est le défaut » afin de satisfaire à l'exigence « Soigner plus sans dépenser plus ». L'acte ambulatoire en chirurgie plastique et de reconstruction peut être considéré comme accessible à une majorité de patients, mais demeure un acte sous conditions.

http://bit.ly/2Sm8NQ2

Facteurs de risque de sévérité de la papillomatose respiratoire récidivante juvénile lors de la première endoscopie

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): E. Moreddu, E. Lambert, D. Kacmarynski, R. Nicollas, J.-M. Triglia, R.J. Smith

Résumé

Objectifs

L'objectif de cette étude était de définir les facteurs de risque de sévérité de la papillomatose respiratoire récidivante (PRR) juvénile lors de la première évaluation endoscopique.

Matériels et méthodes

Il d'agit d'une revue de tous les cas opérés pour PRR juvénile dans deux centres d'oto-rhino-laryngologie pédiatrique situés aux États-Unis et en France. Le nombre d'étages laryngés atteints, l'extension sous-glottique et la bilatéralité des lésions ont été analysés comme facteurs de risque de sévérité.

Résultats

Trente-deux patients ont été inclus, pour un total de 571 procédures endoscopiques. Le nombre d'endoscopies par patient était différent selon l'extension initiale de la maladie : 30,67 procédures quand les 3 étages laryngés étaient atteints, 15,57 procédures quand 2 étages étaient atteints et 14,08 quand un seul étage était atteint (p = 0,03). L'odds ratio du risque de subir plus de 14 procédures était de 20,43 (p = 0,047) quand les 3 étages étaient atteints. Les patients présentant une extension sous-glottique des lésions avaient tendance à nécessiter plus de procédures (23,67 contre 15,56, p = 0,16).

Conclusions

La sévérité de la PRRJ est corrélée à l'extension initiale des lésions papillomateuses lors de la première endoscopie. Cette observation a permis de créer une échelle d'évaluation rapide composée de 3 items, complémentaire de l'échelle de Derkay.

http://bit.ly/2GiX8eh

Ablation chirurgicale des amygdales linguales dans le traitement du syndrome d’apnées obstructives du sommeil

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): C. Mure, M. Blumen, L. Page, F. Chabolle

Résumé

Objectifs

L'espace rétro-basilingual peut être un site obstructif dans le syndrome d'apnées obstructives du sommeil (SAOS) et les amygdales linguales (AL) sont des structures anatomiques qui, quand elles sont hypertrophiées, peuvent y contribuer. L'objectif de cette étude est de mesurer l'efficacité et la tolérance de l'ablation des AL dans le SAOS.

Matériels et méthodes

Nous avons réalisé une étude rétrospective basée sur l'analyse des dossiers médicaux des patients opérés des AL. Nous avons inclus les patients porteurs d'un SAOS confirmé par un enregistrement du sommeil en échec ou refus de traitement médical. L'hypertrophie des AL était diagnostiquée par un examen clinique avec une naso-fibroscopie complété d'une IRM et d'une endoscopie sous sédation (ES). L'intervention chirurgicale était réalisée par voie endoscopique avec utilisation du laser diode ou de la coblation. Le critère de jugement principal était la baisse de l'index d'apnées-hypopnées (IAH) à 6 mois sur l'enregistrement du sommeil. Les critères secondaires étaient la diminution du ronflement, le score de somnolence diurne d'Epworth et la tolérance post-opératoire.

Résultats

Onze patients, âgés de 44,3 ± 12,6 ans, ont été inclus. Nous avons observé une baisse de l'IAH de 29,5 ± 21,7/h à 11,6 ± 9,6/h, soit une réduction de 60 % (p = 0,005). Cinq patients avaient un IAH inférieur à 10/h soit 45 % de guérison complète. Le score d'Epworth a baissé de 13 ± 3,4 à 8,1 ± 4,9 (p = 0,012). Il n'y a eu aucune complication.

Conclusion

Dans le cas d'un SAOS en échec de traitement médical avec une obstruction rétro-basilinguale, l'ablation des AL paraît être un traitement efficace.

Niveau de preuve

4.Mots clés: Amygdales linguales; Apnées du sommeil; Traitement chirurgical, Espace rétro-basilingual

http://bit.ly/2SjG7Y6

Intérêt de la vidéo-otoscopie en médecine générale

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): L. Damery, E. Lescanne, K. Reffet, C. Aussedat, D. Bakhos

Résumé

Introduction

Le rôle des omnipraticiens est primordial dans la prise en charge des pathologies otologiques. Il demeure cependant des insuffisances diagnostiques concernant les tympans pathologiques. L'objectif de ce travail était de comparer la qualité des diagnostics otoscopiques réalisés par des omnipraticiens avec l'otoscopie conventionnelle versus la vidéo-otoscopie.

Sujets et méthode

Onze généralistes ont examiné 124 patients (193 otoscopies) présentant des plaintes otologiques. Ils devaient réaliser l'examen à l'otoscope puis à la vidéo-otoscopie. Après chacun de ces examens, une grille composée de 10 critères était remplie et un diagnostic était proposé. Chaque cliché issu de la vidéo-otoscopie était relu par 2 ORL qui devaient remplir la même grille et poser un diagnostic. L'appréciation de la vidéo-otoscopie, par les médecins généralistes, était effectuée par une échelle de Likert.

Résultats

Il n'existait pas de différence significative entre les résultats des 3 groupes (otoscopie conventionnelle, vidéo-otoscopie et ORL) sur l'ensemble des examens. Concernant l'analyse des tympans pathologiques, il existait une différence significative entre les résultats des ORL et ceux des omnipraticiens utilisant un otoscope (p = 0,0032). En revanche, il n'était pas mis en évidence de différence entre les scores des omnipraticiens et des ORL dans l'interprétation des tympans issus de la vidéo-otoscopie (p = 0,0754). L'ensemble des omnipraticiens était conquis par cet outil diagnostic même s'ils n'étaient pas décidés à en faire l'acquisition.

Conclusion

La vidéo-otoscopie montre sa supériorité par rapport à l'otoscopie conventionnelle concernant l'interprétation des tympans pathologiques.

http://bit.ly/2GiThy7

Cancer du larynx d’origine professionnelle : tendances en France de 2001 à 2016

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): J. Grignoux, Q. Durand-Moreau, N. Vongmany, S. Brunel, membres du RNV3P, J.-D. Dewitte

Résumé

Objectifs

Dans le cadre du plan cancer 2014–2019 et de l'amélioration des connaissances en cancérologie professionnelle, nous avons analysé les situations professionnelles à risque de cancer du larynx recensé dans le réseau national de vigilance et de prévention des pathologies professionnelles (RNV3P) de 2001 à 2016.

Matériel et méthodes

L'étude a porté sur les cas de cancers du larynx d'origine professionnelle avec une exposition jugée par le médecin expert en lien direct avec la pathologie (imputabilité moyenne ou forte). Ont été analysés les données démographiques, les circonstances d'exposition professionnelle (nuisances, poste de travail, secteur d'activité), les facteurs de risque extraprofessionnels et l'avis pour une déclaration de maladie professionnelle.

Résultats

Entre 2001 et 2016, 244 cancers du larynx ont été enregistrés. Cent quarante-sept cas ont été conclus d'origine professionnelle dont 87 jugés avec une imputabilité moyenne ou forte. Cette population est exclusivement masculine, d'un âge médian de 59 ans. On recense 97 expositions différentes dont l'amiante pour 78 cas. Les secteurs d'activité majoritaires sont ceux des travaux de construction spécialisés (14 cas) et de la métallurgie (7 cas). Une déclaration de maladie professionnelle a été conseillée à 60 patients et l'amiante est retrouvé dans 80 % des demandes.

Conclusion

L'amiante est le facteur de risque de cancer du larynx le plus décrit dans le réseau de 2001 à 2016. Notre étude confirme l'implication de l'amiante dans la cancérogénicité du larynx, une réflexion sur la création d'un tableau de maladie professionnelle en France paraîtrait ainsi légitime à l'instar de pays voisins européens.

http://bit.ly/2SjG3aO

Évaluation de la déglutition des patients opérés d’une pharyngolaryngectomie totale circulaire. Étude multicentrique du GETTEC

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): S. Morinière, P. Gorphe, F. Espitalier, D. Blanchard, N. Fakhry, N. Saroul, C. Bach, X. Dufour, C. Fuchsmann, S. Vergez, S. Albert

Résumé

But

Les pharyngolaryngectomies totale circulaires sont réalisées pour des tumeurs évoluées du pharynx ou dans un contexte de récidive post-radique. Plusieurs procédés de reconstruction du pharynx par lambeau libres ou pédiculés sont utilisés et sont choisis selon l'opérateur. Cette étude a pour but d'évaluer les résultats fonctionnels sur la déglutition à long terme de ces patients en fonction du type de lambeau utilisé pour la reconstruction.

Matériel et méthode

Une étude rétrospective multicentrique a été menée de janvier à septembre 2016 dans le groupe Gettec. Tous les patients opérés d'une pharyngolaryngectomie totale circulaire et en rémission étaient inclus et devaient remplir le questionnaire du déglutition handicap index (DHI) et avoir une fibroscopie de déglutition. 46 patients (39 hommes 7 femmes) ont été inclus pendant cette période. Le lambeau ante-brachial tubulisé (groupe LABT) était utilisé dans 19 cas, le grand pectoral en fer à cheval (groupe LGP) dans 15 cas et le jéjunum libre (groupe LJL) dans 12 cas.

Résultats

Le DHI moyen était de 24 : 20 groupes LABT, 23 groupes LJL, 25 groupes LGP, sans différence significative ; 27 patients avaient une déglutition normale, 9 mixée, 8 liquide, 3 étaient alimentés par gastrostomie. La nasofibroscopie de la déglutition obtenait un pourcentage de patient avec une déglutition normale de salive et de yaourt significativement plus important pour les patients reconstruits avec un lambeau libre (LJL et LABT) par rapport au groupe LGP (p = 0,04).

Conclusion

Cette étude a montré que le type de lambeau de reconstruction d'une pharyngolaryngectomie totale circulaire n'a pas d'impact sur la qualité de la déglutition postopératoire évaluée par le patient par autoquestionnaire du DHI.

http://bit.ly/2GmQbct

Menaces sur le facteur d’impact ?

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s): O. Laccourreye, H. Maisonneuve

http://bit.ly/2SjFUEi

Editorial Board

Publication date: February 2019

Source: Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, Volume 136, Issue 1

Author(s):

http://bit.ly/2GgOw89

Modified Z‐plasty of the internal nasal valve ‐ to treat mechanical nasal obstruction: How we do it

Abstract

The internal nasal valve (INV) is bound by the nasal septum, inferior turbinate and the upper lateral cartilage (ULC). It is the most important determinant of nasal airflow, and critical for nasal breathing. The normal internal nasal valve angle is 10‐15^o.¹ Even a small change in the INV angle can have a significant impact on nasal airflow.

This article is protected by copyright. All rights reserved.

http://bit.ly/2DPAHMo

A contemporary review of machine learning in otolaryngology–head and neck surgery

One of the key challenges with big data is leveraging the complex network of information to yield useful clinical insights. The confluence of massive amounts of health data and a desire to make inferences and insights on these data has produced a substantial amount of interest in machine‐learning analytic methods. There has been a drastic increase in the otolaryngology literature volume describing novel applications of machine learning within the past 5 years. In this timely contemporary review, we provide an overview of popular machine‐learning techniques, and review recent machine‐learning applications in otolaryngology–head and neck surgery including neurotology, head and neck oncology, laryngology, and rhinology. Investigators have realized significant success in validated models with model sensitivities and specificities approaching 100%. Challenges remain in the implementation of machine‐learning algorithms. This may be in part the unfamiliarity of these techniques to clinician leaders on the front lines of patient care. Spreading awareness and confidence in machine learning will follow with further validation and proof‐of‐value analyses that demonstrate model performance superiority over established methods. We are poised to see a greater influx of machine‐learning applications to clinical problems in otolaryngology–head and neck surgery, and it is prudent for providers to understand the potential benefits and limitations of these technologies. Laryngoscope, 2019

http://bit.ly/2D7NckW

Long‐term quality of life after definitive treatment of sinonasal and nasopharyngeal malignancies

Objective

To evaluate long‐term global and site‐specific health‐related quality of life (HRQoL) in patients treated for sinonasal and nasopharyngeal malignancies.

Study Design

Cross‐sectional.

Methods

One hundred fourteen patients with sinonasal and nasopharyngeal malignancies received surgery, radiation, systemic chemotherapy, or a combination thereof, with curative intent. Validated global ([EuroQol‐5D] Visual Analogue Scale [EQ‐5D VAS]) and disease‐specific instruments (MD Anderson Symptom Inventory–Head and Neck [MDASI‐HN], Anterior Skull Base Questionnaire [ASBQ]) were administered to patients who were both free of disease and had completed treatment at least 12 months previously. Associations between instruments, instrument domains, and specific clinical parameters were analyzed.

Results

The median age was 55 years. The mean EQ‐5D VAS, MDASI‐22 composite score, and ASBQ score were 74 (standard deviation [SD] 21), 48 (SD 36), and 130 (SD 27), respectively. The most frequently reported high‐severity items in MDASI‐HN were dry mouth and difficulty tasting food. The most frequently reported high‐severity items in ASBQ were difficulty with smell and nasal secretions. Advanced Tumor (T) classification was associated with worse overall ASBQ sum score (P = 0.02). ASBQ performance at home and MDASI‐HN drowsy symptom items independently predicted worse global HRQoL as measured by the EQ‐5D VAS (P < 0.001).

Conclusion

Global HRQoL for survivors of sinonasal and nasopharyngeal malignancies after multimodality treatment approximates that of the U.S. population for the same age group. ASBQ and MDASI‐HN correlate well with global HRQoL outcomes as measured by EQ‐5D VAS. MDASI‐HN and ASBQ elicited unique symptoms, highlighting the complex symptom burden experienced by these patients. Further studies should identify patients predisposed to reduced long‐term QOL.

Level of Evidence

3. Laryngoscope, 2019

http://bit.ly/2G5VtJS

Role of c‐Met expression on prognosis of head and neck cancer: A literature review and meta‐analysis

Abstract

The prognostic role of c‐Met expression in patients with head and neck cancer were controversial among different studies. Thus, we performed a meta‐analysis to evaluate the relationships between c‐Met expression and survival and clinical parameters of head and neck cancer patients.

Summary hazard ratio (HR) and 95% confidence intervals (CIs) were calculated to analyze the correlations between c‐Met expression and overall survival (OS), and disease‐free survival (DFS). Furthermore, odds ratios (ORs) and 95% CIs were used to describe the relationships between c‐Met expression and different clinicopathological parameters.

A total of 2417 patients from 19 studies were enrolled in the final analysis. The results showed that patients with higher c‐Met expression had a poor OS (HR, 1.65; 95% CI, 1.20‐2.27) and DFS (HR, 1.48; 95% CI, 0.99‐2.20). In addition, c‐Met expression was associated with the N classification of patients with head and neck cancer.

These results suggested that c‐Met expression was a risk factor for head and neck cancer, and increased c‐Met expression would be a predictor of a poorer prognosis for the patients.

http://bit.ly/2DOTKGy

Multicenter retrospective study of the prognosis and treatment outcomes of Japanese oral squamous cell carcinoma patients with level IV/V metastasis

Abstract

Background

The purpose of this study was to retrospectively describe the characteristics and outcomes of patients with oral squamous cell carcinoma and level IV/V metastasis and to compare patients who underwent no postoperative therapy with those who underwent postoperative radiotherapy (RT) and concomitant chemoradiotherapy (CCRT).

Methods

We evaluated 669 patients. Clinicopathological data, postoperative therapy, and clinical course were investigated.

Results

Sixty‐one patients (9.1%) developed level IV/V metastasis. The 3‐year cumulative overall survival rates of patients with and without level IV/V metastasis were 47.3% and 64.3%, respectively. Tongue tumors, pN2 or N3 classification, and moderate or poor differentiation were significantly associated with the development of level IV/V metastasis. The surgery+RT/CCRT group was associated with better 3‐year cumulative disease‐specific survival and overall survival rates than the surgery only group.

Conclusion

Adjuvant therapy (RT alone or CCRT) after surgery is recommended for patients with level IV/V metastasis.

http://bit.ly/2MKFC3U

An individual patient data meta‐analysis on the effect of chemotherapy on survival in patients with craniofacial osteosarcoma

Abstract

Chemotherapy improves the survival of patients with long bone osteosarcomas. However, the benefits of chemotherapy in the treatment of craniofacial osteosarcoma (CFOS) are still controversial. We searched PubMed and EMBASE from February 1997 to December 2016 to identify studies on CFOS. The individual patient data of these studies were pooled into a meta‐analysis. Univariate and multivariate survival analyses were performed. Thirteen studies with a total of 184 patients met our inclusion criteria. Positive resection margin was a poor prognostic factor for CFOS in the univariate and multivariate survival analyses. Chemotherapy improved overall survival (OS) and disease‐specific survival (DSS) in patients with CFOS who had tumors in the maxilla, positive resection margins, or high‐grade tumors. Patients with local tumor recurrence had better OS and DSS when treated with chemotherapy. Chemotherapy improves survival in patients with CFOS with adverse factors, such as tumors with positive margins, high‐grade tumors, and recurrent tumors.

http://bit.ly/2DQw7gP

Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study

Background

Specimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen.

Methods

During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed.

Results

The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved.

Conclusion

Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.

http://bit.ly/2MJZUKL

Risk factors for postoperative hemorrhage in patients with oral squamous cell carcinoma: A retrospective study

Abstarct

Background

Postoperative hemorrhage is one of the life‐threatening complications of oral cancer surgery. The purpose of this study was to identify the risk factors in a large cohort.

Patients and methods

Patients with oral squamous cell carcinoma who had received surgery were enrolled. The variables between patients with and without postoperative hemorrhage were compared using univariate and multivariate models.

Results

Of the 1513 patients (or 1581 cases) enrolled in the study, 34 patients suffered from postoperative hemorrhage. In the univariate analysis, cigarette, and alcohol consumption, floor of mouth tumors, T4 classified tumors, flap reconstruction, surgical site infection, and flap necrosis were risk factors for postoperative hemorrhage. In the multivariate model, flap necrosis and surgical site infection were independent risk factors for postoperative hemorrhage.

Conclusions

The patients with surgical site infection or flap necrosis should be closely monitored in order to avoid postoperative hemorrhage.

http://bit.ly/2DS00gH

Aurora kinase A induces chemotherapy resistance through revival of dormant cells in laryngeal squamous cell carcinoma

Background

Chemotherapy resistance was an important tumor metastasis mechanism.

Methods

Cell Counting Kit‐8 assay and plate colony formation assay were applied to examine the proliferation of laryngeal squamous cell carcinoma (LSCC). Immunofluorescent staining and Western blotting were carried out to show the expression of related proteins. Wound healing, migration, and invasion assays were used to examine the mobility, migration, and invasion of LSCC.

Results

Downregulated Aurora kinase A (AURKA) increased chemotherapy sensitivity and reduced the ability of mobility, migration, and invasion of Hep2 cells, while upregulated AURKA possessed opposite results. Hep2/5‐Fu cells possessed dormancy‐like properties and upregulated AURKA in Hep2/5‐Fu cells (Hep2/5‐Fu/AURKA cells) revived dormant state. Furthermore, Erk1/2 was restrained in Hep2/5‐Fu cells and activated in Hep2/5‐Fu/AURKA cells. Moreover, Erk1/2 accelerated the ability of mobility, migration, and invasion in Hep2/5‐Fu/AURKA cells.

Conclusion

AURKA activated dormant state to induce chemotherapy resistance and promoted metastasis of LSCC through Erk1/2 pathway.

http://bit.ly/2MNCqV3

Importance of incorporating intraoperative neuromonitoring of the external branch of the superior laryngeal nerve in thyroidectomy: A review and meta‐analysis study

Abstract

Background

Voice changes are frequently reported after thyroidectomy due to injury to the external branch of the superior laryngeal nerve (EBSLN) and paralysis of the cricothyroid muscle, The objective is to evaluate the advantage of intraoperative neuromonitoring (IONM) in identifying EBSLN during thyroid surgery.

Methods

Data sources were MEDLINE, PubMed, Web of Science, and Cochrane Library from January 1, 1995, through July 1, 2018. Published studies of adult patients who had thyroid surgery and an attempt to identify EBSLN done by conventional methods and/or IONM were selected.

Results

Seven studies met all inclusion criteria. Patients who had IONM during thyroid surgery had a significantly increased number of identified EBSLN at risk, compared to the control group.

Conclusion

The use of IONM during open thyroid surgery increases EBSLN identification/visualization, and hence it may decrease the incidence of post‐thyroidectomy voice disorders.

http://bit.ly/2DQdRnG

Outcomes of drainless outpatient parotidectomy

Abstract

Background

Superficial parotidectomy has traditionally been completed with a drain and overnight hospital stay. We report perioperative and postoperative outcomes for patients undergoing drainless outpatient parotidectomy vs traditional drained extended stay parotidectomy.

Methods

Retrospective chart review from a single surgeon from 2009 to 2017 of patients undergoing parotidectomy, including demographic data, surgical approach, tumor pathology and size, blood loss, drain placement, postoperative pain control, and complications, was done. A comparison was performed between patients undergoing drain placement and those treated with "drainless" technique.

Results

Ninety‐one patients underwent parotidectomy (42 drainless; 49 drained). Intraoperative blood loss was lower in the "drainless" group (16.0 mL vs 34.9 mL, P < .001). There was a lower rate of facial nerve paresis in the "drainless" group compared with the "drained" cohort (7% vs 16.3%, P = .18). Seroma formation and infection rate was similar.

Conclusion

In the properly selected patient, outpatient drainless parotidectomy is a viable procedure with comparable outcomes to traditional extended stay drained parotidectomy.

http://bit.ly/2MLZhR4

Developing case‐finding algorithms for second events of oropharyngeal cancer using administrative data: A population‐based validation study

Abstract

Background

Second event (recurrence or second primary cancer)‐free survival is an important indicator for assessing treatment efficacy. However, second events are not explicitly documented in administrative data such as cancer registries. Thus, validated algorithms using administrative data are needed to identify second events of oropharyngeal cancers.

Methods

The algorithms were developed using classification and regression tree models. Data from chart review served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.

Results

The high‐sensitivity algorithm achieved 87.9% (95% confidence interval: 82.2%‐93.6%) sensitivity, 84.5% (81.1%‐87.8%) specificity, 61.2% (54.1%‐68.4%) PPV, 96.2% (94.2%‐98.1%) NPV, and 85.2% (82.3%‐88.1%) accuracy. The high‐PPV algorithm obtained 52.4% (43.6%‐61.2%) sensitivity, 99.1% (98.2%‐100.0%) specificity, 94.2% (88.7%‐99.7%) PPV, 88.2% (85.3%‐91.0%) NPV, and 88.9% (86.3%‐91.5%) accuracy.

Conclusion

The validity of the algorithms for identifying second events following primary treatment of oropharyngeal cancers was acceptable.

http://bit.ly/2t1TuOo

Ten‐year outcome of curative “exclusive” chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx with complete clinical response

Abstract

Background

The aim of our study was to document 10‐year outcome after curative "exclusive" chemotherapy in N0M0 squamous cell carcinoma of the larynx and pharynx.

Methods

Retrospective nonrandomized analysis of an inception cohort of 191 patients. Platinum salt and 5‐fluorouracil were used in all patients.

Results

The 3‐, 5‐, 10‐year overall actuarial survival and local control estimates were 83.3%, 74.4%, and 55.4% and 62.1%, 62.1%, and 55.3%, respectively. Main causes of death were metachronous second primary cancer (n = 39) and intercurrent disease (n = 28). No clinical variables were associated with increased risk of local recurrence. Salvage treatment resulted in 94.7% ultimate local control and 88.4% organ preservation. "Exclusive" chemotherapy was considered "beneficial" in 62.3% and "detrimental" in 7.8% of cases.

Conclusion

The high rate of local recurrence may be thought not to justify this treatment. Nevertheless, many patients avoided surgery and remained free of disease. Therefore, this approach deserves further study in the era of immune checkpoints inhibitors.

http://bit.ly/2HKEXkk

Marked responses to pemetrexed chemotherapy for metastatic adenocarcinoma of the parotid gland: Case series

Abstract

Background

There are no proven systemic therapies for metastatic adenocarcinoma of the salivary glands. Pemetrexed use in adenocarcinoma of the salivary glands has not been previously described.

Methods

Retrospective case reports and literature review.

Results

Two patients with metastatic salivary gland adenocarcinoma were treated with single‐agent pemetrexed with marked response and clinical benefit. Case 1 describes a sustained clinical response for 8 months after failing several lines of chemotherapy. Case 2 describes a marked interval response of diffuse metastatic disease at 2 months with resolution of bone pain and sustained response at 8 months.

Conclusion

To our knowledge, this is the first report of efficacy of single‐agent pemetrexed for metastatic salivary gland adenocarcinoma. Given the significant and sustained responses in heavily pretreated patients, further investigation of pemetrexed for salivary cancer may be warranted.

http://bit.ly/2sZf7P8

Sellar and Parasellar Pain Syndromes

Abstract

Purpose of Review

Sellar and parasellar lesions are numerous and varying in terms of their patholphysiology and physical and radiographic characteristics but often incite pain syndromes that are similar in semiology. The goal of this review was to familiarize the reader with a variety of sellar and parasellar lesions grouped together based on common clinical symptomatology, with a focus on important imaging characteristics that are often distinguishing features diagnostically.

Recent Findings

In most cases, tissue acquisition via surgical resection or stereotactic biopsy are the mainstay for definitive diagnosis of sellar and parasellar lesions. With advances in MRI technology in particular in terms of resolution and the inclusion of new techniques including dynamic imaging with delayed contrast, imaging studies of lesions in the sellar and parasellar regions have become increasingly important for diagnostic purposes, with pituitary adenomas and schwannomas as prime examples. In the case of chordoid gliomas, molecular features of the tumor also help distinguish it from other disease processes similar in presentation, which have dramatic impacts on management. Advances in surgical approaches and radiation techniques offer more precise and targeted therapy to lesions in an area with increased risk of clinical morbidity given the high concentration of critically important structures that must be spared during treatment.

Summary

Sellar and parasellar lesions have the potential to cause significant morbidity and mortality, highlighting the importance of clinical recognition of warning signs/symptoms, obtaining high-quality imaging studies in various modalities for diagnostic purposes, and prompt management which often involves a multimodal approach that includes surgical resection, radiation, and/or medical therapy. Future advanced imaging techniques will only improve presurgical diagnostic accuracy and lead to more prompt and efficient management.

http://bit.ly/2HJdFdN