Understanding giant cell sarcoma of the head and neck: A population‐based study

xlomafota13 shared this article with you from Inoreader Understanding giant cell sarcoma of the head and neck: A population‐based study Via Head & Neck Abstract Background Giant cell sarcomas (GCS) are rare head and neck neoplasms. Methods The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for all patients who have been diagnosed with GCS from 1973 to 2014. Results Four hundred and forty cases of GCS of the head and neck were identified. The average age at diagnosis was 74.4 years, 86.8% were white, 82.5% were male, 70.7% were insured, and 88.2% lived in an urban metropolitan region. Connective tissue was the most frequent primary site (42.5%). The 5Y-DSS rate was 91.1%, while the 5Y-OS was 54.6% for all cases. Patients treated with surgery alone had the highest 5Y-DSS rate of 94.5. T-classification odds ratio was a significant predictor of survival accounting for confounding variables on multivariate analysis. Conclusions GCS presents most frequently in connective tissue of the head and neck with overall high probability of survival. The treatment of choice is surgery alone. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sialendoscopy and Sjogren's Disease: A Systematic Review

xlomafota13 shared this article with you from Inoreader Sialendoscopy and Sjogren's Disease: A Systematic Review Via The Laryngoscope Objectives/Hypothesis This study is a systematic review of the literature which seeks to estimate the expected treatment outcomes of a patient with Sjogren's syndrome (SS) undergoing therapeutic sialendoscopy. Study Design Systematic Review. Methods PubMed, Scopus, and Cochrane library databases were used to search for studies published as of August 2020 regarding the treatment outcomes of SS with sialendoscopy. The key search terms included "Sjogren's syndrome" and "sialendoscopy." Only studies in the English language involving more than one human patient were included. PRISMA guidelines were followed in study inclusion and data extraction. The primary outcome assessed was improvement in patient symptoms. Results Six studies met criteria and were analyzed in this review, including 125 patients undergoing sialendoscopy of parotid and/or submandibular glands as well as 25 controls. Of these patients, 90% were female with an age range of 18 to 79 years. There was significant diversity in outcome reporting tools. The outcomes of symptom improvement were pooled qualitatively based on improvement noted in each study. Outcomes were defined as partial improvement if the measured outcomes improved and complete improvement if measured outcomes resolved entirely. Despite the limited number of studies on this topic, this meta-analysis suggests that a similar study of therapeutic sialendoscopy could expect to provide at least temporary improvement of symptoms 90% to 99% of the time. Conclusions This review provides support for the application of sialendoscopy in the treatment of SS salivary disease. Larger studies with consistent outcome reporting tools and control groups are needed to validate these results and provide a consistent therapy protocol. Laryngoscope, 131:1474–1481, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Geographic and Socioeconomic Factors on Survival in Esthesioneuroblastoma

xlomafota13 shared this article with you from Inoreader Geographic and Socioeconomic Factors on Survival in Esthesioneuroblastoma Via The Laryngoscope Objectives Esthesioneuroblastoma (ENB) is a rare sinonasal malignancy with little known regarding how regional and socioeconomic differences in the United States alter disease survival. The aim of this study is to explore the geographic difference in clinical features, socioeconomic factors, and survival outcomes of ENB patients. Methods ENB cases were extracted from the Surveillance, Epidemiology, and End Results registry from 1975–2016. Patient data were stratified based on geographical location and comparative analyses of socioeconomic features, disease characteristics, and survival patterns were performed. Kaplan–Meier regression analyses were used to estimate disease-specific survival (DSS). Results A total of 987 patients were identified: 56.4% West, 14.0% South, 12.7% Midwest, and 16.6% East. The West had the highest proportion of patients with Medicaid coverage (P < .001), stage A malignancy (P < .001), and treated with surgery and adjuvant radiotherapy (P < .001). The South had the highest proportion of patients who were Black (P < .001), uninsured (P < .001), and resided in rural areas (P < .001). Five-year DSS patterns were 81.0% (West), 79.8% (East), 67.4% (Midwest), and 72.7% (South) [P = .018]. Ten-year DSS outcomes were 74.0% (West), 73.7% (East), 60.9% (Midwest), and 63.6% (South) [P = .017]. Conclusion In ENB patients, survival disparity exists in the United States based on geographical region. Patients from the West and East exhibit higher survival than those from the South and Midwest. Level of Evidence 4 Laryngoscope, 131:E2162–E2168, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival

xlomafota13 shared this article with you from Inoreader Effect of Patient Demographics and Tracheostomy Timing and Technique on Patient Survival Via The Laryngoscope Objectives The ideal timing and technique of tracheostomy vary among patients and may impact outcomes. We aim to examine the association between tracheostomy timing, placement technique, and patient demographics on survival. Study Design Retrospective cohort study. Methods A retrospective review was performed for all patients who underwent tracheostomy in 2016 and 2017 at one urban academic tertiary-care hospital. Kaplan–Meier curves were created based on combinations of tracheostomy timing and technique (early percutaneous, early non-percutaneous, late percutaneous, and late non-percutaneous). Cox proportional hazard models were used to determine multivariable effects of timing, technique, and other demographic factors. Primary outcome measures were tracheostomy-related mortality and overall survival. Secondary outcomes were in-hospital, 30-day, and 90-day mortality. Results Our study included 523 patients. There were six tracheostomy-related deaths, with hemorrhage and tracheoesophageal fistula being the most common causes. Tracheostomy timing and technique combinations were not associated with differences in all-cause mortality or survival following discharge. Cox proportional hazard models showed that Charlson Comorbidity Index (CCI) and unknown partner status were associated with a decrease in survival (P < .01 and P = .05, respectively). Additionally, patient age, gender, race, CCI, and body mass index were not independently associated with changes in survival. Conclusion Late and non-percutaneous tracheostomies were associated with more tracheostomy-related deaths, but timing and technique were not associated with differences in patient survival. Multiple regression analysis showed that increased patient comorbidities, measured via CCI, and unknown partner status were independently associated with decreased survival. Proceduralists should discuss timing, technique, and patient social factors together with the medical care team when constructing plans for postdischarge management. Level of Evidence 4 Laryngoscope, 131:1468–1473, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictors of Long‐Term Nasal Obstruction Symptom Evaluation Score Stability Following Septoplasty With Inferior Turbinate Reduction

xlomafota13 shared this article with you from Inoreader Predictors of Long‐Term Nasal Obstruction Symptom Evaluation Score Stability Following Septoplasty With Inferior Turbinate Reduction Via The Laryngoscope Objectives/Hypothesis Determine the postoperative Nasal Obstruction Symptom Evaluation (NOSE) score stability between 1 and ≥6 months after septoplasty with inferior turbinate reduction (ITR). Education level and occupation were evaluated to determine their effects on NOSE score stability during the postoperative period. Study Design Retrospective case series. Methods This was a retrospective case series. Patients were included if they underwent septoplasty with ITR for nasal obstruction due to septal deviation and inferior turbinate hypertrophy. NOSE scores were collected preoperatively, and at 1 and ≥6 months postoperatively. Education level and occupation were collected postoperatively via telephone survey. Changes in NOSE scores were compared between the different time points. Education level and occupation were analyzed to determine if they affected NOSE scores. Results There were 98 patients included, and 56 were male (57.1%). Mean NOSE scores preoperatively and at 1 and ≥6 months postoperatively were 72.1, 17.1, and 12.0, respectively. Patients demonstrated a statistically and clinically significant reduction in NOSE score at 1 month (−54.9, P < .001) and at ≥6 months postoperatively (−60.0, P < .001). The mean 6.2-point decrease in NOSE score from 1 to ≥6 months was statistically, but not clinically significant. There were no significant differences in NOSE score changes based on educational level and occupation. Conclusions Patients achieved statistically and clinically significant reductions in NOSE scores at 1 months, with no clinically significant differences in NOSE scores at ≥6 months, suggesting NOSE score stability between these postoperative time points. Neither education level nor occupation influenced NOSE scores. Level of Evidence 4 Laryngoscope, 131:E2105–E2110, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Septal Perforation Repair Using Bilateral Rotational Flaps With Interposed Mastoid Periosteal Graft

xlomafota13 shared this article with you from Inoreader Septal Perforation Repair Using Bilateral Rotational Flaps With Interposed Mastoid Periosteal Graft Via The Laryngoscope Objectives/Hypothesis To evaluate the outcomes of endonasal repair of septal perforations utilizing opposing bilateral rotational flaps and a periosteum interposition graft. Methods Retrospective review of a single surgeon, tertiary referral center experience of patients who underwent septal perforation repair. Patient demographics, etiology of perforation, closure rate, and complication data were obtained. Patients screening positively for cocaine use or anti-neutrophil cytoplasmic antibodies (ANCA) were not offered repair. Results A total of 104 patients were included, 65 male and 39 female with mean age of 45.4 years. Etiology of perforations included prior surgery in 45, trauma in 15, and unknown in 44, and the average perforation size in each etiologic group were 1.35 cm, 1.25 cm, and 1.30 cm, respectively. The greatest dimension of perforations repaired ranged from 0.5 cm to 1.5 cm. The overall success rate was 87.5% at 6 month follow-up. Successful closure was achieved in 95.6%, 86.7%, and 79.5%, respectively (χ2 = 5.264, P = .0218). Conclusion Our described technique is a reliable endonasal approach with predictable outcomes in septal perforations up to 1.5 cm in size. Having an unknown etiology of septal perforation may be a risk factor for failure. Level of Evidence 4 Laryngoscope, 131:1497–1500, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Value of Epithelial Cell Adhesion Molecules in T1‐2N0M0 Glottic Cancer

xlomafota13 shared this article with you from Inoreader Prognostic Value of Epithelial Cell Adhesion Molecules in T1‐2N0M0 Glottic Cancer Via The Laryngoscope Objective This is an ancillary study of a multi-institutional randomized non-inferiority phase III trial of accelerated fractionation (AF) versus standard fractionation (SF) radiation therapy for T1-2N0M0 glottic cancer (JCOG0701). Biopsy specimens of tumors from the patients enrolled in the JCOG0701 are collected and the association between clinical outcomes and histopathologic features such as expression of epithelial cell adhesion molecule (EpCAM), p53, and p16 were investigated. Methods Five slices of undyed slides from biopsy specimens were sent to the National Cancer Center Hospital and all the specimens were assessed for the expression of EpCAM, p53, and p16. The primary objective was to investigate the association between 3-year progression-free survival (PFS) and expression of EpCAM, p53, and p16. Results A total of 88 out of 370 patients were enrolled in this ancillary study. The 3-year PFS for tumors with strong expression of EpCAM was 70.6% (95% CI 43.1%–86.6%), while that of tumors without strong expression of EpCAM was 77.5% (95% CI 65.9%–85.5%) with no remarkable difference between groups (P = .67). Likewise, there was no significant difference in 3-year PFS between tumors regardless of p53 or p16 status. However, in a subgroup analysis for 17 patients with a strong expression of EpCAM, AF showed better 3-year PFS than SF (100% vs 54.5%, P = .07). Conclusions From the current study, it could not be concluded that EpCAM, p16, and p53 were prognostic factors for early-stage glottic cancer after primary radiation therapy. AF might be an appropriate fractionation for tumors with a strong expression of EpCAM. Level of Evidence 3 Laryngoscope, 131:1522–1527, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictors of Completion of Sublingual Immunotherapy

xlomafota13 shared this article with you from Inoreader Predictors of Completion of Sublingual Immunotherapy Via The Laryngoscope Objectives Sublingual immunotherapy (SLIT) has emerged as an effective treatment alternative to subcutaneous immunotherapy (SCIT) given its improved safety profile and more convenient dosing. However, SLIT still relies on daily dosing for many years to optimize effectiveness. This study sought to investigate factors that influence patient completion of SLIT. Methods We performed an institutional retrospective review of patients who received SLIT (2008–2020). Completion was defined as completing at least 36 months of SLIT. Patient demographics and characteristics, including the number of allergens treated, history of asthma and sinus surgery, number of clinic visits, and total time undergoing SLIT, were documented. Multivariate models were used to analyze predictors of SLIT completion. Subgroup analysis was performed among pediatric patients and patients who discontinued SLIT. Results Of the 404 total patients, 249 (61.6%) discontinued, 47 (11.6%) completed, and 108 (26.7%) were currently undergoing SLIT. The mean duration of therapy was 11.2 months for those who discontinued and 49.4 months for patients who completed SLIT. The odds of SLIT completion were twice as high with each additional clinic visit (P < .001), and twice as high when the dosage was increased during therapy (P = .06). Pediatric patients younger than age 12 with a history of asthma were over five times more likely to complete therapy (P = .045). Patients with more clinic visits (P < .001) and higher associated costs (P = .003) were less likely to be lost to follow-up. Conclusion Increasing the frequency of clinic visits, improving therapy availability, and mitigating concerns about clinical efficacy may increase patient completion of SLIT. Level of Evidence 4 Laryngoscope, 131:E2111–E2115, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Absent Posterior Belly of Digastric Muscle

xlomafota13 shared this article with you from Inoreader Absent Posterior Belly of Digastric Muscle Via The Laryngoscope Objective Report a unique case of absent posterior belly of digastric muscle, with a literature review and discussion of its clinical importance. Methods Present a case report and review the current literature including PUBMED search terms; "absent posterior digastric", "digastric muscle", "posterior belly". Results While there were multiple reports of accessory anterior and posterior bellies and absence of anterior belly, there is a paucity of literature on absence of posterior belly of digastric muscle. Conclusion To our knowledge, this is the first report of an absent posterior belly of the digastric muscle. The posterior belly of the digastric muscle is an important landmark in neck dissection, and its absence makes knowledge of other anatomic landmarks critically important. Laryngoscope, 131:1501–1502, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prognostic Significance of Pain in Parotid Gland Malignancy

xlomafota13 shared this article with you from Inoreader Prognostic Significance of Pain in Parotid Gland Malignancy Via The Laryngoscope Objectives/Hypothesis To better understand the significance of pain as a predictor of disease severity in parotid gland malignancy. Study Design A retrospective chart review of patients treated for primary parotid gland malignancy at our institution between 1991 and 2020 was performed. Methods Patient records were retrospectively reviewed and relevant clinical parameters were collected. Patients were stratified into low stage (I and II) disease and high stage (III and IV) disease groups to analyze the independent effect of pain at initial presentation on disease recurrence rate and disease-free survival using Kaplan–Meier survival curves and an independent two-sample t-test. Results Of 154 patients evaluated, there were 69 patients in the low stage group and 80 patients in the high stage group. Thirty-seven high stage patients presented with pain. High stage patients with pain were significantly more likely to develop disease recurrence than high stage patients without pain (58.5% [22/37] versus 33.3% [13/39], P = .022). High stage patients with pain also had significantly decreased disease-free survival time compared to high stage patients without pain (P = .027). Conclusion Pain on presentation appears to be a poor prognostic factor for patients with parotid gland malignancy. For patients with demonstrated high stage disease, pain is independently associated with increased risk of recurrence and decreased disease-free survival time. Level of Evidence 4 Laryngoscope, 131:1503–1508, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quality of Life Outcomes in Patients With Sinonasal Malignancy After Definitive Treatment

xlomafota13 shared this article with you from Inoreader Quality of Life Outcomes in Patients With Sinonasal Malignancy After Definitive Treatment Via The Laryngoscope Objectives/Hypothesis To describe multidimensional quality of life (QOL) outcomes in patients with sinonasal malignancies (SNM). To elucidate factors predicting worse QOL in this population. Study Design Retrospective chart review at tertiary institution. Methods A retrospective chart review on patients treated for SNM from 2006 to 2019 at a tertiary medical center was conducted. QOL outcomes were measured using the Hospital Anxiety and Depression Scale (HADS) and the Functional Assessment Cancer Therapy – Nasopharynx (FACT-NP) score. A stepwise multiple linear regression analysis was conducted to assess factors predicting worse QOL. Results Eighty-one patients met inclusion criteria. Twelve (14.8%) patients had a subscale score >11 for anxiety (HADS-A) or depression (HADS-D) indicating significant anxiety or depression, at a median of 24 (8–68.5) months post treatment. The median FACT-NP total score was 136 (110–152). On multivariable analysis, advanced T classification, single status, and worse social support survey score were significant predictors of worse HADS score. Worse social support survey score was a significant predictor of worse total FACT-NP score. Conclusion After adjusting for confounders, at a median of 24 months after completion of definitive therapy for SNM, advanced T classification and single relationship status were found to be significant predictors of anxiety and depression (based on HADS). A worse social support survey score was associated with worse anxiety, depression, and QOL (based on HADS and FACT-NP). Identifying these factors early may help to guide treatment and psychiatric referral to at-risk individuals after the treatment of SNM. Level of Evidence 3 Laryngoscope, 131:E2212–E2221, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis

xlomafota13 shared this article with you from Inoreader Predominant Vertical Location of Benign Vocal Fold Lesions by Sex and Music Genre: Implication for Pathogenesis Via The Laryngoscope Objectives/Hypothesis Vertical locations of vocal fold mucosal lesions (VFMLs) vary along the free edge. As the vertical contact area of vocal folds (VFs) depends on the vocal register, lesions may occur in the contact area of more frequently used vocal registers. This study investigated the cause of location variations by comparing the vertical sites of VFMLs in singers of both sexes with different music genres. Study Design Retrospective review. Methods Sixty professional classical and rock singers (11 male classical [M-classical], 22 male rock [M-rock], 13 female classical [F-classical], and 14 female rock [F-rock] singers) who underwent microlaryngeal surgery for VF polyps and nodules and their 108 lesions were enrolled. The VF free edge was vertically divided into three equal parts and classified into the following four lesion sites: upper, middle, lower, and multiple sites. Results Upper lesions were most common among F-classical singers (73.9%), whereas lower lesions were most common among M-classical (90.0%) and M-rock (60.6%) singers. Among lesions localized to a single site, lower lesions were most common among F-rock singers (37.0%). F-classical singers had significantly more upper lesions than the other groups (P < .001). M-classical singers had significantly more lower lesions than female singers of any genre (P < .001). Conclusion Upper lesions were most common among F-classical singers who mostly used the head voice. Lower lesions were most common among singers who mainly used the modal voice. This study suggests that sex, the dominant vocal register used for singing, and mechanical stress on VFs influence the vertical site of VFMLs. Level of Evidence 4 Laryngoscope, 131:E2284–E2291, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.